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Ratnapradipa KL, Wang R, Kabayundo J, Marquez Lavenant W, Nelson E, Ahuja M, Zhang Y, Wang H. Cross-sectional analysis of primary care clinics' policies, practices, and availability of patient support services during the COVID-19 pandemic. BMC Health Serv Res 2024; 24:279. [PMID: 38443959 PMCID: PMC10916250 DOI: 10.1186/s12913-024-10660-6] [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: 10/31/2023] [Accepted: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Healthcare accessibility and utilization are important social determinants of health. Lack of access to healthcare, including missed or no-show appointments, can have negative health effects and be costly to patients and providers. Various office-based approaches and community partnerships can address patient access barriers. OBJECTIVES (1) To understand provider perceptions of patient barriers; (2) to describe the policies and practices used to address late or missed appointments, and (3) to evaluate access to patient support services, both in-clinic and with community partners. METHODS Mailed cross-sectional survey with online response option, sent to all Nebraska primary care clinics (n = 577) conducted April 2020 and January through April 2021. Chi-square tests compared rural-urban differences; logistic regression of clinical factors associated with policies and support services computed odds ratios (OR) and 95% confidence intervals (CI). RESULTS Response rate was 20.3% (n = 117), with 49 returns in 2020. Perceived patient barriers included finances, higher among rural versus urban clinics (81.6% vs. 56.1%, p =.009), and time (overall 52.3%). Welcoming environment (95.5%), telephone appointment reminders (74.8%) and streamlined admissions (69.4%) were the top three clinic practices to reduce missed appointments. Telehealth was the most commonly available patient support service in rural (79.6%) and urban (81.8%, p =.90) clinics. Number of providers was positively associated with having a patient navigator/care coordinator (OR = 1.20, CI = 1.02-1.40). For each percent increase in the number of privately insured patients, the odds of providing legal aid decreased by 4% (OR = 0.96, CI = 0.92-1.00). Urban clinics were less likely than rural clinics to provide social work services (OR = 0.16, CI = 0.04-0.67) or assist with applications for government aid (OR = 0.22, CI = 0.06-0.90). CONCLUSIONS Practices to reduce missed appointments included a variety of reminders. Although finances and inability to take time off work were the most frequently reported perceived barriers for patients' access to timely healthcare, most clinics did not directly address them. Rural clinics appeared to have more community partnerships to address underlying social determinants of health, such as transportation and assistance applying for government aid. Taking such a wholistic partnership approach is an area for future study to improve patient access.
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Affiliation(s)
- Kendra L Ratnapradipa
- Department of Epidemiology, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA.
| | - Runqiu Wang
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Josiane Kabayundo
- Department of Epidemiology, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
| | - Walter Marquez Lavenant
- Department of Epidemiology, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
| | - Eleanore Nelson
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Muskan Ahuja
- Department of Epidemiology, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
| | - Ying Zhang
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Hongmei Wang
- Department of Health Services Research & Administration, University of Nebraska Medical Center, Omaha, NE, USA
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Watanabe-Galloway S, Napit K, McCullough J, Luma LB, Kabayundo J, Carritt NL, Schabloske L, Robinson T, Rohde J, Champion V, LoConte NK, Ratnapradipa KL. Engaging Communities in Cancer Prevention and Control Activity Prioritization through a Statewide Needs Assessment: A Case Study from Nebraska. Cancer Prev Res (Phila) 2024; 17:97-106. [PMID: 38437585 DOI: 10.1158/1940-6207.capr-23-0355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/06/2023] [Accepted: 01/18/2024] [Indexed: 03/06/2024]
Abstract
Community outreach and engagement (COE) activities are important in identifying catchment area needs, communicating these needs, and facilitating activities relevant to the population. The National Cancer Institute-designated cancer centers are required to conduct catchment-wide cancer needs assessments as part of their COE activities. The University of Nebraska Medical Center Buffett Cancer Center undertook a three-year-long process to conduct a needs assessment, identify priorities, and develop workgroups to implement cancer prevention and control activities. Activities were conducted through collaborations with internal and external partners. The needs assessment focused on prevention, early detection, and treatment of cancer and involved secondary data analysis and focus groups with identified underrepresented priority populations (rural, African American, Hispanic, Native American, and LGBTQ+ populations). Results were tailored and disseminated to specific audiences via internal and external reports, infographics, and presentations. Several workgroups were developed through meetings with the internal and external partners to address identified priorities. COE-specific initiatives and metrics have been incorporated into University of Nebraska Medical Center and Buffett Cancer Center strategic plans. True community engagement takes a focused effort and significant resources. A systemic and long-term approach is needed to develop trusted relationships between the COE team and its local communities.
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Affiliation(s)
- Shinobu Watanabe-Galloway
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, Nebraska
| | - Krishtee Napit
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jordan McCullough
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, Nebraska
| | - Lady Beverly Luma
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, Nebraska
| | - Josiane Kabayundo
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Nicole L Carritt
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, Nebraska
- Rural Health Initiatives, University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | - Jolene Rohde
- Comprehensive Cancer Control Program, Nebraska Department of Health and Human Services, Lincoln, Nebraska
| | - Victoria Champion
- Community Outreach and Engagement and Population Science, Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana
| | - Noelle K LoConte
- Community Outreach and Engagement, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
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Ratnapradipa KL, Jadhav S, Kabayundo J, Wang H, Smith LC. Factors associated with delaying medical care: cross-sectional study of Nebraska adults. BMC Health Serv Res 2023; 23:118. [PMID: 36739376 PMCID: PMC9899134 DOI: 10.1186/s12913-023-09140-0] [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: 09/23/2022] [Accepted: 02/02/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Delayed medical care may result in adverse health outcomes and increased cost. Our purpose was to identify factors associated with delayed medical care in a primarily rural state. METHODS Using a stratified random sample of 5,300 Nebraska households, we conducted a cross-sectional mailed survey with online response option (27 October 2020 to 8 March 2021) in English and Spanish. Multiple logistic regression models calculated adjusted odds ratios (aOR) and 95% confidence intervals. RESULTS The overall response rate was 20.8% (n = 1,101). Approximately 37.8% of Nebraskans ever delayed healthcare (cost-related 29.7%, transportation-related 3.7%), with 22.7% delaying care in the past year (10.1% cost-related). Cost-related ever delay was associated with younger age [< 45 years aOR 6.17 (3.24-11.76); 45-64 years aOR 2.36 (1.29-4.32)], low- and middle-income [< $50,000 aOR 2.85 (1.32-6.11); $50,000-$74,999 aOR 3.06 (1.50-6.23)], and no health insurance [aOR 3.56 (1.21-10.49)]. Transportation delays were associated with being non-White [aOR 8.07 (1.54-42.20)], no bachelor's degree [≤ high school aOR 3.06 (1.02-9.18); some college aOR 4.16 (1.32-13.12)], and income < $50,000 [aOR 8.44 (2.18-32.63)]. Those who did not have a primary care provider were 80% less likely to have transportation delays [aOR 0.20 (0.05-0.80)]. CONCLUSIONS Delayed care affects more than one-third of Nebraskans, primarily due to financial concerns, and impacting low- and middle-income families. Transportation-related delays are associated with more indicators of low socio-economic status. Policies targeting minorities and those with low- and middle-income, such as Medicaid expansion, would contribute to addressing disparities resulting from delayed care.
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Affiliation(s)
- Kendra L. Ratnapradipa
- grid.266813.80000 0001 0666 4105Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4395 USA
| | - Snehal Jadhav
- grid.266813.80000 0001 0666 4105Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4395 USA
| | - Josiane Kabayundo
- grid.266813.80000 0001 0666 4105Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4395 USA
| | - Hongmei Wang
- grid.266813.80000 0001 0666 4105Department of Health Services Research & Administration, University of Nebraska Medical Center, Omaha, NE USA
| | - Lisa C. Smith
- grid.266815.e0000 0001 0775 5412Grace Abbott School of Social Work, University of Nebraska Omaha, Omaha, NE USA
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Degarege A, Naveed Z, Kabayundo J, Brett-Major D. Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis. Pathogens 2022; 11:563. [PMID: 35631084 PMCID: PMC9147100 DOI: 10.3390/pathogens11050563] [Citation(s) in RCA: 2] [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: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
This systematic review and meta-analysis synthesized the evidence on the impacts of demographics and comorbidities on the clinical outcomes of COVID-19, as well as the sources of the heterogeneity and publication bias of the relevant studies. Two authors independently searched the literature from PubMed, Embase, Cochrane library, and CINAHL on 18 May 2021; removed duplicates; screened the titles, abstracts, and full texts by using criteria; and extracted data from the eligible articles. The variations among the studies were examined by using Cochrane, Q.; I2, and meta-regression. Out of 11,975 articles that were obtained from the databases and screened, 559 studies were abstracted, and then, where appropriate, were analyzed by meta-analysis (n = 542). COVID-19-related severe illness, admission to the ICU, and death were significantly correlated with comorbidities, male sex, and an age older than 60 or 65 years, although high heterogeneity was present in the pooled estimates. The study design, the study country, the sample size, and the year of publication contributed to this. There was publication bias among the studies that compared the odds of COVID-19-related deaths, severe illness, and admission to the ICU on the basis of the comorbidity status. While an older age and chronic diseases were shown to increase the risk of developing severe illness, admission to the ICU, and death among the COVID-19 patients in our analysis, a marked heterogeneity was present when linking the specific risks with the outcomes.
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Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA; (Z.N.); (J.K.); (D.B.-M.)
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Emerson MR, Harsh Caspari J, Notice M, Watanabe-Galloway S, Dinkel D, Kabayundo J. Mental health mobile app use: Considerations for serving underserved patients in integrated primary care settings. Gen Hosp Psychiatry 2021; 69:67-75. [PMID: 33571926 DOI: 10.1016/j.genhosppsych.2021.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Margaret R Emerson
- University of Nebraska Medical Center College of Nursing, Omaha, NE, United States of America.
| | - Jennifer Harsh Caspari
- University of Nebraska Medical Center College of Medicine, Omaha, NE, United States of America
| | - Maxine Notice
- University of Central Missouri, School of Human Service, Warrensburg, MO, United States of America
| | | | - Danae Dinkel
- University of Nebraska Omaha, School of Health & Kinesiology, Omaha, NE, United States of America
| | - Josiane Kabayundo
- University of Nebraska Medical Center College of Public Health, Omaha, NE, United States of America
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