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Das RK, Makhoul AT, Jackson KR, Drolet BC. Trends in revenue on undergraduate and graduate medical education recruitment, 2004-2021. Am J Surg 2024:S0002-9610(24)00236-8. [PMID: 38653708 DOI: 10.1016/j.amjsurg.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/22/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Rishub K Das
- Department of Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Alan T Makhoul
- Division of Plastic and Reconstructive Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Kianna R Jackson
- Department of Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian C Drolet
- Department of Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Wollum A, De Zordo S, Zanini G, Mishtal J, Garnsey C, Gerdts C. Barriers and delays in access to abortion care: a cross-sectional study of people traveling to obtain care in England and the Netherlands from European countries where abortion is legal on broad grounds. Reprod Health 2024; 21:7. [PMID: 38221617 PMCID: PMC10789034 DOI: 10.1186/s12978-023-01729-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/19/2023] [Indexed: 01/16/2024] Open
Abstract
INTRODUCTION This study characterized the extent to which (1) financial barriers and (2) abortion care-seeking within a person's country of residence were associated with delays in abortion access among those travelling to England and the Netherlands for abortion care from European countries where abortion is legal on broad grounds in the first trimester but where access past the first trimester is limited to specific circumstances. METHODOLOGY We drew on cross-sectional survey data collected at five abortion clinics in England and the Netherlands from 2017 to 2019 (n = 164). We assessed the relationship between difficulty paying for the abortion/travel, acute financial insecurity, and in-country care seeking on delays to abortion using multivariable discrete-time hazards models. RESULTS Participants who reported facing both difficulty paying for the abortion procedure and/or travel and difficulty covering basic living costs in the last month reported longer delays in accessing care than those who had no financial difficulty (adjusted hazard odds ratio: 0.39 95% CI 0.21-0.74). This group delayed paying other expenses (39%) or sold something of value (13%) to fund their abortion, resulting in ~ 60% of those with financial difficulty reporting it took them over a week to raise the funds needed for their abortion. Having contacted or visited an abortion provider in the country of residence was associated with delays in presenting abroad for an abortion. DISCUSSION These findings point to inequities in access to timely abortion care based on socioeconomic status. Legal time limits on abortion may intersect with individuals' interactions with the health care system to delay care.
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Affiliation(s)
- Alexandra Wollum
- Ibis Reproductive Health, 1111 Broadway, Oakland, CA, 94607, USA.
| | - Silvia De Zordo
- Department of Anthropology, University of Barcelona, Montalegre 6-8, 08001, Barcelona, Spain
| | - Giulia Zanini
- Department of Philosophy and Cultural Heritage, Ca' Foscari University of Venice, Venice, Italy
| | - Joanna Mishtal
- Department of Anthropology, University of Central Florida, 4297 Andromeda Loop, Orlando, FL, 32816, USA
| | - Camille Garnsey
- Ibis Reproductive Health, 1111 Broadway, Oakland, CA, 94607, USA
| | - Caitlin Gerdts
- Ibis Reproductive Health, 1111 Broadway, Oakland, CA, 94607, USA
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Hussain K, Macrinici V, Wathen L, Balasubramanian SS, Minga I, Gaznabi S, Kwak E, Wang CH, Iqbal SH, Pursnani A, Sarswat N. Impact of Tafamidis on Survival in a Real World Community-Based Cohort. Curr Probl Cardiol 2022; 47:101358. [PMID: 35995245 DOI: 10.1016/j.cpcardiol.2022.101358] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Tafamidis is the only therapy shown to improve survival in transthyretin cardiac amyloidosis (ATTR) based on randomized controlled trial data. OBJECTIVES We sought to evaluate the impact of tafamidis on survival in a real-world community based cohort. METHODS This was a prospective observational cohort study that included consecutive patients with confirmed ATTR based on biopsy or TcPYP imaging. Baseline characteristics were compared between patients taking tafamidis versus not, and Kaplan-Meier survival analysis was performed to compare survival between these groups. We examined the reasons that ATTR patients were not on tafamidis. RESULTS Of 107 ATTR patients, median age was 83.9 years, 79% were men, and 63 (59%) of them were on tafamidis. Demographics and baseline cardiovascular risk factors did not differ significantly between those on versus off tafamidis, although there was a higher proportion of NYHA Class III or IV heart failure in those off tafamidis (76% vs 57%, p<.01). The most common reasons patients were not on tafamidis included delays in obtaining the drug or financial barriers (59%) and NYHA Class IV heart failure (19.5%). Patients taking tafamidis had a significantly higher median survival compared to those not on tafamidis (median survival 6.70 vs 1.43 years, p<.0001). CONCLUSIONS Our study demonstrates significantly improved survival in ATTR patients taking tafamidis. Barriers exist to tafamidis initiation including delayed access and affordability, and efforts should be made to improve patient access.
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Affiliation(s)
- Kifah Hussain
- NorthShore University HealthSystem, Evanston, Illinois; Department of Cardiology, NorthShore University HealthSystems, Evanston, Illinois.
| | - Victor Macrinici
- NorthShore University HealthSystem, Evanston, Illinois; Department of Cardiology, NorthShore University HealthSystems, Evanston, Illinois
| | - Lucas Wathen
- Department of Cardiology, NorthShore University HealthSystems, Evanston, Illinois
| | - Senthil S Balasubramanian
- NorthShore University HealthSystem, Evanston, Illinois; Department of Cardiology, NorthShore University HealthSystems, Evanston, Illinois
| | - Iva Minga
- NorthShore University HealthSystem, Evanston, Illinois; Department of Cardiology, NorthShore University HealthSystems, Evanston, Illinois
| | - Safwan Gaznabi
- NorthShore University HealthSystem, Evanston, Illinois; Department of Cardiology, NorthShore University HealthSystems, Evanston, Illinois
| | - Esther Kwak
- Department of Cardiology, NorthShore University HealthSystems, Evanston, Illinois
| | - Chi-Hsiung Wang
- Department of Cardiology, NorthShore University HealthSystems, Evanston, Illinois
| | | | - Amit Pursnani
- NorthShore University HealthSystem, Evanston, Illinois; Department of Cardiology, NorthShore University HealthSystems, Evanston, Illinois; University of Chicago Pritzker School of Medicine, Chicago
| | - Nitasha Sarswat
- NorthShore University HealthSystem, Evanston, Illinois; Department of Cardiology, NorthShore University HealthSystems, Evanston, Illinois; University of Chicago Pritzker School of Medicine, Chicago
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Brusnahan A, Carrasco-Tenezaca M, Bates BR, Roche R, Grijalva MJ. Identifying health care access barriers in southern rural Ecuador. Int J Equity Health 2022; 21:55. [PMID: 35459253 PMCID: PMC9027412 DOI: 10.1186/s12939-022-01660-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Access to professional health care providers in Loja Province, Ecuador can be difficult for many citizens. The Health Care Access Barrier Model (HCAB) was established to provide a framework for classification, analysis, and reporting of modifiable health care access barriers. This study uses the HCAB Model to identify barriers and themes impacting access to health care access in southern rural Ecuador. Methods The research team interviewed 22 participants and completed 15 participant observation studies in the study area. Interviews and a single focus group session of artisans were recorded and transcribed from Spanish to English, and thematic analysis was performed. Results The thematic analysis found financial, structural, and cognitive health care access barriers. Cost of medications, transportation, missed responsibilities at work and home, difficulty scheduling appointments, and misconceptions in health literacy were the predominant themes contributing to health care access. These pressure points provide insight on where actions may be taken to alleviate access barriers. Conclusion Modifiable health care access barriers outlined in the HCAB are evident in the study area. Further research and implementation of programs to resolve these barriers, such as the creation of health care subcenters and/or mobile clinic, insurance coverage of specialized care, increasing availability and accessibility to affordable transportation, improving roadways, introduction of a 24/7 call center to schedule medical visits, monetary incentive for primary care physicians to practice in rural and underserved areas, provision of affordable work equipment, and emphasizing the improvement of health care literacy through education, may diminish current barriers, identify additional barriers, and improve overall health in the rural area of Loja, Ecuador and similar rural regions around the world. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01660-1.
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Affiliation(s)
- Anthony Brusnahan
- Infectious and Tropical Disease Institute, Department of Biomedical Sciences, Heritage College of Osteopathic Medicine 204 Grosvenor Hall, Ohio University, Athens, OH, 45701, USA
| | - Majo Carrasco-Tenezaca
- Infectious and Tropical Disease Institute, Department of Biomedical Sciences, Heritage College of Osteopathic Medicine 204 Grosvenor Hall, Ohio University, Athens, OH, 45701, USA.,Centro de Investigación Para La Salud en América Latina (CISeAL), Escuela de Ciencias Biológicas, Facultad de Ciencias Exactas Y Naturales, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Benjamin R Bates
- Infectious and Tropical Disease Institute, Department of Biomedical Sciences, Heritage College of Osteopathic Medicine 204 Grosvenor Hall, Ohio University, Athens, OH, 45701, USA.,School of Communication Studies, Scripps College of Communication, Ohio University, Athens, OH, USA
| | - Rosellen Roche
- Infectious and Tropical Disease Institute, Department of Biomedical Sciences, Heritage College of Osteopathic Medicine 204 Grosvenor Hall, Ohio University, Athens, OH, 45701, USA.,Department of Primary Care, Heritage College of Osteopathic Medicine, Ohio University, Cleveland, OH, USA
| | - Mario J Grijalva
- Infectious and Tropical Disease Institute, Department of Biomedical Sciences, Heritage College of Osteopathic Medicine 204 Grosvenor Hall, Ohio University, Athens, OH, 45701, USA. .,Centro de Investigación Para La Salud en América Latina (CISeAL), Escuela de Ciencias Biológicas, Facultad de Ciencias Exactas Y Naturales, Pontificia Universidad Católica del Ecuador, Quito, Ecuador.
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Prabhudesai D, Chen JJ, Lim E. Evaluation of Access to Care Barriers and Their Effect on General Health Status Among Native Hawaiian and Pacific Islander Adults. J Racial Ethn Health Disparities 2022; 10:1178-1186. [PMID: 35445925 DOI: 10.1007/s40615-022-01304-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022]
Abstract
There is a paucity of information on access to care barriers faced by Native Hawaiian and Pacific Islander (NHPI) community. This study utilized the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI NHIS) data to evaluate access to care barriers among NHPI population and their effect on general health status. Access to care barriers were categorized as financial barrier (affordability) and non-financial barriers (availability, accommodation, acceptability, and accessibility). Overall, 13.7% reported of the fair/poor general health and over 30% reported at least one access to care barrier. Logistic regression model was used to evaluate how financial and non-financial barriers affect general health status, adjusting for socio-demographic variables such as age, poverty threshold, and marital status and health-related variables such as smoking status and chronic health conditions. Those who reported financial barrier (21.2%) were more likely to be in fair/poor general health (odds ratio 2.25, 95% confidence interval 1.43-3.56). Non-financial barrier, reported by 20.0% of the study population, was found to be not associated with general health status after adjusting for socio-demographic and health-related variables. Improving access to care among NHPI community could be achieved by identifying and addressing the barriers, which in turn could lead to improvement in the general health status among NHPI community.
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Affiliation(s)
- Devashri Prabhudesai
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - John J Chen
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Eunjung Lim
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
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Soffe BW, Miranda JE, Fang J, Epperson DG, Lara RA, Williamson HL, Lipsky MS. Development and implementation of a patient assistance fund: a descriptive study. BMC Health Serv Res 2021; 21:14. [PMID: 33407435 PMCID: PMC7789741 DOI: 10.1186/s12913-020-06000-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this descriptive study is to outline the Roseman University of Health Sciences (RUHS) College of Dental Medicines' Patient Assistance Fund development, organization and outcomes. The description and reported results provide insight to others considering similar health professions programs. METHODS The Patient Assistance Fund (PAF) affords dental students an opportunity to petition for and obtain financial assistance for their most disadvantaged patients. In this study, two sources of data were collected and used with a quantitative analysis for data collected as part of the PAFs operation and a qualitative analysis to evaluate the patient experiences. RESULTS A total of 16 student advocates, consisting of 6 males and 10 females from the D3 and D4 classes made 26 presentations to the PAF board committee. The combined amount requested from the PAF was $47,428.00 ("Cost of Treatment Plan") representing an average request per patient of $1824.15 (range $324.00 to $4070.00). The approved procedures and treatment plans totaled $21,278.36 ("Cost of Approved Procedures") with an average of $818.40 (range $204.00 to $2434.00) per patient. Patients and students expressed a high degree of satisfaction with the program. CONCLUSIONS This study provides an overview of the structure, funding sources, expenditures and patient services supported by a dental student managed patient assistance fund. The experiences at RUHS College of Dental Medicine (CODM) suggest that other healthcare professions schools can develop similar type programs that yield benefit both to students and to patients in need.
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Affiliation(s)
- Burke W Soffe
- College of Dental Medicine, Roseman University of Health Sciences, 10895 S. River Front Pkwy, South Jordan, UT, 84095, USA.
| | - Justine E Miranda
- College of Dental Medicine, Roseman University of Health Sciences, 10895 S. River Front Pkwy, South Jordan, UT, 84095, USA
| | - Jenny Fang
- College of Dental Medicine, Roseman University of Health Sciences, 10895 S. River Front Pkwy, South Jordan, UT, 84095, USA
| | - Daniel G Epperson
- College of Dental Medicine, Roseman University of Health Sciences, 10895 S. River Front Pkwy, South Jordan, UT, 84095, USA
| | - Roberto A Lara
- College of Dental Medicine, Roseman University of Health Sciences, 10895 S. River Front Pkwy, South Jordan, UT, 84095, USA
| | - Hazel L Williamson
- College of Dental Medicine, Roseman University of Health Sciences, 10895 S. River Front Pkwy, South Jordan, UT, 84095, USA
| | - Martin S Lipsky
- College of Dental Medicine, Roseman University of Health Sciences, 10895 S. River Front Pkwy, South Jordan, UT, 84095, USA
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SOLTANI S, TAKIAN A, AKBARI SARI A, MAJDZADEH R, KAMALI M. Financial Barriers to Access to Health Services for Adult People with Disability in Iran: The Challenges for Universal Health Coverage. Iran J Public Health 2019; 48:508-515. [PMID: 31223579 PMCID: PMC6570792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/20/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Reducing inequities in access to healthcare is one of the most important goals for all health systems. Financial barriers play a fundamental role here. People with disability (PWD) experience further financial barriers in access to their needed healthcare services. This study aimed to explore the causes of barriers in access to health services for PWD in Tehran, Iran. METHODS In this qualitative study, we used semi-structured in-depth interviews to collect data and selected participants through purposeful sampling with maximum variation. We conducted 56 individual interviews with people with disability, healthcare providers and policymakers from Sep 2015 until May 2016, at different locations in Tehran, Iran. RESULTS We identified four categories and eight subcategories of financial barriers affecting access to healthcare services among PWD. Four categories were related to health insurance (i.e. lack of insurance coverage for services like dentistry, occupational therapy and speech therapy), affordability (low income for PWD and their family), financial supports (e.g. low levels of pensions for people with disabilities) and transportation costs (high cost of transportation to reach healthcare facilities for PWD). CONCLUSION Financial problems can lead to poor access to health care services. To achieve universal health coverage, government should reduce health insurance barriers and increase job opportunities and sufficient financial support for PWD.
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Affiliation(s)
- Shahin SOLTANI
- Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein TAKIAN
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Ali AKBARI SARI
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza MAJDZADEH
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad KAMALI
- Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Thumfart J, Müller D, Wagner S, Jayanti A, Borzych-Duzalka D, Schaefer F, Warady B, Schmitt CP. Barriers for implementation of intensified hemodialysis: survey results from the International Pediatric Dialysis Network. Pediatr Nephrol 2018; 33:705-712. [PMID: 29103152 DOI: 10.1007/s00467-017-3831-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/20/2017] [Accepted: 10/13/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients on conventional hemodialysis (HD), morbidity is high and quality of life is poor. Intensified HD programs have been developed to help overcome these shortcomings, , but very few pediatric dialysis centers have reported the implementation of such a HD program. METHODS An online survey was sent to all 221 pediatric dialysis centers which participate in the International Pediatric Dialysis Network (IPDN). The aim of the survey was to assess the attitude of pediatric nephrologists towards intensified HD, the penetrance of intensified HD into their clinical practice and barriers to implementation. RESULTS Of the 221 pediatric dialysis centers sent the survey, respondents from 61% (134) replied. Among these respondents, 69% acknowledged being aware of the evidence in support of the use of intensified HD, independent of whether intensified HD was offered at their own center, and 50% associated the use of daily nocturnal HD with the best overall patient outcome. In contrast, only 2% of respondents were in favor of conventional HD. Overall, 38% of the respondents stated that at their center intensified HD is prescribed to a subgroup of patients, most commonly in the form of short daily HD sessions. The most important barriers to expansion of intensified HD programs were lack of adequate funding (66%) and shortage of staff (63%), whereas lack of expertise and of motivation were reported infrequently as obstacles (21 and 14%, respectively). CONCLUSION Intensified HD is considered by many pediatric nephrologists to be the dialysis modality most likely associated with the best patient outcome. The limited use of this treatment approach highlights the importance of defining and successfully addressing the barriers to implementation.
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Affiliation(s)
- Julia Thumfart
- Department of Pediatric Nephrology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Dominik Müller
- Department of Pediatric Nephrology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | - Anuradha Jayanti
- Manchester Institute of Nephrology & Transplantation, Manchester Royal Infirmary, Manchester, UK
| | - Dagmara Borzych-Duzalka
- Department Pediatrics, Nephrology & Hypertension, Medical University of Gdansk, Gdansk, Poland
| | - Franz Schaefer
- Department of Pediatric Nephrology, University Hospital for Pediatric and Adolescent Medicine, Heidelberg, Germany
| | - Bradley Warady
- Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Claus Peter Schmitt
- Department of Pediatric Nephrology, University Hospital for Pediatric and Adolescent Medicine, Heidelberg, Germany
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Kulhawy-Wibe S, King-Shier KM, Barnabe C, Manns BJ, Hemmelgarn BR, Campbell DJT. Exploring structural barriers to diabetes self-management in Alberta First Nations communities. Diabetol Metab Syndr 2018; 10:87. [PMID: 30524507 PMCID: PMC6276258 DOI: 10.1186/s13098-018-0385-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/09/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Type 2 diabetes is highly prevalent in Canadian First Nations (FN) communities. FN individuals with diabetes are less likely to receive guideline recommended care and access specialist care. They are also less likely to be able to engage in optimal self-management behaviours. While the systemic and racial contributors to this problem have been well described, individuals' experiences with structural barriers to care and self-management remain under-characterized. METHODS We utilized qualitative methods to gain insight into the structural barriers to self-management experienced by FN individuals with diabetes. We conducted a qualitative descriptive analysis of a subcohort of patients with diabetes from FN communities (n = 5) from a larger qualitative study. Using detailed semi-structured telephone interviews, we inquired about participants' diabetes and barriers to diabetes self-management. Inductive thematic analysis was performed in duplicate using NVivo 10. RESULTS The structural barriers faced by this population were substantial yet distinct from those described by non-FN individuals with diabetes. For example, medication costs, which are usually cited as a barrier to care, are covered for FN persons with status. The barriers to diabetes self-management that were commonly experienced in this cohort included transportation-related difficulties, financial barriers to uninsured health services, and lack of accessible diabetes education and resultant knowledge gaps. CONCLUSIONS FN Albertans with diabetes face a myriad of barriers to self-management, which are distinct from the Non-FN population. In addition to the barriers introduced by colonialism and historical injustices, finances, geographic isolation, and lack of diabetes education each impede optimal management of diabetes. Programs targeted at addressing FN-specific barriers may improve aspects of diabetes self-management in this population.
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Affiliation(s)
- Stephanie Kulhawy-Wibe
- Department of Medicine, Cumming School of Medicine, University of Calgary, North Tower, 9th Floor, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Kathryn M. King-Shier
- Department of Community Health Sciences, Cumming School of Medicine, O’Brien Institute for Public Health, Libin Cardiovascular Institute of Alberta, Faculty of Nursing, University of Calgary, TRW 3rd Floor, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, O’Brien Institute for Public Health, Libin Cardiovascular Institute of Alberta, University of Calgary, North Tower, 9th Floor, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Braden J. Manns
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, O’Brien Institute for Public Health, Libin Cardiovascular Institute of Alberta, University of Calgary, North Tower, 9th Floor, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Brenda R. Hemmelgarn
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, O’Brien Institute for Public Health, Libin Cardiovascular Institute of Alberta, University of Calgary, North Tower, 9th Floor, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - David J. T. Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, 1820 Richmond Road SW, Calgary, AB T2N 4N1 Canada
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Dhaliwal KK, King-Shier K, Manns BJ, Hemmelgarn BR, Stone JA, Campbell DJT. Exploring the impact of financial barriers on secondary prevention of heart disease. BMC Cardiovasc Disord 2017; 17:61. [PMID: 28196528 PMCID: PMC5310053 DOI: 10.1186/s12872-017-0495-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/07/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patients with coronary artery disease experience various barriers which impact their ability to optimally manage their condition. Financial barriers may result in cost related non-adherence to medical therapies and recommendations, impacting patient health outcomes. Patient experiences regarding financial barriers remain poorly understood. Therefore, we used qualitative methods to explore the experience of financial barriers to care among patients with heart disease. METHODS We conducted a qualitative descriptive study of participants in Alberta, Canada with heart disease (n = 13) who perceived financial barriers to care. We collected data using semi-structured face-to-face or telephone interviews inquiring about patients experience of financial barriers and the strategies used to cope with such barriers. Multiple analysts performed inductive thematic analysis and findings were bolstered by member checking. RESULTS The aspects of care to which participants perceived financial barriers included access to: medications, cardiac rehabilitation and exercise, psychological support, transportation and parking. Some participants demonstrated the ability to successfully self-advocate in order to effectively navigate within the healthcare and social service systems. CONCLUSION Financial barriers impacted patients' ability to self-manage their cardiovascular disease. Financial barriers contributed to non-adherence to essential medical therapies and health recommendations, which may lead to adverse patient outcomes. Given that it is such a key skill, enhancing patients' self-advocacy and navigation skills may assist in improving patient health outcomes.
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Affiliation(s)
| | - Kathryn King-Shier
- Faculty of Nursing, University of Calgary, Calgary, AB Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB Canada
| | - Braden J. Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Health Sciences Centre, G236, 3330 Hospital Drive NW, Calgary, AB T2N 1 N4 Canada
| | - Brenda R. Hemmelgarn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Health Sciences Centre, G236, 3330 Hospital Drive NW, Calgary, AB T2N 1 N4 Canada
| | - James A. Stone
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Health Sciences Centre, G236, 3330 Hospital Drive NW, Calgary, AB T2N 1 N4 Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - David J. T. Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Health Sciences Centre, G236, 3330 Hospital Drive NW, Calgary, AB T2N 1 N4 Canada
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Ganesh A, King-Shier K, Manns BJ, Hill MD, Campbell DJ. Money is Brain: Financial Barriers and Consequences for Canadian Stroke Patients. Can J Neurol Sci 2017; 44:146-51. [PMID: 27869051 DOI: 10.1017/cjn.2016.411] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Stroke patients of lower socioeconomic status have worse outcomes. It remains poorly understood whether this is due to illness severity or personal or health system barriers. We explored the experiences of stroke patients with financial barriers in a qualitative descriptive pilot study, seeking to capture perceived challenges that interfere with their poststroke health and recovery. METHODS We interviewed six adults with a history of stroke and financial barriers in Alberta, Canada, inquiring about their: (1) experiences after stroke; (2) experience of financial barriers; (3) perceived reasons for financial barriers; (4) health consequences of financial barriers; and (5) mechanisms for coping with financial barriers. Two reviewers analyzed data using inductive thematic analysis. RESULTS The participants developed new or worsened financial circumstances as a consequence of stroke-related disability. Poststroke impairments and financial barriers took a toll on their mental health. They struggled to access several aspects of long-term poststroke care, including allied health professional services, medications, and proper nutrition. They described opportunity costs and tradeoffs when accessing health services. In several cases, they were unaware of health resources available to them and were hesitant to disclose their struggles to their physicians and even their families. CONCLUSION Some patients with financial barriers perceive challenges to accessing various aspects of poststroke care. They may have inadequate knowledge of resources available to them and may not disclose their concerns to their health care team. This suggests that providers themselves might consider asking stroke patients about financial barriers to optimize their long-term poststroke care.
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Cacko JA, Cissé K, Pambè MW, Compaoré R, Kouanda S. Evaluation of the implementation and effects of an obstetric kit used in the Adamawa region of Cameroon. Int J Gynaecol Obstet 2016; 135 Suppl 1:S103-S106. [PMID: 27836075 DOI: 10.1016/j.ijgo.2016.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the implementation and effects of the strategy, introduced in June 2011, of making obstetric kits readily available in health facilities in the Adamaoua region of Cameroon. METHODS We conducted a quasi-experimental study using an interrupted time series to assess the effects of the strategy, and a case study to evaluate its implementation. The reviewed data were gathered from 13 health facilities over a period from January 2008 to December 2014. Qualitative data were collected from in-depth interviews. RESULTS The provision of obstetric kits was effective in the intervention health facilities, although some challenges existed and included lack of staff motivation and rampant illegal practices. The number of deliveries and cesareans increased. CONCLUSION There is a need to rethink this strategy, given its gaps and shortcomings.
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Affiliation(s)
- Joachim Aimé Cacko
- Higher Institute of Population Sciences, University of Ouagadougou, Ouagadougou, Burkina Faso; Project "Chèque santé", Garoua, Cameroon
| | - Kadari Cissé
- National Institute of Statistics and Demography, Ouagadougou, Burkina Faso; Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Madeleine Wayack Pambè
- Higher Institute of Population Sciences, University of Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Seni Kouanda
- Research Institute of Health Sciences, Ouagadougou, Burkina Faso; African Institute of Public Health, Ouagadougou, Burkina Faso.
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