7,450 results
Search Results
2. 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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3. 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
- Abstract
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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4. 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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5. 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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6. 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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7. 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
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8. Conceptual framework on barriers and facilitators to implementing perinatal mental health care and treatment for women: the MATRIx evidence synthesis.
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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
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- Female, Humans, Pregnancy, Health Services Accessibility organization & administration, Mental Disorders therapy, Mental Health Services organization & administration, Perinatal Care organization & administration
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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.
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- 2024
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9. The palliative clinical specialist radiation therapist: A CAMRT White Paper.
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Lavergne, Carrie, Rozanec, Natalie, and Harnett, Nicole
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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
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10. The impact of health insurance on hypertension care: a household fixed effects study in India.
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Feng Z, Chen Q, Jiao L, Ma X, Atun R, Geldsetzer P, Bärnighausen T, and Chen S
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- 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).)
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- 2024
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11. Bridging distances and saving costs: insights from a pilot project of telerheumatology in a rural area of Pakistan.
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Khursheed T, Rasheed U, Raza UA, Zammurrad S, Islam M, Aziz W, and Sharif M
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- Humans, Pakistan, Pilot Projects, Female, Male, Middle Aged, Adult, Rural Population, Aged, Rheumatic Diseases therapy, Rheumatic Diseases economics, Travel economics, Remote Consultation economics, Rural Health Services economics, Rheumatology economics, Health Services Accessibility economics, Telemedicine economics
- Abstract
Enhancing access to healthcare remains a formidable challenge in rural regions of low- and lower-middle-income countries. Amid evolving healthcare challenges, telerheumatology provides opportunities to bridge gaps and expand access to rheumatology care, particularly in remote areas. We describe a pilot telerheumatology program and its cost-, time-, and travel-saving potential in a remote rural setting in northern Pakistan. The telerheumatology program commenced at the Pakistan Institute of Medical Sciences Islamabad, providing services through video consultations to a basic health unit in the Gilgit-Baltistan region. Patients visiting from the Gilgit-Baltistan region willing to participate were recruited in the program. Demographics and logistical metrics were recorded in a dedicated registry. A total of 533 consultations were carried out from April 2022 to April 2023. The majority of the patients were female (318/533, 59.7%). The median age of patients was 50 ± 15.7 years. The average wait time for consultation was 20 ± 13 min. The average travel time to reach telecentre was 59 ± 53 min. The average travel cost to reach telecentre was 379 ± 780 PKR (1.85 ± 3.81 USD). The average duration of consultation was 15 ± 5 min. The most common diagnosis for consultation was knee osteoarthritis (237, 44.5%), chronic low back pain (118, 22.1%), and rheumatoid arthritis (42, 7.9%). On average, patients saved 787 ± 29 km of distance, 15 ± 1 h of traveling, and 6702 ± 535 PKR (33 ± 3 USD) that would have been required to travel to our tertiary care hospital. Telerheumatology substantially reduced travel time, distance, and cost for patients. It has the potential to deliver outpatient rheumatology consultation in an economically efficient manner, effectively breaking geographical barriers and expanding access to essential services for patients in remote areas., (© 2024. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)
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- 2024
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12. The impact of the 2014 Medicaid expansion on the health, health care access, and financial well-being of low-income young adults.
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Hamilton C
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- Humans, United States, Female, Male, Adult, Young Adult, Health Status, Insurance, Health, Health Services Accessibility, Medicaid, Patient Protection and Affordable Care Act, Poverty, Insurance Coverage statistics & numerical data
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Prior to the 2014 Affordable Care Act (ACA) expansion, 37% of young adults ages 19-25 in the United States were low-income and a third lacked health insurance coverage-both the highest rates for any age group in the population. The ACA's Medicaid eligibility expansion, therefore, would have been significantly beneficial to low-income young adults. This study evaluates the effect of the ACA Medicaid expansion on the health, health care access and utilization, and financial well-being of low-income young adults ages 19-25. Using 2010-2017 National Health Interview Survey data, I estimate policy effects by applying a difference-in-differences design leveraging the variation in state implementation of the expansion policy. I show that Medicaid expansion improved health insurance coverage, health care access, and financial well-being for low-income young adults in expansion states, but had no effect on their health status and health care utilization. I also find that the policy was associated with larger gains in health coverage for racial minorities relative to their Non-Hispanic White counterparts. With the continued health policy reform debates at the state and federal levels, the empirical evidence from this study can help inform policy decisions that aim to improve health care access and utilization among disadvantaged groups., (© 2024 John Wiley & Sons Ltd.)
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- 2024
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13. Over-the-counter access to hormonal contraception: a global perspective.
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Otto AK, Klein DA, Lau M, Dhar CP, and Hwang LY
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- Humans, Adolescent, Female, United States, Global Health, United Kingdom, Contraceptives, Oral, Hormonal supply & distribution, Hormonal Contraception, Nonprescription Drugs supply & distribution, Nonprescription Drugs economics, Health Services Accessibility
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Purpose of Review: Oral contraceptive pills are among the most popular contraceptives worldwide, including among adolescents, and are available over the counter in over 100 countries. However, when a prescription is required, oral contraceptives may be difficult to obtain, particularly for adolescents. Recent approvals of over-the-counter progestin-only pills in the United Kingdom and United States have brought widespread attention to this topic., Recent Findings: Progestin-only pills, including the norgestrel pill recently approved for over-the-counter use in the United States, are highly effective and may be used safely without a prescription or medical monitoring, including by adolescents. These pills are associated with relatively high user satisfaction. Although over-the-counter availability may improve contraceptive access overall, issues related to insurance coverage and out-of-pocket cost may continue to pose practical barriers to access for many individuals., Summary: Over-the-counter oral contraceptives are an appropriate and important contraceptive option for many adolescents. Over-the-counter availability has the potential to increase access to safe and effective contraception in the United States, United Kingdom, and other countries where a prescription is currently required. Future research on use patterns among adolescents is needed, as are advocacy efforts and policies to ensure access and affordability., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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14. Improving access to evidence-based interventions for trauma-exposed adults in low- and middle-income countries.
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Kaminer D, Booysen D, Ellis K, Kristensen CH, Patel AR, Robjant K, and Sardana S
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- Humans, Mental Health Services organization & administration, Adult, Evidence-Based Practice, Survivors psychology, Developing Countries, Health Services Accessibility, Stress Disorders, Post-Traumatic therapy
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In low- and middle-income countries (LMICs), the mental health consequences of trauma exposure pose a substantial personal, societal, and economic burden. Yet, the significant need for evidence-based mental health treatment remains largely unmet. To unlock the potential for mental health care for trauma survivors in lower-resource contexts, it is critical to map treatment barriers and identify strategies to improve access to evidence-based, culturally appropriate, and scalable interventions. This review, based on an International Society for Traumatic Stress (ISTSS) briefing paper, describes the treatment gap facing adults with traumatic stress in LMICs and identifies the barriers that contribute to this gap. We then highlight strategies for enhancing access to effective treatments for these populations, including task-sharing, the use of culturally adapted and multiproblem interventions, and digital tools to scale access to appropriate care. Finally, we offer recommendations for policymakers, researchers, and service providers to guide an agenda for action to close the treatment gap for trauma survivors in LMICs., (© 2024 International Society for Traumatic Stress Studies.)
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- 2024
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15. Geospatial and Socioeconomic Disparities Influencing the Management and Outcomes of Nonsyndromic Craniosynostosis: A Systematic Review.
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Belza CC, Sheahan L, Becker M, and Gosman AA
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- Humans, Treatment Outcome, Infant, Socioeconomic Disparities in Health, Craniosynostoses surgery, Craniosynostoses therapy, Healthcare Disparities, Socioeconomic Factors, Health Services Accessibility
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Geospatial and socioeconomic health disparities are potential barriers to timely diagnosis and treatment of nonsyndromic craniosynostosis. This systematic review aims to assess published literature describing disparities in craniosynostosis care and to summarize the findings surrounding patient proximity to care centers and familial socioeconomic status as predictors of surgical management and outcomes. The data sources used include PubMed, MEDLINE, and Google Scholar. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for appraisal of the quality of the studies included. Generally, the literature reviewed suggested that socioeconomic variables including race, insurance payor, and median zip code income quartile are predictors of suboptimal craniosynostosis surgical management outcomes including older age at time of surgery and more invasive surgical approach performed. The only geospatial data element assessed was the general region of the hospital where the patient was treated. The review highlighted various knowledge gaps within published literature describing health-related disparities in patients with craniosynostosis. There is a paucity of research assessing geospatial access to craniosynostosis care centers, suggesting that further research should be performed to evaluate this potential disparity. In addition, previous studies lack granularity when assessing socioeconomic factors and only one study accounted for suture fused, which is a potential confounding variable across the other published work. These considerations should be addressed in future studies addressing this topic. The limitations of this review include potential publication bias given that unpublished work was not included. An element of reviewer bias also exists considering only one reviewer screened the articles and extracted the data., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)
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- 2024
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16. A systematic review of digital access to post-diagnostic health and social care services for dementia.
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Watson J, Hanna K, Talbot C, Hansen M, Cannon J, Caprioli T, Gabbay M, Komuravelli A, Eley R, Tetlow H, and Giebel C
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- Humans, Social Work, Telemedicine, Dementia therapy, Dementia diagnosis, Caregivers, Health Services Accessibility
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Objectives: For many people with dementia and unpaid carers, using technology for care and support has become essential. Rapid proliferation of technology highlights the need to understand digital access to health and social care services for dementia. This mixed-methods systematic review aims to explore digital access to health and social care services for dementia, from the perspective of people with dementia and unpaid carers., Methods: Nine electronic databases were searched in May 2023 for qualitative, quantitative, or mixed-method studies, published in English or German, focused on experiences of using technology-delivered health and social care services for people with dementia and unpaid carers. After removal of duplicates and screening, 44 empirical papers were included., Results: From the 44 studies, findings were grouped into five categories, highlighting experiences for people with dementia and unpaid carers: (1) Adapting to technology, (2) Inequalities and variations in outcomes, (3) Impact on caring, (4) Impact on health, and (5) Impact on relationships. Proliferation of technology in care access emphasised the need for quick adaptation to technology and examination of its impact. The impact of such service delivery has evidenced mixed findings. There were improvements in the health and wellbeing of people with dementia and unpaid carers, and benefits for their dyadic relationship. However, using technology for health and social care access is not always possible and is often reliant on unpaid carers for support. Lower tech-literacy, lack of equipment or money to buy equipment and poor internet connection can impact the potential for positive outcomes., Conclusions: Technology can bring great benefits: social inclusion, improved service access and care. However, using technology in service delivery in dementia needs careful thought. Professionals and service providers need to be cognizant of the complex nature of dementia, and the benefits and challenges of hybrid service delivery., (© 2024 The Author(s). International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.)
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- 2024
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17. Contextual determinants associated with children's and adolescents' mental health care utilization: a systematic review.
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Verhoog S, Eijgermans DGM, Fang Y, Bramer WM, Raat H, and Jansen W
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- Humans, Adolescent, Child, Mental Disorders therapy, Adolescent Health Services, Mental Health Services, Health Services Accessibility, Patient Acceptance of Health Care statistics & numerical data
- Abstract
Determinants at the contextual level are important for children's and adolescents' mental health care utilization, as this is the level where policy makers and care providers can intervene to improve access to and provision of care. The objective of this review was to summarize the evidence on contextual determinants associated with mental health care utilization in children and adolescents. A systematic literature search in five electronic databases was conducted in August 2021 and retrieved 6439 unique records. Based on eight inclusion criteria, 74 studies were included. Most studies were rated as high quality (79.7%) and adjusted for mental health problems (66.2%). The determinants that were identified were categorized into four levels: organizational, community, public policy or macro-environmental. There was evidence of a positive association between mental health care utilization and having access to a school-based health center, region of residence, living in an urban area, living in an area with high accessibility of mental health care, living in an area with high socio-economic status, having a mental health parity law, a mental health screening program, fee-for-service plan (compared to managed care plan), extension of health insurance coverage and collaboration between organizations providing care. For the other 35 determinants, only limited evidence was available. To conclude, this systematic review identifies ten contextual determinants of children's and adolescents' mental health care utilization, which can be influenced by policymakers and care providers. Implications and future directions for research are discussedPROSPERO ID: CRD42021276033., (© 2022. The Author(s).)
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- 2024
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18. Strategies to improve diagnosis and access to treatment of retinoblastoma in low- and middle-income countries: A systematic review.
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Rabelo BS, de Alvarenga KAF, Fernando Lopes L, Guimarães Ribeiro A, and de Sá Rodrigues KE
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- Humans, Retinoblastoma therapy, Retinoblastoma diagnosis, Developing Countries, Retinal Neoplasms therapy, Retinal Neoplasms diagnosis, Health Services Accessibility
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Retinoblastoma, the most common intraocular tumor in childhood, still faces challenges in diagnosis and treatment, particularly in low- and middle-income countries. Identifying strategies to improve the time to diagnosis and access to treatment is crucial to enhance survival rates and preserve ocular health. We conducted a systematic review to identify interventions that have demonstrated potential in addressing these challenges. We performed a comprehensive search across databases until March 2023. Out of the studies reviewed, 21 met the inclusion criteria and were categorized into five main areas: surveillance strategies, genetic counseling, education, public assistance, and international partnership. Despite the obstacles faced, the initiatives identified in this review present acts toward improving the time to diagnosis and access to treatment for retinoblastoma. Based on the extracted data, we propose a comprehensive chain of initiatives. We firmly believe that implementing this chain of initiatives can lead to improved clinical outcomes for retinoblastoma patients., (© 2024 Wiley Periodicals LLC.)
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- 2024
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19. Perspectives from the pandemic epicenter: Sexual and reproductive health of immigrant women in New York City.
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Samari G, Wurtz HM, Desai S, and Coleman-Minahan K
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- Humans, New York City epidemiology, Female, Adult, Pregnancy, SARS-CoV-2, Contraception, Contraception Behavior ethnology, Contraception Behavior psychology, Young Adult, Pandemics, Middle Aged, Interviews as Topic, Qualitative Research, COVID-19 ethnology, COVID-19 epidemiology, Emigrants and Immigrants psychology, Emigrants and Immigrants statistics & numerical data, Sexual Health ethnology, Reproductive Health ethnology, Health Services Accessibility
- Abstract
Context: The United States' response to COVID-19 created a policy, economic, and healthcare provision environment that had implications for the sexual and reproductive health (SRH) of racialized and minoritized communities. Perspectives from heterogenous immigrant communities in New York City, the pandemic epicenter in the United States (US), provides a glimpse into how restrictive social policy environments shape contraception, abortion, pregnancy preferences, and other aspects of SRH for marginalized immigrant communities., Methods: We conducted in-depth interviews in 2020 and 2021 with 44 cisgender immigrant women from different national origins and 19 direct service providers for immigrant communities in New York City to explore how immigrants were forced to adapt their SRH preferences and behaviors to the structural barriers of the COVID-19 pandemic. We coded and analyzed the interviews using a constant comparative approach., Results: Pandemic-related fears and structural barriers to healthcare access shaped shifts in contraceptive use and preferences among our participants. Immigrant women weighed their concerns for health and safety and the potential of facing discrimination as part of their contraceptive preferences. Immigrants also described shifts in their pregnancy preferences as rooted in concerns for their health and safety and economic constraints unique to immigrant communities., Conclusion: Understanding how immigrant women's SRH shifted in response to the structural and policy constraints of the COVID-19 pandemic can reveal how historically marginalized communities will be impacted by an increasingly restrictive reproductive health and immigration policy landscape., (© 2024 The Authors. Perspectives on Sexual and Reproductive Health published by Wiley Periodicals LLC on behalf of University of Ottawa.)
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- 2024
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20. Did Medicaid Reimbursements Shape the Effects of Medicaid Expansion on Access to Health Care Among the Low-Income Population?
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Benitez J, Freed SS, Huang H, and Oladele T
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- Humans, United States, Adult, Middle Aged, Female, Male, Young Adult, Insurance Coverage economics, Insurance Coverage statistics & numerical data, Patient Protection and Affordable Care Act economics, Insurance, Health, Reimbursement economics, Behavioral Risk Factor Surveillance System, Medicaid economics, Medicaid statistics & numerical data, Health Services Accessibility economics, Health Services Accessibility statistics & numerical data, Poverty economics
- Abstract
Background: Whether variation in Medicaid reimbursement fees influenced the impacts of the Medicaid expansions is not well understood., Objective: We examine whether changes in health care access associated with Medicaid expansion are different in states with comparatively high Medicaid reimbursement rates compared against expanding in states with lower Medicaid reimbursement rates., Design: Using a difference-in-difference-in-difference (DDD or triple-difference) regression approach, we compare relative differences in Medicaid expansion effects between lower and higher reimbursement states., Participants: 512,744 low-income adults aged 20-64 in the 2011-2019 Behavioral Risk Factor Surveillance System., Main Measures: Health insurance coverage status, unmet medical needs due to cost, regular source for health care, and a regular/scheduled checkup within the past year., Key Results: Medicaid expansion has significant and positive impacts on health coverage and access in both high- and low-fee states. In states with fee levels above the median Medicare-to-Medicaid ratios, expanding Medicaid eligibility reduced uninsurance rate by 15.2 percentage point (ppt, p < 0.01), shrank the cost-associated unmet medical need by 10.3 ppt (p < 0.01), improved access to usual source of care by 1.9 ppt (p < 0.1), and increased regular checkup by 14.4 ppt (p < 0.01), while such effects in low-fee states were 11.7 ppt (p < 0.01), 8.3 ppt (p < 0.01), 3.1 ppt (p < 0.1), and 12.3 ppt (p < 0.01), respectively. Our results suggest that Medicaid expansion effect on unmet medical need due to cost in higher-reimbursing states was 2.98 ppt (p < 0.05) larger than in lower-reimbursing states. Evidence suggests modest increases in health care access were more strongly associated with expansions in higher-fee states., Conclusions: Medicaid's fee structure should be considered as a factor influencing large-scale coverage expansions., (© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.)
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- 2024
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21. Characteristics of Vulnerable Foreigners in Need of Emergency Care Support in Japan: A Case Study of Thai Nationals from 2004 to 2020.
- Author
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Supakul S, Yoshida M, Kosaka M, Murayama A, Tani Y, Bhandari D, Ozaki A, and Tanimoto T
- Subjects
- Humans, Female, Male, Retrospective Studies, Middle Aged, Thailand epidemiology, Adult, Japan ethnology, Aged, Vulnerable Populations, Emergency Medical Services statistics & numerical data, Emigrants and Immigrants statistics & numerical data, Insurance Coverage statistics & numerical data, Young Adult, Adolescent, Chronic Disease, Southeast Asian People, Health Services Accessibility
- Abstract
In Japan, a considerable number of foreigners encounter challenges in accessing appropriate healthcare services due to the lack of insurance coverage. However, the absence of a public database on these individuals makes it difficult to assess their health problems and healthcare access status. This study aims to investigate the characteristics of vulnerable Thai patients in Japan and to shed light on the specific challenges they face within Japan's healthcare system. A retrospective analysis was conducted using records of patients who required emergency healthcare support from the Royal Thai Embassy in Tokyo between 2004 and 2020. Descriptive statistical analyses were performed to examine the general characteristics, insurance status, and diseases of the patients. Additionally, patients were classified as either prolonged residents or brief residents based on their duration of stay in Japan until hospital admission (1 year or more or less than 1 year). A total of 74 patients were identified, with the majority (91.9%) lacking insurance coverage. Notably, there was an increase in the number of brief residents, including tourists, during the 2010s. Prolonged residents were more likely to experience chronic diseases, whereas brief residents were more prone to sustaining injuries. The patient records from the Thai Embassy consistently highlight the urgent requirement for emergency healthcare support within this population. However, the existing policies in Japan fall short in adequately addressing the healthcare access needs of this vulnerable population. Therefore, it is crucial to provide additional support and interventions to enhance their healthcare access., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2024
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22. Prenatal and postpartum care during the COVID-19 pandemic: An increase in barriers from early to mid-pandemic in the United States.
- Author
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Diamond-Smith N, Logan R, Adler A, Gutierrez S, Marshall C, and Kerns JL
- Subjects
- Humans, Female, Pregnancy, United States epidemiology, Adult, Socioeconomic Factors, Cross-Sectional Studies, Young Adult, SARS-CoV-2, COVID-19 epidemiology, Prenatal Care, Postnatal Care, Health Services Accessibility
- Abstract
Background: The COVID-19 pandemic led to changes in the provision of pregnancy and postpartum care. The purpose of this study was to describe changes in access to prenatal and postpartum care over time, from early in the pandemic (July 2020) to mid-pandemic (January 2021) and to explore socioeconomic and COVID-19-related economic factors associated with experiencing barriers to care., Methods: We recruited two cross sections of women and birthing people in the US in July 2020 (N = 4645) and January 2021 (N = 3343) using Facebook and Instagram Ads., Results: Three out of four women in the prenatal period and four out of five women in the postpartum period reported barriers to scheduling a visit. The likelihood of not having a visit (OR = 4.44, 95% CI 2.67-7.40), being unable to schedule a visit (OR = 2.73, 95% CI 1.71-4.35), and not being offered visits (OR = 4.26, 95% CI 2.32-7.81) increased over time. Participants were more likely to report barriers attending scheduled prenatal or postpartum appointments over time (OR = 2.72, 95% CI 2.14-3.45). Women who experienced more economic impacts from COVID-19 were older, less educated, and were Black, Indigenous, or a person of color, and were more likely to have barriers to attending appointments., Conclusions: Certain subgroups are more at risk during COVID-19, and around 9 months into the pandemic, women were not only still facing barriers to care, but these had been amplified. Additional research using other data sources is needed to identify and ameliorate barriers and inequalities in access to prenatal and postpartum care that appear to have persisted throughout the pandemic., (© 2023 The Authors. Birth published by Wiley Periodicals LLC.)
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- 2024
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23. Wellbeing Outcomes and Risk and Protective Factors for Parents with Migrant and Refugee Backgrounds from the Middle East in the First 1000 Days: A Systematic Review.
- Author
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Winter, Amelia Kate, Due, Clemence, and Ziersch, Anna
- Subjects
MENTAL illness risk factors ,MENTAL illness prevention ,ANXIETY prevention ,PREVENTION of mental depression ,RISK assessment ,MEDICAL information storage & retrieval systems ,EMIGRATION & immigration ,HEALTH services accessibility ,INFANT development ,HEALTH attitudes ,HEALTH status indicators ,RESEARCH funding ,PSYCHOLOGICAL distress ,MATERNAL health services ,PSYCHOLOGY of refugees ,MOTHERS ,CHILD health services ,PARENT attitudes ,POSTPARTUM depression ,HELP-seeking behavior ,DESCRIPTIVE statistics ,DISEASE prevalence ,LONELINESS ,PARENTING ,FAMILY roles ,FAMILIES ,PREGNANCY outcomes ,POPULATION geography ,EXPERIENCE ,SYSTEMATIC reviews ,MEDLINE ,THEMATIC analysis ,MIGRANT labor ,CHILD development ,PATIENT-professional relations ,PSYCHOLOGY of parents ,ONLINE information services ,SOCIAL support ,PATIENT satisfaction ,PSYCHOSOCIAL factors ,WELL-being ,PSYCHOLOGY information storage & retrieval systems ,MENTAL depression ,SOCIAL isolation ,COMMUNICATION barriers ,COVID-19 pandemic ,PREGNANCY - Abstract
The First 1000 Days (the period from conception to a child's second birthday) is an important developmental period. However, little is known about experiences of parents with refugee and migrant backgrounds during this period. A systematic review was conducted according to PRISMA guidelines. Publications were identified through searches of the Embase, PsycINFO, PubMed, and Scopus databases, critically appraised, and synthesised using thematic analysis. A total of 35 papers met inclusion criteria. Depressive symptomatology was consistently higher than global averages, however maternal depression conceptualisations differed across studies. Several papers reported changes in relationship dynamics as a result of having a baby post-migration. Consistent relationships were found between social and health support and wellbeing. Conceptualisations of wellbeing may differ among migrant families. Limited understanding of health services and relationships with health providers may impede help-seeking. Several research gaps were identified, particularly in relation to the wellbeing of fathers, and of parents of children over 12 months old. [ABSTRACT FROM AUTHOR]
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- 2024
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24. Health Care for Our Nation's Veterans: A Policy Paper From the American College of Physicians
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Ryan, Crowley, Omar, Atiq, David, Hilden, Thomas G, Cooney, and Michael, Tan
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Mental Health Services ,Advisory Committees ,Population ,Holistic Health ,Modernization theory ,Health Services Accessibility ,Patient satisfaction ,Nursing ,Health care ,Internal Medicine ,Electronic Health Records ,Humans ,Medicine ,Health Workforce ,education ,Societies, Medical ,health care economics and organizations ,Patient Care Team ,education.field_of_study ,Primary Health Care ,Emergency management ,Delivery of Health Care, Integrated ,business.industry ,Health Policy ,Medical record ,General Medicine ,Telemedicine ,United States ,United States Department of Veterans Affairs ,Education, Medical, Graduate ,Veterans Health Services ,Position paper ,Private Sector ,Health Services Research ,business ,Administration (government) - Abstract
The Veterans Health Administration (VHA) is the United States' largest integrated health care delivery system, serving over 9 million enrollees at nearly 1300 health care facilities. In addition to providing health care to the nation's military veterans, the VHA has a research and development program, trains thousands of medical residents and other health care professionals, and conducts emergency preparedness and response activities. The VHA has been celebrated for delivering high-quality care to veterans, early adoption of electronic medical records, and high patient satisfaction. However, the system faces challenges, including implementation of an expanded community care program, modernization of its electronic medical records system, and providing care to a population with complex needs. The position paper offers policy recommendations on VHA funding, the community care program, medical and health care professions training, and research and development.
- Published
- 2021
25. Accessing opioid agonist treatment in prison in England and Scotland remains problematic - the views of people with lived experience.
- Author
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Webster R, Fearns C, Harriott P, Millar L, Simpson J, Wallace J, and Wheatley M
- Subjects
- Humans, Scotland, England, Male, Female, Adult, Buprenorphine therapeutic use, Prisons, Focus Groups, Surveys and Questionnaires, Middle Aged, Analgesics, Opioid therapeutic use, Health Services Accessibility, Opiate Substitution Treatment, Prisoners psychology, Prisoners statistics & numerical data, Opioid-Related Disorders drug therapy, Opioid-Related Disorders epidemiology, Opioid-Related Disorders psychology, Methadone therapeutic use
- Abstract
Purpose: The purpose of this paper is to examine lived experiences of opioid agonist treatment (OAT) during and immediately following release from detention in prisons in England and Scotland., Design/methodology/approach: Surveys were completed by serving prisoners in both countries and by those recently released from prison (England only). The survey findings were discussed in focus groups of people with lived experience. The combined findings from the surveys and focus groups were shared with an expert group of prison OAT providers and people with lived experience with the purpose of making recommendations for more accessible and effective OAT in custodial environments and continuity of OAT on release., Findings: The quality and accessibility of OAT varied considerably between establishments. It was reported to be harder to access OAT in Scottish prisons. It was often hard for people in prison to get the dosage of OAT they felt they needed and it was generally harder to access buprenorphine than methadone in English prisons. Only Scottish people in prison were aware of long-lasting forms of buprenorphine. People in English prisons had mixed experiences of the help available in prison, with no improvement recorded since a 2016 study. People in Scottish prisons were more likely to rate the help available as poor., Research Limitations/implications: The number of people accessed while actually in prison (73) was reduced by the impact of the pandemic, making it more difficult to access people in prison and because some were resistant to participating on the basis that they had already been consulted for a wide variety of research projects focused on the impact of COVID. The Scottish cohort (a total of 19 individuals comprising 14 survey respondents and five focus group members) is clearly too small a number on which to base robust claims about differences in OAT provision between the English and Scottish prison systems.., Practical Implications: The study identifies key barriers to accessing OAT in prisons and suggests key components of more user-friendly approaches., Social Implications: This study provides an overview of the recent lived experiences of people accessing OAT in prison and on release and offers valuable recommendations on how to make service provision more effective and consistent., Originality/value: This study provides an overview of the recent lived experiences of people accessing OAT in prison and on release in England and Scotland and offers valuable recommendations on how to make service provision more effective and consistent., (© Emerald Publishing Limited.)
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- 2024
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26. Barriers and facilitators of receiving prosthetic services in people with lower limb amputation during Covid-19 pandemic: A qualitative study in a developing country.
- Author
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Nabizadeh S, Jalali M, Kamali M, Shahabi S, and Babaee T
- Subjects
- Humans, Pandemics, Developing Countries, Communicable Disease Control, Amputation, Surgical, Lower Extremity, Health Services Accessibility, COVID-19
- Abstract
Purpose: This study investigated the barriers, challenges, and facilitators in receiving prosthetic services in people with lower limb amputation during Covid-19 pandemic., Materials and Methods: In this qualitative study, we conducted in-depth semistructured face-to-face interviews with individuals with lower limb amputation who needed prosthetic services during Covid-19 pandemic. We discussed about challenges and barriers that the participants had encountered during this period. The collected data were analyzed using a conceptual framework., Results: Six broad themes of availability, accessibility, acceptability, affordability, accommodation, and awareness emerged from the analysis. Staff shortage, lack of remote services, accommodation, insurance and governmental support, and cost of services were the main concerns. Moreover, long waiting lists, postponed referrals, noncompliance with Covid-19 protocols and preventive measures, and lockdowns were the other important concerns that were noted. In addition, unsatisfactory services in hometown, distance to capital, transportation permit in lockdowns, traffic jam, and public transport problems were other reasons of service not being accessible. The positive aspects were the facilitators such as having home visits, social work and charity, and using private drive services., Conclusion: It seems that after the beginning of Covid-19 pandemic, people with lower limb amputation have faced more drastic challenges in accessing and receiving prosthetic services than in the prepandemic situations., (Copyright © 2023 International Society for Prosthetics and Orthotics.)
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- 2024
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27. Perceptions of access to care after a rural hospital closure in an economically distressed county of Appalachian Tennessee.
- Author
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Letheren A, Brown KC, Barroso CS, Myers CR, and Nobles R
- Subjects
- Humans, Rural Population, Tennessee, Hospitals, Rural, Health Facility Closure, Health Services Accessibility
- Abstract
Purpose: The rise in rural hospital closures has sparked concern about the potential loss of essential health care services for rural communities. It is crucial to incorporate the perspectives of community residents, which have been largely missing from the literature, when devising strategies to improve health care for this population. The purpose of this study was to describe community residents' perceptions of access to care following a rural hospital closure in an economically distressed Appalachian county of Tennessee., Methods: This study used a qualitative descriptive approach to illustrate how community residents perceive accessing care post hospital closure. We conducted semi-structured interviews with 24 community residents via telephone in May through August of 2020. Interviews were analyzed using conventional content analysis., Findings: Five themes were identified based on Penchansky and Thomas' framework of health care: accessibility, availability, affordability, accommodation, and acceptability. Accessibility was identified as the most common concern among participants. Specifically, participants perceived longer travel times to receive care, reduced availability of emergency and specialty care, increased costs associated with ambulance services, and extended wait times to see providers., Conclusions: Our findings provide a critical perspective to inform local leaders and policymakers on the impacts of a hospital closure in a rural community. As rural hospitals continue to close, it is crucial to develop multi-level, community-driven solutions to ensure access to care for rural communities., (© 2023 National Rural Health Association.)
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- 2024
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28. Principles for Ending Human Immunodeficiency Virus as an Epidemic in the United States: A Policy Paper of the Infectious Diseases Society of America and the HIV Medical Association.
- Author
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Person, Anna K, Armstrong, Wendy S, Evans, Tyler, Fangman, John J W, Goldstein, Robert H, Haddad, Marwan, Jain, Mamta K, Keeshin, Susana, Tookes, Hansel E, Weddle, Andrea L, and Feinberg, Judith
- Subjects
- *
HIV infection epidemiology , *HIV prevention , *HEALTH services accessibility , *MEDICAL care , *HEALTH care reform , *QUALITY of life , *MEDICAL societies - Abstract
While we have the tools to achieve this goal, the persistent barriers to healthcare services experienced by too many individuals will need to be addressed to make significant progress and improve the health and quality of life of all people with human immunodeficiency virus (HIV). The necessary structural changes require actions by federal, state, and local policymakers and range from ensuring universal access to healthcare services to optimizing care delivery to ensuring a robust and diverse infectious diseases and HIV workforce. In this article, we outlines 10 key principles for policy reforms that, if advanced, would make ending the HIV epidemic in the United States possible and could have much more far-reaching effects in improving the health of our nation. [ABSTRACT FROM AUTHOR]
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- 2023
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29. Integration of Population Health, Social Determinants, and Social Justice in Transcultural Nursing and Culturally Competent Care: White Paper by the Scholars Education Interest Group.
- Author
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Pacquiao, Dula F., Maxwell, Joanna Basuray, Ludwig-Beymer, Patti, Stievano, Alessandro, Sagar, Priscilla L., Purnell, Larry, Daub, Katharyn F., and Halabi, Jehad O.
- Subjects
- *
OCCUPATIONAL roles , *SOCIAL determinants of health , *HEALTH services accessibility , *SOCIAL justice , *TRANSCULTURAL nursing , *CULTURAL competence , *NURSES , *POPULATION health , *PATIENT safety , *HEALTH promotion - Abstract
Introduction: As part of its mission to advance Transcultural Nursing worldwide, the Transcultural Nursing Society Scholars upholds the central role of the discipline and cultural competence in advocacy, empowerment, and transformation of the life conditions of disadvantaged populations. This White Paper affirms the Scholars' core belief in the value of Transcultural Nursing and culturally competent care in addressing social determinants to promote health equity. Methods: The Scholars Education Interest Group proposes recommendations for changes in education, practice, and research undergirding the discipline and expand cultural competence to directly address social structural and historical forces that perpetuate health vulnerability in diverse populations. Results: Collaborative leadership between the TCNS Scholars, Board of Trustess and members should develop initiatives to foster implementation of the recommendations and promote global dissemination of exemplars in education, research and practice. Discussion: Collaborative implementation of recommendations will generate evidence of health equity outcomes through TCN and culturally competent care. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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30. Migrant workers occupational health research: an OMEGA-NET working group position paper.
- Author
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Aktas, Emine, Bergbom, Barbara, Godderis, Lode, Kreshpaj, Bertina, Marinov, Mario, Mates, Dana, McElvenny, Damien M., Mehlum, Ingrid Sivesind, Milenkova, Valentina, Nena, Evangelia, and Glass, Deborah C.
- Subjects
- *
INDUSTRIAL hygiene , *MIGRANT labor , *GROUP work in research , *PUBLIC health research , *OCCUPATIONAL health services , *HEALTH services accessibility - Abstract
Objective: The aims of the study were: (1) to clarify the definitions of "migrant" used in occupational health research; (2) to summarize migrant workers' industry sectors, occupations and employment conditions; (3) to identify the occupational health and safety services available to migrant workers; (4) to summarize work-related health problems found among migrant workers; (5) to identify the methodological challenges to research into occupational health of migrant workers; and (6) to recommend improvements in migrant occupational health research. Methods: This position paper was prepared by researchers from several European countries and Australia, working within the EU COST Action OMEGA-NET. The paper drew on two recent systematic reviews on the occupational health of international migrant workers and other literature, and also identified uncertainties and gaps in the research literature. Migrants may, for example, be temporary or permanent, moving for specific jobs migrants or other reasons. Their ethnicity and language capabilities will affect their work opportunities. Results: The occupational health literature seldom adequately identifies the heterogeneity or characteristics of the migrant group being studied. Migrants tend to work in more physically and mentally demanding environments with higher exposures than native workers. Migrants tend to have an increased risk of physical and mental ill health, but less access to health care services. This has been demonstrated recently by high rates of COVID-19 and less access to health care. There have been a number of cross-sectional studies of migrant health but few long-term cohort studies were identified. Other study designs, such as registry-based studies, surveys and qualitative studies may complement cross-sectional studies. Mixed-methodology studies would be valuable in research on migrants' occupational health. Language and lack of trust are barriers to migrant research participation. Conclusion: Targeted research, especially longitudinal, identifying how these economically important but often-vulnerable workers can be best assisted is needed. Researchers should identify the characteristics of the migrant workers that they are studying including visa/migration circumstances (temporary, permanent, undocumented), racial and ethnic characteristics, existing skills and language abilities. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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31. Inequality in access to dental services in a market-based dental care system: A population study from Norway 1975-2018.
- Author
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Jiang N, Grytten J, and Kinge JM
- Subjects
- Adult, Humans, Cross-Sectional Studies, Poverty, Dental Care, Norway epidemiology, Healthcare Disparities, Socioeconomic Factors, Health Services Accessibility, Income
- Abstract
Objective: To examine income-related inequalities in access to dental services from 1975 to 2018. In Norway, dental care services for adults are privately financed. This may lead to income-related inequalities in access. In the early 1970s, that is, at the beginning of the study period, there were marked inequalities in access to dental services according to personal income. However, from the beginning of the 1970s, there has been a large increase in gross national income per capita in Norway as a result of the growth of the oil and gas industry. This increase in income also meant that people with a low income in 1975 had a rise in their level of income. According to the law of diminishing utility, an increase in income leads to higher consumption of dental services for people with a low level of income compared to people with a high level of income. The study hypothesis is that the inequalities in access to dental services that existed in 1975 became less over time., Methods: Statistics Norway collected samples of cross-sectional health survey data for the following years: 1975, 1985, 1995, 2002, 2008, 2012 and 2018. For each sample, individuals 21 years and older were drawn randomly from the non-institutionalized adult population using a two-stage stratified cluster sample technique. Inequalities were measured using the concentration index. The dependent variable was the use of dental services during the last year, and the key independent variable was equivalized household income., Results: The concentration index for inequalities in use of dental services according to income decreased from 0.10 (95% CI = 0.09, 0.11) in 1975 to 0.04 (95% CI = 0.03, 0.05) in 2018. The decrease was particularly large from 2002 to 2012. This was a period with a large growth in gross national income., Conclusion: People with a low income had a marked increase in their purchasing power from 1975 to 2018. This coincided with an increase in demand for dental care for this low-income group., (© 2021 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)
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- 2022
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32. Demonstrated in This Issue's Papers: Complexity and Diversity of the Field of Visual Impairment.
- Author
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Lewis, Sandra
- Subjects
- *
SERIAL publications , *HEALTH services accessibility , *VISION disorders , *BODY image , *CERTIFICATION , *REHABILITATION of blind people , *EXPERIENCE , *STUDENTS , *TEACHERS , *ONLINE education , *VIDEOCONFERENCING , *LABOR demand , *OPTOMETRY - Abstract
An introduction is presented in which the author discusses articles within the issue on topics including the role of visual experiences and sociocultural pressures in the shaping of body images of people diagnosed with blindness, feasibility and acceptability of using videoconferencing tools to present an adapted job-search intervention, and low vision rehabilitation of optometrists providing services in the Pubjab, Pakistan.
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- 2024
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33. Health inequalities in the geographic distribution of dental practitioners in Costa Rica: An ecological study.
- Author
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Barboza-Solis C, Barahona-Cubillo J, and Fantin R
- Subjects
- Humans, Costa Rica epidemiology, Professional Role, Health Inequities, Health Services Accessibility, Dentists
- Abstract
Objective: The uneven distribution of dental health services in a territory can cause an imbalance in accessibility, increasing health inequalities. This study aimed to describe the geographical distribution of dental health practitioners according to urbanicity and area-level socio-economic status in Costa Rica., Methods: A National Dentist Survey was developed to identify employment status, number of working hours, address and list of the working clinics. Data was completed using information from the national College of Surgeons, including all Costa Rican dentists. The Minimal Geographic Units (MGU) allowed for aggregating the population's individual level socio-economic position. Local Potential Accessibility (LPA) calculated the density of full-time hour's equivalents around each MGU using floating sectors. Clinics were geocoded using Geographic Information Systems, creating 2853 clinical points. Distance between each MGU and the nearest accessible clinics considering full-time working hours equivalents was estimated. MGU were divided into six categories: 'No accessibility', 'Very low accessibility', 'Low accessibility', 'Good accessibility' 'High accessibility' and 'Very high accessibility'., Results: Mean national LPA was 6.5 full-time equivalents per 10 000 inhabitants, 3.4% of the Costa Rican population had no access to dentist; 12.9% had very low accessibility, 22.7% had low accessibility, 35.0% had good accessibility, 16.2% had high accessibility, and 9.8% had very high accessibility. Overall, 39% of the population has a rather low accessibility. LPA was higher in urban districts compared to rural districts and in wealthiest districts compared to most disadvantaged districts. Within districts, after adjustment for district's characteristics, LPA was higher in urban MGU compared to rural MGU and in wealthiest MGU compared to most disadvantaged MGU., Conclusions: This study found that despite having a high number of dentists, their numbers are small in many areas, increasing inequalities in access to health care. The dentist's free establishment, where they can decide to provide private services within a community, creates zones with very high densities, in particular in the wealthiest urban areas, and others with very low densities, in particular the poorest rural areas. The lack of territorial planning has been one of the reasons that has encouraged an imbalance in the availability of dental human resources. To achieve effective universal health coverage, public institutions should focus their efforts on improving access to dental services in underserved areas., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2024
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34. Barriers and delays in access to abortion care: a cross-sectional study of people traveling to obtain care in England and the Netherlands from European countries where abortion is legal on broad grounds.
- Author
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Wollum A, De Zordo S, Zanini G, Mishtal J, Garnsey C, and Gerdts C
- Subjects
- Pregnancy, Female, Humans, Cross-Sectional Studies, Netherlands, England, Abortion, Legal, Health Services Accessibility, Abortion, Induced
- Abstract
Introduction: This study characterized the extent to which (1) financial barriers and (2) abortion care-seeking within a person's country of residence were associated with delays in abortion access among those travelling to England and the Netherlands for abortion care from European countries where abortion is legal on broad grounds in the first trimester but where access past the first trimester is limited to specific circumstances., Methodology: We drew on cross-sectional survey data collected at five abortion clinics in England and the Netherlands from 2017 to 2019 (n = 164). We assessed the relationship between difficulty paying for the abortion/travel, acute financial insecurity, and in-country care seeking on delays to abortion using multivariable discrete-time hazards models., Results: Participants who reported facing both difficulty paying for the abortion procedure and/or travel and difficulty covering basic living costs in the last month reported longer delays in accessing care than those who had no financial difficulty (adjusted hazard odds ratio: 0.39 95% CI 0.21-0.74). This group delayed paying other expenses (39%) or sold something of value (13%) to fund their abortion, resulting in ~ 60% of those with financial difficulty reporting it took them over a week to raise the funds needed for their abortion. Having contacted or visited an abortion provider in the country of residence was associated with delays in presenting abroad for an abortion., Discussion: These findings point to inequities in access to timely abortion care based on socioeconomic status. Legal time limits on abortion may intersect with individuals' interactions with the health care system to delay care., (© 2024. The Author(s).)
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- 2024
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35. Rural-urban differences in access to care among children and adolescents in the United States.
- Author
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Crouch E, Hung P, Benavidez G, Giannouchos T, and Brown MJ
- Subjects
- Child, United States, Humans, Adolescent, Cross-Sectional Studies, Poverty, Logistic Models, Insurance, Health, Health Services Accessibility, Child Health Services
- Abstract
Purpose: Rural children and adolescents face disproportionate challenges in access to health care services than their urban counterparts. Yet, recent evidence on disparities in access to health care between rural and urban children and adolescents has been limited. This study examines the associations of residence location with receipt of preventive care, foregone medical care, and continuity of insurance coverage among US children and adolescents., Methods: This study used cross-sectional data from the 2019 to 2020 National Survey of Children's Health, with a final sample size of 44,679 children. Descriptive statistics, bivariate analyses, and multivariable logistic regression models were used to examine the differences in preventive care, foregone care, and continuity of insurance coverage between rural and urban children and adolescents., Findings: Rural children had lower odds of receiving preventive care (aOR 0.64; 95% CI 0.56-0.74) and having continuous health insurance coverage (aOR 0.68; 95% CI 0.56-0.83) compared to urban children. The odds of foregone care were similar between rural and urban children. Children at every federal poverty level (FPL) less than 400% were less likely to receive preventive care, and more likely to forego care than children residing at 400% or above FPL., Conclusions: Rural disparities in child preventive care and insurance continuity warrant ongoing surveillance and local access to care initiatives, especially for children in low-income households. Without updated public health surveillance, policymakers and program developers may not be aware of current disparities. School-based health centers are 1 avenue for meeting the unmet health care needs of rural children., (© 2023 National Rural Health Association.)
- Published
- 2024
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36. The health of detainees and the role of primary care: Position paper of the European Forum for Primary Care.
- Author
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Groenewegen, Peter, Dirkzwager, Anja, van Dam, Anke, Massalimova, Dina, Sirdifield, Coral, and Smith, Lauren
- Subjects
- *
HEALTH services accessibility , *PRISONERS , *PRIMARY health care , *CONTINUUM of care , *POLICY sciences , *MEDICAL needs assessment - Abstract
This position paper aims to increase awareness among primary care practitioners and policymakers about the specific and complex health needs of people who experience incarceration. We focus on the importance of primary care and of continuity of care between prison and community. We highlight what is known from the literature on the health of people who experience incarceration, on the organisation of prison health care, and on the role of primary care both during and after detention. We present three case descriptions of detainees' encounters with the organisation of prison health care in three European countries. Finally, we describe the position that the European Forum for Primary Care takes. Prisoners and ex-prisoners have a worse physical and mental health compared with a cross-section of the population. However, access to good quality treatment and care is often worse than in the outside situation. In particular, well-organised primary care in the prison context could benefit prisoners and, indirectly, society at large. Moreover, continuity of care between the community and the prison situation needs improvement. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
37. Exploring the health consequences of armed conflict: the perspective of Northeast Ethiopia, 2022: a qualitative study.
- Author
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Arage MW, Kumsa H, Asfaw MS, Kassaw AT, Dagnew EM, Tunta A, Kassahun W, Addisu A, Yigzaw M, Hailu T, and Tenaw LA
- Subjects
- Humans, Female, Pregnancy, Aged, Ethiopia, Qualitative Research, Armed Conflicts, Health Services Accessibility, Violence
- Abstract
Background: Conflict is a complicated topic with a multidimensional consequences for community health. Its effects have a broad pattern, starting from direct war-related morbidity and mortality caused by bullets and bombs to indirect consequences due to the interruption of the delivery of preventive and curative health services. This study aimed to explore the health consequences of the northern Ethiopian conflict in the North Wollo zone, northeast Ethiopia, in 2022., Methods: This descriptive qualitative study was conducted from May to June 2022 on six conflict-affected Woredas in the north Wollo zone. A total of 100 purposively selected participants, which included patients, pregnant women, elders, community and religious leaders, and health professionals, were interviewed using IDI and FGD. The data was entered, coded, and analyzed using Open Code version 4.03. Thematic analysis approach employed to conduct the interpretation. Data was presented using descriptive statistics in the form of texts and tables., Results: The findings indicate that the conflict has caused a profound consequence on population health. It has resulted in a wide range of direct and indirect consequences, ranging from war-related casualties, famine, and disruptions of supply chains and forced displacement to instances of violence and rape associated with insecurity. The conflict also caused a breakdown in the health system by causing distraction of health infrastructure, fleeing of health workers and shortage of medication, together with insecurity and lack of transportation, which greatly affected the provision and utilization of health services. Additionally, the conflict has resulted in long-term consequences, such as the destruction of health facilities, interruption of immunization services, posttraumatic stress disorders, and lifelong disabilities. The coping strategies utilized were using available traditional medicines and home remedies, obtaining medications from conflict-unaffected areas, and implementing home-to-home healthcare services using available supplies., Conclusion: The Northern Ethiopian conflict has an impact on community health both directly and indirectly through conflict-related causalities and the breakdown of the health system and health-supporting structures. Therefore, this study recommends immediate rehabilitation interventions for damaged health infrastructure and affected individuals., (© 2023. BioMed Central Ltd., part of Springer Nature.)
- Published
- 2023
- Full Text
- View/download PDF
38. Provision of health services for elderly populations in rural and remote areas in Australia: A systematic scoping review.
- Author
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Zheng LX, Walsh EI, and Sutarsa IN
- Subjects
- Humans, Aged, Australia, Rural Population, Health Workforce, Health Services Accessibility, Rural Health Services
- Abstract
Introduction: Although various studies have examined availability, access barriers and patient experiences of rural health services for the ageing population, no synthesis of this literature exists in Australia., Objective: The objective of this study was to examine the current literature surrounding rural service provision and to evaluate the barriers to access for older individuals and to recognise gaps in the literature., Design: A systematic scoping review of peer-reviewed literature from three online databases (PUBMED, SCOPUS and Web of Science)., Findings: Thirty-two papers were included in analysis. The most prominent types of health service discussed were residential aged care (n = 12) and community health care (n = 10). More studies explored the perspectives of health personnel than the service end users. Qualitative synthesis revealed three themes associated with health service and rural ageing: access to services, health workforce experiences and end user experiences., Discussion: Access to health services for the elderly population is a complex issue. Promoting positive experiences for both health providers and patients is critical to assisting in healthy ageing for people living in rural and remote areas. This requires intervention on a social and institutional level. Key research gaps in the literature include the effectiveness of an integrated approach to institutional interventions, utilisation of preventative measures such as screening programs for cancer and greater identification of the health needs and perceptions among culturally diverse elderly residents. These studies are critical to promote appropriate and patient-centred care for elderly populations in rural and remote areas., Conclusion: The review highlights the need to address availability, retention and service innovations across health services to improve access to care and health outcomes of rural elderly residents., (© 2023 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)
- Published
- 2023
- Full Text
- View/download PDF
39. Twenty-five years of the Medicare Rural Hospital Flexibility Program: The past as prologue.
- Author
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Gale JA
- Subjects
- Aged, Humans, United States, Adult, Medicare, Health Services Accessibility, Hospitals, Rural
- Abstract
Purpose: The Medicare Rural Hospital Flexibility (Flex) Program and the Critical Access Hospital (CAH) provider type are now 25 years old. Since the inception of the program, the needs of CAHs have evolved greatly. This article describes the history of the limited-service hospital model that led to the creation of CAHs, the evolution and impact of the Flex Program on CAHs, and the trends likely to impact CAHs and rural healthcare in the future. It concludes with recommendations to address these future needs., Methods: This review of the 25-year history of the Flex Program and CAHs is based on a detailed analysis of the literature on the limited-service hospital model and CAHs, the evaluation reports of the Flex Tracking and Flex Monitoring Teams, and the author's 25-year history with the program., Findings: The Flex Program has made important contributions to the viability of rural hospitals through the conversion of 1,360 CAHs. The program has encouraged attention on CAH quality of care and the role of CAHs in addressing the population health needs of their communities. It has further encouraged the development of a robust rural health policy and advocacy infrastructure that has heightened attention on the needs of rural providers and communities., Conclusions: The needs of CAHs and rural delivery systems have evolved greatly since the implementation of the Flex Program. The 25th anniversary of the program is an ideal time to re-evaluate and update the program to support CAHs in adapting to the fast-changing healthcare environment., (© 2023 National Rural Health Association.)
- Published
- 2023
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40. Strategies to optimise culturally appropriate perioperative care for Aboriginal and Torres Strait Islander peoples: A discussion paper.
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Joye, Maureen and Foran, Paula
- Subjects
PERIOPERATIVE care ,INDIGENOUS Australians ,NURSE liaisons ,HEALTH services accessibility ,PATIENT advocacy ,OPERATING room nurses ,NURSE-patient relationships ,HEALTH equity ,EVIDENCE-based nursing ,NURSING interventions ,TRUST - Abstract
The disparity in health outcomes between Indigenous and non-indigenous Australians continues to increase. Barriers to accessing health care, particularly surgical treatment, contribute to health inequalities among Indigenous Australians. Despite a positive correlation between improved patient experiences and health outcomes, there is little research available on nursing interventions to improve Indigenous patients' perioperative health care treatment. This discussion paper investigates culturally appropriate and evidence- based nursing interventions that can be applied in the perioperative setting to improve the surgical experience of Indigenous patients. It was shown that establishing trust among Aboriginal and Torres Strait Islander patients through anaesthetic nurse practices and advocating for family involvement is critical in providing culturally safe care and enhancing patient experiences. Indigenous health liaison officers were also identified as a valuable resource in bridging cultural and communication gaps between health care providers and Indigenous patients. These findings demonstrate that using tailored nursing strategies while providing perioperative care to Indigenous Australians can enhance their perioperative health care experience and contribute to improving health outcomes of Indigenous Australians. It is therefore recommended that perioperative nurses adopt these strategies; however, further research is needed to investigate implementation of an enhanced role for anaesthetic nurses, advocating for family involvement and referral to Indigenous health liaison officers. Such research should evaluate the impact of these new holistic and patient-centred approaches on the health outcomes and experiencecs of Indigenous patients. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
41. Meningococcal vaccines: WHO position paper on the use of multivalent meningococcal conjugate vaccines in countries of the African meningitis belt.
- Subjects
- *
PREVENTION of epidemics , *HEALTH policy , *PUBLIC health surveillance , *IMMUNIZATION , *HEALTH services accessibility , *CROWDS , *PUBLIC health , *BACTERIAL meningitis , *MENINGOCOCCAL vaccines , *MEDICAL protocols , *RISK assessment , *VACCINATION mandates , *INFECTIOUS disease transmission - Abstract
The article presents an addendum to the position paper on the use of meningococcal conjugate vaccines (MMCV) in the African meningitis belt issued by the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) on Immunization at its meeting in September 2023. Topics include the WHO off-label recommendations for meningococcal vaccines and vaccination that apply to countries in the African meningitis belt and research priorities on the impact of Men5CV vaccine.
- Published
- 2024
42. Wireless sensor network technology and adoption in healthcare: A review.
- Author
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Ahmed, Hamsa M. and Rashid, Ahmed Noori
- Subjects
RADIO frequency identification systems ,TELECOMMUNICATION ,ELECTRONIC paper ,MEDICAL care costs ,WIRELESS communications ,HEALTH services accessibility ,INTERNET of things ,WIRELESS sensor networks - Abstract
The ongoing development and improvement of low-power wireless communication technologies enable many new applications to emerge on an Internet of Things (IoT). One of the main areas of healthcare research including new IoT programs to enhance both quality and access to healthcare and smart services; in this paper, we present the IoT hybrid health care monitoring system that integrates Radio-Frequency Identification (RFID) and Wireless networks technologies into a single platform that provides patient location, status, and tracking. Despite the great potential of such technologies to increase quality and experience and lower the cost of health care. The paper aims to address the complexities of RFID implementation in healthcare on patient safety through a literature review. Our primary findings indicate that the major obstacles to adoption are high adoption costs, protection and privacy-related concerns, and human security threats. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
43. Recommendations to improve maternal health equity among Black women in "The South": A position paper from the SNRS minority health research interest & implementation group.
- Author
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Eapen, Doncy, Mbango, Catherine, Daniels, Glenda, Mathew Joseph, Nitha, Mary, Annapoorna, Mathews, Nisha, Carr, Kathryn Kravetz, Wells, Cheryl, Suriaga, Armiel, and Saint Fleur, Angeline
- Subjects
MATERNAL health services ,MEDICAL quality control ,HEALTH services accessibility ,MINORITIES ,BLACK people ,WOMEN ,QUALITY assurance ,NURSING research ,PREGNANCY complications ,HEALTH care teams ,PROFESSIONAL associations ,MATERNAL mortality - Abstract
Black women in the United States experience a higher maternal mortality rate compared to other racial groups. The maternal mortality rate among non‐Hispanic Black women is 3.5 times that of non‐Hispanic White women and is higher in the South compared to other regions. The majority of pregnancy‐related deaths in Black women are deemed to be preventable. Healthy People 2030 directs healthcare providers to advance health equity through societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. The Southern Nursing Research Society has put forward this position paper to provide recommendations to improve maternal health equity among Black women. Recommendations for nurses, multidisciplinary healthcare providers, policymakers, and researchers are discussed. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
44. Perspectives of culturally and linguistically diverse (CALD) community members regarding mental health services: A qualitative analysis.
- Author
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Radhamony R, Cross WM, Townsin L, and Banik B
- Subjects
- Humans, Australia, Cultural Diversity, Health Personnel, Health Services Accessibility, Mental Health Services
- Abstract
WHAT IS KNOWN ABOUT THE SUBJECT?: Immigrant, refugee and asylum seeker populations worldwide are at high risk of mental health issues National mental health policies call for recognising Australian society's multicultural characteristics to ensure adequate mental health services to CALD communities Several barriers exist for people from CALD communities in Victoria to access and utilise mental health services Improving mental health professionals' knowledge of mental health service provision and cultural responsiveness can enhance CALD community access to services. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: We analysed the perspectives of people from CALD communities in Victoria regarding their needs and experiences with mental health services. Participants reported diverse perceptions and understanding of mental health issues and services Various challenges were identified regarding health service utilisation for the CALD community in Victoria, including language barriers, stigma towards mental health issues, mental health illiteracy, distrust and lack of familiarity with mainstream mental health services. These challenges were acknowledged by community members even after a long residence in Australia The data generated on the beliefs about mental health issues and consequent help-seeking behaviours highlight the importance of culturally sensitive targeted prevention and early intervention strategies and ongoing commitment to building mental health literacy in the wider community WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The information from the study can be adapted for quality improvement and culturally responsive practices The strategies for effective service delivery drawn by this paper can be a comprehensive resource tool for mental health professionals, organisations and policymakers The findings imply that CALD mental health service users and their families will likely benefit from improved service assessment and quality of mental health care and equity when MHNs undertake cultural competence training and bring that into their practice., Abstract: INTRODUCTION: Victoria is one of the most multicultural states in Australia. Many CALD communities in Victoria may have encountered complicated migration journeys and complex life stressors during their initial settlement, leading to adverse mental health concerns. This diversity necessitates public policy settings to ensure equity and access in health services planning and delivery. While the MH policies and services take cultural diversity into account, there needs to be more implementation of those components of MH policies that relate to the particular needs of various CALD communities in Victoria. Even though mental health services prevent and address mental health issues, many barriers can impair CALD community access and utilisation of mental health services. Furthermore, the recent Royal Commission inquiry into the Victorian Mental Health system drives a renewed policy imperative to ensure meaningful engagement and cultural safety of all people accessing and utilising mental health services (Department of Health, 2023)., Aim: This study focused on the perspectives of people from CALD communities in Victoria regarding their mental health service needs, understandings of and experiences with mental health services to prepare an education package for mental health nurses as part of a larger multi-method research project., Method: A qualitative descriptive design was used to collect and analyse the perspectives of 21 participants in Victoria, using telephone interviews, followed by thematic analysis., Results: The themes and sub-themes identified were: Settling issues; Perceptions of understanding of mental health issues (help-seeking attitudes toward mental health issues; the need for CALD community education); perceived barriers to accessing and utilising mental health services in Victoria (socio-cultural and language barriers; stigma, labelling and discrimination; knowledge and experience of accessing health facilities); experience with mental health services and professionals., Discussion: Community participation, mental health professional education and robust research regarding the mental health needs of CALD people are some of the recommended strategies to improve access and utilisation of mental health services in Victoria., Implications for Practice: The current study can contribute to the existing knowledge, understanding, practice and quality improvement as it vividly portrays the issues of various CALD communities in Victoria. The findings of this study imply that CALD MH service users and their families are likely to benefit in terms of improved service assessment and quality of MH care and equity when MHNs undertake CC training and bring that into their practice., (© 2023 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)
- Published
- 2023
- Full Text
- View/download PDF
45. The effect of distance on maternal institutional delivery choice: Evidence from Malawi.
- Author
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McGuire F, Kreif N, and Smith PC
- Subjects
- Delivery, Obstetric, Female, Health Facilities, Humans, Malawi, Patient Acceptance of Health Care, Pregnancy, Social Class, Health Services Accessibility, Maternal Health Services
- Abstract
In many low- and middle-income countries, geographical accessibility continues to be a barrier to health care utilization. In this paper, we aim to better understand the full relationship between distance to providers and utilization of maternal delivery services. We address three methodological challenges: non-linear effects between distance and utilization; unobserved heterogeneity through non-random distance "assignment"; and heterogeneous effects of distance. Linking Malawi Demographic Health Survey household data to Service Provision Assessment facility data, we consider distance as a continuous treatment variable, estimating a Dose-Response Function based on generalized propensity scores, allowing exploration of non-linearities in the effect of an increment in distance at different distance exposures. Using an instrumental variables approach, we examine the potential for unobserved differences between women residing at different distances to health facilities. Our results suggest distance significantly reduces the probability of having a facility delivery, with evidence of non-linearities in the effect. The negative relationship is shown to be particularly strong for women with poor health knowledge and lower socio-economic status, with important implications for equity. We also find evidence of potential unobserved confounding, suggesting that methods that ignore such confounding may underestimate the effect of distance on the utilization of health services., (© 2021 The Authors. Health Economics published by John Wiley & Sons Ltd.)
- Published
- 2021
- Full Text
- View/download PDF
46. WORKSHOP: SHORT PAPER AND POSTER ABSTRACTS.
- Subjects
OCCUPATIONAL roles ,CULTURAL identity ,HEALTH services accessibility ,ORAL health ,LEADERSHIP ,TRANSCULTURAL medical care ,CONFERENCES & conventions ,DENTAL therapists ,CLINICAL competence ,HEALTH promotion - Published
- 2023
47. Paper: State Medicaid expansion holdouts and managed care impede treatment.
- Author
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Enos, Gary
- Subjects
- *
SUBSTANCE abuse treatment , *SUBSTANCE abuse prevention , *POLICY sciences , *HEALTH services accessibility , *MANAGED care programs , *MEDICAID - Abstract
The expanded scope of the Medicaid program has accomplished a great deal in bolstering substance use treatment, but further progress will depend on correcting deficiencies in non‐expansion states and within Medicaid managed care entities, a newly published commentary suggests. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
48. Feasibility and acceptability of involving bilingual community navigators to improve access to health and social care services in general practice setting of Australia.
- Author
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Mistry SK, Harris E, Li X, and Harris MF
- Subjects
- Humans, Feasibility Studies, Australia, Social Support, Health Services Accessibility, General Practice
- Abstract
Background: Patients from culturally and linguistically diverse (CALD) backgrounds often face difficulties in accessing health and social care services. This study explored the feasibility and acceptability of involving community health workers (CHWs) as bilingual community navigators (BCNs) in general practice setting, to help patients from CALD backgrounds access health and social care services in Australia., Methods: This research was conducted in two general practices in Sydney where most patients are from specific CALD backgrounds (Chinese in one practice and Samoan in other). Three CHWs trained as BCNs were placed in these practices to help patients access health and social care service. A mixed-method design was followed to explore the feasibility and acceptability of this intervention including analysis of a record of services provided by BCNs and post-intervention qualitative interviews with patients, practice staff and BCNs exploring the feasibility and acceptability of the BCNs' role. The record was analyzed using descriptive statistics and interviews were audio-recorded, transcribed, and thematically analyzed., Results: BCNs served a total of 95 patients, providing help with referral to other services (52.6%), information about appointments (46.3%), local resources (12.6%) or available social benefits (23.2%). Most patients received one service from BCNs with the average duration of appointments being half an hour. Overall, BCNs fitted in well within the practices and patients as well as staff of participating practices accepted them well. Their role was facilitated by patients' felt need for and acceptance of BCNs' services, recruitment of BCNs from the patient community, as well as BCNs' training and motivation for their role. Major barriers for patients to access BCNs' services included lack of awareness of the BCNs' roles among some patients and practice staff, unavailability of information about local culture specific services, and inadequate time and health system knowledge by BCNs. Limited funding support and the short timeframe of the project were major limitations of the project., Conclusion: BCNs' placement in general practice was feasible and acceptable to patients and staff in these practices. This first step needs to be followed by accredited training, development of the workforce and establishing systems for supervision in order to sustain the program. Future research is needed on the extension of the intrevention to other practices and culture groups., (© 2023. The Author(s).)
- Published
- 2023
- Full Text
- View/download PDF
49. Barriers to dental care in a rural community.
- Author
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Castillo KB, Echeto L, and Schentrup D
- Subjects
- Humans, Medically Underserved Area, Dental Care, Health Services Accessibility, Rural Population
- Abstract
Purpose: A nurse-led rural practice, Archer Family Health Care, established a partnership with the University of Florida College of Dentistry to improve access to dental care for underserved rural populations. The purpose of this project was to evaluate the impact of this partnership on dental care access and identify perceived barriers patients' experience in this rural community., Methods: A qualitative design was used to evaluate if this partnership improved access to dental care and identify care barriers existing in this population. Outcome measures were 1) completed dental visits and 2) a qualitative analysis of patients' perceived barriers to accessing care if they did not complete their dental appointment., Results: As a result of this partnership, 118 direct dental referrals were placed. From those referrals, 45 (38%) patients completed their dental appointments, and 73 (62%) patients did not. Twenty-five patients provided a rationale for not presenting for their appointment. Cited barriers included cost (32%), time (24%), frustration with the referral process (20%), obtaining care at an alternate dental location (12%), fear (7%), and transportation issues (4%)., Conclusion: This project suggests that specific interventions may increase opportunities for dental care in rural areas however barriers continue to exist that may impact that access., (© 2023 American Dental Education Association.)
- Published
- 2023
- Full Text
- View/download PDF
50. Availability of medical abortion medicines in eight countries: a descriptive analysis of key findings and opportunities.
- Author
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Grossman A, Prata N, Williams N, Ganatra B, Lavelanet A, Läser L, Asmani C, Elamin H, Ouedraogo L, Rahman MM, Conneh-Duworko MJ, Tehoungue BZ, Chanza H, Phiri H, Bhattarai B, Dhakal NP, Ojo OA, Afolabi K, Kabuteni TJ, Hailu BG, Moses F, Dlamini-Nqeketo S, Zulu T, and Rehnström Loi U
- Subjects
- Female, Humans, Pregnancy, Mifepristone, Misoprostol, South Africa, Drug Industry legislation & jurisprudence, Abortion, Induced legislation & jurisprudence, Abortion, Induced methods, Abortifacient Agents, Internationality legislation & jurisprudence, Health Services Accessibility legislation & jurisprudence
- Abstract
Background: In recent years a growing number of manufacturers and medical abortion products have entered country markets and health systems, with varying degrees of quality and accessibility. An interplay of factors including pharmaceutical regulations, abortion laws, government policies and service delivery guidelines and provider's knowledge and practices influence the availability of medical abortion medicines. We assessed the availability of medical abortion in eight countries to increase understanding among policymakers of the need to improve availability and affordability of quality-assured medical abortion products at regional and national levels., Methods: Using a national assessment protocol and an availability framework, we assessed the availability of medical abortion medicines in Bangladesh, Liberia, Malawi, Nepal, Nigeria, Rwanda, Sierra Leone and South Africa between September 2019 and January 2020., Results: Registration of abortion medicines-misoprostol or a combination of mifepristone and misoprostol-was established in all countries assessed, except Rwanda. Mifepristone and misoprostol regimen for medical abortion was identified on the national essential medicines list/standard treatment guidelines for South Africa as well as in specific abortion care service and delivery guidelines for Bangladesh, Nepal, Nigeria, and Rwanda. In Liberia, Malawi, and Sierra Leone-countries with highly restrictive abortion laws and no abortion service delivery guidelines or training curricula-no government-supported training on medical abortion for public sector providers had occurred. Instead, training on medical abortion was either limited in scope to select private sector providers and pharmacists or prohibited. Community awareness activities on medical abortion have been limited in scope across the countries assessed and where abortion is broadly legal, most women do not know that it is an option., Conclusion: Understanding the factors that influence the availability of medical abortion medicines is important to support policymakers improve availability of these medicines. The landscape assessments documented that medical abortion commodities can be uniquely impacted by the laws, policies, values, and degree of restrictions placed on service delivery programs. Results of the assessments can guide actions to improve access., (© 2023. World Health Organization.)
- Published
- 2023
- Full Text
- View/download PDF
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