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Clinical outreach is a crucial but understudied health care service delivery model. Physicians staffing rural outreach clinics must allocate a limited resource (i.e., their time) between caring for patients at their main sites and outreach locations. Using a unique 30-year data set of decisions made by cardiologists, the authors estimate a constrained utility maximization model of time allocations across home and outreach locations. The results show that travel distance, potential competition, and patient demand for cardiology services significantly influence allocation decisions. This structural model is used to simulate the impact of a predicted reduction in cardiologist supply. The expected impacts are unevenly distributed, with some rural locations experiencing large decreases in access. The authors evaluate two policies to restore rural access: targeted immigration and a subsidy program. A subsidy program with an estimated annual cost of $406,000 can restore outreach after a 10% reduction in cardiologist supply. This option should be preferred to recruiting and supporting five additional cardiologists under a targeted immigration strategy. This research demonstrates the value of marketing modeling in addressing limited access to health care services and evaluating alternative policies for maintaining access in the face of coming physician shortages. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this retrospective study were to analyze telehealth utilization for two specialty care practices: oral medicine (OM) and oral and maxillofacial surgery (OMFS) during the first 2 years of the pandemic, its impact as a new treatment modality and on participating providers, as well as identify the type of patient visit that most readily adopted telehealth. Methods: Retrospective study of patients who sought specialty services, OM and OMFS, at an outpatient clinic in a university health system setting between March 1, 2019, and February 28, 2022. Source data were obtained from Epic, an electronic medical record application. Data were graphed using Tableau and Microsoft Excel software. Statistical analysis was performed utilizing chi-squared test and analysis of variance (ANOVA). Results: OMFS utilized telehealth 12% of the time, and OM 8% of the time. The majority (87%) of telehealth visits were for return patients (RPs). Compared with the first year of the pandemic, there was a decrease in the number of telehealth visits in the second year (p = 0.0001). As of August 2022, new patient (NP) telehealth encounters have largely returned to prepandemic levels (0-1.5%), whereas RP telehealth visits remained at an average level of 11.4% (9.4-12.4%). Surveyed providers consider telehealth as an effective complement to in-person care and will continue its use (4.2/5 Likert scale). Conclusions: Telehealth has become a viable pathway of care for OM and OMFS who previously did not utilize the remote platform to deliver healthcare. As a new treatment modality, telehealth is perceived as impactful in increasing access to specialty care by participating providers. NP visits are now almost completely in person, but telehealth continues for RPs. Ongoing demand for telehealth highlights urgency to develop appropriate standards and effective remote diagnostic/monitoring tools to maximize telehealth's capability to leverage finite health care resources and increase access to specialty care.

BACKGROUND: In the U.S. and globally, dominant metrics of contraceptive access focus on the use of certain contraceptive methods and do not address self-defined need for contraception; therefore, these metrics fail to attend to person-centeredness, a key component of healthcare quality. This study addresses this gap by presenting new data from the U.S. on preferred contraceptive method use, a person-centered contraceptive access indicator. Additionally, we examine the association between key aspects of person-centered healthcare access and preferred contraceptive method use. METHODS: We fielded a nationally representative survey in the U.S. in English and Spanish in 2022, surveying non-sterile 15-44-year-olds assigned female sex at birth. Among current and prospective contraceptive users (unweighted n = 2119), we describe preferred method use, reasons for non-use, and differences in preferred method use by sociodemographic characteristics. We conduct logistic regression analyses examining the association between four aspects of person-centered healthcare access and preferred contraceptive method use. FINDINGS: A quarter (25.2%) of current and prospective users reported there was another method they would like to use, with oral contraception and vasectomy most selected. Reasons for non-use of preferred contraception included side effects (28.8%), sex-related reasons (25.1%), logistics/knowledge barriers (18.6%), safety concerns (18.3%), and cost (17.6%). In adjusted logistic regression analyses, respondents who felt they had enough information to choose appropriate contraception (Adjusted Odds Ratio [AOR] 3.31; 95% CI 2.10, 5.21), were very (AOR 9.24; 95% CI 4.29, 19.91) or somewhat confident (AOR 3.78; 95% CI 1.76, 8.12) they could obtain desired contraception, had received person-centered contraceptive counseling (AOR 1.72; 95% CI 1.33, 2.23), and had not experienced discrimination in family planning settings (AOR 1.58; 95% CI 1.13, 2.20) had increased odds of preferred contraceptive method use. INTERPRETATION: An estimated 8.1 million individuals in the U.S. are not using a preferred contraceptive method. Interventions should focus on holistic, person-centered contraceptive access, given the implications of information, self-efficacy, and discriminatory care for preferred method use. FUNDING: Arnold Ventures.

Objectives: Long-acting reversible contraceptives (LARCs) are the most effective forms of contraception available and therefore play a critical role in supporting patients to exercise bodily autonomy and achieve reproductive goals. A comprehensive set of quality improvement (QI) interventions were implemented between March and June 2019 to improve LARC access at a federally qualified health center (FQHC) in (US State). Methods: An evaluation study was conducted to assess the impact of the QI initiative considering the number of LARCS delivered as a proxy for access. The Wilcoxon-rank test was applied to test for significance, given a non-parametric sample of LARCs delivered by 13 providers (matched to themselves) pre- and post-intervention. Reimbursement for LARC procedures pre- and post-intervention was also examined to determine economic impact and sustainability of incorporating a new device, the Liletta™, in the floor stock. Results: There was a statistically significant increase in LARC delivery between July 2019-March 2020 compared to July 2018-March 2019. Approximately $1,000 per month increased reimbursement for LARC services occurred post-intervention. The evaluation study concluded success of the QI intervention, with need for further study needed to determine equitable delivery of contraceptive services between different subpopulations and by insurance status. Conclusions for Practice: The study provides a blueprint for QI initiatives to improve access to LARCs while also increasing revenue for LARC services in an FQHC setting. Significance: What is already known on this subject?: LARC services at FQHCs has been described at the national level. (Beeson et al., Contraception (Stoneham), 89(2), 91–96. https://doi.org/10.1016/j.contraception.2013.09.014, 2014) Prospective cohort trials have been conducted to assess the impact of optimizing LARC access via the CHOICE project studies. McNicholas (Clin. Obstet. Gynecol. 57(4):635–643, 2014) A study of Title X funded clinics examined the impact of stocking the Liletta™ device (Roth et al., Contraception (Stoneham), 98(1), 63–68. https://doi.org/10.1016/j.contraception.2018.03.029, 2018), and DeBoer (NWH 22(4):302–309, 2018) report on a QI approach to align LARC delivery with recent guidelines. What this study adds?: The paper defines operational considerations for improving LARC access, including device stocking and management, staff capacity, and appointment/schedule management, using a multidisciplinary QI approach, with positive financial impact. [ABSTRACT FROM AUTHOR]

Background: Disparities secondary to underinsurance present throughout the surgical care continuum. Community free clinics are uniquely capable to provide health care services to the medically underserved, but surgery often falls outside their scope of care. Methods: Retrospective chart review was conducted on consecutive community free clinic patients receiving free surgical services via referral to a partnering ambulatory surgery center between March 2016 and September 2021. Those with documented contact information were recruited 1-3 years post-procedure for long-term quality-of-life (LTQOL) outcomes assessment via modified Veterans RAND 12-item health survey. Results: Of 142 included patients, 95.7% identified as Hispanic/Latino and 75.6% were uninsured. Twelve patients had cancerous or precancerous lesions detected and/or removed through diagnostic or definitive procedures. 3.5% experienced postoperative complication including bacterial (n = 2) or fungal (n = 1) surgical site infection and wound dehiscence (n = 2). With a 48.9% response rate, no significant differences in sociodemographic or clinical characteristics were found between surveyed vs non-surveyed patients. Of surveyed patients, 59.7% and 52.2% reported pre-/post-operative improvement in physical health and emotional health, respectively. Discussion: Free diagnostic screening procedures provided timely diagnoses while free definitive surgeries safely and positively impacted long-term patient-reported physical health. Longitudinal, multidisciplinary follow-up and social support may be warranted to concurrently improve emotional and mental health in similarly underinsured populations. [ABSTRACT FROM AUTHOR]

Background: The Australian Government began implementing Medicare policies in the late 1990s aiming to improve Indigenous Peoples' access to the primary care. No aggregate central list of what policies have been implemented exists. The aim of this review was twofold: first to perform a scoping review to identify any literature mentioning a policy implemented between 1996 and 2023 regarding Indigenous Peoples' access to Medicare or the Pharmaceutical Benefits Scheme for primary care, and secondly to synthesise and describe any policies to enable learning from past successes and failures. Methods: Scoping review following the PRISMA-ScR process. Seven electronic databases were searched for any papers identifying any policy implemented between 1996–2023 to improve Indigenous Peoples' access to primary care. This was supplemented with searches in Google, key government databases, hand searching and expert input. Results: Sixteen policies were implemented and organised into six categories according to the primary care barrier they targeted: Medicare Benefits Schedule (MBS) funding structure; lack of Indignenous-appropriate MBS items; Pharmaceutical Benefits Scheme (PBS) access barriers; inappropriate care from mainstream general practitioners; bureaucratic impediments to MBS and PBS access; and data gaps. Discussion/conclusion: This is the first synthesis of Medicare and PBS policy history to improve Indigenous Peoples' access to primary health care, and provides a platform for future analysis. Identifying the names of relevant policies in any area is key to accountability and reliance on individual expertise is no substitute for transparent and durable policy record-keeping. A searchable long-term policy repository should be established to ensure that related policies can be identified, and that key policy documentation is publicly available in perpetuity. [ABSTRACT FROM AUTHOR]

Child and adolescent mental health are major public health concerns in the US. Overall, 20% of US children have a reported mental health condition, while an estimated 40% will be diagnosed with one by age 18. Despite these concerns, little is known about factors associated with access to mental health services among children and adolescents. We analyzed data from a sample of 6655 children (aged 6 to 17 years) with either anxiety and/or depression drawn from the 2020–2021 National Survey of Children's Health (NSCH). A multivariable logistic regression model was fit to investigate predisposing, enabling, and need factors associated with caregiver's (i.e., parent or other guardian) perceived access to mental health services for their children. Approximately 50.8% of caregivers perceived obtaining mental health services for their children to be somewhat difficult, very difficult, or impossible. Children meeting criteria for having a medical home had lower odds of experiencing such difficulties (adjusted [a]OR = 0.38; 95% CI: 0.30–0.49). Further, compared to children who sometimes or never had health insurance coverage for mental or behavioral health needs, children who were always insured (aOR: 0.19; 95% CI 0.14, 0.25) and those who usually had coverage (aOR: 0.38; 95% CI 0.28, 0.51) had lower odds of experiencing perceived difficulties in obtaining care. The results indicate several enabling and need predictors of perceived access to mental health services––highlighting potential structural barriers to care access. Efforts to address access challenges should adopt a multifaceted approach and be tailored to families living in poverty, those with limited health coverage, and minoritized children with less than optimal general health. [ABSTRACT FROM AUTHOR]

Children and young people with a social worker (CYPwSW) have particular mental health profiles and needs. Research indicates that despite having higher levels of mental health distress this group tend to experience inequitable access to specialist mental health services. Therefore, much of their mental health support currently falls to generalists including paediatricians. We are currently undertaking a four-year study the CAMHS Referrals and Outcomes for Adolescents and Children with Social Workers (COACHES). Here we present initial insights from an analysis of 20,166 unique case notes which identified 1) High thresholds for entry to CAMHS 2) A requirement that young people must be perceived as stable prior to accessing services 3) that young people often did not feel that their voices were taken seriously 4) the importance of time for trust. Based off these findings and expert-by-experience's insights, we conclude by suggesting ways that paediatricians and health care professionals can best support CYPwSW. These include being the 'connective tissue' around young people's support network, gently and proactively building relationships, redressing power imbalances and supporting transitions to adulthood. [ABSTRACT FROM AUTHOR]

Background: Vulnerable social groups have greater difficulty in accessing care and a lower quality of care. Health systems focused on primary care appear to be more effective, efficient and equitable. However, difficulties in accessing primary care are persisting. We focused on primary care screening for cervical cancer through Cervico-Uterine Smear (CUS), which has been shown to be effective in reducing disease incidence and mortality. In this study, we aimed to investigate the characteristics of women who undergo CUS according to the category of health professionals (general practitioners or gynaecologists) performing CUS and to analyse potential differences in access to care in terms of socioeconomic and geographical characteristics. Methods: This was a retrospective observational study based on data from the main health insurance schemes in France, allowing analysis of health care consumption according to socioeconomic levels and proximity to health care services. We included women aged 25 to 64 years in 2012 for whom CUS would be a relevant procedure (695,694). The sociodemographic and territorial indicators were age, geographical area deprivation, and the availability of gynaecological care. The analysis was performed using multinomial logistic regression. Results: A total of 202,271 (29%) patients underwent CUS; of whom 68% underwent CUS administered by gynaecologists and 28% were administered by general practitioners (GPs). However, inequalities in CUS screening rates were observed, with a decrease in the number of CUSs performed with increased age, a rural location, deprivation, and sparse health care provisions. Deprived people seemed less penalised by GPs. Conclusions: Involvement of General Practitioners may improve cervical screening equality in France. The organisation of health systems around primary care may allow a better access to care and to account for the specific needs of deprived populations. [ABSTRACT FROM AUTHOR]

Cette étude qualitative exploratoire vise à repérer des facteurs influençant l'orientation, l'accès et le maintien des soins orthophoniques chez les adolescents avec autisme. Nous avons questionné des professionnels du champ de la pédopsychiatrie sur leurs perceptions de la place et des objectifs de l'orthophonie dans les troubles du spectre de l'autisme à l'adolescence, dans un contexte où les adolescents peinent à en bénéficier. Huit professionnels de pédopsychiatrie dont quatre pédopsychiatres, trois orthophonistes et une psychomotricienne ont participé à des entretiens semi-dirigés selon la méthode de l'Interpretative Phenomenological Analysis (IPA). La perception des adolescents avec TSA en tant que porteurs de troubles du comportement sévères et peu sujets à des évolutions cliniques significatives influence défavorablement l'indication de suivi orthophonique à cet âge. Par ailleurs, la gestion de la pénurie en orthophonie se fait au détriment des adolescents pour prioriser les plus jeunes. Les suivis orthophoniques sont vécus comme lourds, avec un manque de spécificité des bilans et des outils orthophoniques pour les adolescents avec autisme. Les troubles du langage et de la communication sont insuffisamment évalués par les professionnels prescripteurs qui ont une représentation plus floue des spécificités du travail orthophonique à cet âge. Dans la situation de pénurie orthophonique actuelle, les orthophonistes sont entre le désir de continuer à suivre un adolescent, dont le potentiel d'évolution n'est pas toujours perçu, et l'obligation morale et clinique de prendre en charge les tout-petits qui sont généralement priorisés. Ces résultats révèlent le besoin de bilans et outils orthophoniques plus spécifiques aux adolescents porteurs d'autisme pour mieux cibler leurs besoins langagiers et communicatifs et proposer une prise en soins plus adaptée. Une formation spécifique sur les TSA à l'adolescence permettrait d'envisager la diversité des besoins et des présentations des troubles à cet âge. Le suivi orthophonique des adolescents avec autisme soulève également des interrogations sur les évolutions en cours du travail orthophonique et plus largement sur les modes de diffusion des outils de communication. This exploratory qualitative study aims to identify factors influencing orientation, access to speech therapy professionals and its maintenance in adolescents with autism. This was carried out by questioning them about their perceptions of the place and objectives of speech therapy concerning teenagers with autism spectrum disorders in a context where adolescents struggle to benefit from it. Eight child psychiatry professionals including four child psychiatrists, three speech therapists and a psychomotor-therapist took part. These semi-structured interviews have been analyzed using the Interpretative Phenomenological Analysis (IPA). The perception of adolescents with ASD as carriers of severe behavioral disorders and unlikely to be e subject to significant clinical changes has an unfavorable influence on the indication for speech therapy at this age. In addition, the management of the shortages in speech therapy is done to the detriment of adolescents in order to prioritize the youngest. Speech therapy follow-ups are experienced as cumbersome with a lack of specific assessments and speech therapy tools for this age. Communication disorders are insufficiently assessed by prescribing professionals who have a more vague representation of the specificities of speech therapy work at this age. In the current situation of speech therapy shortage, speech therapists are torn between the desire to continue to follow an adolescent, whose development potential is not always perceived, and the moral and clinical obligation to take care of toddlers who are generally prioritized. These results reveal the need for more specific speech therapy assessments and tools for adolescents with autism to better target their communication needs and offer more appropriate care. Precise training on the issue of ASD in adolescence would make it possible to consider the diversity of needs and presentations of disorders at this age. Speech therapy monitoring of adolescents with autism raises questions about possible changes in the practice of speech therapy. [ABSTRACT FROM AUTHOR]

Current literature on internal bordering has suggested understanding health care as a key migration control field. This article takes a closer look at the humanitarian medical offices in Frankfurt am Main, Germany, and patients from Romania and Bulgaria in precarious life circumstances. It addresses the strategies identified in the accounts of frontline workers beyond the mere provision of access to free and anonymous medical attention. Based on 16 interviews with medical staff, social workers and administrative officers, two approaches emerged. One clearly strives for the formalisation of the human right to health care in close collaboration with, or by challenging the local bordering actors; the other insists on bypassing any point of contact with them, focusing exclusively on informal and direct solutions. The interviews showcase how the resulting strategies can contribute to internal bordering and debordering on an urban scale, and affect the individuals' trajectories as patients and as migrants. [ABSTRACT FROM AUTHOR]

Samuel J Martin,1 Phaibun Chiraphatthakun,2 Anan Samson Keereemalee,2 Wirachat Chiraphatthakun,2 Robert W Arnold2– 4 1Loma Linda University School of Medicine, Loma Linda, CA, USA; 2Jungle School of Medicine Kawthoolei, the Free Burma Rangers, Kawthoolei, Karen State, Burma; 3Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USA; 4Ophthalmology Department Consultant, Providence Alaska Medical Center (1989-2024), Anchorage, AK, USACorrespondence: Robert W Arnold, Alaska Children’s EYE & Strabismus, 3500 Latouche Street #280, Anchorage, AK, 99508, USA, Tel +1 (907)561-1917, Fax +1 (907)563-5373, Email eyedoc@alaska.netPurpose: The rate of moderate-to-severe hearing loss in Southeast Asia is 5.8%, among the world’s most prevalent. However, it is difficult to measure for people whose healthcare access is limited by the ongoing civil war. Therefore, a cross-sectional study of the impacts of hearing loss was incorporated with ongoing vision/cataract clinics along the Thai-Burma border.Patients and Methods: In this cross-sectional observational study, culturally sensitive informed consent was obtained from patients presenting to a regionally promoted hearing clinic in Karen State, Burma (Myanmar) with a chief complaint of hearing loss. They were then administered a standardized survey derived from the Hearing Handicap Inventory for Adults/Elderly (HHI), then assessed based on history, otoscopy, Weber and Rinne testing, and portable audiometry.Results: Twenty-two adults and children presented with a chief complaint of hearing loss, and 26 others came seeking vision care needing cataract surgery. HHI survey showed 41% had mild-to-moderate, and 34% had moderate-to-severe hearing impairment. On a 0– 4 Likert scale, prominent complaints due to hearing loss were feeling upset (2.4 ± 1.8), limited social life (2.2 ± 1.6), using the phone less (2.1 ± 1.8) and needing to be warned of the danger by others (2.1 ± 1.9). Seventy-three percent had no prior hearing care. Access was limited due to financial (59%), limited travel (50%), and military conflict (41%). Pure-tone averages were 55.3 + 22.1 dB and 67.9 + 14.5 dB for the right and left ears, respectively. Pure tone averages are negatively correlated with HHI survey score (R = − 0.53). Chicken feathers were a common mechanism of ear drum trauma. Twenty patients received Solar Ear hearing aids.Conclusion: Ongoing military conflict in the Karen State leaves the internally displaced people with high prevalence of hearing loss and fear of additional injury due to inability to hear danger. Surveys such as this appear more useful to assess the individual impact of hearing loss rather than severity. Efforts by regional medics to provide hearing care should be supported.Plain Language Summary: Residents in a war zone in Karen State, Burma, had survey, ear exam and audiometry showing high prevalence of hearing loss including tympanic membrane perforation by chicken feathers.Keywords: internally displaced persons, hearing loss, audiometry, chicken feather injury, tympanic membrane perforation, health care access

Abstract Background Vulnerable social groups have greater difficulty in accessing care and a lower quality of care. Health systems focused on primary care appear to be more effective, efficient and equitable. However, difficulties in accessing primary care are persisting. We focused on primary care screening for cervical cancer through Cervico-Uterine Smear (CUS), which has been shown to be effective in reducing disease incidence and mortality. In this study, we aimed to investigate the characteristics of women who undergo CUS according to the category of health professionals (general practitioners or gynaecologists) performing CUS and to analyse potential differences in access to care in terms of socioeconomic and geographical characteristics. Methods This was a retrospective observational study based on data from the main health insurance schemes in France, allowing analysis of health care consumption according to socioeconomic levels and proximity to health care services. We included women aged 25 to 64 years in 2012 for whom CUS would be a relevant procedure (695,694). The sociodemographic and territorial indicators were age, geographical area deprivation, and the availability of gynaecological care. The analysis was performed using multinomial logistic regression. Results A total of 202,271 (29%) patients underwent CUS; of whom 68% underwent CUS administered by gynaecologists and 28% were administered by general practitioners (GPs). However, inequalities in CUS screening rates were observed, with a decrease in the number of CUSs performed with increased age, a rural location, deprivation, and sparse health care provisions. Deprived people seemed less penalised by GPs. Conclusions Involvement of General Practitioners may improve cervical screening equality in France. The organisation of health systems around primary care may allow a better access to care and to account for the specific needs of deprived populations.

Disparities in social determinants of health (SDOH) play a significant role in causing health inequities globally. The physical environment, including housing and workplace environment, can increase the prevalence and spread of fungal infections. A number of professions are associated with increased fungal infection risk and are associated with low pay, which may be linked to crowded and sub-optimal living conditions, exposure to fungal organisms, lack of access to quality health care, and risk for fungal infection. Those involved and displaced from areas of armed conflict have an increased risk of invasive fungal infections. Lastly, a number of fungal plant pathogens already threaten food security, which will become more problematic with global climate change. Taken together, disparities in SDOH are associated with increased risk for contracting fungal infections. More emphasis needs to be placed on systematic approaches to better understand the impact and reducing the health inequities associated with these disparities.

In primary‐care‐centric models of care provision, specialist co‐location with primary care physicians (PCPs) can potentially improve care coordination and continuity. This study asks whether the co‐location of specialists with referring PCPs can reinforce racial, ethnic, and class inequities in spatial access to care. Given a US healthcare policy context wherein audiologist services are only reimbursed if they are medical practitioner‐referred, audiologists are hypothesized to co‐locate with PCPs. Using spatial cluster analysis and spatial regression approaches, this study quantifies the tendency for PCPs and audiologists to co‐locate and analyzes the consequences for spatial access disparities in the Chicago, Illinois metropolitan region. Audiologists and PCPs co‐cluster significantly across Chicagoland. The spatial lag model confirms racial, ethnic, and class disparities in network travel distance to audiology services in the core counties of the region. The results suggest that, for audiology services, health policies and the resultant interdependence across the hierarchy of care manifest spatially, possibly reinforcing service access disparities within segregated city regions. Key points: Healthcare policies governing interprofessional practice have a spatial dimension.Provider co‐location across the hierarchy of care can reinforce access disparities.Racial, ethnic, and class disparities in access to hearing care shape service use. [ABSTRACT FROM AUTHOR]

Description: New York State Department of Health (NYSDOH) recommends that all pregnant patients receive human immunodeficiency virus (HIV) screening during pregnancy. This study assessed the prevalence of repeat prenatal HIV testing and factors associated with receipt of the recommended tests. Methods: Data from the NYSDOH newborn screening program were used to randomly select pregnant persons without HIV who delivered a liveborn infant in 2017. Receipt of repeat testing was defined as an initial HIV test in the first or second trimesters and the final in the third trimester (relaxed); or an initial test in the first trimester and the final in the third trimester (strict). Relative risks (RRs) and 95% confidence intervals were calculated in bivariate analyses. Adjusted RRs were calculated to determine associations between demographic and clinical factors and receipt of repeat HIV testing. Results: The cohort included 2,225 individuals. Roughly one quarter (24%) received the recommended tests in the first or second and third trimesters and 17% received them in the first and third trimesters. Individuals who reported Hispanic or Asian race/ethnicities, had government-funded insurance, started prenatal care in the first trimester, delivered in New York City, or received prenatal hepatitis C virus screening were significantly more likely to receive repeat testing using either definition. Conclusions: Despite the benefits and cost-effectiveness, the prevalence of repeat prenatal HIV screening during the third trimester remains persistently low. Improved messaging and targeted education and resources to assist prenatal providers could reinforce the importance of repeat testing and reduce residual perinatal HIV transmission. [ABSTRACT FROM AUTHOR]

Background: Direct-to-consumer (DTC) pharmacies sell generic prescription drugs, often at lower prices than traditional retail pharmacies; however, not all drugs are available, and prices vary. Objective: To determine the availability and cost of generic drugs at DTC pharmacies. Design: Cross-sectional study. Setting: Five national DTC pharmacies in April and May 2023. Participants: Each qualifying form of 100 generic drugs with the highest cost-per-patient (expensive) and the 50 generic drugs with the highest number of patients (common) in Medicare Part D in 2020 Main Measures: Availability of these drugs and the lowest DTC pharmacy price for a standardized drug strength and supply (e.g., 30 pills), compared to GoodRx retail pharmacy prices. Key Results: Of the 118 expensive generic dosage forms, 94 (80%) were available at 1 or more DTC pharmacies; out of 52 common generic dosage forms, 51 (98%) were available (p < 0.001). Of the 88 expensive generics available in comparable quantities and strengths across pharmacies, 42 (47%) had the lowest cost at Amazon, 23 (26%) at Mark Cuban Cost Plus Drug Company, 13 (14%) at Health Warehouse, and 12 (13%) at Costco; for 51 common generic formulations, 16 (31%) had the lowest cost at Costco, 14 (27%) at Amazon, 10 (20%) at Walmart, 6 (12%) at Health Warehouse, and 5 (10%) at Mark Cuban Cost Plus Drug Company. For the 77 expensive generics with available GoodRx retail pharmacy prices, the median cost savings at DTC pharmacies were $231 (95% CI, $129–$792) or 76% (IQR, 53–91%); for 51 common generics, savings were $19 (95% CI, $10–$34) or 75% (IQR, 67–83%). Conclusions: Many of the most expensive generic drugs are unavailable at direct-to-consumer pharmacies. Meanwhile, less expensive, commonly used generics are widely available, but drug prices vary by pharmacy and savings are modest, requiring patients to shop around for the lowest cost. [ABSTRACT FROM AUTHOR]

People with disabilities (PWD) are thought to be low risk for HIV because of social norms regarding disability and sex. However, qualitative studies indicate they are at risk and are not being reached by HIV programs. The Demographic and Health Survey (DHS) conducted in Haiti in 2016 included HIV biomarker data and disability status. Crude and adjusted odds ratios were calculated using a disability severity indicator as the independent variable and HIV infection as the dependent variable. Covariates were selected based on theory and previous studies. Individuals reporting milder disabilities had a higher odds of HIV infection in the crude model (OR:1.65; CI: 1.16-2.34) and those adjusted for demographics (OR:1.73; CI:1.19-2.51) and sexual activity (OR:1.60; CI:1.06-2.42). Those with moderate and more severe disabilities have the same odds of HIV infection as the general population. PWD are HIV-positive and at risk of HIV infection. Based on this, it is essential that HIV education, testing, and treatment programs are inclusive of PWD. Accessible HIV education materials need to be created. HIV testing programs should involve PWD in planning and implementation. Providers of HIV care must be trained regarding the needs of PWD for reproductive healthcare. [ABSTRACT FROM AUTHOR]

Background Access to health care remains suboptimal in low- and middle-income countries (LMICs) and continues to hinder survival in early childhood. We systematically assessed the association between problems accessing health care (PAHC) and under-five mortality (U5M). Methods Child mortality data on 724 335 livebirths came from the latest Demographic and Health Surveys of 50 LMICs (2013–2021). Reasons for PAHC were classified into three domains: 'money needed for treatment' (economic), 'distance to health facility' (physical), 'getting permission' or 'not wanting to go alone' (socio-cultural). Multivariable logistic regression was used to estimate the association between PAHC (any and by each type) and U5M. Results In our pooled sample, 47.3 children per 1000 livebirths died before age of 5, and 57.1% reported having experienced PAHC (ranging from 45.3% in Europe & Central Asia to 72.7% in Latin America & Caribbean). Children with any PAHC had higher odds of U5M (OR: 1.05, 95% CI: 1.02, 1.09), and this association was especially significant in sub-Saharan Africa. Of different domains of PAHC, socio-cultural PAHC was found to be most significant. Conclusions Access to health care in LMICs needs to be improved by expanding health care coverage, building health facilities, and focusing more on context-specific socio-cultural barriers. [ABSTRACT FROM AUTHOR]

According to prior research, Asian and Pacific Islander American (APIA) immigrants often refrain from seeking health care unless necessitated by medical conditions. Utilizing data from health screenings conducted in APIA immigrant enclaves in Los Angeles, we hypothesize that poorer obesity status would predict higher rates of regular physician access. Analyses involved objectively measured percent body fat (%BF) and survey responses collected between 2011 and 2019. We assessed the association between obesity status and regular physician access, adjusting for insurance status, demographic, and socioeconomic factors. The study population (n = 4102) primarily consisted low-income, low English proficiency APIAs. Participants with a regular physician were significantly more likely to be obese compared to participants without (adjusted odds ratio [aOR] = 1.28). This association may suggest that care was sought reactively rather than proactively within this community. Interventions with emphasis on cultural competency and language services may encourage preventative care utilization among this understudied community. [ABSTRACT FROM AUTHOR]

Objective: The current longitudinal study examined how (1) cognitive measures, including episodic memory, executive function, and global cognition, predict later healthcare access and how (2) healthcare access predicts later cognition. Methods: Drawing a sample (n = 9920) from the Health and Retirement Study dataset, we created a cross-lagged panel model to examine the longitudinal association between cognitive measures and healthcare access from 2012 to 2018. Results: Results revealed that cognitive measures significantly predict later healthcare access, with effects increasing across waves. However, within sub-domains, memory was more predictive of later healthcare access over time compared to executive function. Discussions: Our study suggested an increased link between cognition and healthcare access during aging. Even outside of the context of AD, there are likely both policy-based and practical implications to ensure those experiencing cognitive decline continue to maintain access to care. [ABSTRACT FROM AUTHOR]

Gender-affirming surgeries, which have well-established mental health benefits, were cancelled and delayed for transgender people worldwide during the COVID-19 crisis. Of 253 scheduled gender-affirming surgeries among transgender adults across 35 countries in late 2020, 27% (n=69) reported that the COVID-19 crisis limited their access to gender-affirming surgery (i.e., cancelled, postponed indefinitely, or rescheduled). In adjusted models, respondents with reduced access to surgeries were somewhat more likely to screen positive for depressive or anxiety symptoms, whereas those who maintained access were more likely to report higher levels of happiness. Our findings illustrate the transgender-specific harms of the COVID-19 crisis on gender-affirming surgeries and mental health. [ABSTRACT FROM AUTHOR]

In Jamaica and the wider Caribbean, the legal system allows for discrimination based on gender and sexual identity with impunity. This exposes trans people to disparate risks of violence and barriers to accessing social services such as health care. In this paper we assess the social determinants of health in the Jamaican trans population using a modified social-ecological model of transgender stigma and stigma interventions. To conduct this assessment, we situated the findings of the 2021 Jamaican Trans Health Needs Assessment and Trans Health Strategy within the socio-ecological framework with direct application to rights-based health services as well as the Jamaican legal system to develop a model for understanding the socio-legal determinants of health. The social determinants of health identified within the Jamaican trans community are all influenced by a lack of legal protection suggesting a need for legal reform toward nondiscrimination of sexual and gender-diverse populations. [ABSTRACT FROM AUTHOR]

Introduction: Chronic low back pain (CLBP) is a debilitating condition that affects millions of people worldwide. Healthcare providers play a crucial role in improving access to care for patients with CLBP, but they face numerous challenges in doing so. This study focuses on healthcare provider perspectives of CLBP healthcare access. Methods: Semi-structured interviews were conducted with 16 healthcare providers across a variety of disciplines who care for people with CLBP across Saskatchewan, Canada. A qualitative interpretive research approach with inductive thematic analysis was employed. Results: Years of experience ranged from 1 to >20 years. Participants represented 11 disciplines across urban, rural, and/or remote settings. Four overarching themes were identified: (1) Challenges for healthcare providers; (2) Anticipating and recognizing barriers and consequences for patients; (3) Facilitators for healthcare providers and patients; (4) Recommendations on improving accessibility to healthcare. Several barriers were identified for healthcare providers to provide optimal, evidence-based care across Saskatchewan, including patient complexity and past experiences, access to resources and coordinating care. Healthcare providers recognized barriers for patients, which ultimately influenced healthcare provider decisions and care provision. Coordinated care and funding were identified as facilitators that support healthcare provider recommendations of multidisciplinary care and improving provider education to enhance provision of care for chronic low back pain. Conclusion: Future care models should build on these identified factors, while considering clinical and community-specific contexts. [ABSTRACT FROM AUTHOR]

Background: Individuals with a uterus experience menopause, the cessation of menses, on average at age 51 years in the United States. While menopause is a natural occurrence for most, over 85% of women experience multiple interfering symptoms. Menopausal women face health disparities, including a lack of access to high-quality healthcare and greater disparities are experienced by women who are black, indigenous, and people of color. Some women are turning away from hormone therapy, and some seek integrative health interventions. Objective: Some menopausal women who seek healthcare do not receive it as they lack access to medical and integrative healthcare providers. A potential solution to this problem is a medical group visit (MGV), during which a provider sees multiple patients at once. The aims of this study were to gather women's opinions about the menopause, provider access, and conventional and integrative health interventions for later use to develop a menopause MGV. Methods: We conducted a Community Engagement Session and a Return of Results (RoR) with midlife women to learn about their menopause experiences, barriers and facilitators to accessing health providers, and their interest in and suggestions for designing a future integrative MGV (IMGV). Thematic qualitative research methods were used to summarize session results. Results: Nine women participated in the Session and six attended the RoR. Participants were well-educated and diverse in race and ethnicity. Themes included: an interest in this topic; unfamiliar medical terms; relevant social factors; desired whole person care; interest in integrative health; barriers and facilitators to accessing healthcare. The group expressed interest in ongoing participation in the future process of adapting an IMGV, naming it MENOGAP. Conclusion: These findings highlight the importance of stakeholder engagement before designing and implementing MENOGAP and the great need among midlife women for education about the menopausal transition, integrative self-care, and healthcare. [ABSTRACT FROM AUTHOR]

Introduction:The COVID-19 pandemic has led to the rapid and widespread adoption of telehealth services. Telehealth may aid in bridging gaps in access to care. The specific impact of telehealth on opioid use disorder (OUD) and its treatment remains uncertain. Methods:A retrospective review of commercial insurance claim records within the United States was conducted to investigate the association between the COVID-19 pandemic and changes in the rates of(a) OUD treatments with and without telehealth support and (b) prescriptions for medications for opioid use disorder (MOUD) with and without telehealth support among individuals diagnosed with OUD. Results:In a study population of 1,340,506 individuals, OUD diagnosis rates were 5 per 1,000 in-person and 1 per 1,000 via telehealth. COVID-19 decreased in-person OUD diagnoses by 0.89 per 1,000, while telehealth diagnoses increased by 0.83 per 1,000. In-person MOUD treatment rates increased by 0.07 per 1,000 during COVID-19, while telehealth rates remained low. The onset of COVID-19 saw a 1.13 per 1,000 higher increase in telehealth-supported MOUD treatment compared to solely in-person treatment. Conclusions:A retrospective review of commercial insurance claim records within the United States was conducted to investigate the association between the COVID-19 pandemic and changes in the rates of (a) OUD treatments with and without telehealth support and (b) prescriptions for MOUD with and without telehealth support among individuals diagnosed with OUD. [ABSTRACT FROM AUTHOR]

Studies examining the relationship among hospital case volume, socioeconomic determinants of health, and patient outcomes are lacking. We sought to evaluate these associations in the surgical management of intracranial meningiomas. We queried the National Inpatient Sample (NIS) database for patients who underwent craniotomy for the resection of meningioma in 2013. We categorized hospitals into high-volume centers (HVCs) or low-volume centers (LVCs). We compared outcomes in 2016 to assess the potential impact of the Affordable Care Act on health care equity. Primary outcome measures included hospital mortality, length of stay, complications, and disposition. A total of 10,270 encounters were studied (LVC, n = 5730 [55.8%]; HVC, n = 4340 [44.2%]). Of LVC patients, 62.9% identified as white compared with 70.2% at HVCs (P < 0.01). A higher percentage of patients at LVCs came from the lower 2 quartiles of median household income than did patients at HVCs (49.9% vs. 44.2%; P < 0.001). Higher mortality (1.3% vs. 0.9%; P = 0.041) was found in LVCs. Multivariable regression analysis showed that LVCs were significantly associated with increased complication (odds ratio, 1.36; 95% confidence interval, 1.30–1.426, P <0.001) and longer hospital length of stay (odds ratio, –0.05; 95% confidence interval, –0.92 to –0.45; P <0.001). There was a higher proportion of white patients at HVCs in 2016 compared with 2013 (67.9% vs. 72.3%). More patients from top income quartiles (24.2% vs. 40.5%) were treated at HVCs in 2016 compared with 2013. This study found notable racial and socioeconomic disparities in LVCs as well as access to HVCs over time. Disparities in meningioma treatment may be persistent and require further study. [ABSTRACT FROM AUTHOR]

The issue of access to the American health care system seems destined to reappear in the 2024 presidential election. The political and economic debates regarding single-payer systems providing (near) universal health care are well documented. Supporters of the status quo, knowingly or unknowingly, rest their argument on the basic assumptions of utilitarianism. In response patrons investigating inequalities in access to the American health care system can turn to biblical, philosophical, and theological reflections on justice. [ABSTRACT FROM AUTHOR]

The health service access point (PASS) allows people in precarious situations to benefit from medical and social care. A mobile PASS service was set up in 2020 in Marseille for people seeking asylum (DA). The objective of our study was to describe the care pathways within the PASS for DA. We led a retrospective observational study of care pathways of the 418 DA included in the PREMENTADA study (ClinicalTrials number: NCT05423782) in the 3 months following their inclusion. We conducted a quantitative study, which ran from March 1, 2021, to August 31, 2021, to collect data from mobile and hospital PASS consultations, referrals following PASS consultations or hospitalizations, emergency room visits, hospitalizations, prescription, and dispensing of treatment following PASS consultations or on discharge from hospital, between D0 and M3. A total of 163 (39.0%) patients were lost to follow-up after an initial assessment of their health status. Overall, 74.4% of the patients were followed only by the mobile PASS for a mental health problem, and 57.4% were followed for a somatic problem until they obtained their rights. The mobile PASS referred 43.5% of patients to the hospital PASS for access to various technical facilities: medical imaging, pharmacy (63% of them benefited from the dispensing of health products), biological tests, and so on. The morbidities of the DAs were severe enough to require technical support that the mobile PASS could not provide, but recourse to the emergency department was fairly low (1.6%), testifying to the efficiency of the primary care provided by the mobile PASS. Our study provides the first data concerning the DA's healthcare pathway in France. Considering the health status of this population and the fact that early management of health problems allows for rationalization of costs, we can ask the question of the future of these patients in the absence of adapted care systems. The PASS and the hospitals to which they are attached will have to adapt their care offer to take into account the DA's specific problems. [ABSTRACT FROM AUTHOR]

To examine the associations between demographic/medical and geographic factors with follow-up medical care and health-related quality of life (HRQoL) among cancer survivors during the SARS-CoV-2 pandemic. Cross-sectional survey. An online survey was sent to cancer survivors between May 2020 and January 2021, exploring their experience with SARS-CoV-2, follow-up care, and HRQoL. PolicyMap was used to geocode home addresses. Both geographic and demographic/medical factors were examined for their associations with SARS-CoV-2 experience, follow-up care, and HRQoL (FACT-G7). Geographic data were available for 9651 participants. Patients living in the highest area deprivation index (ADI) neighborhoods (most deprived) had higher odds of avoiding in-person general (odds ratio [OR] = 7.20; 95% confidence interval [CI] = 2.79–18.60), cancer (OR = 8.47; 95% CI = 3.73–19.30), and emergency (OR = 14.2; 95% CI = 5.57–36.30) medical care, as well as lower odds of using telemedicine (OR = 0.61; 95% CI = 0.52–0.73) compared to the lowest ADI group. Race/ethnicity was not associated with follow-up care after controlling for ADI. The effect of ADI on HRQoL was generally in the expected direction, with higher ADI being associated with worse HRQoL. ADI influenced follow-up medical care more than age, race/ethnicity, or health insurance type. Healthcare providers and institutions should focus on decreasing barriers to in-person and telemedicine health care that disproportionally impact those living in more deprived communities, which are exacerbated by health care disruptions like those caused by the SARS-CoV-2 pandemic. [ABSTRACT FROM AUTHOR]

Background: More than 20 million children in the United States lack access to primary health care. Practice Learning: Research shows that students with regular access to physical and mental health services have fewer absences, are more social, less likely to participate in risky behaviors, have improved focus and higher test scores. Implication For School Health Policy, Practice, And Equity: School‐based health centers (SBHCs) can be an important, valuable and viable health care delivery option to meet the full‐range of primary health care needs of students where they spend the majority of their wake hours, ie, in school. Children in rural and other underserved communities, as well as those underinsured, non‐insured, economically challenged, underserved, and the most vulnerable among us are especially at risk. Conclusions: This paper discusses the history, value, and importance of SBHCs from myriad perspectives, including physical and emotional wellbeing, academic and social success, and the promotion of a positive transition to adulthood. In addition, the authors' experiences that resulted in building the first SBHC in the Mid‐Hudson Valley Region of New York State are shared. These experiences form the foundation for creating an important roadmap for individuals and school leaders that are interested in bringing a SBHC to their school and district. [ABSTRACT FROM AUTHOR]

Background: Pervasive health and healthcare disparities experienced by transgender (trans) and gender diverse (TGD) people require innovative solutions. Peer-based interventions may address disparities, and are an approach endorsed by TGD communities. However, the scope of the literature examining peer-based interventions to address health and healthcare access inclusive of TGD people is uncharted. Aim: This scoping review aimed to understand the extent of the literature about peer-based interventions conducted with and/or inclusive of TGD populations; specifically, study participants (e.g. sociodemographics), study designs/outcomes, intervention components (e.g. facilitator characteristics), and intervention effectiveness. Methods: Underpinned by Arksey and O'Malley's framework: (1) identifying the research question; (2) identifying studies; (3) study selection; (4) charting data; and (5) collating, summarizing, and reporting results, eligible studies were identified, charted, and thematically analyzed. Databases (e.g. ProQuest) and snowball searching were utilized to identify peer-reviewed literature published within 15 years of February 2023. Extracted data included overarching study characteristics (e.g. author[s]), methodological characteristics (e.g. type of research), intervention characteristics (e.g. delivery modality), and study findings. Results: Thirty-six eligible studies documented in 38 peer-reviewed articles detailing 40 unique peer-based interventions were identified. Forty-four percent (n = 16/36) of studies took place in United States (U.S.) urban centers. Over half (n = 23/40, 58%) focused exclusively on TGD people, nearly three-quarters of which (n = 17/23, 74%) focused exclusively on trans women/transfeminine people. Ninety-two percent (n = 33/36) included quantitative methods, of which 30% (n = 10/33) were randomized controlled trials. HIV was a primary focus (n = 30/36, 83.3%). Few interventions discussed promotion of gender affirmation for TGD participants. Most studies showed positive impacts of peer-based intervention. Discussion: Although promising in their effectiveness, limited peer-based interventions have been developed and/or evaluated that are inclusive of gender-diverse TGD people (e.g. trans men and nonbinary people). Studies are urgently need that expand this literature beyond HIV to address holistic needs and healthcare barriers among TGD communities. [ABSTRACT FROM AUTHOR]

Migrant children face numerous challenges when settling in their new home. One of the challenges that exists is difficulties accessing health care, with many barriers existing and few facilitators to ease access. The goal of this paper is to analyze previous literature related to migrants' access to access to health care in Canada to better understand the barriers they face, and the factors that help them access services, or the facilitators. Arksey and O'Malley's stages in scoping reviews was employed to search CINAHL, PubMed, Sociological Abstract, SocIndex, Scopus, Cochrane Library, Ovid MEDLINE(R), and Ovid Embase from 1997 to February 2020. A total of 26 Canadian studies met the inclusion criteria. The review revealed the following barriers: language and culture barriers, low socioeconomic status, lack of health insurance, transportation, shortage of social support, lack of knowledge, fear of service providers/authorities, and discrimination. The facilitators for accessing health care for this population included outreach, benefit and assistance programs, cultural training, strengthening education, and various services. The abundance of barriers to health care access and the existence of few facilitators may worsen migrant children's health, however further research is required to understand the impact. There is a need to increase the understanding of migrant children's experiences with accessing health care services in order to inform policy, educate providers, and improve access and health outcomes. • Scoping review highlighting barriers and facilitators to accessing health care. • Many barriers to accessing services for migrant children exist. • Barriers include language, low income, lack of insurance, & lack of social support. • Facilitators include outreach and benefit programs and cultural training/education. • Nurses should advocate for migrant children and enhance resources. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the experience of first- and second- generation immigrant youth living with chronic health conditions in Canada, their parents or caregivers, and healthcare and service providers who care for immigrant youth, regarding the transition from pediatric to adult healthcare. We conducted semi-structured individual interviews and focus groups. Youth were 1st or 2nd generation immigrants, aged 16–25, with pediatric-onset chronic health conditions. Parents or caregivers had raised youth children as described. Providers delivered healthcare or other services to immigrant populations. Thematic analysis was conducted of all transcripts. Twenty youth, 14 parents/caregivers and five service providers participated. Most participants described healthcare transition as very difficult to navigate. Two major themes emerged across participant narratives: 1. Barriers to transition: lack of family experience in Canada, language, discrimination, financial strain, stigma, and long wait times. Some of these barriers are specific to newcomer families, but others are generalizable to the Canadian population. 2. Facilitators of transition: youth independence, youth acting as cultural bridges within their families, and cross-sector support between healthcare, education, social work and settlement services. Immigrant youth and their families face a broad range of barriers to healthcare transition. The collaborative nature of cross-sector support effectively addressed some of the barriers faced by newcomer families. Clinicians should provide immigrant youth and their families with accessible information about the health condition and how to navigate the adult healthcare system prior to transition, particularly when language barriers exist. • Immigrant youth living chronic health conditions face major transition hurdles. • Barriers to transition include language barriers, discrimination, and finances. • Cross-sector support between health care, education and settlement services helped. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The Development and Behavior Access Clinic (DBAC) deploys a general pediatrician with brief/intensive training and proctoring by developmental-behavioral pediatricians (DBP) to provide developmental-behavioral (DB) care to children referred with mild/moderate complexity needs as determined by a team of clinical psychologists. This pilot study utilizes visit data, chart review, and surveys to assess wait times, need for subspecialty care, and referring clinician satisfaction. In its first 18 months, DBAC decreased the need for subspecialty DB care, providing initial services for 44% of patients referred for DB pediatric care from the study site; 89% did not require subsequent subspecialty evaluation. Among DBAC participants, average wait times for DB care decreased from a baseline of 218 to 41 calendar days. This pilot study provides a model for building DB clinical skills among interested general pediatricians, decreasing wait times, and building the capacity of primary care settings to address mild-to-moderate complexity DB concerns.

BACKGROUND: The Philippines primary care is delivered via local health centers called barangay health centers (BHCs). Barangays are the most local government units in the Philippines. Designed to promote and prevent disease via basic health care, these BHCs are staffed mainly by barangay health workers (BHWs). However, there has been limited research on the social and environmental factors affecting underserved communities access to health care in underserved areas of the Philippines. Given the importance of BHCs in disease prevention and health promotion, it is necessary to identify obstacles to providing their services and initiatives. OBJECTIVE: This study aimed to explore multilevel barriers to accessing and providing basic health care in BHCs. METHODS: We used a qualitative approach and the socioecological model as a framework to investigate the multilevel barriers affecting basic health care provision. A total of 18 BHWs from 6 BHCs nationwide participated in focus group interviews. Traditional thematic content analysis was used to analyze the focus group data. After that, we conducted individual semistructured interviews with 4 public health nurses who supervised the BHWs to confirm findings from focus groups as a data source triangulation. The final stage of thematic analysis was conducted using the socioecological model as the framework. RESULTS: Findings revealed various barriers at the individual (lack of staff motivation and misperceptions of health care needs), interpersonal (lack of training, unprofessional behaviors, and lack of communication), institutional (lack of human resources for health, lack of accountability of staff, unrealistic expectations, and lack of physical space or supplies), community (lack of community support, lack of availability of appropriate resources, and belief in traditional healers), and policy (lack of uniformity in policies and resources and lack of a functional infrastructure) levels. CONCLUSIONS: Examining individual-, interpersonal-, institutional-, community-, and policy-level determinants that affect BHCs can inform community-based health promotion interventions for the countrys underserved communities. Given the multidimensional barriers identified, a comprehensive program must be developed and implemented in collaboration with health care providers, community leaders, local and regional health care department representatives, and policy makers.

Background: Preconception diabetes is strongly associated with adverse birth outcomes. Less is known about the effects of elevated glycemia at levels below clinical cutoffs for diabetes. In this study, we estimated associations between preconception diabetes, prediabetes, and hemoglobin A1c (HbA1c) on the risk of preterm birth, and evaluated whether associations were modified by access to or utilization of health care services. Materials and Methods: We used data from Add Health, a US prospective cohort study with five study waves to date. At Wave IV (ages 24-32), glucose and HbA1c were measured. At Wave V (ages 32-42), women with a live birth reported whether the baby was born preterm. The analytic sample size was 1989. Results: The prevalence of preterm birth was 13%. Before pregnancy, 6.9% of women had diabetes, 23.7% had prediabetes, and 69.4% were normoglycemic. Compared to the normoglycemic group, women with diabetes had 2.1 (confidence interval [95% CI]: 1.5-2.9) times the risk of preterm birth, while women with prediabetes had 1.3 (95% CI: 1.0, 1.7) times the risk of preterm birth. There was a nonlinear relationship between HbA1c and preterm birth such that risk of preterm birth emerged after HbA1c = 5.7%, a standard cutoff for prediabetes. The excess risks of preterm birth associated with elevated HbA1c were four to five times larger among women who reported unstable health care coverage and among women who used the emergency room as usual source of care. Conclusion: Our findings replicate prior research showing strong associations between preconception diabetes and preterm birth, adding that prediabetes is also associated with higher risk. Policies and interventions to enhance access and utilization of health care among women before pregnancy should be examined.

INTRODUCTION: Non-Hispanic Black men experience a disproportionate rate of morbidity and mortality from hypertension, cardiovascular disease, and other chronic conditions in the United States. Studies have demonstrated the efficacy of community-based health outreach in settings not traditionally utilized for health care. Understanding how potential future participants view health care services in nontraditional settings is a necessary step to ascertain the success of these interventions in the real world. Our study objective was to explore the preferences of Black male barbershop patrons regarding health care-provided services in these nontraditional settings. METHODS: We recruited patrons of a Black-owned barbershop in the San Francisco Bay Area. Study participants were asked to complete a survey assessing individual attitudes and preferences toward the idea of receiving health care services in traditional and nontraditional settings. RESULTS: Among non-Hispanic Black males (n=17), 81% agreed or strongly agreed that they would prefer to receive health care in traditional clinics. Receiving care at the pharmacy (56% agreed or strongly agreed) and the patients own home (53% agreed or strongly agreed) were the next most preferred locations. A minority of participants agreed or strongly agreed that they preferred to receive health care in nontraditional settings: 47% for barbershops, 19% for churches, and 6% for grocery stores. DISCUSSION: Participants expressed preference for traditional over nontraditional settings, despite listing barriers that may be addressed, in part, by nontraditional settings. One potential reason for this is simply a lack of familiarity. Establishing and normalizing nontraditional clinical settings may allow for enhanced acceptance within Black communities, ultimately increasing health care access.

Introduction: The United States has one of the highest rates of gun violence and mass shootings. Timely medical attention in such events is critical. The objective of this study was to assess geographic disparities in mass shootings and access to trauma centers. Methods: Data for all Level I and II trauma centers were extracted from the American College of Surgeons and the Trauma Center Association of America registries. Mass shooting event data (4+ individuals shot at a single event) were taken from the Gun Violence Archive between 2014 and 2018. Results: A total of 564 trauma centers and 1672 mass shootings were included. Ratios of the number of mass shootings vs trauma centers per state ranged from 0 to 11.0 mass shootings per trauma center. States with the greatest disparity (highest ratio) included Louisiana and New Mexico. Conclusion: States in the southern regions of the US experience the greatest disparity due to a high burden of mass shootings with less access to trauma centers. Interventions are needed to increase access to trauma care and reduce mass shootings in these medically underserved areas. [ABSTRACT FROM AUTHOR]

Objectives: Social determinants of health (SDH) are nonmedical, societal factors that influence health. There is limited information on the current relationship between SDH and hearing loss (HL) in the United States. This study aims to compare the odds of HL among US adults by race/ethnicity, education level, income‐to‐poverty level ratio, health insurance coverage, and health care access. Study Design: Cross‐sectional study. Methods: The 2015–2020 National Health and Nutrition Examination Survey data were analyzed to compare odds ratios (ORs) for HL, defined as pure tone average over 25 dB HL in at least one ear, by SDH categories using sample weights. Adjusted ORs were calculated using logistic regression models controlling for sex, age, race/ethnicity, education level, income‐to‐federal‐poverty level, health care insurance coverage and access, and loud noise, pesticide, and cigarette exposure. Results: A total of 6028 participants were included. Non‐Hispanic Black participants had half the odds of HL as Non‐Hispanic White participants (OR 0.52, p < 0.05). Lower education level correlated with higher odds of HL: those without a high school diploma had double the odds of HL compared with college graduates or above (OR 2.05, 1.91, p < 0.05). The income‐to‐federal‐poverty level ratio of 1.3 to less than 2 had higher odds of HL than the 4+ group (OR 1.45, p < 0.05). Use of multiple health care locations was associated with nearly three times the odds of HL than the group using one location (OR 2.87, p < 0.05). Conclusion: SDH are associated with HL. Further investigation is needed into the mechanism of disparities for targeted prevention and treatment for hearing care equity. Level of Evidence: IV Laryngoscope, 134:2848–2856, 2024 [ABSTRACT FROM AUTHOR]

Introduction: Previous research has documented how the implementation of the 2019 Title X Final Rule reduced the Title X network capacity and led to decreases in patient numbers. Our objective was to examine the relationship between the Rule and patients' reproductive health care access and outcomes. Methods: Our analysis draws on panel data from patients recruited when seeking publicly funded family planning care in Iowa between May 2018 and February 2019 who completed a baseline survey and agreed to be contacted for follow-up surveys at 6-, 12-, 18-, and/or 24-month intervals. We employ a difference-in-difference (DiD) approach, comparing reproductive health outcomes (access to care and contraceptive use) of respondents who had recently received care at sites that eventually left the Title X system following the Rule, the exposed group, to outcomes among those who had recently received care at sites that did not shift from being in the Title X system to exiting it, the control group, both before and after its implementation. Results: After adjusting for respondents' demographic characteristics in the DiD models, we found that those in the exposure group were 11% less likely to have received recent contraceptive care compared to respondents in the control group after the implementation of the Title X Final Rule when examining the full study period (p <.01). When examining only the pre-COVID 19 time period, we found that respondents in the exposure group were 13% less likely to have been using a provider-involved method (p < 0.01), 11% less likely to have been using a method that carries a cost (p < 0.05), and 18% less likely to report being satisfied with their method (p < 0.001) compared to respondents in the control group. Conclusions: Using Iowa as a case study to understand how the 2019 Title X Final Rule may have changed family planning patients' sexual and reproductive health outcomes, we found evidence of a negative association of the Rule with patients' access to, and use of, contraception. Policy Implications: These findings expand the evidence base of the influence of the 2019 Title X Final Rule on the Title X health care system and its capacity to provide SRH care by highlighting the trickle-down effects of the Rule on patients themselves. Policies that restrict access to any aspect of sexual and reproductive health care, including contraception and abortion, are in direct conflict with people's realization of reproductive autonomy. [ABSTRACT FROM AUTHOR]

Background:The COVID-19 pandemic led to a dramatic increase in Medicare reimbursed telehealth utilization in the United States, but significant racial disparities persist. Methods:This research analyzed trends and disparities in Medicare reimbursed telehealth usage and claims from 2020 through 2022 using data from the Centers for Medicare & Medicaid Services. Results:Medicare telehealth user claims were 10.1 million in 2020, 52.7 million in 2021, and 85.3 million in 2023. The adjusted odds of telehealth use were significantly lower in 2021 (adjusted odds ratios [aORs]: 0.746; 95% confidence intervals [CI]: 0.683–0.815) and 2022 (aOR: 0.529; 95% CI: 0.484–0.578) compared with 2020. Large racial differences were observed in 2020–2022, with lower telehealth usage among African Americans (aOR: 0.068; 95% CI: 0.054–0.087), Hispanics (aOR: 0.036; 95% CI: 0.027–0.047), American Indians/Alaska Natives (aOR: 0.012; 95% CI: 0.009–0.017), and Asian Pacific Americans (aOR: 0.001; 95% CI: 0.001–0.002) versus Non-Hispanic Whites. Rural residents, older adults, and beneficiaries with disabilities also had reduced telehealth utilization. However, women were more likely to use telehealth versus men (aOR: 1.689; 95% CI: 1.363–2.094). Conclusion:Despite telehealth expansion during the pandemic, significant disparities remain, highlighting the need for targeted efforts to increase access and reduce barriers among underserved populations. Addressing disparities is critical to ensuring equitable access to health care through telehealth. [ABSTRACT FROM AUTHOR]

Pharmacist prescribing has been introduced in several countries as a strategy to improve access to health care and medicines. However, the direct impacts of pharmacist prescribing on medicines access, and the overall accessibility of pharmacist prescribing services, are not well known. This systematic review aimed to assess the direct impacts of pharmacist prescribing on medicines access, and the accessibility of pharmacist prescribing services, in community and primary care settings. PubMed, Embase, and CINAHL were searched for studies published in English between 01 January 2003 to 15 June 2023. Both quantitative and qualitative primary studies were included if they described pharmacist prescribing in a primary care setting. Outcomes included findings related to access to medicines as a result of pharmacist prescribing (primary outcome), and access to pharmacist prescribing services overall (secondary outcome). Narrative synthesis of outcomes was undertaken. A total of 47 studies were included from four countries (United States, United Kingdom, Canada, New Zealand). Thirteen studies provided evidence that pharmacist prescribing may improve medicines access in several ways, including: increasing the proportion of eligible people receiving medicines, increasing the number of overall dispensed prescriptions, or reducing time to receipt of treatment. The remainder of the included studies reported on the accessibility of pharmacist prescribing services. Published studies highlight that pharmacist prescribers practicing in community settings are generally accessible, with pharmacist prescribers viewed by patients as easy and convenient to consult. There was limited evidence about the affordability of pharmacy prescribing services, and a number of potential equity issues were observed, including reduced access to pharmacist prescribers in more socioeconomically disadvantaged areas and those with greater proportions of populations at risk of health inequities, such as culturally and linguistically diverse communities. This systematic review found that pharmacist prescribing services were both highly accessible and beneficial in improving access to medicines. However, measures of medicines access varied, and few studies included direct measures of medicines access as an outcome of pharmacist prescribing, highlighting a need for future studies to incorporate direct measures of medicines access when assessing the impact of pharmacist prescribing services. [ABSTRACT FROM AUTHOR]

Carotid endarterectomy (CEA) is an effective treatment for carotid stenosis. All previous studies on racial disparity of CEA outcomes omitted Asian Americans. This study aimed to address this gap by investigating racial disparities in 30-day outcomes following CEA among Asian Americans. Asian American and Caucasian patients who underwent CEA were identified in the American College of Surgeons National Surgical Quality Improvement Program targeted database from 2011 to 2021. Patients with age less than 18 years old were excluded. Patients with symptomatic and asymptomatic carotid stenosis were examined separately. A 1:5 propensity-score matching was used to address preoperative differences. Thirty perioperative outcomes were assessed. There were 380 Asian Americans (2.27%) and 13,250 Caucasians (79.18%) with symptomatic carotid stenosis who underwent CEA. Also, 289 Asian Americans (1.40%) and 18,257 Caucasians (88.14%) with asymptomatic carotid stenosis had CEA. Asian Americans undergoing CEA presented with higher comorbid burdens and more severe symptomology. Also, asymptomatic Asian Americans were more likely to undergo surgeries for mild stenosis (<50%), which is not in line with practice guidelines. After 1:5 propensity-matching, all symptomatic Asian Americans were matched to 1550 Caucasian patients, and all asymptomatic Asian Americans were matched to 1445 Caucasians; preoperative differences were addressed. Asian Americans exhibited low overall 30-day mortality (symptomatic, 1.61%; asymptomatic, 0.35%) and stroke (symptomatic, 2.26%; asymptomatic, 0.69%). All perioperative outcomes were comparable to Caucasians, with the exception that Asian Americans experienced longer operation times. Evidence suggested that Asian Americans with asymptomatic stenosis were underrepresented in CEA. After propensity-score matching, Asian Americans demonstrated comparable 30-day outcomes to Caucasians. These suggest that, when afforded equal access to quality health care, CEA serves as an effective treatment for carotid stenosis among Asian Americans. Therefore, efforts may be aimed at addressing health care access, potentially in the screening for asymptomatic carotid stenosis in Asian Americans. This would ensure they have equitable benefits from CEA. Nevertheless, the exact preoperative differences and long-term CEA outcomes in Asian Americans should warrant further examination in future studies. [ABSTRACT FROM AUTHOR]

We evaluated outcomes from a telephone-based transitional patient navigation (TPN) service for people living with hepatitis C virus (HCV) upon returning to the community after incarceration in New York City (NYC) jails. NYC Health + Hospitals/Correctional Health Services offered referrals for TPN services provided by the NYC local health department patient navigation staff. We compared rates of connection to care among people referred for TPN services with those who were not referred. People living with HIV had a higher connection to care rate at three months (65.0% vs 39.8%, p≤.05) and people with opioid use disorder had a higher connection rate at six months (55.1% vs 36.1%, p≤.05) compared with people without these conditions. However, there was not an improved connection to HCV care associated with referral to TPN services for the overall cohort. Further research, including qualitative studies, may inform improved strategies for connection to HCV care after incarceration. [ABSTRACT FROM AUTHOR]

Background: Cancer survival and mortality outcomes for people with mental health and substance use conditions (MHSUC) are worse than for people without MHSUC, which may be partly explained by poorer access to timely and appropriate healthcare, from screening and diagnosis through to treatment and follow-up. Access and quality of healthcare can be evaluated by comparing the proportion of people who receive a cancer diagnosis following an acute or emergency hospital admission (emergency presentation) across different population groups: those diagnosed with cancer following an emergency presentation have lower survival. Methods: National mental health service use datasets (2002–2018) were linked to national cancer registry and hospitalisation data (2006–2018), to create a study population of people aged 15 years and older with one of four cancer diagnoses: lung, prostate, breast and colorectal. The exposure group included people with a history of mental health/addiction service contact within the five years before cancer diagnosis, with a subgroup of people with a diagnosis of bipolar disorder, schizophrenia or psychotic disorders. Marginal standardised rates were used to compare emergency presentations (hospital admission within 30 days of cancer diagnosis) in the exposure and comparison groups, adjusted for age, gender (for lung and colorectal cancers), ethnicity, area deprivation and stage at diagnosis. Results: For all four cancers, the rates of emergency presentation in the fully adjusted models were significantly higher in people with a history of mental health/addiction service use than people without (lung cancer, RR 1.19, 95% CI 1.13, 1.24; prostate cancer RR 1.69, 95% CI 1.44, 1.93; breast cancer RR 1.42, 95% CI 1.14, 1.69; colorectal cancer 1.31, 95% CI 1.22, 1.39). Rates were substantially higher in those with a diagnosis of schizophrenia, bipolar disorder or psychotic disorders. Conclusions: Implementing pathways for earlier detection and diagnosis of cancers in people with MHSUC could reduce the rates of emergency presentation, with improved cancer survival outcomes. All health services, including cancer screening programmes, primary and secondary care, have a responsibility to ensure equitable access to healthcare for people with MHSUC. [ABSTRACT FROM AUTHOR]

Background:Studies suggest that telemedicine worsens health care disparities in certain groups, partly owing to a lack of access to appropriate technology or poor technological literacy. Our aim was to use clinic no-show data to determine the impact of telemedicine on patient access to care in the ambulatory gastroenterology setting. Methods:Single-center retrospective study of ambulatory in-person and telemedicine clinic appointments comparing the 15-month prepandemic (PP) with the first 15 months during the pandemic (DTP) using an administrative database. Statistical analysis was performed using univariate and multivariable logistic regression. Results:About 9,746 and 12,808 patient-encounters were scheduled PP and DTP respectively. The no-show rate decreased from 9.8% to 6.9% DTP (p < 0.001). The no-show rate decreased for Black (p = 0.02) and non-Hispanic White patients (p = 0.018). The no-show rate increased for LatinX (p < 0.001) and Asian (p = 0.007) patients. In multivariate analysis, older patients and patients identifying as Black, Asian, or LatinX all had higher odds of no-show DTP (p < 0.05 for all). Patients from high-income counties were 43% less likely to no-show than those in the lowest income counties. Conclusions:The transition to telemedicine improves health care access by decreasing the overall no-show rate. Some groups have been negatively affected, including the older, lower income, LatinX, and Asian populations. Future studies should aim to identify the risk factors within these populations that can be modified to increase health care participation, including targeted application of in-person visits, and improved technology to drive engagement. [ABSTRACT FROM AUTHOR]