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Tikouk J, Ait Boubkr A. Transportation and Access to Healthcare in Morocco: An Exploratory Study of Guelmim-Oued Noun Region. Ann Glob Health 2024; 90:11. [PMID: 38344006 PMCID: PMC10854410 DOI: 10.5334/aogh.4063] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/07/2024] [Indexed: 02/15/2024] Open
Abstract
Objective The aim of this study was to examine the correlation between accessibility to healthcare facilities and transportation in the Guelmim Oued Noun region of Morocco, where transportation barriers continue to pose a major challenge to accessing healthcare, despite efforts aimed at reducing access barriers. Methods Data collection for this study involved the administration of a survey among 328 outpatients residing in the Guelmim Oued Noun region, Morocco. The utilization of canonical correlation served as the analytical method, employed to quantify and assess the relationship between transportation related barriers and the access of healthcare services in the specified region. Results Our research reveals that transportation factors account for approximately 25% of the variation in access to healthcare services. The number of transportation modes utilized by outpatients and the affordability of transportation were found to be significant contributors to the transportation dimension. These findings confirm the significant relationship between transportation and access to healthcare facilities in the region under investigation. Conclusion Further research is recommended to specifically address transportation barriers to healthcare access services among socially excluded populations, with a focus on promoting mobility inclusivity.
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Affiliation(s)
- Jamal Tikouk
- Applied Modeling in Economics and Management Laboratory, University of Hassan II Casablanca, Casablanca, Morocco
| | - Asmaa Ait Boubkr
- Applied Modeling in Economics and Management Laboratory, University of Hassan II Casablanca, Casablanca, Morocco
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2
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Trepka MJ, Ward MK, Fennie K, Sheehan DM, Fernandez SB, Li T, Jean-Gilles M, Dévieux JG, Ibañez GE, Gwanzura T, Nawfal E, Gray A, Beach MC, Ladner R. Patient-Provider Relationships and Antiretroviral Therapy Adherence and Durable Viral Suppression Among Women with HIV, Miami-Dade County, Florida, 2021-2022. AIDS Patient Care STDS 2023; 37:361-372. [PMID: 37432309 PMCID: PMC10354312 DOI: 10.1089/apc.2023.0029] [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] [Indexed: 07/12/2023] Open
Abstract
Women with HIV in the United States are more negatively affected by adverse social determinants such as low education and poverty than men, and thus, especially need a supportive health care system. This cross-sectional study assessed the role of the patient-provider relationship on antiretroviral therapy (ART) adherence and durable viral suppression among women with HIV (WHIV) in Miami-Dade County, Florida. Patient-provider relationship was measured, in part, using the Health Care Relationship Trust Scale and Consumer Assessment of Health Care Providers and Systems. The survey was administered by telephone to women in the Ryan White Program June 2021-March 2022. Adherence was defined as 90% adherent on the average of three self-reported items. Lack of durable viral suppression was defined by at least one viral load ≥200 copies/mL among all tests conducted in a year. Logistic regression models were generated using backward stepwise modeling. Of 560 cis-gender women, 401 (71.6%) were adherent, and 450 (80.4%) had durable viral suppression. In the regression model, adherence was associated with higher patient-provider trust and provider communication as well as excellent perceived health, lack of significant depressive symptoms, no alcohol use within the last 30 days, and lack of transportation problems. In the regression model using provider as a random effect, durable viral suppression was associated with older age, Hispanic ethnicity, and lack of illegal drug use. While the results show that a strong patient-provider relationship facilitates ART adherence in WHIV, there was no association with durable viral suppression.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | - Melissa K. Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | | | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | - Sofia Beatriz Fernandez
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Tan Li
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Jessy G. Dévieux
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Gladys E. Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Tendai Gwanzura
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Ekpereka Nawfal
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Aaliyah Gray
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Mary Catherine Beach
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Robert Ladner
- Behavioral Science Research Corp., Coral Gables, Florida, USA
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3
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Tabler J, Schmitz RM, Charak R, Propst A. Forgone Care among LGBTQ and Non-LGBTQ Americans during the COVID-19 Pandemic: The Role of Health, Social Support, and Pandemic-Related Stress. South Med J 2022; 115:752-759. [PMID: 36191911 PMCID: PMC9512140 DOI: 10.14423/smj.0000000000001456] [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] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In this study, we explore the role of Coronavirus Disease 2019 pandemic-related stress, social support, and health on unmet healthcare needs during the Coronavirus Disease 2019 pandemic, particularly among lesbian, gay, bisexual, transgender, and queer plus (LGBTQ+) adults. METHODS We collected data using a self-administered online survey of US adults. Using logistic regression, we modeled potential risk and protective factors for not receiving needed care during the pandemic (forgone care) among LGBTQ+ individuals (n = 121), cisgender and heterosexual-identifying women (n = 235), and cisgender and heterosexual-identifying men (n = 62). Limiting analyses to the LGBTQ+ subsample, we also assessed the unique role of LGBTQ+ discrimination and depressive symptoms. RESULTS Logistic regression results suggested that social support was associated with lower odds of forgone care (odds ratio [OR] 0.95, P < 0.01). Furthermore, better self-rated health and higher levels of income were associated with lower odds of forgone care (OR 0.56, P < 0.001, and OR 0.92, P < 0.05, respectively). Finally, LGBTQ+ individuals experienced uniquely high levels of forgone care, and LGBTQ+ discrimination (OR 1.03, P < 0.05) and depressive symptoms (OR 1.09, P < 0.01) were associated with higher odds of forgone care among LGBTQ+ participants. CONCLUSIONS Future research should examine the unique factors shaping the access to health care of LGBTQ+ adults in the United States, and healthcare practitioners should consider strategies to screen for discrimination and leverage the protective benefits of social support.
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Affiliation(s)
- Jennifer Tabler
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology, Oklahoma State University, Stillwater, and the Department of Psychological Science, the University of Texas Rio Grande Valley, Edinburg
| | - Rachel M. Schmitz
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology, Oklahoma State University, Stillwater, and the Department of Psychological Science, the University of Texas Rio Grande Valley, Edinburg
| | - Ruby Charak
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology, Oklahoma State University, Stillwater, and the Department of Psychological Science, the University of Texas Rio Grande Valley, Edinburg
| | - Aidan Propst
- From the Department of Criminal Justice and Sociology, University of Wyoming, Laramie, the Department of Sociology, Oklahoma State University, Stillwater, and the Department of Psychological Science, the University of Texas Rio Grande Valley, Edinburg
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4
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Hu K, Vranis NM, Daar D, Ali-Khan S, Hacquebord J. A Comparative Analysis of Nonthumb Metacarpal Fracture Treatments in New York City Civilians and Incarcerated Individuals. J Correct Health Care 2022; 28:260-266. [PMID: 35696236 DOI: 10.1089/jchc.20.09.0081] [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] [Indexed: 11/12/2022]
Abstract
Nonthumb metacarpal (NTMC) fractures are common in the incarcerated and the underinsured civilian populations. However, certain social challenges contribute to high rates of follow-up noncompliance and complications in these unique populations. We conducted a retrospective review of the treatments, outcomes, and complications in the incarcerated and civilian patient population who were treated at a tertiary public hospital for NTMC fractures. Even though incarcerated patients were more likely than their civilian counterparts to undergo operative interventions, both populations showed similar complication profiles as well as low rates of treatment compliance and follow-up. This article affirms that incarcerated individuals do not receive inferior care compared with civilians, and both the incarcerated and underinsured civilians would benefit from careful consideration of treatment algorithms and additional access to hand therapy.
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Affiliation(s)
- Kelly Hu
- Hansjörg Wyss Department of Plastic and Reconstructive Surgery, NYU Langone Health, New York, New York, USA
| | - Neil M Vranis
- Hansjörg Wyss Department of Plastic and Reconstructive Surgery, NYU Langone Health, New York, New York, USA
| | - David Daar
- Hansjörg Wyss Department of Plastic and Reconstructive Surgery, NYU Langone Health, New York, New York, USA
| | - Safi Ali-Khan
- Division of Plastic Surgery and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Jacques Hacquebord
- Hansjörg Wyss Department of Plastic and Reconstructive Surgery, NYU Langone Health, New York, New York, USA.,Department of Orthopaedic Surgery, NYU Langone Health, New York, New York, USA
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Berkowitz SA, Ricks KB, Wang J, Parker M, Rimal R, DeWalt DA. Evaluating A Nonemergency Medical Transportation Benefit For Accountable Care Organization Members. Health Aff (Millwood) 2022; 41:406-413. [PMID: 35254938 PMCID: PMC9400526 DOI: 10.1377/hlthaff.2021.00449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nonemergency medical transportation benefits, often using smartphone application-based ridesharing services, are increasingly being offered as part of population health management programs. However, the impact of these programs on health care use and costs remains understudied. We conducted a mixed-methods evaluation of a nonemergency medical transportation benefit offered to members of a Medicare accountable care organization (ACO) within a large academic health system, the UNC Health Alliance ACO. Participation in the transportation program was associated with a greater number of per person per year outpatient visits (9.2) and higher outpatient spending ($4,420) than in a comparison group. However, there was no difference in inpatient admissions or emergency department visits, and the program was not cost saving. Qualitative analyses revealed that participants were highly satisfied with the program, reporting that it eased financial burdens and made them feel safer, more empowered, and better able to take control of their health. These findings suggest that although transportation programs are commonly introduced as ways to contain health care spending, it may be better to think of them as programs to improve health care access for people facing difficult circumstances.
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Affiliation(s)
- Seth A. Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katharine Ball Ricks
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jingyan Wang
- Enterprise Analytics and Data Sciences, UNC Health Care System, Morrisville, NC
| | - Morgan Parker
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ram Rimal
- Enterprise Analytics and Data Sciences, UNC Health Care System, Morrisville, NC
| | - Darren A. DeWalt
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
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6
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Coss D, Chapman D, Fleming J. Providing occupational and physical therapy services in a free community-based interprofessional primary care clinic. J Interprof Care 2022; 35:26-32. [DOI: 10.1080/13561820.2021.1981261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Darla Coss
- Department of Occupational Therapy, St. Catherine University, St. Paul, MN USA, United States
| | - David Chapman
- Doctor of Physical Therapy Program, St. Catherine University, St. Paul MN USA, United States
| | - John Fleming
- Department of Occupational Therapy, St. Catherine University, St. Paul, MN USA, United States
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7
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Acquah-hagan G, Boateng D, Appiah-brempong E, Twum P, Atta JA, Agyei-baffour P, Burns CJ. Access Differentials in Primary Healthcare among Vulnerable Populations in a Health Insurance Setting in Kumasi Metropolis, Ghana: A Cross-Sectional Study. Advances in Public Health 2021; 2021:1-14. [DOI: 10.1155/2021/9911436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Access to healthcare remains a challenge towards the achievement of the Sustainable Development Goals in Ghana. There still remain inequalities in the distribution of health services especially among vulnerable groups despite sustained efforts to strengthen the health system. This study was conducted to analyze access differentials among different vulnerable groups in the context of primary healthcare under a National Health Insurance Scheme (NHIS) in Ghana. Methods. This study was a descriptive cross-sectional study conducted among multilevel participants of vulnerable groups in Kumasi Metropolis: 710 vulnerable people constituting elderly/aged (n = 359), pregnant women (n = 117), head poters (teenage girls who migrated from the northern Ghana mainly to the capital cities of the Ashanti and Greater Accra region to help in carrying of goods for their livelihood) (n = 86), sex workers (n = 75), and other vulnerable groups (people with disabilities and street participants) (n = 73). Data were collected using a semistructured questionnaire. Poisson regression with robust variance was used to access the association between vulnerability and access to healthcare. Results. Close to a fifth, 18.5% of the study respondents were unable to access care at any point in time during the last 12 months. Reasons for the inability to access healthcare included limited funding (69.7%), poor attitude of service providers (7.6%), distance to health centers (8.3%), and religious reasons (6.2%). More than 95% of respondents were insured under the NHIS, but acceptability of service provision under the NHIS was low among the vulnerable groups. In the crude models, pregnant women had lower prevalence of access to medications as compared to the elderly (prevalence ratio (PR): 0.88; 95% CI: 0.80–0.98). Head poters and other vulnerable groups were also less likely to view healthcare as affordable as compared to the elderly. The differences in healthcare access observed were attenuated after adjustment for sociodemographic characteristics and healthcare-related factors. Conclusions. Despite the introduction of a NHIS in Ghana, this study highlights challenges in healthcare access among vulnerable populations independent of the type of vulnerability. This suggests the need for stakeholders to work to address access differentials in the NHIS and adopt other innovative care strategies that may have broader applicability for all populations.
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8
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Trivedi MM, Das A. Did the Timing of State Mandated Lockdown Affect the Spread of COVID-19 Infection? A County-level Ecological Study in the United States. J Prev Med Public Health 2021; 54:238-244. [PMID: 34370936 PMCID: PMC8357543 DOI: 10.3961/jpmph.21.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/10/2021] [Accepted: 06/01/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives: Previous pandemics have demonstrated that several demographic, geographic, and socioeconomic factors may play a role in increased infection risk. During this current coronavirus disease 2019 (COVID-19) pandemic, our aim was to examine the association of timing of lockdown at the county level and aforementioned risk factors with daily case rate (DCR) in the United States. Methods: A cross-sectional study using publicly available data was performed including Americans with COVID-19 infection as of May 24, 2020. The United States counties with >100 000 population and >50 cases per 100 000 people were included. The independent variable was the days required from the declaration of lockdown to reach the target case rate (50/100 000 cases) while the dependent (outcome) variable was the DCR per 100 000 on the day of statistical calculation (May 24, 2020) after adjusting for multiple confounding socio-demographic, geographic, and health-related factors. Each independent factor was correlated with outcome variables and assessed for collinearity with each other. Subsequently, all factors with significant association to the outcome variable were included in multiple linear regression models using stepwise method. Models with best R2 value from the multiple regression were chosen. Results: The timing of mandated lockdown order had the most significant association on the DCR per 100 000 after adjusting for multiple socio-demographic, geographic and health-related factors. Additional factors with significant association with increased DCR include rate of uninsured and unemployment. Conclusions: The timing of lockdown order was significantly associated with the spread of COVID-19 at the county level in the United States.
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Affiliation(s)
- Megh M Trivedi
- Pediatric Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anirudha Das
- Pediatric Institute, Cleveland Clinic, Cleveland, OH, USA
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Henderson LM, O'Meara ES, Haas JS, Lee CI, Kerlikowske K, Sprague BL, Alford-Teaster J, Onega T. The Role of Social Determinants of Health in Self-Reported Access to Health Care Among Women Undergoing Screening Mammography. J Womens Health (Larchmt) 2020; 29:1437-1446. [PMID: 32366199 DOI: 10.1089/jwh.2019.8267] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background: Social determinants of health (SDOH) contribute to health care disparities, with social and economic barriers often leading to difficulties in obtaining necessary care. We evaluated barriers to receiving health care, focusing on caretaker responsibilities, health insurance and cost, and transportation. Materials and Methods: We included women ages ≥40 years receiving screening mammography across three Breast Cancer Surveillance Consortium registries from 2012 to 2017. Women self-reported social and financial barriers to receiving health care in the 12 months before their screening mammogram. We evaluated woman- and census-based community-level factors associated with reporting a barrier using multivariate logistic regression. We assessed interaction with urban versus nonurban residence using Wald tests. Results: Among 393,430 women, 3.6% reported a barrier with a higher proportion in urban versus nonurban settings (3.9% [n = 11,977] vs. 2.2% [n = 1,655], respectively; p < 0.001). Among women reporting a barrier, health care cost and/or no insurance was the most common (49.3%), and no transportation was the least common (7.8%). Compared with white women, odds of reporting barriers were higher among black (adjusted odds ratio [aOR] = 1.30, 95% confidence interval [CI]: 1.16-1.44), Hispanic (aOR = 1.66, 95% CI: 1.53-1.80), and other race (aOR = 1.84, 95% CI: 1.65-2.04) women. Barriers were less likely in women with higher median household income (aOR = 0.69, 95% CI: 0.61-0.79) or higher average health insurance costs (aOR = 0.85, 95% CI: 0.74-0.98), but were more likely in high diversity index areas (aOR = 1.28, 95% CI: 1.11-1.48). Conclusions: Social and financial barriers exist based on race/ethnicity and SDOH related to income, insurance costs, and place of residence among women undergoing screening mammography. Breast imaging facilities could utilize information on these barriers to improve biennial screening adherence or ensure that women with abnormal findings obtain appropriate follow-up care through targeted interventions.
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Affiliation(s)
- Louise M Henderson
- Epidemiology Research, Department of Radiology, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ellen S O'Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Jennifer S Haas
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA.,Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington, USA
| | - Karla Kerlikowske
- Department of Medicine, University of California, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Brian L Sprague
- Department of Surgery, University of Vermont, Burlington, Vermont, USA.,Department of Radiology, University of Vermont, Burlington, Vermont, USA
| | - Jennifer Alford-Teaster
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Tracy Onega
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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Abstract
INTRODUCTION Lack of reliable transportation can be a barrier to keeping appointments or accessing other health care services. Increasingly, insurers and health care delivery systems subsidize transportation services for patients. This systematic review synthesizes existing research on nonemergency medical transportation interventions. METHODS We searched 3 databases (Embase, PubMed, Google) for studies of health care sector-sponsored programs that provided patients assistance with nonemergency transportation and directly assessed the impact of transportation assistance on health and health care utilization outcomes. Studies meeting inclusion criteria were graded for quality using standard grading criteria. FINDINGS Eight studies met all inclusion criteria. Most were rated as low quality. All studies included examined process or health care utilization outcomes, such as uptake of transportation services, return for follow-up, or missed appointment rates; only 1 included health outcomes, such as illness severity and blood pressure. Results were mixed. More rigorous studies showed low patient uptake of transportation services and inconsistent impacts on health and utilization outcomes. CONCLUSIONS Despite considerable interest in subsidizing transportation services to improve health for patients facing transportation barriers, little rigorously conducted research has demonstrated the impact of transportation services on health or health care utilization. Some extant literature suggests that transportation assistance is more likely to be effective when offered with other interventions to reduce social and economic barriers to health.
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11
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Synovec CE, Aceituno L. Social justice considerations for occupational therapy: The role of addressing social determinants of health in unstably housed populations. Work 2020; 65:235-246. [PMID: 32007967 DOI: 10.3233/wor-203074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Populations of those experiencing homelessness in the United States expand beyond those living in shelters and on the streets. Many individuals living in poverty experience housing instability, as well as refugee populations who experience deprivation of social resources due to displacement. These populations are significantly affected by social determinants of health (SDOH). OBJECTIVE A current policy and literature review was completed to assess prominent SDOH impacting unstably housed populations in the United States, including refugees, encountered in occupational therapy practice. Review of evidence-based practice to address SDOH was completed to provide recommendations for practitioners across healthcare settings. RESULTS A review of policy and its impact on those experiencing housing instability or recently resettled identifies several significant barriers to full occupational performance and health management. Several specific occupational therapy interventions exist to address these barriers and are in alignment with current practice. CONCLUSION Occupational therapy practitioners across practice settings should consider how current housing status and social determinants of health may impact their clients' occupational performance and ability to manage health conditions.
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12
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Passwater C, Itano J. Care Coordination: Overcoming Barriers to Improve Outcomes for Patients With Hematologic Malignancies in Rural Settings. Clin J Oncol Nurs 2018; 22:549-554. [PMID: 30239522 DOI: 10.1188/18.cjon.549-554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most patients with cancer experience financial, emotional, and logistical barriers to care that significantly affect their adherence to and successful completion of treatment. However, patients with hematologic malignancies, particularly those who live in rural settings, must also contend with additional challenges. OBJECTIVES This article aims to synthesize the literature about barriers to timely access to care and to coordination of this care for patients with hematologic malignancies, particularly those in rural settings, as well as identify strategies to improve cancer care delivery for those patients. METHODS A search of the literature from 2008-2018 pertaining to rural health disparities for patients with hematologic malignancies, along with ways to overcome these disparities, was conducted. FINDINGS Patients with hematologic malignancies, particularly those who reside in rural settings, face complex barriers to care. These barriers cause emotional and physical distress. A team approach to care coordination that is focused on eliminating these barriers and improving outcomes is needed.
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Soto Mas F, Iriart C, Pedroncelli R, Binder DS, Qualls CR, Price B. Impact of Health Care and Socioeconomic Needs on Health Care Utilization and Disease Management: The University of New Mexico Hospital Care One Program. Popul Health Manag 2018; 22:113-119. [PMID: 29969375 DOI: 10.1089/pop.2018.0048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Understanding how unmet basic needs impact health care in patients with complex conditions is vital to improve health outcomes and reduce health care costs. The purpose of this observational study was to explore the association between health care and socioeconomic needs and health care utilization and disease management among patients with chronic conditions at an intensive, patient-centered, office-based program. The study used a cross-sectional design and a convenience sampling approach. Data were collected through a patient questionnaire and medical records. Analysis included descriptive and inferential statistics. Data from 48 established patients were analyzed. Financial and lack of transportation were the 2 most frequently reported unmet needs. More than 65% of participants had their chronic condition(s) under control. Sex and ethnicity were the only 2 demographic variables that yielded significant differences (P ≤ 0.01) on visits to the emergency room and having chronic condition(s) under control. Those who reported having unmet transportation needs were more likely to have a condition uncontrolled and to have lost medical appointments compared to those who had this social need met (P ≤ 0.05). Statistically significant differences in terms of missing medical appointments also were found between those whose overall financial and housing needs were unmet and those who had those needs met (P ≤ 0.05). Results indicate that participating patients generally had good control of their conditions. The study adds evidence in support of the call for health care to address patients' socioeconomic needs, and the health care benefits of intensive case management programs. The model may be considered for adoption throughout New Mexico, and nationally.
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Affiliation(s)
- Francisco Soto Mas
- 1 College of Population Health, University of New Mexico , Albuquerque, New Mexico
| | - Celia Iriart
- 1 College of Population Health, University of New Mexico , Albuquerque, New Mexico
| | - Ronnie Pedroncelli
- 2 Clinical and Translational Science Center, University of New Mexico , Albuquerque, New Mexico
| | - Douglas S Binder
- 3 Department of Emergency Medicine, University of New Mexico , Albuquerque, New Mexico
| | - Clifford R Qualls
- 2 Clinical and Translational Science Center, University of New Mexico , Albuquerque, New Mexico
| | - Brittany Price
- 2 Clinical and Translational Science Center, University of New Mexico , Albuquerque, New Mexico
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