26,782 results
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2. [CIPOMO position paper about conflict of interest.]
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- Delivery of Health Care economics, Delivery of Health Care ethics, Humans, Italy, Neoplasms therapy, Quality of Health Care, Conflict of Interest, Delivery of Health Care standards, Health Care Costs, Health Services Accessibility economics
- Abstract
A substantial part of the final cost of health-related products is due to marketing, and the revenue from sales is, at least in some cases, disproportionally higher than the development costs. In this context, financial interests can add to drug pricing and prevail over healthcare issues and equity of access to services. Conflict of interest (COI) is a «condition in which the professional judgment concerning a primary interest (the health of a patient or the reliability of research results or the impartiality of clinical informations) tends to be unduly influenced by a secondary interest (for example an economic gain or a career advantage)». The potential consequences of COI extend from research to guideline drafting, from teaching to clinical decision making. The contiguity of opposing interests can condition the clinician, either consciously or unconsciously. This conditioning, in turn, can have direct consequences on the quality of the provided services, but can also cause insufficient transparency, or distrust of the Health Service. The College of Italian Medical Oncology Directors (CIPOMO) together with all the stakeholders that contribute to the good functioning of cancer care, issues a list of statements that refer to principles of transparency and ethicality in the use of resources. The following recommendations do not intend to establish rules of conduct. Rather, they have the purpose of contributing to awareness of the nature and potential consequences of COI in the clinical community and of promoting constructive reflection within healthcare organizations.
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- 2019
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3. "A piece of paper is not the same as having someone to talk to": accessing post-diagnostic dementia care before and since COVID-19 and associated inequalities.
- Author
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Giebel C, Hanna K, Tetlow H, Ward K, Shenton J, Cannon J, Butchard S, Komuravelli A, Gaughan A, Eley R, Rogers C, Rajagopal M, Limbert S, Callaghan S, Whittington R, Shaw L, and Gabbay M
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- Adult, Aged, Female, Humans, Male, Middle Aged, SARS-CoV-2, COVID-19 epidemiology, Caregivers psychology, Dementia psychology, Health Services Accessibility economics, Health Services Accessibility standards, Healthcare Disparities, Social Work
- Abstract
Background: Social support services such as day care centres are important in post-diagnostic dementia care to enable people living with dementia stay at home for longer. Little research has addressed potential inequalities in access, with no research on variations before and since COVID-19. The aim of this study was to explore inequalities in social support service usage before and since the pandemic., Methods: Unpaid carers and people living with dementia were interviewed over the phone about their experiences of accessing social support services before and since the COVID-19 pandemic. Transcripts were analysed for key themes using inductive and deductive thematic analysis., Results: Fifty participants (42 unpaid carers; eight people living with dementia) were interviewed, and five themes identified: (1) Service issues; (2) Access issues; (3) Relying on own initiative; (4) New inequalities due to COVID-19; and (5) Missing out on the benefits of support services. Participants reported transport, finances, and location as factors reducing their ability to access support service pre-COVID, with inequalities remaining and at times exacerbated since. Carers and people living with dementia also reported struggling with accessing basic necessities during COVID, including food and medicines., Conclusions: Considering the benefits of accessing support services, resourced procedures and facilities are needed to maintain access to support services with more accessible remote support provision, enabling people from all backgrounds to access the care they need.
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- 2021
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4. "No Papers. No Doctor" : A Qualitative Study of Access to Maternity Care Services for Undocumented Immigrant Women in Denmark.
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Funge JK, Boye MC, Johnsen H, and Nørredam M
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- Adult, Child, Denmark, Female, Humans, Pregnancy, Qualitative Research, Emigrants and Immigrants, Health Services Accessibility, Maternal Health Services, Undocumented Immigrants
- Abstract
The purpose of this study is to explore undocumented immigrant women's experiences of, as well as their access to, maternity care services during pregnancy in Denmark. Recruiting through the two branches of a non-governmental organization (NGO)-driven health clinic in Denmark, we conducted 21 semi-structured interviews with undocumented immigrant women in Denmark from January 2018 to January 2019. The undocumented immigrant women experienced barriers such as fear of deportation, concerns about payment for services, and uncertainties about rules for access. Many of them described depending on NGO-driven initiatives to access maternity care services and found these as providing a safe environment for care. Our findings contribute insights towards understanding the health behavior of undocumented immigrant women and highlight the need for inclusive care to safeguard the health of the women and their children.
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- 2020
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5. Exercise-based Rehabilitation to Improve Exercise Tolerance of Severe COVID-19 Survivors: A Review Paper.
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Nazir, Arnengsih, Tiksnadi, Badai Bhatara, and Ridzki, Mochammad Farhan Fajrial Aditama
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HEALTH services accessibility ,HUMAN services programs ,THERAPEUTICS ,EXERCISE therapy ,SEVERITY of illness index ,EXERCISE intensity ,STRENGTH training ,EXERCISE tolerance ,AEROBIC exercises ,QUALITY of life ,ENDURANCE sports training ,COVID-19 ,CARDIAC rehabilitation ,POSTURAL balance - Abstract
Objectives: This review aimed to determine the form, results, and barriers to exercise-based rehabilitation programs for severe COVID-19 survivors. Methods: Searching for the article was carried out from August to October 2021. We used the PubMed database as a search media with the keywords (['COVID-19' OR 'COVID 19' OR 'SARS CoV-2'... [ABSTRACT FROM AUTHOR]
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- 2024
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6. Living with a disability during the pandemic. "Instant paper from the field" on rehabilitation answers to the COVID-19 emergency.
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Boldrini P, Garcea M, Brichetto G, Reale N, Tonolo S, Falabella V, Fedeli F, Cnops AA, and Kiekens C
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- COVID-19, Coronavirus Infections complications, Humans, Italy epidemiology, Pandemics, Pneumonia, Viral complications, SARS-CoV-2, Betacoronavirus, Coronavirus Infections epidemiology, Coronavirus Infections therapy, Disabled Persons rehabilitation, Health Services Accessibility organization & administration, Physical and Rehabilitation Medicine organization & administration, Pneumonia, Viral epidemiology, Pneumonia, Viral therapy
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COVID-19 pandemic is creating collateral damage to persons with disabling conditions of different aetiology. The restrictions imposed to contain the spread of infection is limiting the access to many health services, including rehabilitation. It is expected that such situation will lead to long lasting negative consequences for persons with disability, increasing functional limitations in chronic conditions and hindering the recovery after acute events. The aim of this paper is to explore the impact on people with disability, reporting the contents of the sixth Italian Society of Physical and Rehabilitation Medicine (SIMFER) webinar on the COVID-19 impact on rehabilitation ("Covinars"). Seven representatives of Associations of persons affected by different disabling conditions described the difficulties they are facing during the pandemic, the initiatives undertaken to support their members and their future perspectives and expectations. The users' inputs will be helpful in planning the future phases of the emergency and improve preparedness for other emergencies.
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- 2020
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7. Contrasting current challenges from the Brazilian and Canadian national health systems: The Besrour Papers: a series on the state of family medicine in Canada and Brazil.
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Ponka D, Pinto LF, Whalen-Browne M, Meuser A, Prado JC Jr, Michaelides O, and Rouleau K
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- Brazil, Canada, Capacity Building, Delivery of Health Care, Integrated trends, Family Practice education, Global Health, Health Services Accessibility organization & administration, Humans, Poverty, Primary Health Care organization & administration, Delivery of Health Care, Integrated standards, Family Practice standards, Health Services Accessibility standards, Primary Health Care standards
- Abstract
Objective: To compare the national health systems of Canada and Brazil and how both countries have addressed similar challenges in their primary care sectors., Composition of the Committee: A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with colleagues in Brazil and collaborated to undertake a between-country comparison, comparing and contrasting various elements of both countries' efforts to strengthen primary care over the past few decades., Methods: Following a literature review, the authors collectively reflected on their experiences in an attempt to explore the past and current state of family medicine in Canada and Brazil., Report: The Brazilian and Canadian primary care systems are faced with similar challenges, including geography, demographic changes, population health inequities, and gaps in universal access to comprehensive primary care services. Although the approaches to addressing these challenges are different in both settings, they highlight the central importance of family physicians in both systems. Both countries continue to face considerable challenges in the context of mental health services in primary care. It remains important for Canada to draw lessons from the primary care systems and reforms of other countries, such as Brazil., (Copyright© the College of Family Physicians of Canada.)
- Published
- 2019
8. HIV Pre-Exposure Prophylaxis Medication for Adolescents and Young Adults: A Position Paper of the Society for Adolescent Health and Medicine.
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- Adolescent, Adult, Anti-HIV Agents therapeutic use, Emtricitabine administration & dosage, Female, Humans, Male, Medication Adherence, Tenofovir administration & dosage, Young Adult, Adolescent Health, HIV Infections prevention & control, Health Services Accessibility, Pre-Exposure Prophylaxis, Sexual and Gender Minorities
- Abstract
Pre-exposure prophylaxis (PrEP) is a biomedical prevention intervention that has demonstrated high efficacy in reducing human immunodeficiency virus (HIV) transmission. While an increasing number of jurisdictions have endorsed the use of emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) for PrEP, access to PrEP varies widely. Adolescents and young adults (AYAs), especially those at high risk of HIV acquisition, such as young gay, bisexual, and other men having sex with men (YGBMSM) and individuals living in countries where HIV is endemic, face multiple barriers that limit their access to PrEP. This position paper provides context and recommendations for the promotion and use of PrEP among AYAs., (Copyright © 2018. Published by Elsevier Inc.)
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- 2018
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9. Acupuncture's Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management-White Paper 2017.
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Fan AY, Miller DW, Bolash B, Bauer M, McDonald J, Faggert S, He H, Li YM, Matecki A, Camardella L, Koppelman MH, Stone JAM, Meade L, and Pang J
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- Analgesics, Opioid therapeutic use, Epidemics, Humans, Quality of Life, United States, Acupuncture Therapy, Analgesics, Opioid adverse effects, Cost-Benefit Analysis, Health Services Accessibility, Pain drug therapy, Pain Management methods, Substance-Related Disorders
- Abstract
The United States (U.S.) is facing a national opioid epidemic, and medical systems are in need of non-pharmacologic strategies that can be employed to decrease the public's opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture's cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, and neonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.
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- 2017
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10. Identifying critical steps towards improved access to innovation in cancer care: a European CanCer Organisation position paper.
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Aapro M, Astier A, Audisio R, Banks I, Bedossa P, Brain E, Cameron D, Casali P, Chiti A, De Mattos-Arruda L, Kelly D, Lacombe D, Nilsson PJ, Piccart M, Poortmans P, Riklund K, Saeter G, Schrappe M, Soffietti R, Travado L, van Poppel H, Wait S, and Naredi P
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- Europe, Healthcare Disparities, Humans, Delivery of Health Care organization & administration, Health Services Accessibility organization & administration, Neoplasms therapy, Therapies, Investigational
- Abstract
In recent decades cancer care has seen improvements in the speed and accuracy of diagnostic procedures; the effectiveness of surgery, radiation therapy and medical treatments; the power of information technology; and the development of multidisciplinary, specialist-led approaches to care. Such innovations are essential if we are to continue improving the lives of cancer patients across Europe despite financial pressures on our healthcare systems. Investment in innovation must be balanced with the need to ensure the sustainability of healthcare budgets, and all health professionals have a responsibility to help achieve this balance. It requires scrutiny of the way care is delivered; we must be ready to discontinue practices or interventions that are inefficient, and prioritise innovations that may deliver the best outcomes possible for patients within the limits of available resources. Decisions on innovations should take into account their long-term impact on patient outcomes and costs, not just their immediate costs. Adopting a culture of innovation requires a multidisciplinary team approach, with the patient at the centre and an integral part of the team. It must take a whole-system and whole-patient perspective on cancer care and be guided by high-quality real-world data, including outcomes relevant to the patient and actual costs of care; this accurately reflects the impact of any innovation in clinical practice. The European CanCer Organisation is committed to working with its member societies, patient organisations and the cancer community at large to find sustainable ways to identify and integrate the most meaningful innovations into all aspects of cancer care., (Copyright © 2017. Published by Elsevier Ltd.)
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- 2017
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11. Maternal and neonatal implementation for equitable systems. A study design paper.
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Ekirapa-Kiracho E, Tetui M, Bua J, Muhumuza Kananura R, Waiswa P, Makumbi F, Atuyambe L, Ajeani J, George A, Mutebi A, Kakaire A, Namazzi G, Paina L, and Namusoke Kiwanuka S
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- Adult, Female, Focus Groups, Health Services Research, Humans, Infant, Newborn, Maternal Health Services standards, Power, Psychological, Pregnancy, Prenatal Care organization & administration, Quality of Health Care standards, Research Design, Rural Health Services standards, Uganda, Capacity Building organization & administration, Health Services Accessibility organization & administration, Maternal Health Services organization & administration, Quality of Health Care organization & administration, Rural Health Services organization & administration
- Abstract
Background: Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability., Objectives: The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach., Methods: The study consisted of a quasi-experimental design, with a participatory action research approach to implementation in three rural districts (Pallisa, Kibuku and Kamuli) in Eastern Uganda. The intervention had two main components; namely, community empowerment for comprehensive birth preparedness, and health provider and management capacity-building. We collected data using both quantitative and qualitative methods using household and facility-level structured surveys, record reviews, key informant interviews and focus group discussions. We purposively selected the participants for the qualitative data collection, while for the surveys we interviewed all eligible participants in the sampled households and health facilities. Descriptive statistics were used to describe the data, while the difference in difference analysis was used to measure the effect of the intervention. Qualitative data were analysed using thematic analysis., Conclusions: This study was implemented to generate evidence on how to increase access to quality maternal and newborn health services in a sustainable manner using a multisectoral participatory approach.
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- 2017
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12. Developing family practice to respond to global health challenges: The Besrour Papers: a series on the state of family medicine in the world.
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Arya N, Dahlman B, Gibson C, Ponka D, Haq C, Rouleau K, and Hansel S
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- Africa South of the Sahara, Capacity Building, Cuba, Delivery of Health Care, Integrated trends, Family Practice education, Global Health, Health Services Accessibility organization & administration, Humans, Poverty, Primary Health Care organization & administration, Delivery of Health Care, Integrated standards, Family Practice standards, Health Services Accessibility standards, Primary Health Care standards
- Abstract
Objective: To assess family medicine's role in developing strong, coordinated, community-based, integrated health care systems in low-resource settings globally., Composition of the Committee: A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with selected international colleagues with expertise in international family medicine practice, health systems and capacity building, and teaching to map family medicine globally and give a bird's eye view of family medicine internationally., Methods: Following a background literature review, the authors collectively reflected on their substantial international experience to attempt to describe best practices for various contexts., Report: With the failure of vertical, disease-oriented models to provide sustained improvements in health outcomes, the need to develop integrated primary care involving the most appropriate health professionals for differing contexts is becoming apparent worldwide. Health system planning is required to develop policies on health professional training to achieve this. Advocating and offering appropriate incentives for, and coordination of, local opportunities within the health system also becomes paramount. The adaptability and generalist nature of family medicine allows it to respond to the unique needs of a given population. Family physicians with adequate financial and physical resources can function most effectively as members of interdisciplinary teams, thus providing valuable, comprehensive health services in any area of the world., (Copyright© the College of Family Physicians of Canada.)
- Published
- 2017
13. Palliative Care in Rural Communities.
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Fasolino T, Mayfield ME, Valentine K, Rosa WE, and Koci A
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- Humans, United States, Rural Population, Palliative Care, Rural Health Services organization & administration, Health Services Accessibility
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Abstract: Rural communities in the United States are frequently marginalized and misrepresented. These communities face unique challenges, such as limited access to health care, nutritious food, and clean water, that contribute to persistent health disparities. This article presents the CARE (Complex, Access, Resourceful, Extraordinary) framework, which illustrates the dichotomy of rurality-its negative and positive aspects-in order to inform the development of palliative care delivery in rural settings. Various palliative care models are described that address access gaps, bolster provider capacity, and increase the provision of specialty palliative care. However, workforce shortages and reimbursement structures restrict the expansion of these services. Nurses, the largest segment of the health care workforce and the most trusted professionals, must partner with interdisciplinary colleagues and rural communities to advocate for equitable and inclusive care., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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14. Joint effects of Medicaid eligibility and fees on recession-linked declines in healthcare access and health status.
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Benitez J, Callison K, and Adams EK
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- United States, Humans, Medicare economics, Medicaid economics, Health Services Accessibility economics, Economic Recession, Eligibility Determination, Health Status, Insurance Coverage economics, Unemployment
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Whether Medicaid can function as a safety net to offset health risks created by health insurance coverage losses due to job loss is conditional on (1) the eligibility guidelines shaping the pathway for households to access the program for temporary relief, and (2) Medicaid reimbursement policies affecting the value of the program for both the newly and previously enrolled. We find states with more expansive eligibility guidelines lowered the healthcare access and health risk of coverage loss associated with rising unemployment during the 2007-2009 Great Recession. Rises in cost-related barriers to care associated with unemployment were smallest in states with expansive eligibility guidelines and higher Medicaid-to-Medicare fee ratios. Similarly, states whose Medicaid programs had expansive eligibility guidelines and higher fees saw the smallest recession-linked declines in self-reported good health. Medicaid can work to stabilize access to health care during periods of joblessness. Our findings yield important insights into the alignment of at least two Medicaid policies (i.e., eligibility and payment) shaping Medicaid's viability as a safety net., (© 2024 John Wiley & Sons Ltd.)
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- 2024
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15. Effects of Performance-Based Financing on Availability, Quality, and Use of Family Planning Services in the Democratic Republic of Congo: An Impact Evaluation.
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Drouard SHP, Brenner S, Antwisi D, Toure NK, Madhavan S, Fink G, and Shapira G
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- Democratic Republic of the Congo, Humans, Female, Quality of Health Care, Contraception Behavior statistics & numerical data, Contraception economics, Contraception statistics & numerical data, Pregnancy, Family Planning Services economics, Family Planning Services organization & administration, Health Services Accessibility economics, Reimbursement, Incentive
- Abstract
Access to high-quality family planning services remains limited in many low- and middle-income countries, resulting in a high burden of unintended pregnancies and adverse health outcomes. We used data from a large randomized controlled trial in the Democratic Republic of Congo to test whether performance-based financing (PBF) can increase the availability, quality, and use of family planning services. Starting at the end of 2016, 30 health zones were randomly assigned to a PBF program, in which health facilities received financing conditional on the quantity and quality of offered services. Twenty-eight health zones were assigned to a control group in which health facilities received unconditional financing of a similar magnitude. Follow-up data collection took place in 2021-2022 and included 346 health facility assessments, 476 direct clinical observations of family planning consultations, and 9,585 household surveys. Findings from multivariable regression models show that the PBF program had strong positive impacts on the availability and quality of family planning services. Specifically, the program increased the likelihood that health facilities offered any family planning services by 20 percentage points and increased the likelihood that health facilities had contraceptive pills, injectables, and implants available by 23, 24, and 20 percentage points, respectively. The program also improved the process quality of family planning consultations by 0.59 standard deviations. Despite these improvements, and in addition to reductions in service fees, the program had a modest impact on contraceptive use, increasing the modern method use among sexually active women of reproductive age by 4 percentage points (equivalent to a 37 percent increase), with no significant impact on adolescent contraceptive use. These results suggest that although PBF can be an effective approach for improving the supply of family planning services, complementary demand-side interventions are likely needed in a setting with very low baseline utilization., (© 2024 The World Bank. Studies in Family Planning published by Wiley Periodicals LLC on behalf of Population Council.)
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- 2024
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16. Impact of colonialism on Māori and Aboriginal healthcare access: a discussion paper.
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Zambas SI and Wright J
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- Australia, Ethnicity statistics & numerical data, Healthcare Disparities, Humans, Native Hawaiian or Other Pacific Islander statistics & numerical data, New Zealand, Politics, Socioeconomic Factors, Colonialism, Health Services Accessibility, Health Services, Indigenous statistics & numerical data, Racism
- Abstract
Background: Historical socio-political processes have produced gross inequity of health resource for Aboriginal Australians and New Zealand Māori., Objectives: This paper argues that socio-political factors resulting from the entrenchment of colonialism have produced significant personal and structural barriers to the utilisation of healthcare services and directly impact the health status of these two vulnerable groups., Design: Discussion Paper., Conclusions: Understanding the actual barriers preventing the utilisation of healthcare facilities, as perceived by Indigenous people, is essential in reducing the gross disparity between Indigenous and non-Indigenous morbidity and mortality in Australia and New Zealand.
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- 2016
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17. Joint position paper on rural surgery and operative delivery.
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Iglesias S, Kornelsen J, Woollard R, Caron N, Warnock G, Friesen R, Miles P, Vogt Haines V, Batchelor B, Blake J, Mazowita G, Wyman R, Geller B, and de Klerk B
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- Canada, Delivery, Obstetric standards, Family Practice, Female, General Surgery education, General Surgery standards, Gynecology education, Gynecology standards, Health Planning, Health Policy, Humans, Obstetrics education, Obstetrics standards, Patient Safety, Pregnancy, Program Evaluation, Rural Health, Societies, Medical, Workforce, Cesarean Section standards, Community Networks, Health Services Accessibility, Health Services Needs and Demand, Maternal Health Services standards, Physicians supply & distribution, Rural Health Services standards, Surgical Procedures, Operative standards
- Abstract
Our professional organizations have prepared this paper as part of an integrated, multidisciplinary plan to ensure the availability of well-trained practitioner teams to sustain safe, effective and high-quality rural surgical and operative delivery services. Without these robust local (or nearby) surgical services, sustaining rural maternity care is much more difficult. This paper describes the "network model" as a health human resources solution to meet the surgical needs, including operative delivery, of rural residents; outlines necessary policy directions for achieving this solution; and poses a series of enabling recommendations.
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- 2015
18. A Clash of Culture and Structure: Considering Barriers to Access for People Without Papers.
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Robb, Jaime Shamado
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IMMIGRANTS , *CULTURE , *HEALTH services accessibility , *RESEARCH methodology , *CONVERSATION , *INTERVIEWING , *RULES , *SOCIAL structure , *QUALITATIVE research , *FIELD notes (Science) , *HEALTH insurance , *DESCRIPTIVE statistics , *THEMATIC analysis , *HEALTH equity , *HEALTH care rationing , *TRUST - Abstract
As the United States' population grows via migration and immigration, with this rise in diverse identities, there has been increasing concern regarding disparities for undocumented immigrants living in the U.S. with limited access to the health system. Given the various constraints involving communication and social structures that undocumented immigrants face, a culture-centered approach is drawn on to investigating how this group goes about navigating a dominant health system given their restricted access. I explore co-constructed themes that emerged through conversations with undocumented immigrants, (people without papers as I call them in this work) living in the United States to gain an understanding as to the structural and cultural limitations faced by this group. By doing qualitative semi-structured interviews with local participants living in the South Florida region, I describe the various features of a complex U.S. health system that undocumented immigrants (people without papers) deemed as important obstacles that limit their willingness to interact with official medical spaces. This work draws on narratives and accounts to shed light on the intersection of disparities this group has to overcome in order to consider entering a medical space to receive the treatment they might need. The findings of this article highlighted the structural violence that certain subaltern groups, such as people without papers experience due to their limited access to foundational systems in their environment. [ABSTRACT FROM AUTHOR]
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- 2023
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19. Misconstrual of EAPC's position paper on euthanasia.
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Materstvedt LJ
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- Humans, Euthanasia, Active, Voluntary, Health Services Accessibility standards, Palliative Care, Physician's Role, Suicide, Assisted, Terminally Ill psychology
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This is a response to Barutta and Vollmann's article 'Physician-assisted death with limited access to palliative care.' I show how they misconstrue a key empirical statement made by the European Association for Palliative Care regarding legalisation of euthanasia and physician-assisted suicide. Additionally, I include some further remarks on the relationship between euthanasia and palliative care. I read with interest the article, which delineate well several positions and gives a nice overview of arguments presented on either side. I also found the line of argument unprejudiced and clear, and am sure people working within palliative care would benefit from reading it., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
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- 2015
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20. The global challenges and opportunities in the practice of rheumatology: white paper by the World Forum on Rheumatic and Musculoskeletal Diseases.
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Al Maini M, Adelowo F, Al Saleh J, Al Weshahi Y, Burmester GR, Cutolo M, Flood J, March L, McDonald-Blumer H, Pile K, Pineda C, Thorne C, and Kvien TK
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- Global Health, Humans, Musculoskeletal Diseases diagnosis, Musculoskeletal Diseases epidemiology, Musculoskeletal Diseases therapy, Prevalence, Rheumatic Diseases diagnosis, Rheumatic Diseases epidemiology, Rheumatology methods, Biomedical Research, Health Services Accessibility, Rheumatic Diseases therapy, Rheumatology education
- Abstract
Rheumatic and musculoskeletal diseases (RMDs) represent a multitude of degenerative, inflammatory and auto-immune conditions affecting millions of people worldwide. Persons with these diseases may potentially experience severe chronic pain, joint damage, increasing disability and even death. With an increasingly ageing population, the prevalence and burden of RMDs are predicted to increase, placing greater demands on the global practice of rheumatology and related healthcare budgets. Effective treatment of RMDs currently faces a number of challenges in both the developed and developing world, and individual countries may face more specific local challenges. However, limited understanding of the burden of RMDs amongst public health professionals and policy-makers means that these diseases are often not considered a public health priority. The objective of this review is to increase awareness of the RMDs and to identify opportunities to address RMD challenges on both a local and global scale. On 26 September 2014, rheumatology experts from five different continents met at the World Forum on Rheumatic and Musculoskeletal Diseases (WFRMD) to discuss and identify some key challenges for the RMDs community today. The outcomes are presented in this review, focusing on access to rheumatology services, diagnostics and therapies, rheumatology education and training and on clinical trials, as well as investigator-initiated and epidemiological research. The long-term vision of the WFRMD is to increase perception of the RMDs as a major burden to society and to explore potential opportunities to improve global and local RMD care.
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- 2015
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21. Disparities in Overdose Deaths: Looking Back at Larochelle and Colleagues' 2021 Paper.
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Volkow, Nora D., Han, Beth, and Chandler, Redonna K.
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- *
SUBSTANCE abuse treatment , *DRUG overdose , *RISK assessment , *HEALTH services accessibility , *MEDICAL quality control , *OPIOID abuse , *OPIOID analgesics , *HEALTH equity , *NALOXONE - Abstract
The article discusses an article by M. R. Larochelle and colleagues about disparities in overdose deaths. Topics include reason that the opioid overdose crisis most heavily affected non-Hispanic White people, major events that could not have been predicted at the time the article by Larochelle and colleagues was written, and lessons learned about the need for timely data on drug use patterns and overdoses to guide interventions.
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- 2024
- Full Text
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22. Method paper--distance and travel time to casualty clinics in Norway based on crowdsourced postcode coordinates: a comparison with other methods.
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Raknes G and Hunskaar S
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- Cities, Nonlinear Dynamics, Norway, Referral and Consultation, Regression Analysis, Time Factors, Crowdsourcing methods, Health Services Accessibility, Travel
- Abstract
We describe a method that uses crowdsourced postcode coordinates and Google maps to estimate average distance and travel time for inhabitants of a municipality to a casualty clinic in Norway. The new method was compared with methods based on population centroids, median distance and town hall location, and we used it to examine how distance affects the utilisation of out-of-hours primary care services. At short distances our method showed good correlation with mean travel time and distance. The utilisation of out-of-hours services correlated with postcode based distances similar to previous research. The results show that our method is a reliable and useful tool for estimating average travel distances and travel times.
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- 2014
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23. A concept paper: using the outcomes of common surgical conditions as quality metrics to benchmark district surgical services in South Africa as part of a systematic quality improvement programme.
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Clarke DL, Kong VY, Handley J, and Aldous C
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- Appendicitis surgery, Benchmarking, General Surgery statistics & numerical data, Healthcare Disparities, Humans, South Africa, General Surgery standards, Health Services Accessibility, Quality Improvement, Quality Indicators, Health Care
- Abstract
The fourth, fifth and sixth Millennium Development Goals relate directly to improving global healthcare and health outcomes. The focus is to improve global health outcomes by reducing maternal and childhood mortality and the burden of infectious diseases such as HIV/AIDS, tuberculosis and malaria. Specific targets and time frames have been set for these diseases. There is, however, no specific mention of surgically treated diseases in these goals, reflecting a bias that is slowly changing with emerging consensus that surgical care is an integral part of primary healthcare systems in the developing world. The disparities between the developed and developing world in terms of wealth and social indicators are reflected in disparities in access to surgical care. Health administrators must develop plans and strategies to reduce these disparities. However, any strategic plan that addresses deficits in healthcare must have a system of metrics, which benchmark the current quality of care so that specific improvement targets may be set.This concept paper outlines the role of surgical services in a primary healthcare system, highlights the ongoing disparities in access to surgical care and outcomes of surgical care, discusses the importance of a systems-based approach to healthcare and quality improvement, and reviews the current state of surgical care at district hospitals in South Africa. Finally, it proposes that the results from a recently published study on acute appendicitis, as well as data from a number of other common surgical conditions, can provide measurable outcomes across a healthcare system and so act as an indicator for judging improvements in surgical care. This would provide a framework for the introduction of collection of these outcomes as a routine epidemiological health policy tool.
- Published
- 2013
- Full Text
- View/download PDF
24. Operationalisation of the construct of access to dental care: a position paper and proposed conceptual definitions.
- Author
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Harris RV
- Subjects
- Consensus, Continuity of Patient Care, Dental Health Services statistics & numerical data, Efficiency, Organizational, Health Policy, Health Resources, Health Services Needs and Demand, Health Services Research, Healthcare Disparities, Humans, Models, Theoretical, Needs Assessment, Organizational Objectives, Outcome Assessment, Health Care, Power, Psychological, Dental Care statistics & numerical data, Health Services Accessibility, Terminology as Topic
- Abstract
Background: 'Access' is a term readily used in a political and policy context, but one which has not leant itself to measurement of progress towards policy goals or comparisons between health systems. Like 'quality', 'access' is a multi-dimensional construct, but currently often remains a vague and abstract concept which is difficult to translate into something specific, concrete and therefore measureable., Methods: The paper describes previous work and identifies a need for a greater consensus and conceptual clarity in the selection of metrics for dental access., Results: The construct of dental access is described as involving the concepts of 1: opportunity for access; 2, realised access (utilisation); 3, equity and 4, outcomes. Proposed conceptual definitions are given and a case made for measuring 'initial utilisation' separately from 'continued utilisation', reflecting modern approaches which distinguish 'entry access' (gaining entry to the dental care system), from the process of gaining access to higher levels of care. Using a distinction between 'entry access' and 'effective access' allows a choice of whether to restrict measurement to mainly supply side considerations, or alternatively to extend the measurement to include whether there is equity in the proportion of patients who are able obtain effective needed interventions., Conclusions: A development of conceptual definitions of dental access could facilitate measurement of progress towards policy goals and operationalisation of the construct.
- Published
- 2013
25. [In regard to the paper: Developments in the necessity and coverage of the syringe exchange program in Spanish prisons, 1992-2009. Estimation after correction].
- Author
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Acín García EJ
- Subjects
- Humans, Health Services Accessibility statistics & numerical data, Health Services Needs and Demand, Needle-Exchange Programs supply & distribution, Prisons organization & administration
- Published
- 2013
- Full Text
- View/download PDF
26. Conceptual framework on barriers and facilitators to implementing perinatal mental health care and treatment for women: the MATRIx evidence synthesis.
- Author
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Webb R, Ford E, Shakespeare J, Easter A, Alderdice F, Holly J, Coates R, Hogg S, Cheyne H, McMullen S, Gilbody S, Salmon D, and Ayers S
- Subjects
- Female, Humans, Pregnancy, Health Services Accessibility organization & administration, Mental Disorders therapy, Mental Health Services organization & administration, Perinatal Care organization & administration
- Abstract
Background: Perinatal mental health difficulties can occur during pregnancy or after birth and mental illness is a leading cause of maternal death. It is therefore important to identify the barriers and facilitators to implementing and accessing perinatal mental health care., Objectives: Our research objective was to develop a conceptual framework of barriers and facilitators to perinatal mental health care (defined as identification, assessment, care and treatment) to inform perinatal mental health services., Methods: Two systematic reviews were conducted to synthesise the evidence on: Review 1 barriers and facilitators to implementing perinatal mental health care; and Review 2 barriers to women accessing perinatal mental health care. Results were used to develop a conceptual framework which was then refined through consultations with stakeholders., Data Sources: Pre-planned searches were conducted on MEDLINE, EMBASE, PsychInfo and CINAHL. Review 2 also included Scopus and the Cochrane Database of Systematic Reviews., Review Methods: In Review 1, studies were included if they examined barriers or facilitators to implementing perinatal mental health care. In Review 2, systematic reviews were included if they examined barriers and facilitators to women seeking help, accessing help and engaging in perinatal mental health care; and they used systematic search strategies. Only qualitative papers were identified from the searches. Results were analysed using thematic synthesis and themes were mapped on to a theoretically informed multi-level model then grouped to reflect different stages of the care pathway., Results: Review 1 included 46 studies. Most were carried out in higher income countries and evaluated as good quality with low risk of bias. Review 2 included 32 systematic reviews. Most were carried out in higher income countries and evaluated as having low confidence in the results. Barriers and facilitators to perinatal mental health care were identified at seven levels: Individual (e.g. beliefs about mental illness); Health professional (e.g. confidence addressing perinatal mental illness); Interpersonal (e.g. relationship between women and health professionals); Organisational (e.g. continuity of carer); Commissioner (e.g. referral pathways); Political (e.g. women's economic status); and Societal (e.g. stigma). These factors impacted on perinatal mental health care at different stages of the care pathway. Results from reviews were synthesised to develop two MATRIx conceptual frameworks of the (1) barriers and (2) facilitators to perinatal mental health care. These provide pictorial representations of 66 barriers and 39 facilitators that intersect across the care pathway and at different levels., Limitations: In Review 1 only 10% of abstracts were double screened and 10% of included papers methodologically appraised by two reviewers. The majority of reviews included in Review 2 were evaluated as having low ( n = 14) or critically low ( n = 5) confidence in their results. Both reviews only included papers published in academic journals and written in English., Conclusions: The MATRIx frameworks highlight the complex interplay of individual and system level factors across different stages of the care pathway that influence women accessing perinatal mental health care and effective implementation of perinatal mental health services., Recommendations for Health Policy and Practice: These include using the conceptual frameworks to inform comprehensive, strategic and evidence-based approaches to perinatal mental health care; ensuring care is easy to access and flexible; providing culturally sensitive care; adequate funding of services; and quality training for health professionals with protected time to do it., Future Work: Further research is needed to examine access to perinatal mental health care for specific groups, such as fathers, immigrants or those in lower income countries., Trial Registration: This trial is registered as PROSPERO: (R1) CRD42019142854; (R2) CRD42020193107., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR 128068) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.
- Published
- 2024
- Full Text
- View/download PDF
27. Practice paper of the American Dietetic Association: addressing racial and ethnic health disparities.
- Author
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Johnson-Askew WL, Gordon L, and Sockalingam S
- Subjects
- Cultural Diversity, Humans, Minority Groups statistics & numerical data, Practice Guidelines as Topic, Public Policy, Socioeconomic Factors, United States, Dietetics organization & administration, Dietetics standards, Ethnicity statistics & numerical data, Health Services Accessibility, Health Status Disparities, Public Health
- Abstract
Minority populations have remained in relatively poor health compared to the majority population and continue to be underserved by the health care system. Racial and ethnic health disparities are not new phenomena. Understanding the causes of these disparities continues to evolve. Within the past decade researchers have looked more toward social determinants of health to explain the differences. The Institute of Medicine (IOM) report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care provided documentation to shift the discussion from patient behaviors to the contributions of health care systems, including health care providers, that contribute to health disparities. The report was the first comprehensive study that documented racial and ethnic inequities within the US health care delivery system (ie, differential treatment on the basis of race and ethnicity). The authors of the IOM report indicated that they found some evidence to suggest that bias, prejudice, and stereotyping by providers may contribute to differences in care. It is possible that food and nutrition practitioners have the same biases and are presented with the same systems challenges as the health care providers referenced in the IOM report. It is, therefore, also possible that food and nutrition practitioners may be at risk of contributing to health disparities. This article provides an in-depth look at the recommendations put forth by the IOM, offers discipline-specific recommendations consistent with those outlined in the IOM model, and introduces other models that may be of use as food and nutrition practitioners move forward with developing strategies to eliminate racial and ethnic health disparities., (Copyright © 2011 American Dietetic Association. Published by Elsevier Inc. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
28. Liberating the NHS? A commentary on the Lansley White Paper, "Equity and Excellence".
- Author
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Asthana S
- Subjects
- Health Care Reform, Health Policy, Organizational Innovation, United Kingdom, Consensus, Health Services Accessibility, Quality of Health Care, State Medicine organization & administration
- Abstract
In July 2010, the new Coalition Government unveiled its plans to make major changes to the English National Health Service (NHS). This paper, which provides a commentary on the NHS White Paper, Equity and Excellence: Liberating the NHS, casts doubt upon the extent to which the proposals will bring about the fundamental reform that the Government intends, not least because both the British public and GP commissioners (who are expected to play a central role in transforming the NHS) appear to have a limited appetite for radical market reform. The paper also identifies a number of unintended risks, including the large transitional costs and organisational turbulence resulting from further NHS reorganisation; and the fact that key aspects of the White Paper proposals could result in significant financial instability. Given the real world limitations to translating a rhetoric of localism and democratic legitimacy into reality and a lack of hard evidence about the benefits of market reform, the Government would be well advised to take a more cautious approach to health policy formulation and implementation and to ensure that any further changes to the NHS are based on evidence, piloting and evaluation., (Copyright © 2010. Published by Elsevier Ltd.)
- Published
- 2011
- Full Text
- View/download PDF
29. Policy. Paper calls for access to HIV/AIDS treatment for all.
- Subjects
- Humans, HIV Infections drug therapy, Health Policy, Health Services Accessibility
- Published
- 2009
30. Maximizing access to health care in New Jersey the case for advanced practice nurses: a White Paper.
- Author
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Torre C, Joel L, and Aughenbaugh A
- Subjects
- Cost-Benefit Analysis, Humans, Malpractice, New Jersey, Organizational Policy, Quality of Health Care, Universal Health Insurance, Advanced Practice Nursing organization & administration, Health Services Accessibility organization & administration, Nurse's Role, Societies, Nursing organization & administration
- Published
- 2009
31. [Make sure you have the wrong papers].
- Author
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van Laere I
- Subjects
- Emigrants and Immigrants, Humans, Netherlands, Health Services Accessibility, Ill-Housed Persons, Transients and Migrants
- Published
- 2009
32. Clinical preventive services for adolescents: position paper of the Society for Adolescent Medicine.
- Author
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English A, Ford CA, and Santelli JS
- Subjects
- Adolescent, Health Policy, Health Services Needs and Demand, Human Rights legislation & jurisprudence, Humans, Minors legislation & jurisprudence, Parental Consent legislation & jurisprudence, Societies, Medical, United States, Vaccines economics, Vaccines supply & distribution, Adolescent Health Services legislation & jurisprudence, Health Services Accessibility, Preventive Health Services legislation & jurisprudence
- Published
- 2009
- Full Text
- View/download PDF
33. White Paper: EMPI provides a critical foundation for improving access to care.
- Author
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Fernandes L
- Subjects
- Canada, Diffusion of Innovation, Efficiency, Organizational, Humans, Waiting Lists, Health Services Accessibility, Medical Records Systems, Computerized organization & administration, Patient Identification Systems, Systems Integration
- Published
- 2009
- Full Text
- View/download PDF
34. Reducing disparities in the access and use of Internet health information. a discussion paper.
- Author
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Gilmour JA
- Subjects
- Attitude to Computers, Comprehension, Computer Literacy, Computer User Training, Educational Status, Health Knowledge, Attitudes, Practice, Humans, Needs Assessment, Nurse's Role psychology, Self Care, Socioeconomic Factors, Vulnerable Populations psychology, Vulnerable Populations statistics & numerical data, Access to Information psychology, Health Services Accessibility organization & administration, Information Services organization & administration, Internet organization & administration
- Abstract
Internet health information is rated highly by users and is used to compensate for gaps in health information provided by health professionals. Greater understanding of health issues and changes to personal health management has been reported as a consequence of Internet use. However, there are significant disparities in the access and use of Internet health information linked to income, education and ethnicity. In this paper a case is presented that on-line health information particularly benefits the already privileged in terms of health care; well-educated people with access to economic resources. Several intervention points are suggested to improve Internet health information accessibility and use for all population groups. Interventions at an institutional level include improving equity of Internet access through the provision of free services at strategic sites and improving the readability and cultural acceptability of health information. Individually focused interventions involve skill development to enable effective navigation of Internet sites, identification of patient and families' information needs and support to develop evaluation skills. The effectiveness of these interventions in reducing disparities is reliant on nurses and other health professionals' expertise in accessing, evaluating and using Internet health information in their clinical practise. On-line health information is a powerful medium for quick and dynamic knowledge distribution. The challenge for nurses and other health professionals is directing that knowledge to the groups most disadvantaged in the current health care systems, with an agenda of reducing inequalities in access to health information.
- Published
- 2007
- Full Text
- View/download PDF
35. Position paper of the European Federation of IASP Chapters (EFIC) on the subject of pain management.
- Author
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Niv D and Devor M
- Subjects
- Chronic Disease therapy, Education, Medical standards, Europe epidemiology, Global Health, Health Personnel standards, Medicine standards, Pain Clinics standards, Pain Clinics trends, Pain, Intractable diagnosis, Patient Education as Topic standards, Specialization, Health Personnel education, Health Services Accessibility standards, Neurology standards, Pain, Intractable classification, Pain, Intractable therapy
- Abstract
Among the complaints that bring patients to see their physician, pain in its various manifestations is the most frequent. In spite of this, pain is often not adequately addressed or managed. The aim of this position paper is to present the viewpoint and recommendations of EFIC on the subject of pain management. Our overall objective is to encourage adoption by architects of healthcare systems in Europe and worldwide of a set of specific recommendations. Every patient is entitled to the implementation of these recommendations in a professional, accessible and timely manner.
- Published
- 2007
- Full Text
- View/download PDF
36. Financing mental health services for adolescents: a background paper.
- Author
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Kapphahn C, Morreale M, Rickert VI, and Walker L
- Subjects
- Adolescent, Child, Eligibility Determination, Humans, Insurance Coverage legislation & jurisprudence, Insurance Coverage statistics & numerical data, Managed Care Programs economics, Medicaid legislation & jurisprudence, Medicaid statistics & numerical data, Mental Health Services legislation & jurisprudence, Primary Health Care economics, United States, Adolescent Health Services economics, Health Services Accessibility economics, Insurance, Psychiatric legislation & jurisprudence, Insurance, Psychiatric statistics & numerical data, Mental Health Services economics
- Abstract
Good mental health provides an essential foundation for normal growth and development through adolescence and into adulthood. Many adolescents, however, experience mental health problems that significantly impede the attainment of their full potential. The majority of these adolescents do not receive needed mental health services, in part because of financial obstacles to care. This article reviews the magnitude and impact of mental health problems during adolescence and highlights the importance of insurance coverage in assuring access to mental health services for adolescents. Significant limitations in private health insurance coverage of mental health services are outlined. Recent federal and state efforts to move toward parity in private insurance coverage between mental and physical health services are discussed, including an explanation of the role of Medicaid and the State Children's Health Insurance Program (SCHIP) in providing access to mental health services for adolescents. Finally, other elements that would facilitate financial access to essential mental health services for adolescents are presented.
- Published
- 2006
- Full Text
- View/download PDF
37. Debate on the paper by David Vlahov & David D. Celentano.
- Author
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Kalichman A
- Subjects
- Brazil epidemiology, Female, HIV Infections drug therapy, HIV Infections prevention & control, Humans, Incidence, Male, Survival Rate, Antiretroviral Therapy, Highly Active, HIV Infections mortality, Health Services Accessibility, Substance Abuse, Intravenous complications
- Published
- 2006
- Full Text
- View/download PDF
38. Debate on the paper by David Vlahov & David D. Celentano. HIV infection, injection drug users and bioethics.
- Author
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Palácios M
- Subjects
- Humans, Antiretroviral Therapy, Highly Active ethics, Bioethical Issues, HIV Infections drug therapy, Health Services Accessibility ethics, Patient Selection ethics, Substance Abuse, Intravenous complications
- Published
- 2006
- Full Text
- View/download PDF
39. Debate on the paper by David Vlahov & David D. Celentano. Access to AIDS treatment: appropriateness and correctness in the pursuit of good practice.
- Author
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Ayres JR
- Subjects
- Brazil, Evidence-Based Medicine, Humans, Patient Compliance, Prejudice, Anti-Retroviral Agents therapeutic use, HIV Infections drug therapy, Health Services Accessibility ethics, Professional Practice ethics, Substance Abuse, Intravenous
- Published
- 2006
- Full Text
- View/download PDF
40. American Dental Association white paper targets dental care for the underserved.
- Author
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Berthold M
- Subjects
- American Dental Association, Child, Dental Care for Children economics, Humans, Models, Organizational, United States, Vulnerable Populations, Dental Care for Children organization & administration, Health Services Accessibility, Medicaid, Poverty
- Published
- 2005
- Full Text
- View/download PDF
41. Insuring children's health care: a call for papers.
- Author
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Perrin JM
- Subjects
- Adolescent, Child, Humans, United States, Adolescent Health Services economics, Child Health Services economics, Health Services Accessibility economics, Insurance Coverage
- Published
- 2005
- Full Text
- View/download PDF
42. Position paper/statement by members of the Ponte di Legno Group on the right of children to have full access to essential treatment for acute lymphoblastic leukemia.
- Subjects
- Child, Clinical Trials as Topic, Health Policy, Humans, International Cooperation, Child Welfare, Health Services Accessibility, Patient Advocacy, Precursor Cell Lymphoblastic Leukemia-Lymphoma therapy
- Published
- 2004
43. [Research in, about, and for health services: an international panorama and questions for health research in Brazil. Debate on the paper by Hillegonda Maria Dutilh Novaes].
- Author
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Almeida C
- Subjects
- Brazil, Humans, Health Policy, Health Services Accessibility, Health Services Research, Quality of Health Care
- Published
- 2004
- Full Text
- View/download PDF
44. The palliative clinical specialist radiation therapist: A CAMRT White Paper.
- Author
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Lavergne, Carrie, Rozanec, Natalie, and Harnett, Nicole
- Subjects
MEDICAL quality control ,HEALTH services accessibility ,CANCER patients ,RADIOTHERAPY ,INTERDISCIPLINARY education ,PALLIATIVE treatment ,ALLIED health personnel - Abstract
Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2021
- Full Text
- View/download PDF
45. A comprehensive investigation of barriers to adult immunization: a methods paper.
- Author
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Zimmerman RK, Silverman M, Janosky JE, Mieczkowski TA, Wilson SA, Bardella IJ, Medsger AR, Terry MA, Ball JA, and Nowalk MP
- Subjects
- Aged, Female, Focus Groups, Guideline Adherence standards, Guideline Adherence statistics & numerical data, Health Services Research, Humans, Male, Minority Groups education, Minority Groups psychology, Models, Psychological, Organizational Culture, Patient Acceptance of Health Care statistics & numerical data, Pennsylvania, Practice Guidelines as Topic, Regression Analysis, Surveys and Questionnaires, Family Practice organization & administration, Health Knowledge, Attitudes, Practice, Health Services Accessibility organization & administration, Immunization psychology, Immunization statistics & numerical data, Influenza Vaccines, Patient Acceptance of Health Care psychology, Pneumococcal Vaccines, Practice Patterns, Physicians' statistics & numerical data
- Abstract
Objective: Immunization rates for influenza and pneumococcal vaccines among the elderly (especially minority elderly) are below desired levels. We sought to answer 4 questions: (1) What factors explain most missed immunizations? (2) How are patient beliefs and practices regarding adult immunization affected by racial or cultural factors? (3) How are immunizations and patient beliefs affected by physician, organizational, and operational factors? and (4) Based on the relationships identified, can typologies be created that foster the tailoring of interventions to improve immunization rates?, Study Design: A multidisciplinary team chose the PRECEDE-PROCEED framework, the Awareness-to-Adherence model of clinician response to guidelines, and the Triandis model of consumer decision making as the best models to assess barriers to and facilitators of immunization. Our data collection methods included focus groups, face-to-face and telephone interviews, self-administered surveys, site visits, participant observation, and medical record review., Population: To encounter a broad spectrum of patients, facilities, systems, and interventions, we sampled from 4 strata: inner-city neighborhood health centers, clinics in Veterans Administration facilities, rural practices in a network, and urban/suburban practices in a network. In stage 1, a stratified random cluster sample of 60 primary care clinicians was selected, 15 in each of the strata. In stage 2, a random sample of 15 patients was selected from each clinician's list of patients, aiming for 900 total interviews., Conclusions: This multicomponent approach is well suited to identifying barriers to and facilitators of adult immunizations among a variety of populations, including the disadvantaged.
- Published
- 2001
46. Discussion of papers by Karen Scott Collins and Jan Blustein.
- Author
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Briceland-Betts D
- Subjects
- Aged, Drug Prescriptions economics, Female, Humans, Insurance Coverage economics, Poverty economics, United States, Health Services Accessibility organization & administration, Medicare organization & administration, Patient Advocacy, Women's Health
- Published
- 2000
- Full Text
- View/download PDF
47. Meeting health needs of asylum seekers. White paper will make access to health care more difficult.
- Author
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Hogan H
- Subjects
- Health Policy, Humans, United Kingdom, Health Services Accessibility, Refugees
- Published
- 1999
- Full Text
- View/download PDF
48. Improving access to NHS dentistry? Professionals complementary to dentistry: a consultation paper by the General Dental Council.
- Author
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Galloway J and Gorham J
- Subjects
- Dentists, Health Planning Councils, Humans, Interprofessional Relations, Patient Care Team, State Dentistry, United Kingdom, Dental Auxiliaries legislation & jurisprudence, Dental Health Services legislation & jurisprudence, Dental Health Services organization & administration, Health Services Accessibility, State Medicine legislation & jurisprudence
- Published
- 1998
49. Responsibilities and rationalities: should the patient be blamed? Paper two: Rationality, harm and risk.
- Author
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Loughlin M
- Subjects
- Humans, Life Style, Risk Factors, United Kingdom, Health Behavior, Health Services Accessibility, Social Responsibility
- Published
- 1994
- Full Text
- View/download PDF
50. The impact of health insurance on hypertension care: a household fixed effects study in India.
- Author
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Feng Z, Chen Q, Jiao L, Ma X, Atun R, Geldsetzer P, Bärnighausen T, and Chen S
- Subjects
- Humans, India, Adult, Middle Aged, Male, Female, Adolescent, Young Adult, Health Surveys, Family Characteristics, Hypertension epidemiology, Hypertension therapy, Insurance, Health statistics & numerical data, Insurance Coverage statistics & numerical data, Health Services Accessibility statistics & numerical data
- Abstract
Introduction: Hypertension is highly prevalent in India, but the proportion of patients achieving blood pressure control remains low. Efforts have been made to expand health insurance coverage nationwide with the aim of improving overall healthcare access. It is critical to understand the role of health insurance coverage in improving hypertension care., Methods: We used secondary data from the nationally representative sample of adults aged 15-49 years from the 2015-2016 National Family Health Survey (NFHS) in India. We defined the hypertension care cascade as four successive steps of (1) screened, (2) diagnosed, (3) treated, and (4) controlled, and operationalized these variables using blood pressure measurements and self-reports. We employed household fixed effect models that conceptually matched people with and without insurance within the household, to estimate the impact of insurance coverage on the likelihood of reaching each care cascade step, while controlling for a wide range of additional individual-level variables., Results: In all 130,151 included individuals with hypertension, 20.4% reported having health insurance. For the insured hypertensive population, 79.8% (95% Confidence Interval: 79.3%-80.3%) were screened, 49.6% (49.0%-50.2%) diagnosed, 14.3% (13.9%-14.7%) treated, and 7.9% (7.6%-8.2%) controlled, marginally higher than the percentages for the uninsured 79.8% (79.5%-80.0%), 48.2% (47.9%-48.6%), 13.3% (13.1%-13.5%), and 7.5% (7.4%-7.7%) for each cascade step, respectively. From the household fixed effects model, health insurance did not show significant impact on the hypertension care cascade, with the estimated relative risks of health insurance 0.97 (0.93-1.02), 0.97 (0.91-1.03), 0.95 (0.77-1.30), and 0.97 (0.65-1.10) for each cascade step, respectively. We further performed stratified analyses by sociodemographic and behavioral risk factors and a sensitivity analysis with district fixed effects, all of which yielded results that confirmed the robustness of our main findings., Conclusions: Health insurance did not show significant impact on improving hypertension care cascade among young and middle-aged adults with hypertension in India. Innovative strategies for overcoming practical barriers to healthcare services in addition to improving financial access are needed to address the large unmet need for hypertension care., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
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