Rural Health Networks and Care Coordination: Health Care Innovation in Frontier Communities to Improve Patient Outcomes and Reduce Health Care Costs

PubMed Central

Conway, Pat; Favet, Heidi; Hall, Laurie; Uhrich, Jenny; Palcher, Jeanette; Olimb, Sarah; Tesch, Nathan; York-Jesme, Margaret; Bianco, Joe

2017-01-01

Rural residents’ health is challenged by high health care costs, chronic diseases, and policy decisions affecting rural health care. This single-case, embedded design study, guided by community-based participatory research principles and using mixed methods, describes outcomes of implementation of a community care team (CCT) and care coordination to improve outcomes of patients living in a frontier community. Seventeen organizations and 165 adults identified as potential care coordination candidates constituted the target populations. Following CCT development, collaboration and cohesion increased among organizations. Patients who participated in care coordination reported similar physical and lower emotional health quality of life than national counterparts; emergency department use decreased following care coordination. Key components identified as successful in urban settings seem applicable in rural settings, with emphasis on the key role of team facilitators; need for intense care coordination for people with complex health needs, especially behavioral health needs; and access to specialty care through technology. PMID:27818417

National Health Care Reform, Medicaid, and Children in Foster Care.

ERIC Educational Resources Information Center

Halfon, Neal; And Others

1994-01-01

Outlines access to health care for children in out-of-home care under current law, reviews how health care access for these children would be affected by President Clinton's health care reform initiative, and proposes additional measures that could be considered to improve access and service coordination for children in the child welfare system.…

How Medicaid Expansion Affected Out-of-Pocket Health Care Spending for Low-Income Families.

PubMed

Glied, Sherry; Chakraborty, Ougni; Russo, Therese

2017-08-01

ISSUE. Prior research shows that low-income residents of states that expanded Medicaid under the Affordable Care Act are less likely to experience financial barriers to health care access, but the impact on out-of-pocket spending has not yet been measured. GOAL. Assess how the Medicaid expansion affected out-of-pocket health care spending for low-income families compared to those in states that did not expand and consider whether effects differed in states that expanded under conventional Medicaid rules vs. waiver programs. METHODS. Analysis of the Consumer Expenditure Survey 2010–2015. KEY FINDINGS AND CONCLUSIONS. Compared to families in nonexpansion states, low-income families in states that did expand Medicaid saved an average of $382 in annual spending on health care. In these states, low-income families were less like to report any out-of-pocket spending on insurance premiums or medical care than were similar families in nonexpansion states. For families that did have some out-of-pocket spending, spending levels were lower in states that expanded Medicaid. Low-income families in Medicaid expansion states were also much less likely to have catastrophically high spending levels. The form of coverage expansion — conventional Medicaid or waiver rules — did not have a statistically significant effect on these outcomes.

How access to long-term care affects home health transfers.

PubMed

Kenney, G M

1993-01-01

This study examines the determinants of home health use after hospitalization for acute illness for eleven diagnosis-related groups (DRGs) in 1985, drawing on data from four primary sources: Medicare hospital bills, Medicare home health bills, the Medicare and Medicaid Automated Certification System files, and the American Hospital Association Survey. Separate Tobit models are estimated for each DRG. The analysis shows that transfers to home health care are heavily influenced by the hospital's long-term care arrangement and by conditions in local nursing home and home health care markets. Especially important is whether a hospital has its own long-term care unit, swing beds, or both, and whether nursing home beds are available in the local area. Patients discharged from hospitals are more likely to use home health care in areas with a low supply of nursing home beds and low Medicaid reimbursement levels for skilled nursing facilities. The results of this study have implications for proposals to extend Medicare's Prospective Payment System for hospital services to include postacute care. Proponents of a "bundled payment" that encompasses both acute and postacute services argue that the current system leads to inefficiencies and inequities. This analysis points to systematic relationships between home health and nursing home services, which should be factored into the development of a bundled payment policy.

Petroleum and Health Care: Evaluating and Managing Health Care's Vulnerability to Petroleum Supply Shifts

PubMed Central

Bednarz, Daniel; Bae, Jaeyong; Pierce, Jessica

2011-01-01

Petroleum is used widely in health care—primarily as a transport fuel and feedstock for pharmaceuticals, plastics, and medical supplies—and few substitutes for it are available. This dependence theoretically makes health care vulnerable to petroleum supply shifts, but this vulnerability has not been empirically assessed. We quantify key aspects of petroleum use in health care and explore historical associations between petroleum supply shocks and health care prices. These analyses confirm that petroleum products are intrinsic to modern health care and that petroleum supply shifts can affect health care prices. In anticipation of future supply contractions lasting longer than previous shifts and potentially disrupting health care delivery, we propose an adaptive management approach and outline its application to the example of emergency medical services. PMID:21778473

Interventions for Children Affected by War: An Ecological Perspective on Psychosocial Support and Mental Health Care

PubMed Central

Betancourt, Theresa S.; Meyers-Ohki, Sarah E.; Charrow, Alexandra P.; Tol, Wietse A.

2014-01-01

Background Children and adolescents exposed to armed conflict are at high risk of developing mental health problems. To date, a range of psychosocial approaches and clinical/psychiatric interventions has been used to address mental health needs in these groups. Aims To provide an overview of peer-reviewed psychosocial and mental health interventions designed to address mental health needs of conflict-affected children, and to highlight areas in which policy and research need strengthening. Methods We used standard review methodology to identify interventions aimed at improving or treating mental health problems in conflict-affected youth. An ecological lens was used to organize studies according to the individual, family, peer/school, and community factors targeted by each intervention. Interventions were also evaluated for their orientation toward prevention, treatment, or maintenance, and for the strength of the scientific evidence of reported effects. Results Of 2305 studies returned from online searches of the literature and 21 sources identified through bibliography mining, 58 qualified for full review, with 40 peer-reviewed studies included in the final narrative synthesis. Overall, the peer-reviewed literature focused largely on school-based interventions. Very few family and community-based interventions have been empirically evaluated. Only two studies assessed multilevel or stepped-care packages. Conclusions The evidence base on effective and efficacious interventions for conflict-affected youth requires strengthening. Postconflict development agendas must be retooled to target the vulnerabilities characterizing conflict-affected youth, and these approaches must be collaborative across bodies responsible for the care of youth and families. PMID:23656831

Unhealthy health care costs.

PubMed

Shelton, J K; Janosi, J M

1992-02-01

The private sector has implemented many cost containment measures in efforts to control rising health care costs. However, these measures have not controlled costs in the long run, and can be expected not to succeed as long as business cannot control factors within the health care system which affect costs. Controlling private sector health care costs requires constraints on cost shifting which necessitates a unified financing system with expenditure limits. A unified financing system will involve a partnership between the public and private sectors.

The Quiet Health Care Revolution.

ERIC Educational Resources Information Center

Herzlinger, Regina

1994-01-01

Discusses how entrepreneurs have helped reduce costs in health care and examines the major changes in the health care system that are simultaneously lowering costs and increasing quality. The author then explains how current reform proposals might affect these entrepreneurial innovations. (GLR)

Does Churning in Medicaid Affect Health Care Use?

PubMed Central

Roberts, Eric T.; Pollack, Craig Evan

2017-01-01

Background Transitions into and out of Medicaid, termed churning, may disrupt access to and continuity of care. Low-income, working adults who became eligible for Medicaid under the Affordable Care Act are particularly susceptible to income and employment changes that lead to churning. Objective To compare health care use among adults who do and do not churn into and out of Medicaid. Data Longitudinal data from 6 panels of the Medical Expenditure Panel Survey. Methods We used differences-in-differences regression to compare health care use when adults reenrolled in Medicaid following a loss of coverage, to utilization in a control group of continuously enrolled adults. Outcome Measures Emergency department (ED) visits, ED visits resulting in an inpatient admission, and visits to office-based providers. Results During the study period, 264 adults churned into and out of Medicaid and 627 had continuous coverage. Churning adults had an average of approximately 0.05 Medicaid-covered office-based visits per month 4 months before reenrolling in Medicaid, significantly below the rate of approximately 0.20 visits in the control group. Visits to office-based providers did not reach the control group rate until several months after churning adults had resumed Medicaid coverage. Our comparisons found no evidence of significantly elevated ED and inpatient admission rates in the churning group following reenrollment. Conclusions Adults who lose Medicaid tend to defer their use of office-based care to periods when they are insured. Although this suggests that enrollment disruptions lead to suboptimal timing of care, we do not find evidence that adults reenroll in Medicaid with elevated acute care needs. PMID:26908088

Islamic Cultures: Health Care Beliefs and Practices.

ERIC Educational Resources Information Center

Kemp, Charles

1996-01-01

Presents an overview of Islamic health care beliefs and practices, noting health-related social and spiritual issues, fundamental beliefs and themes in Islam, health care beliefs and practices common among Muslims, and health-affecting social roles among Muslims. Cultural, religious, and social barriers to health care and ways to reduce them are…

Health Care Reform: How Will It Affect Nursing?--Nursing Education.

ERIC Educational Resources Information Center

Zalon, Margarete Lieb

Nursing educators have the opportunity to advance nursing's agenda for health care reform to ensure effective health care for all members of society. They have a key role in fostering the political involvement of student nurses and nurses who have returned to school for baccalaureate or graduate education. Role modeling is critical to increasing…

Digital atmospheres: affective practices of care in Elefriends.

PubMed

Tucker, Ian M; Goodings, Lewis

2017-05-01

This article develops the concept of digital atmosphere to analyse the affective power of social media to shape practices of care and support for people living with mental distress. Using contemporary accounts of affective atmospheres, the article focuses on feelings of distress, support and care that unfold through digital atmospheres. The power of social media intersects with people's support and care-seeking practices in multiple ways and not in a straightforward model of 'accessing or providing support'. Indeed, we find that the caring relations developed through social media often need to be cared for themselves. The article draws on online and interview data from a larger project investigating how practices of care and support are (re)configured in the mental health-related social media site Elefriends. Users have to negotiate the disruption of moving support online, as well as the possibility of becoming subject to a fragility in care, in which caring for oneself becomes bound up in the ambiguities of caring for others. We argue that understanding how experiences of distress are shaped by social media is essential for understanding the implications of the increased digitisation of mental healthcare. © 2017 Foundation for the Sociology of Health & Illness.

Behavioral Health's Integration Within a Care Network and Health Care Utilization.

PubMed

McClellan, Chandler; Flottemesch, Thomas J; Ali, Mir M; Jones, Jenna; Mutter, Ryan; Hohlbauch, Andriana; Whalen, Daniel; Nordstrom, Nils

2018-05-30

Examine how behavioral health (BH) integration affects health care costs, emergency department (ED) visits, and inpatient admissions. Truven Health MarketScan Research Databases. Social network analysis identified "care communities" (providers sharing a high number of patients) and measured BH integration in terms of how connected, or central, BH providers were to other providers in their community. Multivariable generalized linear models adjusting for age, sex, number of prescriptions, and Charlson comorbidity score were used to estimate the relationship between the centrality of BH providers and health care utilization of BH patients. Used outpatient, inpatient, and pharmacy claims data from six Medicaid plans from 2011 to 2013 to identify study outcomes, comorbidities, providers, and health care encounters. Behavioral health centrality ranged from 0 (no BH providers) to 0.49. Relative to communities at the median BH centrality (0.06), in 2012, BH patients in communities at the 75th percentile of BH centrality (0.31) had 0.2 fewer admissions, 2.1 fewer all-cause ED visits, and accrued $1,947 fewer costs, on average. Increased behavioral centrality was significantly associated with a reduced number of ED visits, less frequent inpatient admissions, and lower overall health care costs. © Health Research and Educational Trust.

Seven Ethical Issues Affecting Neurosurgeons in the Context of Health Care Reform.

PubMed

Dagi, T Forcht

2017-04-01

Ethical discussions around health care reform typically focus on problems of social justice and health care equity. This review, in contrast, focuses on ethical issues of particular importance to neurosurgeons, especially with respect to potential changes in the physician-patient relationship that may occur in the context of health care reform.The Patient Protection and Affordable Care Act (ACA) of 2010 (H.R. 3590) was not the first attempt at health care reform in the United States but it is the one currently in force. Its ambitions include universal access to health care, a focus on population health, payment reform, and cost control. Each of these aims is complicated by a number of ethical challenges, of which 7 stand out because of their potential influence on patient care: the accountability of physicians and surgeons to individual patients; the effects of financial incentives on clinical judgment; the definition and management of conflicting interests; the duty to preserve patient autonomy in the face of protocolized care; problems in information exchange and communication; issues related to electronic health records and data security; and the appropriate use of "Big Data."Systematic social and economic reforms inevitably raise ethical concerns. While the ACA may have driven these 7 to particular prominence, they are actually generic. Nevertheless, they are immediately relevant to the practice of neurosurgery and likely to reflect the realities the profession will be obliged to confront in the pursuit of more efficient and more effective health care. Copyright © 2017 by the Congress of Neurological Surgeons.

The employee retention triad in health care: Exploring relationships amongst organisational justice, affective commitment and turnover intention.

PubMed

Perreira, Tyrone A; Berta, Whitney; Herbert, Monique

2018-04-01

To increase understanding of the relationships between organisational justice, affective commitment and turnover intention in health care. Turnover in health care is a serious concern, as it contributes to the global nursing shortage and is associated with declines in quality of care, patient safety and patient outcomes. Turnover also impacts care teams and is associated with decreased staff cohesion and morale. A survey was developed and administered to frontline nurses working in the Province of Ontario, Canada. The data were used to test a hypothetical model developed from a review of the literature. The relationships amongst the three constructs were evaluated using structural equation modelling and mediation analysis. The hypothesised model was generally supported, although we were limited to considerations of interpersonal justice, affective commitment to one's organisation and turnover intention. Interpersonal justice is associated with affective commitment to one's organisation, which is negatively associated with turnover intention. Interpersonal justice was also found to be directly and negatively associated with turnover intention. Affective commitment to one's organisation was also found to mediate the relationship between interpersonal justice and turnover intention. The examination of relationships within the "employee retention triad" in a single, comprehensive model is novel and provides new information regarding relational complexity and insights into what healthcare leaders can do to retain employees. Reducing turnover may help to decrease some of the stressors related to turnover for clinical staff remaining at the organisation such as constant onboarding and orientation of new hires, working with less experienced staff and increased workload due to decreased staffing. © 2018 John Wiley & Sons Ltd.

Does responsibility affect the public's valuation of health care interventions? A relative valuation approach to health care safety.

PubMed

Singh, Jeshika; Lord, Joanne; Longworth, Louise; Orr, Shepley; McGarry, Teresa; Sheldon, Rob; Buxton, Martin

2012-01-01

Health services often spend more on safety interventions than seems cost-effective. This study investigates whether the public value safety-related health care improvements more highly than the same improvements in contexts where the health care system is not responsible. An online survey was conducted to elicit the relative importance placed on preventing harms caused by 1) health care (hospital-acquired infections, drug administration errors, injuries to health care staff), 2) individuals (personal lifestyle choices, sports-related injuries), and 3) nature (genetic disorders). Direct valuations were obtained from members of the public by using a person trade-off or "matching" method. Participants were asked to choose between two preventative interventions of equal cost and equal health benefit per person for the same number of people, but differing in causation. If participants indicated a preference, their strength of preference was measured by using person trade-off. Responses were obtained from 1030 people, reflecting the sociodemographic mix of the UK population. Participants valued interventions preventing hospital-acquired infections (1.31) more highly than genetic disorders (1.0), although drug errors were valued similarly to genetic disorders (1.07), and interventions to prevent injury to health care staff were given less weight than genetic disorders (0.71). Less weight was also given to interventions related to lifestyle (0.65) and sports injuries (0.41). Our results suggest that people do not attach a simple fixed premium to "safety-related" interventions but that preferences depend more subtly on context. The use of the results of such public preference surveys to directly inform policy would therefore be premature. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Strengthening of Oral Health Systems: Oral Health through Primary Health Care

PubMed Central

Petersen, Poul Erik

2014-01-01

Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high burden of oral disease compared to well-off people. Promotion of oral health and prevention of oral diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work with the newly established WHO Collaborating Centre, Kuwait University, to strengthen the development of appropriate models for primary oral health care. PMID:24525450

Primary Health Care: care coordinator in regionalized networks?

PubMed Central

de Almeida, Patty Fidelis; dos Santos, Adriano Maia

2016-01-01

RESUMO OBJECTIVE To analyze the breadth of care coordination by Primary Health Care in three health regions. METHODS This is a quantitative and qualitative case study. Thirty-one semi-structured interviews with municipal, regional and state managers were carried out, besides a cross-sectional survey with the administration of questionnaires to physicians (74), nurses (127), and a representative sample of users (1,590) of Estratégia Saúde da Família (Family Health Strategy) in three municipal centers of health regions in the state of Bahia. RESULTS Primary Health Care as first contact of preference faced strong competition from hospital outpatient and emergency services outside the network. Issues related to access to and provision of specialized care were aggravated by dependence on the private sector in the regions, despite progress observed in institutionalizing flows starting out from Primary Health Care. The counter-referral system was deficient and interprofessional communication was scarce, especially concerning services provided by the contracted network. CONCLUSIONS Coordination capacity is affected both by the fragmentation of the regional network and intrinsic problems in Primary Health Care, which poorly supported in its essential attributes. Although the health regions have common problems, Primary Health Care remains a subject confined to municipal boundaries. PMID:28099663

Can consumer choice replace trust in the National Health Service in England? Towards developing an affective psychosocial conception of trust in health care.

PubMed

Fotaki, Marianna

2014-11-01

Trust has long been regarded as a vitally important aspect of the relationship between health service providers and patients. Recently, consumer choice has been increasingly advocated as a means of improving the quality and effectiveness of health service provision. However, it is uncertain how the increase of information necessary to allow users of health services to exercise choice, and the simultaneous introduction of markets in public health systems, will affect various dimensions of trust, and how changing relations of trust will impact upon patients and services. This article employs a theory-driven approach to investigate conceptual and material links between choice, trust and markets in health care in the context of the National Health Service in England. It also examines the implications of patient choice on systemic, organisational and interpersonal trust. The article is divided into two parts. The first argues that the shift to marketisation in public health services might lead to an over-reliance on rational-calculative aspects of trust at the expense of embodied, relational and social attributes. The second develops an alternative psychosocial conception of trust: it focuses on the central role of affect and accounts for the material and symbolic links between choice, trust and markets in health care. © 2014 The Author. Sociology of Health & Illness © 2014 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Relative magnitude of presenteeism and absenteeism and work-related factors affecting them among health care professionals.

PubMed

Rantanen, Iina; Tuominen, Risto

2011-02-01

To examine the extent and relative value of presenteeism and absenteeism and work-related factors affecting them among health care professionals. Physicians and nurses estimated their hours of absenteeism and presenteeism during the last 4 weeks due to health reasons, and how much their work capacity had been reduced during their presenteeism hours. Socio-economic background, factors related to work and work conditions and possible chronic and acute diseases were solicited. Presenteeism was more common but indicated lower monetary value than absenteeism. Job satisfaction explained the probability and magnitude of presenteeism, but not absenteeism. Experience of acute disease(s) during the study period of 4 weeks significantly predicted the probability of both presenteeism and absenteeism. Experience of presenteeism seemed to be common among health care workers, and it had significant economic value, although not as significant as absenteeism had.

Boundaries and e-health implementation in health and social care.

PubMed

King, Gerry; O'Donnell, Catherine; Boddy, David; Smith, Fiona; Heaney, David; Mair, Frances S

2012-09-07

The major problem facing health and social care systems globally today is the growing challenge of an elderly population with complex health and social care needs. A longstanding challenge to the provision of high quality, effectively coordinated care for those with complex needs has been the historical separation of health and social care. Access to timely and accurate data about patients and their treatments has the potential to deliver better care at less cost. To explore the way in which structural, professional and geographical boundaries have affected e-health implementation in health and social care, through an empirical study of the implementation of an electronic version of Single Shared Assessment (SSA) in Scotland, using three retrospective, qualitative case studies in three different health board locations. Progress in effectively sharing electronic data had been slow and uneven. One cause was the presence of established structural boundaries, which lead to competing priorities, incompatible IT systems and infrastructure, and poor cooperation. A second cause was the presence of established professional boundaries, which affect staffs' understanding and acceptance of data sharing and their information requirements. Geographical boundaries featured but less prominently and contrasting perspectives were found with regard to issues such as co-location of health and social care professionals. To provide holistic care to those with complex health and social care needs, it is essential that we develop integrated approaches to care delivery. Successful integration needs practices such as good project management and governance, ensuring system interoperability, leadership, good training and support, together with clear efforts to improve working relations across professional boundaries and communication of a clear project vision. This study shows that while technological developments make integration possible, long-standing boundaries constitute substantial

V-TECS Guide for Health Care Assistant.

ERIC Educational Resources Information Center

Connell, Shirley

This health care assistant guide addresses the psychomotor, cognitive, and affective learning domains. Thirteen units in the guide cover the following subjects: (1) introducing health care workers and facilities; (2) assisting with examinations; (3) assisting with diagnostic tests; (4) providing health information and performing outreach…

An intervention to improve mental health care for conflict-affected forced migrants in low-resource primary care settings: a WHO MhGAP-based pilot study in Sri Lanka (COM-GAP study)

PubMed Central

2013-01-01

Background Inadequacy in mental health care in low and middle income countries has been an important contributor to the rising global burden of disease. The treatment gap is salient in resource-poor settings, especially when providing care for conflict-affected forced migrant populations. Primary care is often the only available service option for the majority of forced migrants, and integration of mental health into primary care is a difficult task. The proposed pilot study aims to explore the feasibility of integrating mental health care into primary care by providing training to primary care practitioners serving displaced populations, in order to improve identification, treatment, and referral of patients with common mental disorders via the World Health Organization Mental Health Gap Action Programme (mhGAP). Methods/Design This pilot randomized controlled trial will recruit 86 primary care practitioners (PCP) serving in the Puttalam and Mannar districts of Sri Lanka (with displaced and returning conflict-affected populations). The intervention arm will receive a structured training program based on the mhGAP intervention guide. Primary outcomes will be rates of correct identification, adequate management based on set criteria, and correct referrals of common mental disorders. A qualitative study exploring the attitudes, views, and perspectives of PCP on integrating mental health and primary care will be nested within the pilot study. An economic evaluation will be carried out by gathering service utilization information. Discussion In post-conflict Sri Lanka, an important need exists to provide adequate mental health care to conflict-affected internally displaced persons who are returning to their areas of origin after prolonged displacement. The proposed study will act as a local demonstration project, exploring the feasibility of formulating a larger-scale intervention study in the future, and is envisaged to provide information on engaging PCP, and data on

An intervention to improve mental health care for conflict-affected forced migrants in low-resource primary care settings: a WHO MhGAP-based pilot study in Sri Lanka (COM-GAP study).

PubMed

Siriwardhana, Chesmal; Adikari, Anushka; Van Bortel, Tine; McCrone, Paul; Sumathipala, Athula

2013-12-09

Inadequacy in mental health care in low and middle income countries has been an important contributor to the rising global burden of disease. The treatment gap is salient in resource-poor settings, especially when providing care for conflict-affected forced migrant populations. Primary care is often the only available service option for the majority of forced migrants, and integration of mental health into primary care is a difficult task. The proposed pilot study aims to explore the feasibility of integrating mental health care into primary care by providing training to primary care practitioners serving displaced populations, in order to improve identification, treatment, and referral of patients with common mental disorders via the World Health Organization Mental Health Gap Action Programme (mhGAP). This pilot randomized controlled trial will recruit 86 primary care practitioners (PCP) serving in the Puttalam and Mannar districts of Sri Lanka (with displaced and returning conflict-affected populations). The intervention arm will receive a structured training program based on the mhGAP intervention guide. Primary outcomes will be rates of correct identification, adequate management based on set criteria, and correct referrals of common mental disorders. A qualitative study exploring the attitudes, views, and perspectives of PCP on integrating mental health and primary care will be nested within the pilot study. An economic evaluation will be carried out by gathering service utilization information. In post-conflict Sri Lanka, an important need exists to provide adequate mental health care to conflict-affected internally displaced persons who are returning to their areas of origin after prolonged displacement. The proposed study will act as a local demonstration project, exploring the feasibility of formulating a larger-scale intervention study in the future, and is envisaged to provide information on engaging PCP, and data on training and evaluation including

Mental health care roles of non-medical primary health and social care services.

PubMed

Mitchell, Penny

2009-02-01

Changes in patterns of delivery of mental health care over several decades are putting pressure on primary health and social care services to increase their involvement. Mental health policy in countries like the UK, Australia and New Zealand recognises the need for these services to make a greater contribution and calls for increased intersectoral collaboration. In Australia, most investment to date has focused on the development and integration of specialist mental health services and primary medical care, and evaluation research suggests some progress. Substantial inadequacies remain, however, in the comprehensiveness and continuity of care received by people affected by mental health problems, particularly in relation to social and psychosocial interventions. Very little research has examined the nature of the roles that non-medical primary health and social care services actually or potentially play in mental health care. Lack of information about these roles could have inhibited development of service improvement initiatives targeting these services. The present paper reports the results of an exploratory study that examined the mental health care roles of 41 diverse non-medical primary health and social care services in the state of Victoria, Australia. Data were collected in 2004 using a purposive sampling strategy. A novel method of surveying providers was employed whereby respondents within each agency worked as a group to complete a structured survey that collected quantitative and qualitative data simultaneously. This paper reports results of quantitative analyses including a tentative principal components analysis that examined the structure of roles. Non-medical primary health and social care services are currently performing a wide variety of mental health care roles and they aspire to increase their involvement in this work. However, these providers do not favour approaches involving selective targeting of clients with mental disorders.

Beyond the crisis: building back better mental health care in 10 emergency-affected areas using a longer-term perspective.

PubMed

Epping-Jordan, JoAnne E; van Ommeren, Mark; Ashour, Hazem Nayef; Maramis, Albert; Marini, Anita; Mohanraj, Andrew; Noori, Aqila; Rizwan, Humayun; Saeed, Khalid; Silove, Derrick; Suveendran, T; Urbina, Liliana; Ventevogel, Peter; Saxena, Shekhar

2015-01-01

Major gaps remain - especially in low- and middle-income countries - in the realization of comprehensive, community-based mental health care. One potentially important yet overlooked opportunity for accelerating mental health reform lies within emergency situations, such as armed conflicts or natural disasters. Despite their adverse impacts on affected populations' mental health and well being, emergencies also draw attention and resources to these issues and provide openings for mental health service development. Cases were considered if they represented a low- or middle-income country or territory affected by an emergency, were initiated between 2000 and 2010, succeeded in making changes to the mental health system, and were able to be documented by an expert involved directly with the case. Based on these criteria, 10 case examples from diverse emergency-affected settings were included: Afghanistan, Burundi, Indonesia (Aceh Province), Iraq, Jordan, Kosovo, occupied Palestinian territory, Somalia, Sri Lanka, and Timor-Leste. These cases demonstrate generally that emergency contexts can be tapped to make substantial and sustainable improvements in mental health systems. From these experiences, 10 common lessons learnt were identified on how to make this happen. These lessons include the importance of adopting a longer-term perspective for mental health reform from the outset, and focusing on system-wide reform that addresses both new-onset and pre-existing mental disorders. Global progress in mental health care would happen more quickly if, in every crisis, strategic efforts were made to convert short-term interest in mental health problems into momentum for mental health reform.

Misalignment between Medicare Policies and Depression Care in Home Health Care: Home health provider perspectives

PubMed Central

Bao, Yuhua; Eggman, Ashley; Richardson, Joshua; Bruce, Martha

2013-01-01

Objective Depression affects one in four older adults receiving home health care. Medicare policies are influential in shaping home health practice. This study aims to identify Medicare policy areas that are aligned or misaligned with depression care quality improvement in home health care. Methods Qualitative study based on semi-structured interviews with nurses and administrators from five home health agencies in five states (n=20). Digitally recorded interviews were transcribed and analyzed using the grounded theory method. A multi-disciplinary team iteratively developed a codebook from interview data to identify themes. Results Several important Medicare policies are largely misaligned with depression care quality improvement in home health care: Medicare eligibility requirements for patients to remain homebound and to demonstrate a need for skilled care restrict nurses’ abilities to follow up with depressed patients for sufficient length of time; the lack of explicit recognition of nursing time and quality of care in the home health Prospective Payment System (PPS) provides misaligned incentives for depression care; incorporation of a two-item depression screening tool in Medicare-mandated comprehensive patient assessment raised clinician awareness of depression; however, inclusion of the tool at Start-of-Care only but not any other follow-up points limits its potential in assisting nurses with depression care management; under-development of clinical decision support for depression care in vendor-developed electronic health records constitutes an important barrier to depression quality improvement in home health care. Conclusions Several influential Medicare policies and regulations for home health practice may be misaligned with evidence-based depression care for home health patients. PMID:24632686

Health Care System Measures to Advance Preconception Wellness: Consensus Recommendations of the Clinical Workgroup of the National Preconception Health and Health Care Initiative.

PubMed

Frayne, Daniel J; Verbiest, Sarah; Chelmow, David; Clarke, Heather; Dunlop, Anne; Hosmer, Jennifer; Menard, M Kathryn; Moos, Merry-K; Ramos, Diana; Stuebe, Alison; Zephyrin, Laurie

2016-05-01

Preconception wellness reflects a woman's overall health before conception as a strategy to affect health outcomes for the woman, the fetus, and the infant. Preconception wellness is challenging to measure because it attempts to capture health status before a pregnancy, which may be affected by many different service points within a health care system. The Clinical Workgroup of the National Preconception Health and Health Care Initiative proposes nine core measures that can be assessed at initiation of prenatal care to index a woman's preconception wellness. A two-stage web-based modified Delphi survey and a face-to-face meeting of key opinion leaders in women's reproductive health resulted in identifying seven criteria used to determine the core measures. The Workgroup reached unanimous agreement on an aggregate of nine preconception wellness measures to serve as a surrogate but feasible assessment of quality preconception care within the larger health community. These include indicators for: 1) pregnancy intention, 2) access to care, 3) preconception multivitamin with folic acid use, 4) tobacco avoidance, 5) absence of uncontrolled depression, 6) healthy weight, 7) absence of sexually transmitted infections, 8) optimal glycemic control in women with pregestational diabetes, and 9) teratogenic medication avoidance. The focus of the proposed measures is to quantify the effect of health care systems on advancing preconception wellness. The Workgroup recommends that health care systems adopt these nine preconception wellness measures as a metric to monitor performance of preconception care practice. Over time, monitoring these baseline measures will establish benchmarks and allow for comparison within and among regions, health care systems, and communities to drive improvements.

Organizational context and taxonomy of health care databases.

PubMed

Shatin, D

2001-01-01

An understanding of the organizational context and taxonomy of health care databases is essential to appropriately use these data sources for research purposes. Characteristics of the organizational structure of the specific health care setting, including the model type, financial arrangement, and provider access, have implications for accessing and using this data effectively. Additionally, the benefit coverage environment may affect the utility of health care databases to address specific research questions. Coverage considerations that affect pharmacoepidemiologic research include eligibility, the nature of the pharmacy benefit, and regulatory aspects of the treatment under consideration.

Warfare or partnership: which way for health care?

PubMed

MacStravic, R S

1990-01-01

There are many voices urging health care organizations to adopt aggressive competitive warfare, but a careful look at the dynamics affecting health care suggests that partnership may be at least as promising a strategy as warfare to promote mission and survival.

Higher Education and Health Investments: Does More Schooling Affect Preventive Health Care Use?◆

PubMed Central

Fletcher, Jason M.; Frisvold, David E.

2012-01-01

While it is well-known that individuals with higher levels of education consume more preventive medical care, there are several potential explanations for this stylized fact. These explanations include causal and non-causal mechanisms, and distinguishing among explanations is relevant for accessing the importance of educational spillovers on lifetime health outcomes as well as uncovering the determinants of preventive care. In this paper, we use regression analysis, sibling fixed effects, and matching estimators to examine the impact of education on preventive care. In particular, we use a cohort of 10,000 Wisconsin high school graduates that has been followed for nearly 50 years and find evidence that attending college is associated with an increase in the likelihood of using several types of preventive care by approximately five to fifteen percent for college attendees in the early 1960s. We also find that greater education may influence preventive care partly through occupational channels and access to care. These findings suggest that increases in education have the potential to spillover on long-term health choices. PMID:22368727

Administrative Challenges to the Integration of Oral Health With Primary Care: A SWOT Analysis of Health Care Executives at Federally Qualified Health Centers.

PubMed

Norwood, Connor W; Maxey, Hannah L; Randolph, Courtney; Gano, Laura; Kochhar, Komal

Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce.

Mental health care services for children with special health care needs and their family members: prevalence and correlates of unmet needs.

PubMed

Ganz, Michael L; Tendulkar, Shalini A

2006-06-01

To estimate the prevalence and correlates of unmet needs for mental health care services for children with special health care needs and their families. We use the National Survey of Children With Special Health Care Needs to estimate the prevalence of unmet mental health care needs among children with special health care needs (1-17 years old) and their families. Using logistic-regression models, we also assess the independent impact of child and family factors on unmet needs. Substantial numbers of children with special health care needs and members of their families have unmet needs for mental health care services. Children with special health care needs who were poor, uninsured, and were without a usual source of care were statistically significantly more likely to report that their mental health care needs were unmet. More severely affected children and those with emotional, developmental, or behavioral conditions were also statistically significantly more likely to report that their mental health care needs went unmet. Families of severely affected children or of children with emotional, developmental, or behavioral conditions were also statistically significantly more likely to report that their mental health care needs went unmet. Our results indicate that children with special health care needs and their families are at risk for not receiving needed mental health care services. Furthermore, we find that children in families of lower socioeconomic status are disproportionately reporting higher rates of unmet needs. These data suggest that broader policies to identify and connect families with needed services are warranted but that child- and family-centered approaches alone will not meet the needs of these children and their families. Other interventions such as anti-poverty and insurance expansion efforts may be needed as well.

Mental health collaborative care and its role in primary care settings.

PubMed

Goodrich, David E; Kilbourne, Amy M; Nord, Kristina M; Bauer, Mark S

2013-08-01

Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems, as well as engaging patients in their care through self-management support and linkages to community resources. The model is also a cost-efficient strategy for primary care practices to improve outcomes for a range of mental health conditions across populations and settings. CCMs can help achieve integrated care aims underhealth care reform yet organizational and financial issues may affect adoption into routine primary care. Notably, successful implementation of CCMs in routine care will require alignment of financial incentives to support systems redesign investments, reimbursements for mental health providers, and adaptation across different practice settings and infrastructure to offer all CCM components.

Mental Health Collaborative Care and Its Role in Primary Care Settings

PubMed Central

Goodrich, David E.; Kilbourne, Amy M.; Nord, Kristina M.; Bauer, Mark S.

2013-01-01

Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems as well as engaging patients in their care through self-management support and linkages to community resources. The model is also a cost-efficient strategy for primary care practices to improve outcomes for a range of mental health conditions across populations and settings. CCMs can help achieve integrated care aims under healthcare reform yet organizational and financial issues may affect adoption into routine primary care. Notably, successful implementation of CCMs in routine care will require alignment of financial incentives to support systems redesign investments, reimbursements for mental health providers, and adaptation across different practice settings and infrastructure to offer all CCM components. PMID:23881714

Layered stigma among health-care and social service providers toward key affected populations in Jamaica and The Bahamas.

PubMed

Rogers, S J; Tureski, K; Cushnie, A; Brown, A; Bailey, A; Palmer, Q

2014-01-01

While considerable research has documented stigma toward key populations affected by HIV and AIDS - men who have sex with men (MSM), sex workers (SWs) - it provided limited empirical evidence on the presence of layered stigma among health-care professionals providing services for these populations. C-Change conducted a survey among 332 staff of health-care and social service agencies in Jamaica and The Bahamas to understand the levels of stigma toward people living with HIV (PLHIV), including MSM and SWs and factors associated with stigma. While most health-care professionals responding to the survey said that PLHIV, MSM, and SWs deserved quality care, they expressed high levels of blame and negative judgments, especially toward MSM and SWs. Across a stigma assessment involving eight vignette characters, the highest levels of stigma were expressed toward PLHIV who were also MSM or SWs, followed by PLHIV, MSM, and SWs. Differences were assessed by gender, country, type of staff, type of agency, and exposure to relevant training. Findings indicate higher reported stigma among nonclinical vs. clinical staff, staff who worked in general vs. MSM/SW-friendly health facilities, and among untrained vs. training staff. This implies the need for targeted staff capacity strengthening as well as improved facility environments that are MSM/SW-friendly.

Key stakeholder perceptions regarding acute care psychiatry in distressed publicly funded mental health care markets.

PubMed

Frueh, B Christopher; Grubaugh, Anouk L; Lo Sasso, Anthony T; Jones, Walter J; Oldham, John M; Lindrooth, Richard C

2012-01-01

The role of acute care inpatient psychiatry, public and private, has changed dramatically since the 1960s, especially as recent market forces affecting the private sector have had ripple effects on publicly funded mental health care. Key stakeholders' experiences, perceptions, and opinions regarding the role of acute care psychiatry in distressed markets of publicly funded mental health care were examined. A qualitative research study was conducted using semi-structured thematic interviews with 52 senior mental health system administrators, clinical directors and managers, and nonclinical policy specialists. Participants were selected from markets in six regions of the United States that experienced recent significant closures of acute care psychiatric beds. Qualitative data analyses yielded findings that clustered around three sets of higher order themes: structure of care, service delivery barriers, and outcomes. Structure of care suggests that acute care psychiatry is seen as part of a continuum of services; service delivery barriers inhibit effective delivery of services and are perceived to include economic, regulatory, and political factors; outcomes include fragmentation of mental health care services across the continuum, the shift of mental health care to the criminal justice system, and market-specific issues affecting mental health care. Findings delineate key stakeholders' perceptions regarding the role acute care psychiatry plays in the continuum of care for publicly funded mental health and suggest that public mental health care is inefficacious. Results carry implications for policy makers regarding strategies/policies to improve optimal utilization of scarce resources for mental health care, including greater focus on psychotherapy.

Key stakeholder perceptions regarding acute care psychiatry in distressed publicly funded mental health care markets

PubMed Central

Frueh, B. Christopher; Grubaugh, Anouk L.; Lo Sasso, Anthony T.; Jones, Walter J.; Oldham, John M.; Lindrooth, Richard C.

2017-01-01

The role of acute care inpatient psychiatry, public and private, has changed dramatically since the 1960s, especially as recent market forces affecting the private sector have had ripple effects on publicly funded mental health care. Key stakeholders’ experiences, perceptions, and opinions regarding the role of acute care psychiatry in distressed markets of publicly funded mental health care were examined. A qualitative research study was conducted using semi-structured thematic interviews with 52 senior mental health system administrators, clinical directors and managers, and nonclinical policy specialists. Participants were selected from markets in six regions of the United States that experienced recent significant closures of acute care psychiatric beds. Qualitative data analyses yielded findings that clustered around three sets of higher order themes: structure of care, service delivery barriers, and outcomes. Structure of care suggests that acute care psychiatry is seen as part of a continuum of services; service delivery barriers inhibit effective delivery of services and are perceived to include economic, regulatory, and political factors; outcomes include fragmentation of mental health care services across the continuum, the shift of mental health care to the criminal justice system, and market-specific issues affecting mental health care. Findings delineate key stakeholders’ perceptions regarding the role acute care psychiatry plays in the continuum of care for publicly funded mental health and suggest that public mental health care is inefficacious. Results carry implications for policy makers regarding strategies/policies to improve optimal utilization of scarce resources for mental health care, including greater focus on psychotherapy. PMID:22409204

Health care and equity in India.

PubMed

Balarajan, Y; Selvaraj, S; Subramanian, S V

2011-02-05

In India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Health-care expenditures exacerbate poverty, with about 39 million additional people falling into poverty every year as a result of such expenditures. We identify key challenges for the achievement of equity in service provision, and equity in financing and financial risk protection in India. These challenges include an imbalance in resource allocation, inadequate physical access to high-quality health services and human resources for health, high out-of-pocket health expenditures, inflation in health spending, and behavioural factors that affect the demand for appropriate health care. Use of equity metrics in monitoring, assessment, and strategic planning; investment in development of a rigorous knowledge base of health-systems research; development of a refined equity-focused process of deliberative decision making in health reform; and redefinition of the specific responsibilities and accountabilities of key actors are needed to try to achieve equity in health care in India. The implementation of these principles with strengthened public health and primary-care services will help to ensure a more equitable health care for India's population. Copyright © 2011 Elsevier Ltd. All rights reserved.

Future trends in the health care economy.

PubMed

Kajander, J; Samuels, M

1996-01-01

Most articles on the future of health care are by professionals involved in the delivery of health care services. This article is unique in that trends are examined from the perspective of the public and purchasers of care. The authors focus on 12 trends that are or will be affecting the industry, and on the sometimes unintended consequences and new conflicts that may develop.

Workplace bullying in health care affects the meaning of work.

PubMed

MacIntosh, Judith; Wuest, Judith; Gray, Marilyn Merritt; Cronkhite, Marcella

2010-08-01

Our purpose in this grounded theory study was to explore the impact of workplace bullying (WPB) on women working in health care. We analyzed interviews with 21 women, professionals and nonprofessionals. The women experienced a change in their meaning of work (MOW) when they had experienced WPB, and they addressed this change through a process we called the shifting meaning of work. This process has three stages. The first, developing insight, involves recognizing causes of changed MOW as external. In the second stage, resisting, women defend against changed MOW by sustaining acceptable MOW and work performances, and by confronting causes. In the final stage, rebuilding, women try to adapt and modify approaches to work by coming to terms, adjusting work attitudes, and investing in self. We identified implications of this process for managing health and work issues with women, health care providers, and employers.

Equity in health care utilization in Chile

PubMed Central

2013-01-01

One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile. The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992–2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index. Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly. PMID:23937894

Equity in health care utilization in Chile.

PubMed

Núñez, Alicia; Chi, Chunhuei

2013-08-12

One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile.The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992-2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index.Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly.

An Experimental Investigation of Possible Memory Biases Affecting Support for Racial Health Care Policy

PubMed Central

Brunner, Ryan P.

2012-01-01

Objectives. We aimed to test the theory that estimates of racial disparities may be based on small recalled samples of specific individuals (Black vs White), a strategy likely to lead to underestimates of true racial disparities and a corresponding opposition to race-focused health care policies. Methods. We asked a sample of White adults to list the first 5 Black and White individuals who came to mind, and then measured support for various race-focused health care policies. Results. Analyses indicated that the Black individuals recalled by participants tended to be more famous and wealthy than their White counterparts. Furthermore, the tendency to list wealthier Black individuals predicted opposition to progressive racial health care programs. A follow-up study demonstrated that support for certain race-focused health care policies could be increased by informing Whites of potential memory biases. Conclusions. The survival and success of minority health care policies depend partially on public acceptance. Education regarding continuing racial disparities may help to increase support for race-focused health care policies. PMID:22420789

Factors affecting motivation and retention of primary health care workers in three disparate regions in Kenya.

PubMed

Ojakaa, David; Olango, Susan; Jarvis, Jordan

2014-06-06

The World Health Organization (WHO) and the Government of Kenya alike identify a well-performing health workforce as key to attaining better health. Nevertheless, the motivation and retention of health care workers (HCWs) persist as challenges. This study investigated factors influencing motivation and retention of HCWs at primary health care facilities in three different settings in Kenya - the remote area of Turkana, the relatively accessible region of Machakos, and the disadvantaged informal urban settlement of Kibera in Nairobi. A cross-sectional cluster sample design was used to select 59 health facilities that yielded interviews with 404 health care workers, grouped into 10 different types of service providers. Data were collected in November 2011 using structured questionnaires and a Focus Group Discussion guide. Findings were analyzed using bivariate and multivariate methods of the associations and determinants of health worker motivation and retention. The levels of education and gender factors were lowest in Turkana with female HCWs representing only 30% of the workers against a national average of 53%. A smaller proportion of HCWs in Turkana feel that they have adequate training for their jobs. Overall, 13% of the HCWs indicated that they had changed their job in the last 12 months and 20% indicated that they could leave their current job within the next two years. In terms of work environment, inadequate access to electricity, equipment, transport, housing, and the physical state of the health facility were cited as most critical, particularly in Turkana. The working environment is rated as better in private facilities. Adequate training, job security, salary, supervisor support, and manageable workload were identified as critical satisfaction factors. Family health care, salary, and terminal benefits were rated as important compensatory factors. There are distinct motivational and retention factors that affect HCWs in the three regions. Findings and

Factors affecting motivation and retention of primary health care workers in three disparate regions in Kenya

PubMed Central

2014-01-01

Background The World Health Organization (WHO) and the Government of Kenya alike identify a well-performing health workforce as key to attaining better health. Nevertheless, the motivation and retention of health care workers (HCWs) persist as challenges. This study investigated factors influencing motivation and retention of HCWs at primary health care facilities in three different settings in Kenya - the remote area of Turkana, the relatively accessible region of Machakos, and the disadvantaged informal urban settlement of Kibera in Nairobi. Methods A cross-sectional cluster sample design was used to select 59 health facilities that yielded interviews with 404 health care workers, grouped into 10 different types of service providers. Data were collected in November 2011 using structured questionnaires and a Focus Group Discussion guide. Findings were analyzed using bivariate and multivariate methods of the associations and determinants of health worker motivation and retention. Results The levels of education and gender factors were lowest in Turkana with female HCWs representing only 30% of the workers against a national average of 53%. A smaller proportion of HCWs in Turkana feel that they have adequate training for their jobs. Overall, 13% of the HCWs indicated that they had changed their job in the last 12 months and 20% indicated that they could leave their current job within the next two years. In terms of work environment, inadequate access to electricity, equipment, transport, housing, and the physical state of the health facility were cited as most critical, particularly in Turkana. The working environment is rated as better in private facilities. Adequate training, job security, salary, supervisor support, and manageable workload were identified as critical satisfaction factors. Family health care, salary, and terminal benefits were rated as important compensatory factors. Conclusions There are distinct motivational and retention factors that affect

Familism and Health Care Provision to Hispanic Older Adults.

PubMed

Savage, Brittany; Foli, Karen J; Edwards, Nancy E; Abrahamson, Kathleen

2016-01-01

The Hispanic older adult population's rapid growth calls for an awareness of values that can affect the rendering and receipt of care. Familism, or familismo, a traditional Hispanic value, places importance of family over the self and can potentially affect health care perceptions and practices for Hispanic older adults. The current article discusses familism, which is upheld by some Hispanic older adults, and the potential for underuse of health care services. The traditional feminine role, marianismo, and masculine role, machismo, are considered, as well as implications for how decision making may be made by family members rather than the patient. Clinical implications for the provision of health care to Hispanic older adults are provided, along with the importance of considering acculturation and ethnic heterogeneity. Health care management strategies that reflect recognition and respect of familism, yet emphasize optimization of adherence and self-care, are described. Copyright 2016, SLACK Incorporated.

Health care reform: will quality remodeling affect obstetrician-gynecologists in addition to patients?

PubMed

von Gruenigen, Vivian E; Deveny, T Clifford

2011-05-01

The Patient Protection and Affordable Care Act is a federal statute that attempts to address many fundamental problems with the current health care system including the uninsured, rising health care costs, and quality care. Quality metrics have been in development for years (by private and governmental sectors), and momentum is growing. The purpose of this commentary is to explore quality changes in the way practicing obstetricians and gynecologists will be held accountable for quality service. Two new options being explored for health care, both focusing on improving quality and physician metrics, include value-based purchasing and accountable-care organizations. Both will likely consist of universal clinical algorithms and cost monitoring as measures. For obstetrics this will probably include physician's rates of cesarean deliveries and elective inductions. For gynecology this may comprise of indications for hysterectomy with documented failed medical management, minor surgical management, or both medical and minor surgical management. It is anticipated patients will no longer be able to request obstetric testing, pregnancy induction, or hysterectomy. It is imperative we, as obstetrician-gynecologists, are involved in health care reform that inevitably involves the care of women. The expectation is that the American Congress of Obstetricians and Gynecologists (ACOG) will further develop evidenced-based opinions and guidelines, as medical communities embrace ACOG documents and reference these in hospital policies and peer review.

Evolution of US Health Care Reform.

PubMed

Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A

2017-03-01

Major health policy creation or changes, including governmental and private policies affecting health care delivery are based on health care reform(s). Health care reform has been a global issue over the years and the United States has seen proposals for multiple reforms over the years. A successful, health care proposal in the United States with involvement of the federal government was the short-lived establishment of the first system of national medical care in the South. In the 20th century, the United States was influenced by progressivism leading to the initiation of efforts to achieve universal coverage, supported by a Republican presidential candidate, Theodore Roosevelt. In 1933, Franklin D. Roosevelt, a Democrat, included a publicly funded health care program while drafting provisions to Social Security legislation, which was eliminated from the final legislation. Subsequently, multiple proposals were introduced, starting in 1949 with President Harry S Truman who proposed universal health care; the proposal by Lyndon B. Johnson with Social Security Act in 1965 which created Medicare and Medicaid; proposals by Ted Kennedy and President Richard Nixon that promoted variations of universal health care. presidential candidate Jimmy Carter also proposed universal health care. This was followed by an effort by President Bill Clinton and headed by first lady Hillary Clinton in 1993, but was not enacted into law. Finally, the election of President Barack Obama and control of both houses of Congress by the Democrats led to the passage of the Affordable Care Act (ACA), often referred to as "ObamaCare" was signed into law in March 2010. Since then, the ACA, or Obamacare, has become a centerpiece of political campaigning. The Republicans now control the presidency and both houses of Congress and are attempting to repeal and replace the ACA. Key words: Health care reform, Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, American Health Care Act.

Factors associated with health care access and outcome.

PubMed

Paek, Min-So; Lim, Jung-Won

2012-01-01

This study aims to (1) assess ethnic differences in health care access and health outcome between Asian Americans and whites and between Asian American subgroups, (2) examine effects of cultural factors, and (3) investigate moderating effects of health risk behaviors between cultural characteristics and health care access and outcome. Data were derived from the 2007 California Health Interview Survey. Asian Americans (n = 4,462) and whites (n = 4,470) were included. There were significant ethnic differences in health care access and health perception between Asian Americans and Whites and across Asian American subgroups. Health risk behaviors moderated relationships between cultural factors and health care access and outcome. Findings reveal that ethnicity affects an individual's health care access and health perception, and their health behaviors are an important factor that may improve or worsen outcomes. This study may increase our knowledge base of research and interventions to enhance ethnic minority populations' health care accessibility and perceptions.

[How is the implementation of the new legal framework for health care affecting HIV-infected immigrants in an irregular situation in Spain?].

PubMed

Pérez-Molina, José A; Pulido, Federico

2015-01-01

The entry into force of Royal Decree (RD) 16/2012 in Spain in September 2012 led to the exclusion of the group of irregular immigrants from the National Healthcare System. With this work, GESIDA attempts to measure the impact of the entry into force of the RD in relation to its application by the Autonomous Communities (CCAA), and how it has affected the health care of irregular immigrants infected with HIV. Information was requested from the 17 CCAA of the existence of measures to ensure the care and treatment of people with HIV infection that were left unprotected because of the implementation of the RD. Likewise, a survey was conducted on health professionals and NGOs involved in the care of these people, to find out how it has affected the implementation of the RD to their daily healthcare work and the availability of information on regulations to implement it. The response of the CCAA was variable, hardly contributing, in some cases, to mitigate the negative effect of the RD. To this is added a complex bureaucracy to access the benefits offered by some regions, often inaccessible to the most vulnerable subjects. Lack of information for health-care professionals and NGOs involved in the care of immigrants, hinders access of this population to health care and the establishment of control measures for diseases with an impact on the public health. The RD 16/2012 has had a negative impact on daily healthcare working, generating the appearance of deep inequities throughout the country. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Wellness Programs: Preventive Medicine to Reduce Health Care Costs.

ERIC Educational Resources Information Center

Martini, Gilbert R., Jr.

1991-01-01

A wellness program is a formalized approach to preventive health care that can positively affect employee lifestyle and reduce future health-care costs. Describes programs for health education, smoking cessation, early detection, employee assistance, and fitness, citing industry success figures. (eight references) (MLF)

The health care home model: primary health care meeting public health goals.

PubMed

Grant, Roy; Greene, Danielle

2012-06-01

In November 2010, the American Public Health Association endorsed the health care home model as an important way that primary care may contribute to meeting the public health goals of increasing access to care, reducing health disparities, and better integrating health care with public health systems. Here we summarize the elements of the health care home (also called the medical home) model, evidence for its clinical and public health efficacy, and its place within the context of health care reform legislation. The model also has limitations, especially with regard to its degree of involvement with the communities in which care is delivered. Several actions could be undertaken to further develop, implement, and sustain the health care home.

Employer Satisfaction With an Injured Employee's Health Care: How Does It Affect the Selection of an Occupational Health Care Provider?

PubMed

Keleher, Myra P; Stanton, Marietta P

2016-01-01

The purpose of this article is to explore the most important factors that an employer utilizes in selecting an occupational health care provider for their employees injured on the job. The primary practice setting is the attending physician's office who is an occupational health care provider. The responding employers deemed "work restrictions given after each office visit" as their most important factor in selecting an occupational health care provider, with a score of 43. This was followed in order in the "very important" category by communication, appointment availability, employee return to work within nationally recognized guidelines, tied were medical provider professionalism and courtesy with diagnostics ordered timely, next was staff professionalism and courtesy, and tied with 20 responses in the "very important" category were wait time and accurate billing by the provider.The selection of an occupational health care provider in the realm of workers' compensation plays a monumental role in the life of a claim for the employer. Safe and timely return to work is in the best interest of the employer and their injured employee. For the employer, it can represent hard dollars saved in indemnity payments and insurance premiums when the employee can return to some form of work. For the injured employee, it can have a positive impact on their attitude of going back to work as they will feel they are a valued asset to their employer. The case managers, who are the "eyes and ears" for the employer in the field of workers' compensation, have a valuable role in a successful outcome of dollars saved and appropriate care rendered for the employees' on the job injury. The employers in the study were looking for case managers who could ensure their employees received quality care but that this care is cost-effective. The case manager can be instrumental in assisting the employer in developing and monitoring a "stay-at-work" program, thereby reducing the financial exposure

The Affordable Care Act and Implications for Health Care Services for American Indian and Alaska Native Individuals

PubMed Central

Ross, Raven E.; Garfield, Lauren D.; Brown, Derek S.; Raghavan, Ramesh

2016-01-01

American Indian and Alaska Native (AI/AN) populations report poor physical and mental health outcomes while tribal health providers and the Indian Health Service (IHS) operate in a climate of significant under funding. Understanding how the Patient Protection and Affordable Care Act (ACA) affects Native American tribes and the IHS is critical to addressing the improvement of the overall access, quality, and cost of health care within AI/AN communities. This paper summarizes the ACA provisions that directly and/or indirectly affect the service delivery of health care provided by tribes and the IHS. PMID:26548665

Stakeholder management in a hyperturbulent health care environment.

PubMed

Rotarius, T; Liberman, A

2000-12-01

The fast-paced change in today's health care environment presents an unsettling organizational climate within which managers must make important decisions that affect key stakeholders. This ambiguousness has resulted in the proliferation of health care organizations that are bundling together to find a sense of environmental stability in which they can achieve common goals. This means that health care managers need to view stakeholders as parts of larger bundles rather than only as individual organizations.

The Employer-Led Health Care Revolution.

PubMed

McDonald, Patricia A; Mecklenburg, Robert S; Martin, Lindsay A

2015-01-01

To tame its soaring health care costs, intel tried many popular approaches: "consumer-driven health care" offerings such as high-deductible/low-premium plans, on-site clinics and employee wellness programs. But by 2009 intel realized that those programs alone would not enable the company to solve the problem, because they didn't affect its root cause: the steadily rising cost of the care employees and their families were receiving. Intel projected that its health care expenditures would hit a whopping $1 billion by 2012. So the company decided to try a novel approach. As a large purchaser of health services and with expertise in quality improvement and supplier management, intel was uniquely positioned to drive transformation in its local health care market. The company decided that it would manage the quality and cost of its health care suppliers with the same rigor it applied to its equipment suppliers by monitoring quality and cost. It spearheaded a collaborative effort in Portland, Oregon, that included two health systems, a plan administrator, and a major government employer. So far the Portland collaborative has reduced treatment costs for certain medical conditions by 24% to 49%, improved patient satisfaction, and eliminated over 10,000 hours worth of waste in the two health systems' business processes.

Understanding and managing change in health care organizations.

PubMed

Nagaike, K

1997-01-01

Change impacts affected people and often causes difficulties. Health care organizations, locally and nationally, have undergone tremendous change to deliver quality services in a more effective and efficient manner in a competitive environment, with varying degrees of success. This article presents Robbins's categories of change and relates them to current changes in health care organizations. It discusses areas to consider to develop adaptable plans and to assist affected employees to better deal with these changes throughout the transition.

Revitalizing primary health care--another utopian goal?

PubMed

Marahatta, Sujan B

2010-01-01

The quest for greater efficiency, fairness and responsiveness to the expectation of the people that system serve have brought about three generations of health system reforms in the twentieth century. The first generation saw the founding of national health care systems and extension to middle income nations of social insurance systems in the 1940s and 1950s. By the late 1960s the rising costs of hospital based care, its usage by better off, inaccessibility by the poor and rural population of even the most basic services heralded second generation reforms promoting primary health care as a means of achieving the affordable universal coverage. It included the best public health strategy that is prevention and the highest ethical principle of public health that is equity. It was expected the best system for reaching households with essential and affordable care, and the best route towards universal coverage. The primary health care approach though adopted universally did not materialize its notion of translating ethos of Health for All by 2000. Overall, primary health care movement by the end of 20th century became lifeless. Since the Declaration of Alma-Ata, fundamental changes have occurred affecting health service delivery, such as economic development and financing approaches, globalization of trade and knowledge, and the shift to privatization. This is the time to develop a new vision, taking into consideration the many changes affecting global health and the strategic developments in health of recent years. With this recognition, the third generation of reforms now underway in many countries is driven by the idea of responding more to demand, assuring access for the poor and emphasizing financing rather than just provision within the public sector. The key concern is: how to translate ethos of revitalizing in the reality. Otherwise the revitalizing concept will turn into utopian goal so like HFA by 2000 strategy.

Financing of pediatric home health care. Committee on Child Health Financing, Section on Home Care, American Academy of Pediatrics.

PubMed

2006-08-01

In certain situations, home health care has been shown to be a cost-effective alternative to inpatient hospital care. National health expenditures reveal that pediatric home health costs totaled $5.3 billion in 2000. Medicaid is the major payer for pediatric home health care (77%), followed by other public sources (22%). Private health insurance and families each paid less than 1% of pediatric home health expenses. The most important factors affecting access to home health care are the inadequate supply of clinicians and ancillary personnel, shortages of home health nurses with pediatric expertise, inadequate payment, and restrictive insurance and managed care policies. Many children must stay in the NICU, PICU, and other pediatric wards and intermediate care areas at a much higher cost because of inadequate pediatric home health care services. The main financing problem pertaining to Medicaid is low payment to home health agencies at rates that are insufficient to provide beneficiaries access to home health services. Although home care services may be a covered benefit under private health plans, most do not cover private-duty nursing (83%), home health aides (45%), or home physical, occupational, or speech therapy (33%) and/or impose visit or monetary limits or caps. To advocate for improvements in financing of pediatric home health care, the American Academy of Pediatrics has developed several recommendations for public policy makers, federal and state Medicaid offices, private insurers, managed care plans, Title V officials, and home health care professionals. These recommendations will improve licensing, payment, coverage, and research related to pediatric home health services.

Confronting AIDS. Directions for Public Health, Health Care, and Research.

ERIC Educational Resources Information Center

Institute of Medicine (NAS), Washington, DC.

This book is addressed to anyone involved with or affected by the Acquired Immune Deficiency Syndrome (AIDS) epidemic, including legislators, researchers, health care personnel, insurance providers, educators, health officials, executives in the pharmaceutical industry, blood bank administrators, and other concerned individuals. The following…

Does patient-provider gender concordance affect mental health care received by primary care patients with major depression?

PubMed

Chan, Kitty S; Bird, Chloe E; Weiss, Robert; Duan, Naihua; Meredith, Lisa S; Sherbourne, Cathy D

2006-01-01

We sought to determine whether patient-provider gender concordance influences the detection and care of depression and comorbid anxiety and substance use in patients with major depression Cross-sectional analyses of baseline patient survey data linked with provider data were performed. Data based on routine primary care visits in clinics from a variety of health systems serving diverse patient populations across the United States. Participants all had major depression. Depression care was examined in the Quality Improvement for Depression (QID) Collaboration sample (n patients = 1,428, n providers = 389). In a subanalysis of data solely from 714 patients and 157 providers from Partners-In-Care, one of the projects participating in QID, we also examined detection of anxiety disorder and alcohol or drug problems. Rates of detection and care of mental health problems in primary care were low even among patients with major depression. Except for anxiety counseling in female patients, patient-provider gender concordance did not improve care as hypothesized. However, female providers were more likely to counsel on anxiety and less likely to counsel on alcohol or drug use than male providers. Female patients were less likely to be counseled on alcohol or drug use compared with male patients. Detection and care of mental health and substance use problems for patients with major depression is not influenced by patient-provider gender concordance. However, depressed female patients may have greater unmet needs for alcohol and drug use counseling than their male counterparts.

Does Access to Care Still Affect Health Care Utilization by Immigrants? Testing of an Empirical Explanatory Model of Health Care Utilization by Korean American Immigrants with High Blood Pressure

PubMed Central

Han, Hae-Ra; Lee, Jong-Eun; Kim, Ji-Yun; Kim, Kim B.; Ryu, Jai Poong; Kim, Miyong

2015-01-01

Despite well-known benefits of health care utilization for the effective management of chronic diseases, the underlying mechanism of understanding health care utilization in ethnic minority population has not been systematically explored. The purpose of this paper is to examine the predictive ability of a health care utilization model by analyzing the interplay between predisposing, enabling, and need factors. The sample consisted of hypertensive Korean American immigrants (KAIs) 40–64 years of age who participated in a self-help intervention for high blood pressure care (SHIP-HBP). Using structured questionnaires, data were collected from 445 KAIs at baseline and analyzed with path analysis. Insurance status and relevant medical history were not just strong direct effects but also carried the most total effect on the health care utilization of these patients. Life priorities, years of residence in the US and perceived income level exerted indirect effects through the participants’ insurance status. Our statistical analysis indicated a good fit for the proposed model (x2 = 28.4, P = 0.29; NFI = 0.91; CFI = 0.99; RMSEA = 0.02). Overall, the model explained 18% of the variance in health care utilization of hypertensive KAIs. These findings strongly support a need to improve access to health care for KAIs by introducing a variety of community resources and building sustainable community infrastructures. PMID:19649709

[Aspects of economic responsibility in health care].

PubMed

Hauke, Eugen

2007-01-01

According to the final consensus of a panel of intense discussions, the health care system should/can not be excluded from the economic laws of efficiency. Appropriate adaptation of various methods and instruments of economics make these tools applicable for use in the health care system. Due to errors in the implementation of economic methods, though, the question arises who is economically responsible in the health care system. The answer is found at three different levels of the health care system. The physician plays a leading role, both personally and professionally, in being primarily responsible for the direct medical treatment of the patient. The physician's dependence, however, on the health care system reduces his independence, which markedly affects his decision-making and treatment. Management of and in health care institutions is largely independent of the profession learned. Managers and physicians acting as managers must be appropriately and duly educated in the necessary specific talents and knowledge. The organisation of a health care system should also be reserved for trained specialists where the physicians as well as other professionals are obliged to acquire the skills necessary.

Health Care Access and Utilization after the 2010 Pakistan Floods.

PubMed

Jacquet, Gabrielle A; Kirsch, Thomas; Durrani, Aqsa; Sauer, Lauren; Doocy, Shannon

2016-10-01

Introduction The 2010 floods submerged more than one-fifth of Pakistan's land area and affected more than 20 million people. Over 1.6 million homes were damaged or destroyed and 2,946 direct injuries and 1,985 deaths were reported. Infrastructure damage was widespread, including critical disruptions to the power and transportation networks. Hypothesis Damage and loss of critical infrastructure will affect the population's ability to seek and access adequate health care for years to come. This study sought to evaluate factors associated with access to health care in the aftermath of the 2010 Pakistan floods. A population-proportional, randomized cluster-sampling survey method with 80 clusters of 20 (1,600) households of the flood-affected population was used. Heads of households were surveyed approximately six months after flood onset. Multivariate analysis was used to determine significance. A total of 77.8% of households reported needing health services within the first month after the floods. Household characteristics, including rural residence location, large household size, and lower pre- and post-flood income, were significantly associated (P<.05) with inadequate access to health care after the disaster. Households with inadequate access to health care were more likely to have a death or injury in the household. Significantly higher odds of inadequate access to health care were observed in rural populations (adjusted OR 4.26; 95% CI, 1.89-9.61). Adequate health care access after the 2010 Pakistani floods was associated with urban residence location, suggesting that locating health care providers in rural areas may be difficult. Access to health services also was associated with post-flood income level, suggesting health resources are not readily available to households suffering great income losses. Jacquet GA , Kirsch T , Durrani A , Sauer L , Doocy S . Health care access and utilization after the 2010 Pakistan floods. Prehosp Disaster Med. 2016;31(5):485-491.

The Impact of Disasters on Populations With Health and Health Care Disparities

PubMed Central

Davis, Jennifer R.; Wilson, Sacoby; Brock-Martin, Amy; Glover, Saundra; Svendsen, Erik R.

2010-01-01

Context A disaster is indiscriminate in whom it affects. Limited research has shown that the poor and medically underserved, especially in rural areas, bear an inequitable amount of the burden. Objective To review the literature on the combined effects of a disaster and living in an area with existing health or health care disparities on a community’s health, access to health resources, and quality of life. Methods We performed a systematic literature review using the following search terms: disaster, health disparities, health care disparities, medically underserved, and rural. Our inclusion criteria were peer-reviewed, US studies that discussed the delayed or persistent health effects of disasters in medically underserved areas. Results There has been extensive research published on disasters, health disparities, health care disparities, and medically underserved populations individually, but not collectively. Conclusions The current literature does not capture the strain of health and health care disparities before and after a disaster in medically underserved communities. Future disaster studies and policies should account for differences in health profiles and access to care before and after a disaster. PMID:20389193

Health care professional development: Working as a team to improve patient care

PubMed Central

El Husseini, Maha; Al Nemri, Abdurrahman; Al Frayh, Abdurrahman; Al Juryyan, Nasir; Faki, Mohamed O; Assiri, Asaad; Al Saadi, Muslim; Shaikh, Farheen; Al Zamil, Fahad

2014-01-01

In delivering health care, an effective teamwork can immediately and positively affect patient safety and outcome. The need for effective teams is increasing due to increasing co-morbidities and increasing complexity of specialization of care. Time has gone when a doctor or a dentist or any other health practitioner in whatsoever health organization would be able to solely deliver a quality care that satisfies his or her patients. The evolution in health care and a global demand for quality patient care necessitate a parallel health care professional development with a great focus on patient centred teamwork approach. This can only be achieved by placing the patient in the centre of care and through sharing a wide based culture of values and principles. This will help forming and developing an effective team able to deliver exceptional care to the patients. Aiming towards this goal, motivation of team members should be backed by strategies and practical skills in order to achieve goals and overcome challenges. This article highlights values and principles of working as a team and principles and provides team players with a practical approach to deliver quality patient care. PMID:27493399

Health care professional development: Working as a team to improve patient care.

PubMed

Babiker, Amir; El Husseini, Maha; Al Nemri, Abdurrahman; Al Frayh, Abdurrahman; Al Juryyan, Nasir; Faki, Mohamed O; Assiri, Asaad; Al Saadi, Muslim; Shaikh, Farheen; Al Zamil, Fahad

2014-01-01

In delivering health care, an effective teamwork can immediately and positively affect patient safety and outcome. The need for effective teams is increasing due to increasing co-morbidities and increasing complexity of specialization of care. Time has gone when a doctor or a dentist or any other health practitioner in whatsoever health organization would be able to solely deliver a quality care that satisfies his or her patients. The evolution in health care and a global demand for quality patient care necessitate a parallel health care professional development with a great focus on patient centred teamwork approach. This can only be achieved by placing the patient in the centre of care and through sharing a wide based culture of values and principles. This will help forming and developing an effective team able to deliver exceptional care to the patients. Aiming towards this goal, motivation of team members should be backed by strategies and practical skills in order to achieve goals and overcome challenges. This article highlights values and principles of working as a team and principles and provides team players with a practical approach to deliver quality patient care.

Mental Health Nurses Attitudes and Practice Toward Physical Health Care in Jordan.

PubMed

Ganiah, Amal N; Al-Hussami, Mahmoud; Alhadidi, Majdi M B

2017-08-01

Patients with mental illnesses are at high risk for physical disorders and death. The aim of this study is to describe mental health nurses' attitudes and practice toward physical health care for patients with mental illnesses. A descriptive cross-sectional design was used to collect data using self- reported questionnaire from 202 mental health nurses working in mental health settings in Jordan. The study adopted translated version of Robson and Haddad Physical Health Attitudes Scale to the Arabic language. There was significant positive correlation between the participants' positive attitudes and their current practice (r = .388, p = .000), mental health nurses who have more positive attitudes regarding physical health care involved physical health care more in their current practice. Mental health nurses' attitudes affect the quality of care provided to patients with mental illnesses. The results provide implications for practice, education, and research.

Perceived benefits and barriers and self-efficacy affecting the attendance of health education programs among uninsured primary care patients.

PubMed

Kamimura, Akiko; Nourian, Maziar M; Jess, Allison; Chernenko, Alla; Assasnik, Nushean; Ashby, Jeanie

2016-12-01

Lifestyle interventions have shown to be effective in improving health status, health behaviors, and self-efficacy. However, recruiting participants to health education programs and ensuring the continuity of health education for underserved populations is often challenging. The goals of this study are: to describe the attendance of health education programs; to identify stages of change to a healthy lifestyle; to determine cues to action; and to specify factors affecting perceived benefits and barriers to healthy food choices and physical activity among uninsured primary care patients. Uninsured primary care patients utilizing a free clinic (N=621) completed a self-administered survey from September to December of 2015. US born English speakers, non-US born English speakers, and Spanish speakers reported different kinds of cues to action in attending health education programs. While self-efficacy increases perceived benefits and decreases perceived barriers for physical activity, it increases both perceived benefits and perceived barriers for healthy food choices. The participants who had attended health education programs did not believe that there were benefits for healthy food choices and physical activity. This study adds to the body of literature on health education for underserved populations. Copyright © 2016 Elsevier Ltd. All rights reserved.

Men's Preconception Health: A Primary Health-Care Viewpoint.

PubMed

O'Brien, Anthony Paul; Hurley, John; Linsley, Paul; McNeil, Karen Anne; Fletcher, Richard; Aitken, John Robert

2018-05-01

The purpose of this article is to theoretically explore men's preconception health as a mechanism to enhance fertility, as well as the health and well-being of the subject and his descendants. Premorbid risk factors and behaviors associated with stress, environmental toxins, excessive alcohol consumption, smoking, lack of exercise/obesity, and the use of illicit drugs are all known to affect fecundity. While there are many health clinics available to women, where advice in areas such as postnatal care of the newborn, family planning, and couples fertility is provided, there are few, if any, equivalent health clinics available to men. Additionally, getting men to attend primary health-care services has also been continuously problematic, even in the context of there being a clearly discernible need for treatment. It is argued in this article that an impetus is required to encourage men to focus on and improve their preconception health and to utilize primary health-care services to take action. An assertive men's preconception health outlook can positively influence the conjugal relationship, fathering, male self-esteem, and continued good health. Using the sometimes complex concept of preconception health as a motivating factor for healthy lifestyle adaptation has the potential to improve male fertility outcomes and general health and well-being, as well as the health of future generations.

The role of wages in the migration of health care professionals from developing countries

PubMed Central

Vujicic, Marko; Zurn, Pascal; Diallo, Khassoum; Adams, Orvill; Dal Poz, Mario R

2004-01-01

Several countries are increasingly relying on immigration as a means of coping with domestic shortages of health care professionals. This trend has led to concerns that in many of the source countries – especially within Africa – the outflow of health care professionals is adversely affecting the health care system. This paper examines the role of wages in the migration decision and discusses the likely effect of wage increases in source countries in slowing migration flows. This paper uses data on wage differentials in the health care sector between source country and receiving country (adjusted for purchasing power parity) to test the hypothesis that larger wage differentials lead to a larger supply of health care migrants. Differences in other important factors affecting migration are discussed and, where available, data are presented. There is little correlation between the supply of health care migrants and the size of the wage differential between source and destination country. In cases where data are available on other factors affecting migration, controlling for these factors does not affect the result. At current levels, wage differentials between source and destination country are so large that small increases in health care wages in source countries are unlikely to affect significantly the supply of health care migrants. The results suggest that non-wage instruments might be more effective in altering migration flows. PMID:15115549

Do governance, equity characteristics, and venture capital nvolvement affect long-term wealth creation in U.S. health care and biotechnology IPOs?

PubMed

Williams, David R; Duncan, W Jack; Ginter, Peter M; Shewchuk, Richard M

2006-01-01

Agency theory remains the dominant means of examining governance issues and ownership characteristics related to large organizations. Research in these areas within large organizations has increased our understanding, yet little is known about the influence that these mechanisms and characteristics have had on IPO firm performance. This study tests an agency perspective that venture capital involvement, governance and equity characteristics affect health care and biotechnology IPO firm performance. Our results indicate that there is no correlation between these factors and health care and biotechnology IPO wealth creation. For these entrepreneurs, our findings suggest a contingent approach for the use of these mechanisms.

A Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Health-care Professionals. A Call for Action.

PubMed

Moss, Marc; Good, Vicki S; Gozal, David; Kleinpell, Ruth; Sessler, Curtis N

2016-07-01

Burnout syndrome (BOS) occurs in all types of health-care professionals and is especially common in individuals who care for critically ill patients. The development of BOS is related to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. BOS is associated with many deleterious consequences, including increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other health-care professionals who practice worldwide. Until recently, BOS and other psychological disorders in critical care health-care professionals remained relatively unrecognized. To raise awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed this call to action. The present article reviews the diagnostic criteria, prevalence, causative factors, and consequences of BOS. It also discusses potential interventions that may be used to prevent and treat BOS. Finally, we urge multiple stakeholders to help mitigate the development of BOS in critical care health-care professionals and diminish the harmful consequences of BOS, both for critical care health-care professionals and for patients.

Transition Care for Children With Special Health Care Needs

PubMed Central

Davis, Alaina M.; Brown, Rebekah F.; Taylor, Julie Lounds; Epstein, Richard A.

2014-01-01

BACKGROUND: Approximately 750 000 children in the United States with special health care needs will transition from pediatric to adult care annually. Fewer than half receive adequate transition care. METHODS: We had conversations with key informants representing clinicians who provide transition care, pediatric and adult providers of services for individuals with special health care needs, policy experts, and researchers; searched online sources for information about currently available programs and resources; and conducted a literature search to identify research on the effectiveness of transition programs. RESULTS: We identified 25 studies evaluating transition care programs. Most (n = 8) were conducted in populations with diabetes, with a smaller literature (n = 5) on transplant patients. We identified an additional 12 studies on a range of conditions, with no more than 2 studies on the same condition. Common components of care included use of a transition coordinator, a special clinic for young adults in transition, and provision of educational materials. CONCLUSIONS: The issue of how to provide transition care for children with special health care needs warrants further attention. Research needs are wide ranging, including both substantive and methodologic concerns. Although there is widespread agreement on the need for adequate transition programs, there is no accepted way to measure transition success. It will be essential to establish consistent goals to build an adequate body of literature to affect practice. PMID:25287460

Starting a health care system green team.

PubMed

Mejia, Elisa A; Sattler, Barbara

2009-07-01

The health care industry is often overlooked as a major source of industrial pollution, but as this becomes more recognized, many health care facilities are beginning to pursue green efforts. The OR is a prime example of an area of health care that is working to lessen its environmental impact. Nurses can play key roles in identifying areas of waste and presenting ideas about recovering secondary materials. For instance, although infection prevention measures encourage one-time use of some products, nurses can investigate how to reprocess these items so they can be reused. This article examines how the efforts of a Green Team can affect a hospital's waste stream. A health care Green Team can facilitate a medical facility's quest for knowledge and awareness of its effect on the waste stream and environment.

Eldercare work, migrant care workers, affective care and subjective proximity.

PubMed

Lovelock, Kirsten; Martin, Greg

2016-08-01

To document and explore the experience of migrant care workers providing health and social care to the elderly in institutional care settings and in the homes of the elderly in the community in New Zealand with a particular focus on the affective components of care work. This qualitative study involved conducting face-to-face, open-ended, semi-structured interviews with 29 migrant care workers in the eldercare sector in the cities of Auckland and Wellington, New Zealand. Participants were recruited through various agencies focusing on aged care and engaged with migrant eldercare workers and snowballing through participant referral. Sample size was determined when saturation was reached. The interviews were audio recorded, transcribed verbatim, themes were identified and then analysed drawing on a body of theoretical work in the fields of emotional anthropology and moral geography and the international empirical literature addressing migrant eldercare workers. As with the international research in this field we found that these workers were vulnerable to exploitation, the workforce is largely feminised and stereotypical understandings of racial groups and national characteristics informed recruitment and the workplace experience. Here attributing gradients of affect to particular migrant groups in the workforce was the main mechanism employed to establish worker worth and difference. Identifying with these gradients of affect enabled these eldercare workers to demonstrate that they met the moral and ethical requirements of permanent residency and ultimately citizenship. Eldercare workers in the home were vulnerable to 'blurred emotional boundaries' and care recipient demand for greater emotional commitment. The migrant eldercare workers in this study all shared vulnerable residential status and many feared they would never obtain permanent residency or citizenship. All had family who remained in the Philippines and towards whom they had an obligation to substitute

The Catch to Confidentiality: The Use of Electronic Health Records in Adolescent Health Care.

PubMed

Stablein, Timothy; Loud, Keith J; DiCapua, Christopher; Anthony, Denise L

2018-05-01

This study aims to understand pediatric health-care providers' expectations and the practices they employ to protect confidentiality in electronic health records (EHRs) and subsequently how EHRs affect the documentation and dissemination of information in the course of health-care delivery to adolescent minors. Twenty-six pediatric health-care providers participated in in-depth interviews about their experiences using EHRs to understand a broad spectrum of expectations and practices guiding the documentation and dissemination of information in the EHR. A thematic analysis of interviews was conducted to draw findings and conclusions. Two themes and several subthemes emerged centering on how EHRs affected confidentiality expectations and practices. Participants expressed confidentiality concerns due to the EHR's longevity as a legacy record, its multidimensional uses, and increased access by users (theme 1). These concerns affected practices for protecting adolescent confidentiality within the EHR (theme 2). Practices included selectively omitting or concealing information and utilizing sets of personal and collective codes designed to alert providers or teams of providers to confidential information within a patient's record. EHRs create new and unresolved challenges for pediatric health care as they alter expectations of confidentiality and the documentation and dissemination of information within the record. This is particularly relevant in the course of care to adolescent minors as EHRs may compromise the tenuous balance providers maintain between protecting confidentiality and effective documentation within the record. Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Health care use, drug treatment and comorbidity in patients with schizophrenia or non-affective psychosis in Sweden: a cross-sectional study.

PubMed

Brostedt, Erica M; Msghina, Mussie; Persson, Marie; Wettermark, Björn

2017-12-29

This study investigated the prevalence of schizophrenia (ICD-10 F 20) and of other non-affective psychosis (NAP, ICD-10 F 21 - F 29) in Sweden. It further assessed health care use, comorbidity and medication for these patient groups. Most studies either have a study population of patients with strictly defined schizophrenia or a psychosis population of which strict schizophrenia cases form a smaller set. The present study permits comparison of the two mutually exclusive patient groups using data at the individual level in the diagnosis of non-affective psychosis, use of health care, medical treatment and comorbidity by diagnosis or medical treatment. In 2012, data were extracted from a regional registry containing patient-level data on consultations, hospitalisations, diagnoses and dispensed drugs for the total population in the region of Stockholm (2.1 million inhabitants). The size of the total psychosis population was 18,769, of which 7284 had a diagnosis of schizophrenia. Crude prevalence rates and risk rates with 95% confidence intervals were calculated. In 2012, the prevalence of schizophrenia and NAP was 3.5/1000 and 5.5/1000, respectively. Schizophrenia was most common among patients aged 50-59 years and NAP most common among patients aged 40-49 years. Schizophrenia patients used psychiatric health care more often than the NAP patients but less overall inpatient care (78.6 vs. 60.0%). The most prevalent comorbidities were substance abuse/dependence (7.9% in the schizophrenia group vs. 11.7% in the NAP group), hypertension (7.9 vs. 9.7%) and diabetes (6.9 vs. 4.8%). The parenteral form of long-acting injectable antipsychotics was more often dispensed to patients with schizophrenia (10 vs. 2%). This study, analysing all diagnoses recorded in a large health region, confirmed prevalence rates found in previous studies. Schizophrenia patients use more psychiatric and less overall inpatient health care than NAP patients. Differences between the two patient

Open Source, Open Standards, and Health Care Information Systems

PubMed Central

2011-01-01

Recognition of the improvements in patient safety, quality of patient care, and efficiency that health care information systems have the potential to bring has led to significant investment. Globally the sale of health care information systems now represents a multibillion dollar industry. As policy makers, health care professionals, and patients, we have a responsibility to maximize the return on this investment. To this end we analyze alternative licensing and software development models, as well as the role of standards. We describe how licensing affects development. We argue for the superiority of open source licensing to promote safer, more effective health care information systems. We claim that open source licensing in health care information systems is essential to rational procurement strategy. PMID:21447469

Open source, open standards, and health care information systems.

PubMed

Reynolds, Carl J; Wyatt, Jeremy C

2011-02-17

Recognition of the improvements in patient safety, quality of patient care, and efficiency that health care information systems have the potential to bring has led to significant investment. Globally the sale of health care information systems now represents a multibillion dollar industry. As policy makers, health care professionals, and patients, we have a responsibility to maximize the return on this investment. To this end we analyze alternative licensing and software development models, as well as the role of standards. We describe how licensing affects development. We argue for the superiority of open source licensing to promote safer, more effective health care information systems. We claim that open source licensing in health care information systems is essential to rational procurement strategy.

Oral Health of Drug Abusers: A Review of Health Effects and Care

PubMed Central

SHEKARCHIZADEH, Hajar; KHAMI, Mohammad R.; MOHEBBI, Simin Z.; EKHTIARI, Hamed; VIRTANEN, Jorma I.

2013-01-01

Abstract Oral health problems, among the most prevalent comorbidities related to addiction, require more attention by both clinicians and policy-makers. Our aims were to review oral complications associated with drugs, oral health care in addiction rehabilitation, health services available, and barriers against oral health promotion among addicts. Drug abuse is associated with serious oral health problems including generalized dental caries, periodontal diseases, mucosal dysplasia, xerostomia, bruxism, tooth wear, and tooth loss. Oral health care has positive effects in recovery from drug abuse: patients’ need for pain control, destigmatization, and HIV transmission. Health care systems worldwide deliver services for addicts, but most lack oral health care programs. Barriers against oral health promotion among addicts include difficulty in accessing addicts as a target population, lack of appropriate settings and of valid assessment protocols for conducting oral health studies, and poor collaboration between dental and general health care sectors serving addicts. These interfere with an accurate picture of the situation. Moreover, lack of appropriate policies to improve access to dental services, lack of comprehensive knowledge of and interest among dental professionals in treating addicts, and low demand for non-emergency dental care affect provision of effective interventions. Management of drug addiction as a multi-organ disease requires a multidisciplinary approach. Health care programs usually lack oral health care elements. Published evidence on oral complications related to addiction emphasizes that regardless of these barriers, oral health care at various levels including education, prevention, and treatment should be integrated into general care services for addicts. PMID:26060654

Factors affecting rural volunteering in palliative care - an integrated review.

PubMed

Whittall, Dawn; Lee, Susan; O'Connor, Margaret

2016-12-01

To review factors shaping volunteering in palliative care in Australian rural communities using Australian and International literature. Identify gaps in the palliative care literature and make recommendations for future research. A comprehensive literature search was conducted using Proquest, Scopus, Sage Premier, Wiley online, Ovid, Cochran, Google Scholar, CINAHL and Informit Health Collection. The literature was synthesised and presented in an integrated thematic narrative. Australian Rural communities. While Australia, Canada, the United States (US) and the United Kingdom (UK) are leaders in palliative care volunteer research, limited research specifically focuses on volunteers in rural communities with the least occurring in Australia. Several interrelated factors influence rural palliative care provision, in particular an increasingly ageing population which includes an ageing volunteer and health professional workforce. Also current and models of palliative care practice fail to recognise the innumerable variables between and within rural communities such as distance, isolation, lack of privacy, limited health care services and infrastructure, and workforce shortages. These issues impact palliative care provision and are significant for health professionals, volunteers, patients and caregivers. The three key themes of this integrated review include: (i) Geography, ageing rural populations in palliative care practice, (ii) Psychosocial impact of end-end-of life care in rural communities and (iii) Palliative care models of practice and volunteering in rural communities. The invisibility of volunteers in rural palliative care research is a concern in understanding the issues affecting the sustainability of quality palliative care provision in rural communities. Recommendations for future Australian research includes examination of the suitability of current models of palliative care practice in addressing the needs of rural communities; the recruitment

Health care and equity in India

PubMed Central

Balarajan, Yarlini; Selvaraj, S; Subramanian, S V

2011-01-01

India’s health system faces the ongoing challenge of responding to the needs of the most disadvantaged members of Indian society. Despite progress in improving access to health care, inequalities by socioeconomic status, geography and gender continue to persist. This is compounded by high out-of-pocket expenditures, with the rising financial burden of health care falling overwhelming on private households, which account for more than three-quarter of health spending in India. Health expenditures are responsible for more than half of Indian households falling into poverty; the impact of this has been increasing pushing around 39 million Indians into poverty each year. In this paper, we identify key challenges to equity in service delivery, and equity in financing and financial risk protection in India. These include imbalanced resource allocation, limited physical access to quality health services and inadequate human resources for health; high out-of-pocket health expenditures, health spending inflation, and behavioral factors that affect the demand for appropriate health care. Complementing other paper in this Series, we argue for the application of certain principles in the pursuit of equity in health care in India. These are the adoption of equity metrics in monitoring, evaluation and strategic planning, investment in developing a rigorous knowledge-base of health systems research; development of more equity-focused process of deliberative decision-making in health reform, and redefinition of the specific responsibilities and accountabilities of key actors. The implementation of these principles, together with strengthening of public health and primary care services, provide an approach for ensuring more equitable health care for India’s population. PMID:21227492

Health care consumerism: incentives, behavior change and uncertainties.

PubMed

Domaszewicz, Sander; Havlin, Linda; Connolly, Susan

2010-01-01

Employers affected by the recession's 2009 peak must press for cost containment in 2010, especially in health care benefits. Encouraging employee consumerism--through consumer-directed health plans and other strategies--can be enhanced by incentives, but federal efforts at health care reform add some element of uncertainty to the consumer-directed solution. This article provides some lessons to guide the course of action for employers considering implementing a consumerist approach to improve employee health and control the cost trend.

Measuring competition in health care markets.

PubMed Central

Baker, L C

2001-01-01

OBJECTIVE: Measuring competition is increasingly important for analysis of health care markets and policies. Measurement of competition in health care is made complex by the breadth of potential issues under study, by the lack of necessary data, and by rapid changes in health care financing and delivery. This study reviews key issues in the measurement of competition and is designed to familiarize researchers and policymakers interested in competition measurement, but not steeped in its practice, with key concepts, data sources, and ways of adapting measures to fit ongoing changes in health care markets. PRINCIPAL FINDINGS: Attention to several key issues will strengthen measurement. Important components of successful measurement are: careful identification of the products and market areas for study; selection of Herfindahl-Hirschman or other indices to fit the issues being considered; consideration of econometric problems, like endogeneity, with common measures; and attention to the ways that current marketplace changes, like growth in managed care, affect the performance of classic measures. Data needed for constructing measures are also frequently scarce, insufficient, or both. Measurement could be improved with access to better data. PMID:11327175

[Primary care in maternal-child health].

PubMed

Pedreira Massa, J L

1986-07-01

The theoretical and methodological elements of primary health care (PHC) include a philosophy of work and an epistemological focus toward the processes of health and illness, as well as a practical medical anthropological knowledge of the culture-specific aspects of disease. The work methodology of PHC requires care of the individual as a bio-psycho-socio-affective being integrated into a particular environment; none of the aspects of being should be neglected or given priority. Care should also be integrated in the sense of providing preventive health care as well as curative and rehabilitative services, in all phases from training of health personnel to record keeping. The primary health care team is multidisciplinary in constitution and interdisciplinary in function. PHC assumes that health care will be accessible to users and that continuity of care will be provided. The need for community participation in all phases of health care has been reiterated in several international health declarations. A well-functioning PHC system will require new types of pre- and postgraduate health education in a changing social and professional system and continuing education under adequate supervision for health workers. Research capability for identifying community health problems, a rigorous evaluation system, and epidemiologic surveillance are also needed. All of these elements are applicable to the field of maternal and child health as well as to PHC. The most appropriate place to intervene in order to correct existing imbalances in access to health care for mothers and children is in the PHC system. Examples of areas that should be stressed include vaccinations, nutrition, psychomotor development, early diagnosis and treatment for handicapped children, prevention of childhood accidents, school health and absenteeism, all aspects of health education, adoption and alternatives to abandonment of children, alcoholism and addiction, adolescent pregnancy and family planning

Some Basic Determinants of Medical Care and Health Policy

PubMed Central

Somers, Anne R.

1966-01-01

Long-term trends in our economy and social structure are radically affecting the supply and demand for health services. Population increases, both generally and in the over-65-years-of-age bracket, growing ratio of nonwhites to whites, increasing proportion of women, increasing urbanization, industrialization, educational levels and per capita income are only some of the major factors affecting the demand for health services. Major developments in the science, technology and organization of medical care are and will continue breaking traditional patterns in rendering such care, and definitely point in the direction of multidisciplinary and institutional makeup in the delivery of health services. Changes in the financing of medical care are bringing in a foray of public programs sponsored by all levels of the government, contributing to the unique American pluralistic health care economy with its “mix” of public and private activities. Questions, intended to point up some of the more far-reaching issues, are appended to each section of the paper. PMID:5971547

An Official Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Health Care Professionals: A Call for Action.

PubMed

Moss, Marc; Good, Vicki S; Gozal, David; Kleinpell, Ruth; Sessler, Curtis N

2016-07-01

Burnout syndrome (BOS) occurs in all types of health care professionals and is especially common in individuals who care for critically ill patients. The development of BOS is related to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. BOS is associated with many deleterious consequences, including increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other health care professionals who practice worldwide. Until recently, BOS and other psychological disorders in critical care health care professionals remained relatively unrecognized. To raise awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed this call to action. The present article reviews the diagnostic criteria, prevalence, causative factors, and consequences of BOS. It also discusses potential interventions that may be used to prevent and treat BOS. Finally, we urge multiple stakeholders to help mitigate the development of BOS in critical care health care professionals and diminish the harmful consequences of BOS, both for critical care health care professionals and for patients. ©2016 American Association of Critical-Care Nurses.

Fostering the coexistence of caring philosophy and economics in today's health care system.

PubMed

Cara, Chantal M; Nyberg, Jan J; Brousseau, Sylvain

2011-01-01

For the past decade, several health care systems are undergoing continuous administrative restructuring, whose main objective is cost reduction. These changes often result in the patients' needs not being met because nurses are continuously affected by widespread budget cuts and staff downsizing. Have we reached a point, where we are setting aside our prime directive of patient well-being for the sake of finances? If so, are we at risk of forsaking our professional identity as nurses? The authors believe that caring management and economical constraints can coexist while promoting quality patient care. The purpose of this article is to show how nurse managers and administrators can facilitate caring practices while maintaining their financial responsibilities within the health care organization. This article suggests several strategies for assisting nurse managers in promoting caring in the health care environment.

Insurance + Access ≠ Health Care: Typology of Barriers to Health Care Access for Low-Income Families

PubMed Central

DeVoe, Jennifer E.; Baez, Alia; Angier, Heather; Krois, Lisa; Edlund, Christine; Carney, Patricia A.

2007-01-01

PURPOSE Public health insurance programs have expanded coverage for the poor, and family physicians provide essential services to these vulnerable populations. Despite these efforts, many Americans do not have access to basic medical care. This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers. METHODS A mixed methods analysis was undertaken using 722 responses to an open-ended question on a health care access survey instrument that asked low-income Oregon families, “Is there anything else you would like to tell us?” Themes were identified using immersion/crystallization techniques. Pertinent demographic attributes were used to conduct matrix coded queries. RESULTS Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs. Disproportionate reporting of these themes was most notable based on insurance status. A higher percentage of uninsured parents (87%) reported experiencing difficulties obtaining insurance coverage compared with 40% of those with insurance. Few of the uninsured expressed concerns about access to services or health care costs (19%). Access concerns were the most common among publicly insured families, and costs were more often mentioned by families with private insurance. Families made a clear distinction between insurance and access, and having one or both elements did not assure care. Our analyses uncovered a 3-part typology of barriers to health care for low-income families. CONCLUSIONS Barriers to health care can be insurmountable for low-income families, even those with insurance coverage. Patients who do not seek care in a family medicine clinic are not necessarily getting their care elsewhere. PMID:18025488

How Communication Among Members of the Health Care Team Affects Maternal Morbidity and Mortality.

PubMed

Brennan, Rita Allen; Keohane, Carol Ann

In the United States, rates of severe maternal morbidity and mortality have escalated in the past decade. Communication failure among members of the health care team is one associated factor that can be modified. Nurses can promote effective communication. We provide strategies that incorporate team training principles and structured communication processes for use by providers and health care systems to improve the quality and safety of patient care and reduce the incidence of maternal mortality and morbidity. Copyright © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Health Care Satisfaction: Effects of Immigration, Acculturation, Language.

PubMed

Schutt, Russell K; Mejía, Camila

2017-12-01

Differences in health care satisfaction can alter patterns of health care utilization and so affect health outcomes, but little is known about variation in satisfaction in relation to immigration status. Health care satisfaction is analyzed with survey data from state public health program patients. Overall health care satisfaction is higher for first generation Hispanic immigrants and lower among those in the second generation compared to white Americans-consistent with the pattern termed the "healthy migrant effect." This pattern is more pronounced for Portuguese-speaking immigrants and is not explained by self-reported health, communication ability or acculturation. Satisfaction with specific aspects of health care follows different patterns that may be explained by differences in experiences and culture. As anticipated by segmented assimilation theory, we find variation in cross-generational patterns of health care satisfaction both within and between ethnic groups. This variation indicates the importance of distinguishing Portuguese-speakers from Spanish-speakers and of taking into account differences in the ways they are able to communicate with health care providers as well as differences in their orientations toward health care. Our disparate findings with other immigrant groups also reinforce limiting expectations of a "healthy migrant effect" to Latinos. Finally, the variable influences on different satisfaction measures indicate the importance of considering the relative influence of culturally-based orientations and health care experiences on the specific outcomes measured, with particular sensitivity to acceptance of individualized standards of care.

Technological trends in health care: electronic health record.

PubMed

Abraham, Sam

2010-01-01

The most relevant technological trend affecting health care organizations and physician services is the electronic health record (EHR). Billions of dollars from the federal government stimulus bill are available for investment toward EHR. Based on the government directives, it is evident EHR has to be a high-priority technological intervention in health care organizations. Addressed in the following pages are the effects of the EHR trend on financial and human resources; analysis of advantages and disadvantages of EHR; action steps involved in implementing EHR, and a timeline for implementation. Medical facilities that do not meet the timetable for using EHR will likely experience reduction of Medicare payments. This article also identifies the strengths, weaknesses, opportunities, and threats of the EHR and steps to be taken by hospitals and physician medical groups to receive stimulus payment.

Paying more for faster care? Individuals' attitude toward price-based priority access in health care.

PubMed

Benning, Tim M; Dellaert, Benedict G C

2013-05-01

Increased competition in the health care sector has led hospitals and other health care institutions to experiment with new access allocation policies that move away from traditional expert based allocation of care to price-based priority access (i.e., the option to pay more for faster care). To date, little is known about individuals' attitude toward price-based priority access and the evaluation process underlying this attitude. This paper addresses the role of individuals' evaluations of collective health outcomes as an important driver of their attitude toward (price-based) allocation policies in health care. The authors investigate how individuals evaluate price-based priority access by means of scenario-based survey data collected in a representative sample from the Dutch population (N = 1464). They find that (a) offering individuals the opportunity to pay for faster care negatively affects their evaluations of both the total and distributional collective health outcome achieved, (b) however, when health care supply is not restricted (i.e., when treatment can be offered outside versus within the regular working hours of the hospital) offering price-based priority access affects total collective health outcome evaluations positively instead of negatively, but it does not change distributional collective health outcome evaluations. Furthermore, (c) the type of health care treatment (i.e., life saving liver transplantation treatment vs. life improving cosmetic ear correction treatment - priced at the same level to the individual) moderates the effect of collective health outcome evaluations on individuals' attitude toward allocation policies. For policy makers and hospital managers the results presented in this article are helpful because they provide a better understanding of what drives individuals' preferences for health care allocation policies. In particular, the results show that policies based on the "paying more for faster care" principle are more

Networks In ACA Marketplaces Are Narrower For Mental Health Care Than For Primary Care.

PubMed

Zhu, Jane M; Zhang, Yuehan; Polsky, Daniel

2017-09-01

There is increasing concern about the extent to which narrow-network plans, generally defined as those including fewer than 25 percent of providers in a given health insurance market, affect consumers' choice of and access to specialty providers-particularly in mental health care. Using data for 2016 from 531 unique provider networks in the Affordable Care Act Marketplaces, we evaluated how network size and the percentage of providers who participate in any network differ between mental health care providers and a control group of primary care providers. Compared to primary care networks, participation in mental health networks was low, with only 42.7 percent of psychiatrists and 19.3 percent of nonphysician mental health care providers participating in any network. On average, plan networks included 24.3 percent of all primary care providers and 11.3 percent of all mental health care providers practicing in a given state-level market. These findings raise important questions about provider-side barriers to meeting the goal of mental health parity regulations: that insurers cover mental health services on a par with general medical and surgical services. Concerted efforts to increase network participation by mental health care providers, along with greater regulatory attention to network size and composition, could improve consumer choice and complement efforts to achieve mental health parity. Project HOPE—The People-to-People Health Foundation, Inc.

Nurse managed occupational health services: a primary care model in practice.

PubMed

Childre, F

1997-10-01

1. Managed care focus on delivering health care which values prevention, early intervention, continuity of care, commitment to quality care, and outcomes, as well as client satisfaction. Occupational health nurses routinely integrate these values into their practice. 2. An on-site model of primary health care delivery, incorporating the fundamentals of occupational health nursing, can bring significant savings to the organization in health related costs. 3. Case management may provide the greatest potential for growth in occupational health nursing. It is a method that can be used together with managed care to maximize quality health care services. 4. Viewing health related costs as an investment as opposed to part of a benefit plan, influences employees to make positive choices. It also impacts the delivery of health care services on a systematic, global level, which affects total health care costs.

Barriers and motivators affecting tuberculosis infection control practices of Russian health care workers.

PubMed

Woith, W; Volchenkov, G; Larson, J

2012-08-01

Five in-patient and out-patient tuberculosis (TB) care facilities in two regions of Russia. To identify barriers and motivators to the use of infection control measures among Russian TB health care workers. In this qualitative study, a convenience sample of 96 health care workers (HCWs) was used to generate 15 homogeneous focus groups, consisting of physicians, nurses, and laboratory or support staff. Barriers and motivators related to knowledge, attitudes and beliefs, and practices were identified. The three main barriers were 1) knowledge deficits, including the belief that TB was transmitted by dust, linens and eating utensils; 2) negative attitudes related to the discomfort of respirators; and 3) practices with respect to quality and care of respirators. Education and training, fear of infecting loved ones, and fear of punishment were the main motivators. Our results point to the need for evaluation of current educational programs. Positive health promotion messages that appeal to fear might also be successful in promoting TB infection control. Individualized rewards based on personal motivators or group rewards that build on collectivist theory could be explored.

Can self-care health books affect amount of contact with the primary health care team? A randomized controlled trial in general practice.

PubMed

Platts, Amanda; Mitton, Rosly; Boniface, David; Friedli, Karin

2005-09-01

To investigate the effects of two differently styled self-care health books in general practice on the frequency and duration of patients' consultations and their views of the books. Random allocation of patients to either a descriptive or a decision-tree based self-care health book, or a no-book control condition. Three- and 12-months follow-up by postal questionnaire and monitoring of consultations. A large general practice in the South East of England. A total of 1967 volunteer, adult patients who attended the practice in 2001 participated. Demographics; health problems; use of health services; use and perceptions of the trial book; frequency and duration of consultations. Response rates to postal questionnaires at 3 and 12 months were 80% and 74%. In all, 48% consulted their allocated book, compared with 25% who consulted any healthcare book in the Control group. Those reporting health problems were more likely to have consulted their allocated book; 60% reported that the allocated book made them more likely to deal with a problem themselves and 40% reported themselves less likely to consult the practice. However, there were no differences in consultation rates or durations of consultations between the three groups. Handing out of self-care health books may provide qualitative benefits for patients but is unlikely to reduce attendance at the GP practice.

How Health Care Reform Can Transform The Health Of Criminal Justice–Involved Individuals

PubMed Central

Rich, Josiah D.; Chandler, Redonna; Williams, Brie A.; Dumont, Dora; Wang, Emily A.; Taxman, Faye S.; Allen, Scott A.; Clarke, Jennifer G.; Greifinger, Robert B.; Wildeman, Christopher; Osher, Fred C.; Rosenberg, Steven; Haney, Craig; Mauer, Marc; Western, Bruce

2014-01-01

Provisions of the Affordable Care Act offer new opportunities to apply a public health and medical perspective to the complex relationship between involvement in the criminal justice system and the existence of fundamental health disparities. Incarceration can cause harm to individual and community health, but prisons and jails also hold enormous potential to play an active and beneficial role in the health care system and, ultimately, to improving health. Traditionally, incarcerated populations have been incorrectly viewed as isolated and self-contained communities with only peripheral importance to the public health at large. This misconception has resulted in missed opportunities to positively affect the health of both the individuals and the imprisoned community as a whole and potentially to mitigate risk behaviors that may contribute to incarceration. Both community and correctional health care professionals can capitalize on these opportunities by working together to advocate for the health of the criminal justice–involved population and their communities. We present a set of recommendations for the improvement of both correctional health care, such as improving systems of external oversight and quality management, and access to community-based care, including establishing strategies for postrelease care and medical record transfers. PMID:24590946

How health care reform can transform the health of criminal justice-involved individuals.

PubMed

Rich, Josiah D; Chandler, Redonna; Williams, Brie A; Dumont, Dora; Wang, Emily A; Taxman, Faye S; Allen, Scott A; Clarke, Jennifer G; Greifinger, Robert B; Wildeman, Christopher; Osher, Fred C; Rosenberg, Steven; Haney, Craig; Mauer, Marc; Western, Bruce

2014-03-01

Provisions of the Affordable Care Act offer new opportunities to apply a public health and medical perspective to the complex relationship between involvement in the criminal justice system and the existence of fundamental health disparities. Incarceration can cause harm to individual and community health, but prisons and jails also hold enormous potential to play an active and beneficial role in the health care system and, ultimately, to improving health. Traditionally, incarcerated populations have been incorrectly viewed as isolated and self-contained communities with only peripheral importance to the public health at large. This misconception has resulted in missed opportunities to positively affect the health of both the individuals and the imprisoned community as a whole and potentially to mitigate risk behaviors that may contribute to incarceration. Both community and correctional health care professionals can capitalize on these opportunities by working together to advocate for the health of the criminal justice-involved population and their communities. We present a set of recommendations for the improvement of both correctional health care, such as improving systems of external oversight and quality management, and access to community-based care, including establishing strategies for postrelease care and medical record transfers.

Changing factors and changing needs in women's health care.

PubMed

Leslie, L A; Swider, S M

1986-03-01

The aforementioned social trends affecting women, including women in poverty, women in the labor force, and elderly women, are all ultimately related to problems of access to health care. In almost every age group, women use more health and medical services. Women are hospitalized more often, although their stays in hospitals tend to be shorter. Women also make more visits to health care providers for preventive health care, such as examinations and dental care. Access to care, however, is tied to ability to pay for the care. Medicaid payments for medical care are related to eligibility criteria in each state. Recent cuts in federal programs targeted eligibility for welfare and Medicaid. In 1982, 725,000 welfare recipients were declared ineligible. Given the earlier discussion of the predominance of women among those labeled poor in this country and the fact that two thirds of Medicaid recipients are women, these cutbacks have serious implications for women's health. Women are less likely to have medical insurance than men. Insurance coverage as a benefit is least likely to be offered in those areas where women work: part-time employment, small businesses, and manufacturing industries. Insurance eligibility is often dependent on a woman's marital status, despite the fact that 41.5 per cent of all American women are not spousal dependents. Insurance companies frequently adjust premiums for sex, age, income, race, and workforce characteristics, a policy which works against women. As the field of women's health expands and receives more emphasis, the data reflecting the experiences of large groups of women will have to be collected and analyzed ever more carefully. Information collected should include physiologic, psychosocial, and economic factors that together affect the health status of women. These data may then be used to guide health policy decision making, as well as provide a basis for health promotion and disease prevention interventions with individual

Health-Promoting Lifestyles Among Health Care Workers in a Postdisaster Area: A Cross-sectional Study.

PubMed

Yang, Wanqiu; Sim, Timothy; Cui, Ke; Zhang, Jun; Yang, Yanchun; Ma, Xiaohong

2018-06-18

Health care workers performing rescue tasks in large-scale disaster areas are usually challenged in terms of physical and mental endurance, which can affect their lifestyles. Nevertheless, data on whether health care workers tend to adopt healthy lifestyles after disasters are limited. This paper compares the adoption of healthy lifestyle behaviors among health care workers with that among non-health care workers in a postdisaster area. This cross-sectional observational study was conducted in August 2016. The Health-Promoting Lifestyle Profile II questionnaire was used to interview 261 health care workers and 848 non-health care workers. Results of the multivariable linear models showed that health care workers had lower physical activity levels (ß=-1.363, P<.0001), worse stress management (ß=-1.282, P<.0001), slower spiritual growth (ß=-1.228, P=.002), and poorer interpersonal relationships (ß=-0.814, P=.019) than non-health care workers. However, no significant differences were found in either nutrition (ß=-0.362, P=.319) or health responsibility (ß=-0.421, P=.283). Health care workers had less healthy lifestyle behaviors, including physical activity, stress management, spiritual growth, and interpersonal relationships. Further studies are needed to develop health-improving interventions for health care workers in postdisaster areas. (Disaster Med Public Health Preparedness. 2018;page 1 of 6).

An Official Critical Care Societies Collaborative Statement-Burnout Syndrome in Critical Care Health-care Professionals: A Call for Action.

PubMed

Moss, Marc; Good, Vicki S; Gozal, David; Kleinpell, Ruth; Sessler, Curtis N

2016-07-01

Burnout syndrome (BOS) occurs in all types of health-care professionals and is especially common in individuals who care for critically ill patients. The development of BOS is related to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. BOS is associated with many deleterious consequences, including increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other health-care professionals who practice worldwide. Until recently, BOS and other psychological disorders in critical care health-care professionals remained relatively unrecognized. To raise awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed this call to action. The present article reviews the diagnostic criteria, prevalence, causative factors, and consequences of BOS. It also discusses potential interventions that may be used to prevent and treat BOS. Finally, we urge multiple stakeholders to help mitigate the development of BOS in critical care health-care professionals and diminish the harmful consequences of BOS, both for critical care health-care professionals and for patients. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Factors affecting electronic health record adoption in long-term care facilities.

PubMed

Cherry, Barbara; Carter, Michael; Owen, Donna; Lockhart, Carol

2008-01-01

Electronic health records (EHRs) hold the potential to significantly improve the quality of care in long-term care (LTC) facilities, yet limited research has been done on how facilities decide to adopt these records. This study was conducted to identify factors that hinder and facilitate EHR adoption in LTC facilities. Study participants were LTC nurses, administrators, and corporate executives. Primary barriers identified were costs, the need for training, and the culture change required to embrace technology. Primary facilitators were training programs, well-defined implementation plans, government assistance with implementation costs, evidence that EHRs will improve care outcomes, and support from state regulatory agencies. These results offer a framework of action for policy makers, LTC Leaders, and researchers.

Should non-citizens have access to publicly funded health care?: a study of public attitudes and their affecting factors.

PubMed

Sun, L-Y; Lee, E-W; Zahra, A; Park, J-H

2015-09-01

To analyse public attitudes towards access for non-citizens to publicly funded health care and to assess the factors that affect such attitudes. Cross-sectional study. Data from 29 countries were used for a multilevel regression, and data from four countries (United States, Sweden, Philippines, and Korea) were used for a linear regression. The data were collected from the International Social Survey Program (ISSP), the World Bank, the Organization for Economic Cooperation and Development (OECD), and the United Nations. The dependent variable was considered to be agreement for non-citizen access to publicly funded health care. The independent variables included: the gross national income (GNI), the gross national income coefficient (GINI), sex, age, education, household income, employment, health insurance, self-related health status, chronic illness, percent having insurance, percent having public insurance, percent employed, percent migrants, percent of health expenditure of the total gross domestic product (GDP), and percent of social expenditure of the total GDP. Egalitarianism for education policy (EEP), egalitarianism for health policy (EHP), and willingness to contribute to an egalitarian health policy (WCHP) were also examined. In the countries surveyed, more than half of the citizens agreed that non-citizens should have access to publicly funded health care. Agreement with that statement had a negative trend with respect to the GNI. The percent having public insurance and WCHP had a significantly positive association with agreement while the percent of those with insurance had a negative relationship. In the USA, household income, EHP, and WCHP were positively associated with agreement, while females were inversely associated with agreement. In Sweden, having health insurance had an inverse association to agreement while females, postsecondary education, health insurance coverage, and WCHP were positively associated with agreement. In the Philippines

INFORMAL CARE AND CAREGIVER’S HEALTH

PubMed Central

DO, YOUNG KYUNG; NORTON, EDWARD C.; STEARNS, SALLY C.; VAN HOUTVEN, COURTNEY HAROLD

2014-01-01

This study aims to measure the causal effect of informal caregiving on the health and health care use of women who are caregivers, using instrumental variables. We use data from South Korea, where daughters and daughters-in-law are the prevalent source of caregivers for frail elderly parents and parents-in-law. A key insight of our instrumental variable approach is that having a parent-in-law with functional limitations increases the probability of providing informal care to that parent-in-law, but a parent-in-law’s functional limitation does not directly affect the daughter-in-law’s health. We compare results for the daughter-in-law and daughter samples to check the assumption of the excludability of the instruments for the daughter sample. Our results show that providing informal care has significant adverse effects along multiple dimensions of health for daughter-in-law and daughter caregivers in South Korea. PMID:24753386

Insights on a New Era Under a Reforming Health Care System.

ERIC Educational Resources Information Center

Mulvihill, James E.

1995-01-01

Economic and social trends that will affect the health care system are examined, including federal health care reform efforts, federal budget trimming through managed care and cost-cutting, declines in state spending, adoption of single-payer systems, growing competition in the private sector (mergers, alliances, acquisitions), dominance of health…

Understanding patient e-loyalty toward online health care services.

PubMed

Martínez-Caro, Eva; Cegarra-Navarro, Juan Gabriel; Solano-Lorente, Marcelina

2013-01-01

Public health institutions are making a great effort to develop patient-targeted online services in an attempt to enhance their effectiveness and reduce expenses. However, if patients do not use those services regularly, public health institutions will have wasted their limited resources. Hence, patients' electronic loyalty (e-loyalty) is essential for the success of online health care services. In this research, an extended Technology Acceptance Model was developed to test e-loyalty intent toward online health care services offered by public health institutions. Data from a survey of 256 users of online health care services provided by the public sanitary system of a region in Spain were analyzed. The research model was tested by using the structural equation modeling approach. The results obtained suggest that the core constructs of the Technology Acceptance Model (perceived usefulness, ease of use, and attitude) significantly affected users' behavioral intentions (i.e., e-loyalty intent), with perceived usefulness being the most decisive antecedent of affective variables (i.e., attitude and satisfaction). This study also reveals a general support for patient satisfaction as a determinant of e-loyalty intent in online health care services. Policy makers should focus on striving to get the highest positive attitude in users by enhancing easiness of use and, mainly, perceived usefulness. Because through satisfaction of patients, public hospitals will enlarge their patient e-loyalty intent, health care providers must always work at obtaining satisfied users and to encourage them to continue using the online services.

A decision technology system for health care electronic commerce.

PubMed

Forgionne, G A; Gangopadhyay, A; Klein, J A; Eckhardt, R

1999-08-01

Mounting costs have escalated the pressure on health care providers and payers to improve decision making and control expenses. Transactions to form the needed decision data will routinely flow, often electronically, between the affected parties. Conventional health care information systems facilitate flow, process transactions, and generate useful decision information. Typically, such support is offered through a series of stand-alone systems that lose much useful decision knowledge and wisdom during health care electronic commerce (e-commerce). Integrating the stand-alone functions can enhance the quality and efficiency of the segmented support, create synergistic effects, and augment decision-making performance and value for both providers and payers. This article presents an information system that can provide complete and integrated support for e-commerce-based health care decision making. The article describes health care e-commerce, presents the system, examines the system's potential use and benefits, and draws implications for health care management and practice.

Review: Increasing Awareness and Education on Health Disparities for Health Care Providers

PubMed Central

Nesbitt, Shawna; Palomarez, Rigo Estevan

2016-01-01

The focus of this review is to highlight health care disparities and trends in several common diseases in selected populations while offering evidence-based approaches to mitigating health care disparities. Health care disparities cross many barriers and affect multiple populations and diseases. Ethnic minorities, the elderly, and those of lower socioeconomic status (SES) are more at-risk than others. However, many low SES Whites and higher SES racial minorities have poorer health than their racial or SES peers. Also, recent immigrant groups and Hispanics, in particular, maintain high health ratings. The so-called Hispanic Paradox provides an example of how culture and social background can be used to improve health outcomes. These groups have unique determinants of disparity that are based on a wide range of cultural and societal factors. Providing improved access to care and reducing the social determinants of disparity is crucial to improving public health. At the same time, for providers, increasing an understanding of the social determinants promotes better models of individualized care to encourage more equitable care. These approaches include increasing provider education on disparities encountered by different populations, practicing active listening skills, and utilizing a patient’s cultural background to promote healthy behaviors PMID:27103768

Consumer-directed health care: implications for health care organizations and managers.

PubMed

Guo, Kristina L

2010-01-01

This article uses a pyramid model to illustrate the key components of consumer-directed health care. Consumer-directed health care is considered the essential strategy needed to lower health care costs and is valuable for making significant strides in health care reform. Consumer-directed health care presents new challenges and opportunities for all health care stakeholders and their managers. The viability of the health system depends on the success of managers to respond rapidly and with precision to changes in the system; thus, new and modified roles of managers are necessary to successfully sustain consumerism efforts to control costs while maintaining access and quality.

Reforming the health care system: implications for health care marketers.

PubMed

Petrochuk, M A; Javalgi, R G

1996-01-01

Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.

Private health care.

PubMed

Uplekar, M W

2000-09-01

During the last decade there has been considerable international mobilisation around shrinking the role of States in health care. The World Bank reports that, in many low and middle-income countries, private sources of finance comprise the largest share of total national health expenditures. Private sector health care is ubiquitous, reaches throughout the population, preferred by the people and is significant from both economic as well as health perspective. Resources are limited, governments are weak, and a new approach is needed. This paper provides a broad overview and raises key issues with regard to private health care. The focus is on provision of health care by private medical providers. On the background of the world's common health problems and interventions available to tackle them, the place of private health care in the overall context is first discussed. The concept of privatisation within the various forms of health care systems is then explained. The paper then describes the genesis and key elements of rapidly enhancing role of the private sector in health care and points to the paucity of literature from low and middle-income countries. Common concerns about private health care are outlined. Two illustrative examples--tuberculosis, the top infectious killer among the poor and coronary heart disease, the top non-infectious killer among the rich--are presented to understand the current and possible role of private sector in provision of health care. Highlighting the need to distinguish between health care as a public good or a market commodity, the paper leaves it to the reader to draw conclusions.

Does the perception that stress affects health matter? The association with health and mortality.

PubMed

Keller, Abiola; Litzelman, Kristin; Wisk, Lauren E; Maddox, Torsheika; Cheng, Erika Rose; Creswell, Paul D; Witt, Whitney P

2012-09-01

This study sought to examine the relationship among the amount of stress, the perception that stress affects health, and health and mortality outcomes in a nationally representative sample of U.S. adults. Data from the 1998 National Health Interview Survey were linked to prospective National Death Index mortality data through 2006. Separate logistic regression models were used to examine the factors associated with current health status and psychological distress. Cox proportional hazard models were used to determine the impact of perceiving that stress affects health on all-cause mortality. Each model specifically examined the interaction between the amount of stress and the perception that stress affects health, controlling for sociodemographic, health behavior, and access to health care factors. 33.7% of nearly 186 million (unweighted n = 28,753) U.S. adults perceived that stress affected their health a lot or to some extent. Both higher levels of reported stress and the perception that stress affects health were independently associated with an increased likelihood of worse health and mental health outcomes. The amount of stress and the perception that stress affects health interacted such that those who reported a lot of stress and that stress impacted their health a lot had a 43% increased risk of premature death (HR = 1.43, 95% CI [1.2, 1.7]). High amounts of stress and the perception that stress impacts health are each associated with poor health and mental health. Individuals who perceived that stress affects their health and reported a large amount of stress had an increased risk of premature death. PsycINFO Database Record (c) 2012 APA, all rights reserved.

The Changing Health Care Market: Implications for Nursing Education in the Coming Decade.

ERIC Educational Resources Information Center

Huston, Carol Jorgensen; Fox, Sherry

1998-01-01

Dominant trends in health care that will affect nursing education include the following: growth of the health care labor force, economics, movement away from acute-care hospitals, managed care, demographic change, information technology, and replacement of nurses with unlicensed assistants. (JOW)

Bridging Organizational Divides in Health Care: An Ecological View of Health Information Exchange

PubMed Central

Johnson, Kevin B; Gadd, Cynthia S; Lorenzi, Nancy M

2013-01-01

Background The fragmented nature of health care delivery in the United States leads to fragmented health information and impedes patient care continuity and safety. Technologies to support interorganizational health information exchange (HIE) are becoming more available. Understanding how HIE technology changes health care delivery and affects people and organizations is crucial to long-term successful implementation. Objective Our study investigated the impacts of HIE technology on organizations, health care providers, and patients through a new, context-aware perspective, the Regional Health Information Ecology. Methods We conducted more than 180 hours of direct observation, informal interviews during observation, and 9 formal semi-structured interviews. Data collection focused on workflow and information flow among health care team members and patients and on health care provider use of HIE technology. Results We structured the data analysis around five primary information ecology components: system, locality, diversity, keystone species, and coevolution. Our study identified three main roles, or keystone species, involved in HIE: information consumers, information exchange facilitators, and information repositories. The HIE technology impacted patient care by allowing providers direct access to health information, reducing time to obtain health information, and increasing provider awareness of patient interactions with the health care system. Developing the infrastructure needed to support HIE technology also improved connections among information technology support groups at different health care organizations. Despite the potential of this type of technology to improve continuity of patient care, HIE technology adoption by health care providers was limited. Conclusions To successfully build a HIE network, organizations had to shift perspectives from an ownership view of health data to a continuity of care perspective. To successfully integrate external health

Factors affecting health care workers' adoption of a website with infection control guidelines.

PubMed

Verhoeven, Fenne; Steehouder, Michaël F; Hendrix, Ron M G; van Gemert-Pijnen, Julia E W C

2009-10-01

To identify factors that could affect health care workers' (HCWs) adoption of a website for communicating infection control guidelines. In total, 20 semi-structured interviews were conducted with HCWs in 5 different occupational groups and 4 different hospitals in the Netherlands and Germany. A website communicating guidelines for the prevention and control of Methicillin Resistant Staphylococcus aureus served as a casus. The HCWs, the majority of whom had prior experience with the website, were asked to give their opinions about factors that hinder or facilitate adoption of the website in practice. The interviews were based on the PRECEDE (Predisposing, Reinforcing, and Enabling Causes in Educational Diagnosis and Evaluation) model complemented by quality criteria for health-related websites. This model encompasses different categories of factors relevant to technology adoption in health care. A total of 361 interview statements were relevant to the four main categories of the PRECEDE model, yielding the following observations: (1) Technological factors (72 statements): The usability, design, and relevance of the website were positively valued. The website enabled HCWs to access contextually relevant information quickly. The website's credibility was evaluated rather negatively, as respondents perceived that the website's guidelines were not in concurrence with the best available evidence and it was not clear to HCWs who created the website. (2) Individual factors (85 statements): Respondents, particular infection control professionals, showed individual resistance to the website because they preferred to use their personal knowledge and experience (and communication with colleagues) over online sources. (3) Work-related factors (53 statements): Respondents perceived high work pressure during working hours as an impediment to consulting the website. In contrast, respondents thought the website might lower work pressure for infection control professionals, as they

Consumer information needs in a competitive health care environment

PubMed Central

Varner, Theresa; Christy, Jack

1986-01-01

The role of information in facilitating choice in a competitive health care marketplace is clearly pivotal, but it is also complex and occasionally problematic. Although it is clear that information is critical to the competitive approach, less clear is the relationship between the availability of appropriate information and the exercise of informed choice, a relationship that is obscured in the tangle of influences that affect the use and delivery of medical care. Nonetheless, the centralized and standardized collection, review, and dissemination of relevant health care data remain the keys to predicting—and avoiding—adverse outcomes in the development of health care policy. PMID:10311937

Case Study: South Texas Veterans Health Care System’s Communication Center

DTIC Science & Technology

2008-07-14

appropriate access to health care; technical quality is providing world-class care to our veterans; customer satisfaction is ensuring the STVHCS patients and...were not called. These results not only improved access to health care, but also positively affected customer service. 111 Case Study: South Texas...increased waiting times for the patient . With current regulatory requirements calling for improved access to health care services, many hospital and

Health system factors affecting communication with pediatricians: gendered work culture in primary care.

PubMed

Lynch, Sean

2011-01-01

This qualitative study examined the roles that practice setting, education level, and gender may play in social workers' communication satisfaction with pediatricians. Taking an ethnographic approach, the researcher interviewed social workers and pediatricians who worked together to provide mental health services in primary care. The results suggested that gender at the health system level may be an issue and that gendered work culture in primary care was a factor in communication. In particular, reimbursement, an aspect of the gendered work culture, was a substantial communication barrier, and the implications for Medicaid billing are discussed.

Reducing Racial Health Care Disparities: A Social Psychological Analysis.

PubMed

Penner, Louis A; Blair, Irene V; Albrecht, Terrance L; Dovidio, John F

2014-10-01

Large health disparities persist between Black and White Americans. The social psychology of intergroup relations suggests some solutions to health care disparities due to racial bias. Three paths can lead from racial bias to poorer health among Black Americans. First is the already well-documented physical and psychological toll of being a target of persistent discrimination. Second, implicit bias can affect physicians' perceptions and decisions, creating racial disparities in medical treatments, although evidence is mixed. The third path describes a less direct route: Physicians' implicit racial bias negatively affects communication and the patient-provider relationship, resulting in racial disparities in the outcomes of medical interactions. Strong evidence shows that physician implicit bias negatively affects Black patients' reactions to medical interactions, and there is good circumstantial evidence that these reactions affect health outcomes of the interactions. Solutions focused on the physician, the patient, and the health care delivery system; all agree that trying to ignore patients' race or to change physicians' implicit racial attitudes will not be effective and may actually be counterproductive. Instead, solutions can minimize the impact of racial bias on medical decisions and on patient-provider relationships.

Reducing Racial Health Care Disparities: A Social Psychological Analysis

PubMed Central

Penner, Louis A.; Blair, Irene V.; Albrecht, Terrance L.; Dovidio, John F.

2015-01-01

Large health disparities persist between Black and White Americans. The social psychology of intergroup relations suggests some solutions to health care disparities due to racial bias. Three paths can lead from racial bias to poorer health among Black Americans. First is the already well-documented physical and psychological toll of being a target of persistent discrimination. Second, implicit bias can affect physicians’ perceptions and decisions, creating racial disparities in medical treatments, although evidence is mixed. The third path describes a less direct route: Physicians’ implicit racial bias negatively affects communication and the patient–provider relationship, resulting in racial disparities in the outcomes of medical interactions. Strong evidence shows that physician implicit bias negatively affects Black patients’ reactions to medical interactions, and there is good circumstantial evidence that these reactions affect health outcomes of the interactions. Solutions focused on the physician, the patient, and the health care delivery system; all agree that trying to ignore patients’ race or to change physicians’ implicit racial attitudes will not be effective and may actually be counterproductive. Instead, solutions can minimize the impact of racial bias on medical decisions and on patient–provider relationships. PMID:25705721

Child Health and Access to Medical Care

PubMed Central

Leininger, Lindsey; Levy, Helen

2016-01-01

It might seem strange to ask whether increasing access to medical care can improve children’s health. Yet Lindsey Leininger and Helen Levy begin by pointing out that access to care plays a smaller role than we might think, and that many other factors, such as those discussed elsewhere in this issue, strongly influence children’s health. Nonetheless, they find that, on the whole, policies to improve access indeed improve children’s health, with the caveat that context plays a big role—medical care “matters more at some times, or for some children, than others.” Focusing on studies that can plausibly show a causal effect between policies to increase access and better health for children, and starting from an economic framework, they consider both the demand for and the supply of health care. On the demand side, they examine what happens when the government expands public insurance programs (such as Medicaid), or when parents are offered financial incentives to take their children to preventive appointments. On the supply side, they look at what happens when public insurance programs increase the payments that they offer to health-care providers, or when health-care providers are placed directly in schools where children spend their days. They also examine how the Affordable Care Act is likely to affect children’s access to medical care. Leininger and Levy reach three main conclusions. First, despite tremendous progress in recent decades, not all children have insurance coverage, and immigrant children are especially vulnerable. Second, insurance coverage alone doesn’t guarantee access to care, and insured children may still face barriers to getting the care they need. Finally, as this issue of Future of Children demonstrates, access to care is only one of the factors that policy makers should consider as they seek to make the nation’s children healthier. PMID:27516723

Partnerships Between Health Care and Legal Providers in the Veterans Health Administration.

PubMed

Tsai, Jack; Middleton, Margaret; Retkin, Randye; Johnson, Cindy; Kenneally, Kevin; Sherman, Scott; Rosenheck, Robert A

2017-04-01

Medical-legal partnerships (MLPs) represent an innovative service model in which lawyers are integrated into health care teams to address diverse legal problems that affect vulnerable populations. The Veterans Health Administration (VHA) operates the largest safety-net health care system in the country and serves many low-income and disabled veterans who could benefit from MLP services. In this column, the authors describe the development and operations of MLPs at four VHA medical centers that serve veterans who are homeless or who have serious mental illness. The authors also briefly report on the characteristics of 700 veterans served by these MLPs from 2014 to 2016. MLPs can fit within the interdisciplinary, comprehensive system of care provided by VHA, and they offer opportunities to expand VHA-community partnerships to address social determinants of health.

Insurance + access not equal to health care: typology of barriers to health care access for low-income families.

PubMed

Devoe, Jennifer E; Baez, Alia; Angier, Heather; Krois, Lisa; Edlund, Christine; Carney, Patricia A

2007-01-01

Public health insurance programs have expanded coverage for the poor, and family physicians provide essential services to these vulnerable populations. Despite these efforts, many Americans do not have access to basic medical care. This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers. A mixed methods analysis was undertaken using 722 responses to an open-ended question on a health care access survey instrument that asked low-income Oregon families, "Is there anything else you would like to tell us?" Themes were identified using immersion/crystallization techniques. Pertinent demographic attributes were used to conduct matrix coded queries. Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs. Disproportionate reporting of these themes was most notable based on insurance status. A higher percentage of uninsured parents (87%) reported experiencing difficulties obtaining insurance coverage compared with 40% of those with insurance. Few of the uninsured expressed concerns about access to services or health care costs (19%). Access concerns were the most common among publicly insured families, and costs were more often mentioned by families with private insurance. Families made a clear distinction between insurance and access, and having one or both elements did not assure care. Our analyses uncovered a 3-part typology of barriers to health care for low-income families. Barriers to health care can be insurmountable for low-income families, even those with insurance coverage. Patients who do not seek care in a family medicine clinic are not necessarily getting their care elsewhere.

Health Care Waste Management Practice in Health Care Institutions of Nepal.

PubMed

Joshi, H D; Acharya, T; Ayer, R; Dhakal, P; Karki, K B; Dhimal, M

2017-01-01

Medical waste is considered as a major public health hazard. In a developing country like Nepal, there is much concern about the management practice of medical waste. This study aimed to assess Health Care Waste Management practice among Health Care Institutions in Nepal. A cross sectional study was carried out between July 2012 to June 2013 in 62 different Health Care Institutions, selected from stratified proportionate random sampling technique from all administrative regions of Nepal. A structured questionnaire and observation checklist were used for data collection. The waste generation rate is found significantly correlated with bed capacity, patient flow rate and annual budget spent in the hospital. It is found significantly higher in Teaching hospital than other Health Care Institutions of Nepal. An average of 3.3 kg/day/patient of medical waste (2.0 kg/day/patient non-hazardous and 1.0 kg/day/patient hazardous waste) was generated during the study period. Further, it was found that most of the Health care wastes were not disinfected before transportation to waste disposal sites. Very limited number of Health Care Institutions had conducted Environmental Assessment. Similarly, some of the Health Care Institutions had not followed Health care waste management guideline 2009 of Nepal Government. We found poor compliance of medical waste management practice as per existing legislation of Government of Nepal. Hence, additional effort is needed for improvement of Health care waste management practice at Health Care Institutions of Nepal.

What's love got to do with it? Investigating consumer commitment in health care.

PubMed

Kemp, Elyria; Poole, Sonja Martin

2017-01-01

Building relationships with patients to create patient-centered care is critical to the success of health care organizations. A core element in relationships is commitment. Commitment may be based on affect and emotions, perceived costs, and even obligation. This research proposes that three types of commitment-affective, continuance, and normative commitment-differentially impact consumer purchase loyalty, attitudinal loyalty, and advocacy for a health care provider. To examine the impact of commitment type on consumer relationships, exploratory data were garnered and surveys were administered. Findings are discussed and implications for health care marketing managers in developing successful relationships with consumers are delineated.

Employer health care plan design and its effect on plan costs.

PubMed

Custer, W S

1991-01-01

This study uses claims data from employers in the Houston Area Health Care Coalition (HAHCC) for 1985 through the first half of 1987 to examine the effect of health care plan attributes on health care costs. Plan attributes affect the site of care and the costs of care. Utilization review clearly was effective in reducing the demand for inpatient services, but that reduction was in large measure matched by increases in care in the outpatient setting. Restrictions on mental health benefits also shifted the site of care. In contrast, neither premium sharing nor the plan's deductible had a significant impact on total plan charges. The study results demonstrate the need to have a comprehensive cost management strategy.

Are performance measurement systems useful? Perceptions from health care.

PubMed

Demartini, Chiara; Trucco, Sara

2017-01-31

Prior literature identified the use of Performance Measurement Systems (PMS) as crucial in addressing improved processes of care. Moreover, a strategic use of PMS has been found to enhance quality, compared to non-strategic use, although a clear understanding of this linkage is still to be achieved. This paper deals with the test of direct and indirect models related to the link between the strategic use of PMS and the level of improved processes in health care organizations. Indirect models were mediated by the degree of perceived managerial discretion. A PLS analysis on a survey of 97 Italian managers working for health care organizations in the Lombardy region was conducted. The response rate was 77.6%. The strategic use of PMS in health care organizations directly and significantly (p < 0.001) enhances performance in terms of improved processes. Perceived managerial discretion is positively and significantly (p < 0.001) affected by the strategic use of PMS, whereas the mediation effect is non-significant. This study contributes to the literature investigating the design and implementation of a non-financial measurement tool, such as the non-financial information included into a balanced scorecard (BSC), in health care organizations. Managers in health care organizations can benefit from the strategic use of PMS to effectively allocate their time to strategic opportunities and threats, which might arise and affect organizational, output-related performance, such as improving processes.

The role and uptake of private health insurance in different health care systems: are there lessons for developing countries?

PubMed

Odeyemi, Isaac Ao; Nixon, John

2013-01-01

Social and national health insurance schemes are being introduced in many developing countries in moving towards universal health care. However, gaps in coverage are common and can only be met by out-of-pocket payments, general taxation, or private health insurance (PHI). This study provides an overview of PHI in different health care systems and discusses factors that affect its uptake and equity. A representative sample of countries was identified (United States, United Kingdom, The Netherlands, France, Australia, and Latvia) that illustrates the principal forms and roles of PHI. Literature describing each country's health care system was used to summarize how PHI is utilized and the factors that affect its uptake and equity. In the United States, PHI is a primary source of funding in conjunction with tax-based programs to support vulnerable groups; in the UK and Latvia, PHI is used in a supplementary role to universal tax-based systems; in France and Latvia, complementary PHI is utilized to cover gaps in public funding; in The Netherlands, PHI is supplementary to statutory private and social health insurance; in Australia, the government incentivizes the uptake of complementary PHI through tax rebates and penalties. The uptake of PHI is influenced by age, income, education, health care system typology, and the incentives or disincentives applied by governments. The effect on equity can either be positive or negative depending on the type of PHI adopted and its role within the wider health care system. PHI has many manifestations depending on the type of health care system used and its role within that system. This study has illustrated its common applications and the factors that affect its uptake and equity in different health care systems. The results are anticipated to be helpful in informing how developing countries may utilize PHI to meet the aim of achieving universal health care.

Determining Equity in Household's Health Care Payments in Hamedan Province, Iran.

PubMed

Rezapour, Aziz; Arabloo, Jalal; Tofighi, Shahram; Alipour, Vahid; Sepandy, Mojtaba; Mokhtari, Payam; Ghanbary, Abbas

2016-07-01

Financial protection of household against the consequences of the health care expenditures is one of the most important functions of health care systems. The objective of this study was to determine the equity in health care payments and determining factors among households in Hamedan, a province in Iran. In this cross-sectional study, 772 families of patients, who were being discharged from hospitals in Hamedan, were selected for study by using a stratified random sampling method. Required data regarding households' health and non-health expenditures were collected through World Health Organization standard questionnaire by interviews and observation method. According to the findings, 20.7% of households experienced catastrophic health expenditure. The incidence of impoverishment due to out-of-pocket payments for health care was 2.8% among studied households. The highest incidence rate of out-of-pocket health payment indices occurred in the first quintile (poorest or Q1). Variables such as having members under 6 years or over 60 years in household, household size, employment of household head, households' income quintile, existence of the disabled member in households and the education level of the household's head are the most important factors that affect the incidence of out-of-pocket health payment indices. There is considerable inequity in health care financing as well as households' health payments. This requires designing and implementing the operative and protective programs for understanding the important factors that affect equity in health financing, especially for poor households, against the unexpected health expenditures through the health care system.

Health Care Reform and Concurrent Curative Care for Terminally Ill Children: A Policy Analysis

PubMed Central

Lindley, Lisa C.

2012-01-01

Within the Patient Protection and Affordable Care Act of 2010 or health care reform, is a relatively small provision about concurrent curative care that significantly affects terminally ill children. Effective on March 23, 2010, terminally ill children, who are enrolled in a Medicaid or state Children’s Health Insurance Plans (CHIP) hospice benefit, may concurrently receive curative care related to their terminal health condition. The purpose of this article was to conduct a policy analysis of the concurrent curative care legislation by examining the intended goals of the policy to improve access to care and enhance quality of end of life care for terminally ill children. In addition, the policy analysis explored the political feasibility of implementing concurrent curative care at the state-level. Based on this policy analysis, the federal policy of concurrent curative care for children would generally achieve its intended goals. However, important policy omissions focus attention on the need for further federal end of life care legislation for children. These findings have implications nurses. PMID:22822304

Health care reform and care at the behavioral health--primary care interface.

PubMed

Druss, Benjamin G; Mauer, Barbara J

2010-11-01

The historic passage of the Patient Protection and Affordable Care Act in March 2010 offers the potential to address long-standing deficits in quality and integration of services at the interface between behavioral health and primary care. Many of the efforts to reform the care delivery system will come in the form of demonstration projects, which, if successful, will become models for the broader health system. This article reviews two of the programs that might have a particular impact on care on the two sides of that interface: Medicaid and Medicare patient-centered medical home demonstration projects and expansion of a Substance Abuse and Mental Health Services Administration program that colocates primary care services in community mental health settings. The authors provide an overview of key supporting factors, including new financing mechanisms, quality assessment metrics, information technology infrastructure, and technical support, that will be important for ensuring that initiatives achieve their potential for improving care.

What Makes Health Care Special?: An Argument for Health Care Insurance.

PubMed

Horne, L Chad

2017-01-01

While citizens in a liberal democracy are generally expected to see to their basic needs out of their own income shares, health care is treated differently. Most rich liberal democracies provide their citizens with health care or health care insurance in kind. Is this "special" treatment justified? The predominant liberal account of justice in health care holds that the moral importance of health justifies treating health care as special in this way. I reject this approach and offer an alternative account. Health needs are not more important than other basic needs, but they are more unpredictable. I argue that citizens are owed access to insurance against health risks to provide stability in their future expectations and thus to protect their capacities for self-determination.

Social, economic, and political forces affecting the future of occupational health nursing.

PubMed

Miller, M A

1989-09-01

1. By monitoring the major social, economic, and political forces affecting health care, one can predict how these forces may impact the role of occupational health nurses. 2. Nursing can and must chart its own course in the midst of these social, economic, and political changes. 3. Changes which have major implications for occupational health nurses are: health care needs, cost containment, multi-hospital chains, alternative approaches to health care, the workplace, ethical concerns, biomedical technology, nursing shortage, and oversupply of physicians. 4. Nursing implications can also be drawn in the areas of autonomy, political skills, and education. Active involvement and a desire to shape professional change and the future of nursing are keys.

Administrative Challenges to the Integration of Oral Health With Primary Care

PubMed Central

Maxey, Hannah L.; Randolph, Courtney; Gano, Laura; Kochhar, Komal

2017-01-01

Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce. PMID:27218701

Mental health and health-care use of detainees in police custody.

PubMed

Dorn, Tina; Ceelen, Manon; Buster, Marcel; Stirbu, Irina; Donker, Gé; Das, Kees

2014-08-01

In many countries, forensic physicians function as primary care providers for detainees in police custody. Their task is comparable to the tasks of general practitioners. Nevertheless, problems presented by both patient populations may differ. We therefore aimed to systematically compare presented problems and medication use in a population of police detainees to those of regular patients in general practice. Health problems and prescription medications of 3232 detainees seen by the Amsterdam Forensic Medical Service were compared to those of general practice patients (n = 78,975) adjusted for age and gender during a 12-month period. Among those obtaining medical attention (28% of all detainees), almost 50% were diagnosed with mental health problems, with substance abuse as the leading reason for consultation. Forty-two percent received at least one prescription affecting the nervous system. In general practice, 17% (P < 0.001) of patients consulting their GP were diagnosed with mental health problems and 22% (P < 0.001) were prescribed medications affecting the nervous system. The magnitude of mental health problems among police detainees has significant implications for the qualifications of police health staff and those who provide health care in the police setting especially concerning substance abuse. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Health care barriers, racism, and intersectionality in Australia.

PubMed

Bastos, João L; Harnois, Catherine E; Paradies, Yin C

2018-02-01

While racism has been shown to negatively affect health care quality, little is known about the extent to which racial discrimination works with and through gender, class, and sexuality to predict barriers to health care (e.g., perceived difficulty accessing health services). Additionally, most existing studies focus on racial disparities in the U.S. context, with few examining marginalized groups in other countries. To address these knowledge gaps, we analyze data from the 2014 Australian General Social Survey, a nationally representative survey of individuals aged 15 and older living in 12,932 private dwellings. Following an intersectional perspective, we estimate a series of multivariable logit regression models to assess three hypotheses: racial discrimination will be positively associated with perceived barriers to health care (H1); the effect of perceived racial discrimination will be particularly severe for women, sexual minorities, and low socio-economic status individuals (H2); and, in addition to racial discrimination, other forms of perceived discrimination will negatively impact perceived barriers to health care (H3). Findings show that perceptions of racial discrimination are significantly associated with perceived barriers to health care, though this relationship is not significantly stronger for low status groups. In addition, our analyses reveal that perceived racism and other forms of discrimination combine to predict perceived barriers to health care. Taken together, these results speak to the benefits of an intersectional approach for examining racial inequalities in perceived access to health care. Copyright © 2017 Elsevier Ltd. All rights reserved.

Factors Affecting Sexual History Taking in a Health Center Serving Homeless Persons.

PubMed

Sowicz, Timothy Joseph; Bradway, Christine K

2018-03-01

Low rates of documentation of sexual histories have been reported and research on sexual history taking (SHT) has focused on the content of, barriers to collecting, and interventions to improve documentation of sexual histories. Absent from this literature is an understanding of the contextual factors affecting SHT. To address this gap, a focused ethnography of one health center was conducted. Data were collected through observations of health care encounters and interviews with health care providers (HCPs). No SHT was observed and this was likely influenced by patients' characteristics, communication between patients and HCPs, the prioritization of patients' basic needs, and time constraints imposed upon encounters. Given that the health center studied serves patients experiencing homelessness, behavioral health concerns, and opioid use disorder, findings illuminate areas for future inquiry into a patient population affected by social as well as physiologic determinants of health and potentially at high risk for adverse sexual health outcomes.

Future of health care delivery in iran, opportunities and threats.

PubMed

Rajabi, F; Esmailzadeh, H; Rostamigooran, N; Majdzadeh, R; Doshmangir, L

2013-01-01

The aim of this study was to determine the impact of important social and technological trends on health care delivery, in the context of developing "Iran's Health System Reform Plan by 2025". A detailed review of the national and international literature was done to identify the main trends affecting health system. To collect the experts' opinions about important trends and their impact on health care delivery, Focus Group Discussions (FGDs) and semi-structured in-depth interviews techniques were used. The study was based on the STEEP model. Final results were approved in an expert's panel session. The important social and technological trends, affecting health system in Iran in the next 15 years are demographic transition, epidemiologic transition, increasing bio-environmental pollution, increasing slums, increasing private sector partnership in health care delivery, moving toward knowledge-based society, development of information and communication technology, increasing use of high technologies in health system, and development of traditional and alternative medicine. The opportunities and threats resulting from the above mentioned trends were also assessed in this study. Increasing healthcare cost due to some trends like demographic and epidemiologic transition and uncontrolled increase in using new technologies in health care is one of the most important threats that the health system will be facing. The opportunities that advancement in technology and moving toward knowledge-based society create are important and should not be ignored.

Health care for children in Indian Armed Forces.

PubMed

Kanitkar, Madhuri

2017-10-01

Children of Armed Forces personnel constitute 33% of the clientele dependant on our healthcare. Various child health indicators and immunization coverage of Indian Armed Forces children is better than the national figures. With improved patient care, it has been observed that the morbidity and mortality pattern of diseases affecting the children of Armed Forces personnel has shown a change from infectious diseases in the past to more of chronic complex disorders at present. Hospital admissions of children in military hospitals due to nutritional and infectious diseases have reduced and constitute only around 21% of all paediatric hospital admissions. Various factors responsible for this shift are preventive health measures (antenatal care, immunization), Active promotion of health (baby friendly hospital concept, Well baby clinic) curative health services (outpatient services, in-patient care, specialty care, supportive Care) and supportive care-reaching beyond like ASHA schools. Presently, we need to handle, life style diseases like obesity, mental stress, teach coping mechanisms for common stressors such as parental separation, family reunification, parental loss, behavioral problems, diseases other than infectious diseases requiring super specialty care. The challenge lies in planning the road ahead for these children and adolescents ensuring a life-course approach.

Socioeconomic factors affecting patients’ utilization of primary care services at a Tertiary Teaching Hospital in Riyadh, Saudi Arabia

PubMed Central

Alsubaie, Abdulaziz M.; Almohaimede, Khaled A.; Aljadoa, Abdulrahman F.; Jarallah, Osamah J.; Althnayan, Yasser I.; Alturki, Yousef A.

2016-01-01

Background: Primary care services utilization is dependent on socioeconomic factors. It is proven that variation in socioeconomic factors result in discrepancies in the use of such services. Admittedly, research is limited on the socioeconomic factors affecting the utilization of primary care services in Saudi Arabia. Objectives: The aim of this research was to study the effect of the main socioeconomic factors affecting patients' utilization of primary care services at a tertiary teaching hospital, Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional study was conducted from January to February 2014 in a primary care clinic of a tertiary teaching hospital in Riyadh city; subjects selected using a random consecutive sampling technique. A self-administered questionnaire in Arabic was given to the participants to collect the data which comprised sociodemographic data, utilization measures, and health needs. The data were analyzed using SPSS version 21. Results: A total of 358 subjects participated in the study. The main factors that best determine the utilization of primary health care clinic in a tertiary teaching hospital were the possession of a health insurance (P = 0.046, odds ratio [OR] = 8.333), and bad self-health-perception (P < 0.014, OR: 2.088). Chronic illness was also associated with higher utilization (OR = 2.003). Conclusion: Our results reveal that chronic health problems, self-health-perception, and health insurance are the most significant socioeconomic factors affecting the utilization of primary care services. PMID:26929723

Health Care Access among Latinos: Implications for Social and Health Care Reforms

ERIC Educational Resources Information Center

Perez-Escamilla, Rafael

2010-01-01

According to the Institute of Medicine, health care access is defined as "the degree to which people are able to obtain appropriate care from the health care system in a timely manner." Two key components of health care access are medical insurance and having access to a usual source of health care. Recent national data show that 34% of Latino…

Who pays for health care in Ghana?

PubMed Central

2011-01-01

affecting the expansion of the National Health Insurance. Furthermore, the pre-payment funding pool for health care needs to grow so budgetary allocation to the health sector can be enhanced. PMID:21708026

Who pays for health care in Ghana?

PubMed

Akazili, James; Gyapong, John; McIntyre, Diane

2011-06-27

Financial protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". An important element of financial risk protection is to distribute health care financing fairly in relation to ability to pay. The distribution of health care financing burden across socio-economic groups has been estimated for European countries, the USA and Asia. Until recently there was no such analysis in Africa and this paper seeks to contribute to filling this gap. It presents the first comprehensive analysis of the distribution of health care financing in relation to ability to pay in Ghana. Secondary data from the Ghana Living Standard Survey (GLSS) 2005/2006 were used. This was triangulated with data from the Ministry of Finance and other relevant sources, and further complemented with primary household data collected in six districts. We implored standard methodologies (including Kakwani index and test for dominance) for assessing progressivity in health care financing in this paper. Ghana's health care financing system is generally progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes, which account for close to 50% of health care funding. The national health insurance (NHI) levy (part of VAT) is mildly progressive and formal sector NHI payroll deductions are also progressive. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are regressive form of health payment to households. For Ghana to attain adequate financial risk protection and ultimately achieve universal coverage, it needs to extend pre-payment cover to all in the informal sector, possibly through funding their contributions entirely from tax, and address other issues affecting the expansion of the National

Employment, child care, and mental health of mothers caring for children assisted by technology.

PubMed

Thyen, U; Kuhlthau, K; Perrin, J M

1999-06-01

This study examines 1) the way that children with chronic conditions are cared for at home and assisted by technology affects maternal employment and child care; 2) the social and clinical factors associated with the decision of a mother to quit employment to care for a child at home; and 3) the way in which care at home and the decision of a mother to quit a job affects maternal mental health. The 6-month postdischarge status of 70 mothers of children assisted by technology (study group) was compared with the 6-month postdischarge status of 58 mothers of children (matched for age and gender) hospitalized for acute illnesses (comparison group). Between January and December 1993, we gathered information on sociodemographic status, employment status and changes in employment, severity of the child's condition, child care and nursing services at home, family support, and maternal mental health. One third of mothers in the study group reported that they quit employment to take care of a child at home with only 37.1% remaining employed outside the home, compared with 69.0% of comparison group mothers. Single caretakers were 15 times more likely to quit employment compared with mothers in two-parent families. Availability of child care had an independent effect on a mother's decision to quit a job, whereas the severity of the child's condition did not. Child care hours were significantly lower in study group families and were provided mostly by relatives compared with day-care facilities and regular babysitters in comparison families. Family support was highest among employed mothers in both the study and the comparison groups and lowest in study group mothers who were neither employed currently nor before the child's illness or who had quit employment to care for the child. Family income was significantly lower in families with a child assisted by technology. Families in the study group had 20-fold higher uncompensated health care costs than did the comparison group

Cultural diversity and conflict in the health care workplace.

PubMed

Lowenstein, A J; Glanville, C

1995-01-01

Cultural diversity issues affect the health care workplace and nursing practice. The Lowenstein-Glanville conflict model can be used for assessing and intervening in racial and status conflict in hospital settings. Implications for nursing practice include recognizing that cultural diversity will continue to grow in the health care workplace. Nurses must increase sensitivity, become aware of cultural nuances and issues, and make cultural assessment a routine part of their assessment and planning, not only for patient care, but also with their co-workers and subordinates.

Performance of private sector health care: implications for universal health coverage.

PubMed

Morgan, Rosemary; Ensor, Tim; Waters, Hugh

2016-08-06

Although the private sector is an important health-care provider in many low-income and middle-income countries, its role in progress towards universal health coverage varies. Studies of the performance of the private sector have focused on three main dimensions: quality, equity of access, and efficiency. The characteristics of patients, the structures of both the public and private sectors, and the regulation of the sector influence the types of health services delivered, and outcomes. Combined with characteristics of private providers-including their size, objectives, and technical competence-the interaction of these factors affects how the sector performs in different contexts. Changing the performance of the private sector will require interventions that target the sector as a whole, rather than individual providers alone. In particular, the performance of the private sector seems to be intrinsically linked to the structure and performance of the public sector, which suggests that deriving population benefit from the private health-care sector requires a regulatory response focused on the health-care sector as a whole. Copyright © 2016 Elsevier Ltd. All rights reserved.

Mandatory influenza immunization for health care workers--an ethical discussion.

PubMed

Steckel, Cynthia M

2007-01-01

Influenza is a serious vaccine-preventable disease affecting 20% of the U.S. population each year. Vaccination of high-risk groups has been called the single most important influenza control measure by the Centers for Disease Control and Prevention. Studies show that vaccination can lead to decreases in flu-related illness and absenteeism among health care workers, as well as fewer acute care outbreaks and reduced patient mortality in long-term care settings. However, to date, voluntary programs have achieved only a 40% vaccination rate among health care workers, causing concern among government and infectious disease organizations. This article addresses the ethical justification for mandating influenza vaccination for health care workers. Health care workers' attitudes toward vaccination are presented, as well as historical and legal perspectives on compulsory measures. The ethical principles of effectiveness, beneficence, necessity, autonomy, justice, and transparency are discussed.

Health Care in the United States [and] Health Care Issues: A Lesson Plan.

ERIC Educational Resources Information Center

Lewis, John; Dempsey, Joanne R.

1984-01-01

An article on American health care which focuses on health care costs and benefits is combined with a lesson plan on health care issues to enable students to consider both issues of cost effectiveness and morality in decisions about the allocation of health care. The article covers the history of interest in health care, the reasons for the…

School-Based Health Centers in an Era of Health Care Reform: Building on History

PubMed Central

Keeton, Victoria; Soleimanpour, Samira; Brindis, Claire D.

2013-01-01

School-based health centers (SBHCs) provide a variety of health care services to youth in a convenient and accessible environment. Over the past 40 years, the growth of SBHCs evolved from various public health needs to the development of a specific collaborative model of care that is sensitive to the unique needs of children and youth, as well as to vulnerable populations facing significant barriers to access. The SBHC model of health care comprises of on-school site health care delivery by an interdisciplinary team of health professionals, which can include primary care and mental health clinicians. Research has demonstrated the SBHCs’ impacts on delivering preventive care, such as immunizations; managing chronic illnesses, such as asthma, obesity, and mental health conditions; providing reproductive health services for adolescents; and even improving youths’ academic performance. Although evaluation of the SBHC model of care has been complicated, results have thus far demonstrated increased access to care, improved health and education outcomes, and high levels of satisfaction. Despite their proven success, SBHCs have consistently faced challenges in securing adequate funding for operations and developing effective financial systems for billing and reimbursement. Implementation of health care reform (The Patient Protection and Affordable Care Act [P.L. 111-148]) will profoundly affect the health care access and outcomes of children and youth, particularly vulnerable populations. The inclusion of funding for SBHCs in this legislation is momentous, as there continues to be increased demand and limited funding for affordable services. To better understand how this model of care has and could further help promote the health of our nation’s youth, a review is presented of the history and growth of SBHCs and the literature demonstrating their impacts. It may not be feasible for SBHCs to be established in every school campus in the country. However, the lessons

A Comprehensive Observational Coding Scheme for Analyzing Instrumental, Affective, and Relational Communication in Health Care Contexts

PubMed Central

SIMINOFF, LAURA A.; STEP, MARY M.

2011-01-01

Many observational coding schemes have been offered to measure communication in health care settings. These schemes fall short of capturing multiple functions of communication among providers, patients, and other participants. After a brief review of observational communication coding, the authors present a comprehensive scheme for coding communication that is (a) grounded in communication theory, (b) accounts for instrumental and relational communication, and (c) captures important contextual features with tailored coding templates: the Siminoff Communication Content & Affect Program (SCCAP). To test SCCAP reliability and validity, the authors coded data from two communication studies. The SCCAP provided reliable measurement of communication variables including tailored content areas and observer ratings of speaker immediacy, affiliation, confirmation, and disconfirmation behaviors. PMID:21213170

Physical Health Problems and Barriers to Optimal Health Care Among Children in Foster Care.

PubMed

Deutsch, Stephanie Anne; Fortin, Kristine

2015-10-01

Children and adolescents in foster care placement represent a unique population with special health care needs, often resulting from pre-placement early adversity and neglected, unaddressed health care needs. High rates of all health problems, including acute and/or chronic physical, mental, and developmental issues prevail. Disparities in health status and access to health care are observed. This article summarizes the physical health problems of children in foster care, who are predisposed to poor health outcomes when complex care needs are unaddressed. Despite recognition of the significant burden of health care need among this unique population, barriers to effective and optimal health care delivery remain. Legislative solutions to overcome obstacles to health care delivery for children in foster care are discussed. Copyright © 2015 Mosby, Inc. All rights reserved.

Reducing Barriers to Care in the Office-Based Health Care Setting for Children With Autism.

PubMed

Bultas, Margaret W; McMillin, Stephen Edward; Zand, Debra H

2016-01-01

The purpose of this survey-design research study was to evaluate the usefulness of a researcher-developed tool designed to improve office-based health care services and to assess the barriers and resources affecting office-based health care services for children with autism spectrum disorder. Fifty-four health care providers (HCPs) and 59 parents participated in the study. HCPs reported child behaviors, communication, and fears as barriers to providing care, whereas parents reported child behavior, sensory issues, and feelings of a disconnect with the HCP as barriers. HCPs identified the parent as a key resource. Parent-identified resources included provider adaptations to the patient, including slowing down the delivery of care and environmental adaptations to the office. In addition, both HCPs and parents indicated that the researcher-developed tool would be useful in reducing barriers during the HCE. Reducing barriers and improving health care interactions during delivery of care for children with autism spectrum disorder has the potential to improve health outcomes. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Caring for mom and neglecting yourself? The health effects of caring for an elderly parent.

PubMed

Coe, Norma B; Van Houtven, Courtney Harold

2009-09-01

We examine the physical and mental health effects of providing care to an elderly mother on the adult child caregiver. We address the endogeneity of the selection in and out of caregiving using an instrumental variable approach, using the death of the care recipient and sibling characteristics. We also carefully control for baseline health and work status of the adult child. We explore flexible specifications, such as Arellano-Bond estimation techniques. Continued caregiving over time increases depressive symptoms and decreases self-rated health for married women and married men. In addition, the increase in depressive symptoms is persistent for married women. While depressive symptoms for single men and women are not affected by continued caregiving, there is evidence of increased incidence of heart conditions for single men, and that these effects are persistent. Robustness checks indicate that these health changes can be directly attributable to caregiving behavior, and not due to a direct effect of the death of the mother. The initial onset of caregiving has modest immediate negative effects on depressive symptoms for married women and no immediate effects on physical health. Negative physical health effects emerge 2 years later, however, suggesting that there are delayed effects on health that would be missed with a short recall period. Initial caregiving does not affect health of married men.

Health insurance coverage and use of family planning services among current and former foster youth: implications of the health care reform law.

PubMed

Dworsky, Amy; Ahrens, Kym; Courtney, Mark

2013-04-01

This research uses data from a longitudinal study to examine how two provisions in the Patient Protection and Affordable Care Act could affect health insurance coverage among young women who have aged out of foster care. It also explores how allowing young people to remain in foster care until age twenty-one affects their health insurance coverage, use of family planning services, and information about birth control. We find that young women are more likely to have health insurance if they remain in foster care until their twenty-first birthday and that having health insurance is associated with an increase in the likelihood of receiving family planning services. Our results also suggest that many young women who would otherwise lack health insurance after aging out of foster care will be eligible for Medicaid under the health care reform law. Because having health insurance is associated with use of family planning services, this increase in Medicaid eligibility may result in fewer unintended pregnancies among this high-risk population.

Health of health care workers in Canadian nursing homes and pediatric hospitals: a cross-sectional study

PubMed Central

Hoben, Matthias; Knopp-Sihota, Jennifer A.; Nesari, Maryam; Chamberlain, Stephanie A.; Squires, Janet E.; Norton, Peter G.; Cummings, Greta G.; Stevens, Bonnie J.; Estabrooks, Carole A.

2017-01-01

Background: Poor health of health care workers affects quality of care, but research and health data for health care workers are scarce. Our aim was to compare physical/mental health among health care worker groups 1) within nursing homes and pediatric hospitals, 2) between the 2 settings and 3) with the physical/mental health of the Canadian population. Methods: Using cross-sectional data collected as part of the Translating Research in Elder Care program and the Translating Research on Pain in Children program, we examined the health of health care workers. In nursing homes, 169 registered nurses, 139 licensed practical nurses, 1506 care aides, 145 allied health care providers and 69 managers were surveyed. In pediatric hospitals, 63 physicians, 747 registered nurses, 155 allied health care providers, 49 nurse educators and 22 managers were surveyed. After standardization of the data for age and sex, we applied analyses of variance and general linear models, adjusted for multiple testing. Results: Nursing home workers and registered nurses in pediatric hospitals had poorer mental health than the Canadian population. Scores were lowest for registered nurses in nursing homes (mean difference -4.4 [95% confidence interval -6.6 to -2.6]). Physicians in pediatric hospitals and allied health care providers in nursing homes had better physical health than the general population. We also found important differences in physical/mental health for care provider groups within and between care settings. Interpretation: Mental health is especially poor among nursing home workers, who care for a highly vulnerable and medically complex population of older adults. Strategies including optimized work environments are needed to improve the physical and mental health of health care workers to ameliorate quality of patient care. PMID:29162609

Public health emergencies and the public health/managed care challenge.

PubMed

Rosenbaum, Sara; Skivington, Skip; Praeger, Sandra

2002-01-01

The relationship between insurance and public health is an enduring topic in public health policy and practice. Insurers share certain attributes with public health. But public health agencies operate in relation to the entire community that they are empowered by public law to serve and without regard to the insurance status of community residents; on the other hand, insurers (whether managed care or otherwise) are risk-bearing entities whose obligations are contractually defined and limited to enrolled members and sponsors. Public insurers such as Medicare and Medicaid operate under similar constraints. The fundamental characteristics that distinguish managed care-style insurance and public health become particularly evident during periods of public health emergency, when a public health agency's basic obligations to act with speed and flexibility may come face to face with the constraints on available financing that are inherent in the structure of insurance. Because more than 70% of all personal health care in the United States is financed through insurance, public health agencies effectively depend on insurers to finance necessary care and provide essential patient-level data to the public health system. Critical issues of state and federal policy arise in the context of the public health/insurance relations during public health emergencies. These issues focus on coverage and the power to make coverage decisions, as well as the power to define service networks and classify certain data as exempt from public reporting. The extent to which a formal regulatory approach may become necessary is significantly affected by the extent to which private entities themselves respond to the problem with active efforts to redesign their services and operations to include capabilities and accountability in the realm of public health emergency response.

The ORIGINS of Primary Health Care and SELECTIVE Primary Health Care

PubMed Central

Cueto, Marcos

2004-01-01

I present a historical study of the role played by the World Health Organization and UNICEF in the emergence and diffusion of the concept of primary health care during the late 1970s and early 1980s. I have analyzed these organizations’ political context, their leaders, the methodologies and technologies associated with the primary health care perspective, and the debates on the meaning of primary health care. These debates led to the development of an alternative, more restricted approach, known as selective primary health care. My study examined library and archival sources; I cite examples from Latin America. PMID:15514221

US health care policy and reform: implications for cardiac electrophysiology.

PubMed

Turakhia, Mintu P; Ullal, Aditya J

2013-03-01

In response to unsustainably rising costs, variable quality and access to health care, and the projected insolvency of vital safety net insurance programs, the federal government has proposed important health policy and regulatory changes in the USA. The US Supreme Court's decision to uphold most of the major provisions of the Affordable Care Act will lead to some of the most sweeping government reforms on entitlements since the creation of Medicare. Furthermore, implementation of new organizational, reimbursement, and health care delivery models will strongly affect the practice of cardiac electrophysiology. In this brief review, we will provide background and context to the problem of rising health care costs and describe salient reforms and their projected impacts on the field and practice of cardiac electrophysiology.

ACOG Committee Opinion no. 598: Committee on Adolescent Health Care: The initial reproductive health visit.

PubMed

2014-05-01

: The initial visit for screening and the provision of reproductive preventive health care services and guidance should take place between the ages of 13 years and 15 years. The initial reproductive health visit provides an excellent opportunity for the obstetrician-gynecologist to start a patient-physician relationship, build trust, and counsel patients and parents regarding healthy behavior while dispelling myths and fears. The scope of the initial reproductive health visit will depend on the individual's need, medical history, physical and emotional development, and the level of care she is receiving from other health care providers. A general exam, a visual breast exam, and external pelvic examination may be indicated. However, an internal pelvic examination generally is unnecessary during the initial reproductive health visit, but may be appropriate if issues or problems are discovered in the medical history. Health care providers and office staff should be familiar with state and local statutes regarding the rights of minors to consent to health care services and the federal and state laws that affect confidentiality.

Health care reform and people with disabilities.

PubMed

Batavia, A I

1993-01-01

As a group, people with disabilities or chronic conditions experience higher-than-average health care costs and have difficulty gaining access to affordable private health insurance coverage. While the Americans with Disabilities Act will enhance access by prohibiting differential treatment without sound actuarial justification, it will not guarantee equal access for people in impairment groups with high utilization rates. Health care reform is needed to subsidize the coverage of such individuals. Such subsidization can be achieved under either a casualty insurance model, in which premiums based on expected costs are subsidized directly, or a social insurance model, in which low-cost enrollees cross-subsidize high-cost enrollees. Cost containment provisions that focus on the provider, such as global budgeting and managed competition, will adversely affect disabled people if providers do not have adequate incentives to meet these people's needs. Provisions focusing on the consumer, such as cost sharing, case management, and benefit reductions, will adversely affect disabled people if they unduly limit needed services or impose a disproportionate financial burden on disabled people.

Entrepreneurs ' perspective on public-private partnership in health care and social services.

PubMed

Sinisammal, Janne; Leviäkangas, Pekka; Autio, Tommi; Hyrkäs, Elina

2016-01-01

The purpose of this paper is to probe experiences of entrepreneurs in the social and health care service provision. Information was collected regarding entrepreneurs' views on the factors affecting the collaboration between public and private sectors. A sample of social and health care entrepreneurs was interviewed using open-ended questions. The interviews were transcribed and analysed using inductive content analysis. Three main categories of factors affecting the success of partnership were identified: the nature of partnership, business aspects and tension builders. Research LIMITATIONS/IMPLICATIONS: The research was undertaken in rural Finland and the sample consisted 13 entrepreneurs. The results must be considered as observations with more generalised conclusions. PRACTICAL implications - The results of this study support municipalities in their social and health care service strategy work and especially in consideration of how to also facilitate a fruitful public-private partnership (PPP)-framework, which will largely depend on mutual understanding and consensus. The reform of the social and health care system has raised intensive public debate throughout Europe. Key issues include the reorganising of social and health care processes as well as PPPs in provision of services. This study observes the views and experiences of private entrepreneurs and points out where some potential problems and solutions of social and health care PPPs are.

College of Health and Health Care Disparities: The Effect of Social and Environmental Factors on Individual and Population Health

PubMed Central

Thomas, Billy

2014-01-01

Recently the existence and prevalence of health and health care disparities has increased with accompanying research showing that minorities (African Americans, Hispanics/Latinos, Native Americans, and Pacific Islanders) are disproportionately affected resulting in poorer health outcomes compared to non-minority populations (whites). This is due to multiple factors including and most importantly the social determinants of health which includes lower levels of education, overall lower socioeconomic status, inadequate and unsafe housing, and living in close proximity to environmental hazards; all contributing to poor health. Given the ever widening gap in health and health care disparities, the growing number of individuals living at or below the poverty level, the low number of college graduates and the growing shortage of health care professionals (especially minority) the goals of this paper are to: (1) Define diversity and inclusion as interdependent entities. (2) Review the health care system as it relates to barriers/problems within the system resulting in the unequal distribution of quality health care. (3) Examine institutional and global benefits of increasing diversity in research. (4) Provide recommendations on institutional culture change and developing a diverse culturally competent healthcare workforce. PMID:25050656

Interdependence in Health and Functioning Among Older Spousal Caregivers and Care Recipients.

PubMed

Hoffman, Geoffrey J; Burgard, Sarah; Mendez-Luck, Carolyn A; Gaugler, Joseph E

2018-06-01

Older spousal caregiving relationships involve support that may be affected by the health of either the caregiver or care recipient. We conducted a longitudinal analysis using pooled data from 4,632 community-dwelling spousal care recipients and caregivers aged ⩾50 from the 2002 to 2014 waves of the Health and Retirement Study. We specified logistic and negative binomial regression models using lagged predictor variables to assess the role of partner health status on spousal caregiver and care recipient health care utilization and physical functioning outcomes. Care recipients' odds of hospitalization, odds ratio (OR): 0.83, p<.001, decreased when caregivers had more ADL difficulties. When spouses were in poorer versus better health, care recipients' bed days decreased (4.69 vs. 2.54) while caregivers' bed days increased (0.20 vs. 0.96). Providers should consider the dual needs of caregivers caring for care recipients and their own health care needs, in adopting a family-centered approach to management of older adult long-term care needs.

Participation and coordination in Dutch health care policy-making. A network analysis of the system of intermediate organizations in Dutch health care.

PubMed

Lamping, Antonie J; Raab, Jörg; Kenis, Patrick

2013-06-01

This study explores the system of intermediate organizations in Dutch health care as the crucial system to understand health care policy-making in the Netherlands. We argue that the Dutch health care system can be understood as a system consisting of distinct but inter-related policy domains. In this study, we analyze four such policy domains: Finances, quality of care, manpower planning and pharmaceuticals. With the help of network analytic techniques, we describe how this highly differentiated system of >200 intermediate organizations is structured and coordinated and what (policy) consequences can be observed with regard to its particular structure and coordination mechanisms. We further analyze the extent to which this system of intermediate organizations enables participation of stakeholders in policy-making using network visualization tools. The results indicate that coordination between the different policy domains within the health care sector takes place not as one would expect through governmental agencies, but through representative organizations such as the representative organizations of the (general) hospitals, the health care consumers and the employers' association. We further conclude that the system allows as well as denies a large number of potential participants access to the policy-making process. As a consequence, the representation of interests is not necessarily balanced, which in turn affects health care policy. We find that the interests of the Dutch health care consumers are well accommodated with the national umbrella organization NPCF in the lead. However, this is no safeguard for the overall community values of good health care since, for example, the interests of the public health sector are likely to be marginalized.

Effects of the ACA on Health Care Cost Containment.

PubMed

Weiner, Janet; Marks, Clifford; Pauly, Mark

2017-02-01

This brief reviews the evidence on how key ACA provisions have affected the growth of health care costs. Coverage expansions produced a predictable jump in health care spending, amidst a slowdown that began a decade ago. Although we have not returned to the double-digit increases of the past, the authors find little evidence that ACA cost containment provisions produced changes necessary to "bend the cost curve." Cost control will likely play a prominent role in the next round of health reform and will be critical to sustaining coverage gains in the long term.

Cost Analysis of a Digital Health Care Model in Sweden.

PubMed

Ekman, Björn

2017-09-22

Digital technologies in health care are expected to increase in scope and to affect ever more parts of the health care system. It is important to enhance the knowledge of whether new digital methods and innovations provide value for money compared with traditional models of care. The objective of the study was to evaluate whether a digital health care model for primary care is a less costly alternative compared with traditional in-office primary care in Sweden. Cost data for the two care models were collected and analyzed to obtain a measure in local currency per care contact. The comparison showed that the total economic cost of a digital consultation is 1960 Swedish krona (SEK) (SEK100 = US$11.29; February 2017) compared with SEK3348 for a traditional consultation at a health care clinic. Cost differences arose on both the provider side and on the user side. The digital health care model may be a less costly alternative to the traditional health care model. Depending on the rate of digital substitution, gross economic cost savings of between SEK1 billion and SEK10 billion per year could be realized if more digital consultations were made. Further studies are needed to validate the findings, assess the types of care most suitable for digital care, and also to obtain various quality-adjusted outcome measures.

Financial crisis and austerity measures in Greece: their impact on health promotion policies and public health care.

PubMed

Ifanti, Amalia A; Argyriou, Andreas A; Kalofonou, Foteini H; Kalofonos, Haralabos P

2013-11-01

This review study explores the available data relating to the impact of financial crisis and subsequently applied austerity measures on the health care, social services and health promotion policies in Greece. It is evident that Greece is affected more than any other European country by the financial crisis. Unemployment, job insecurity, income reduction, poverty and increase of mental disorders are among the most serious consequences of crisis in the socioeconomic life. The health system is particularly affected by the severe austerity measures. The drastic curtailing of government spending has significantly affected the structure and functioning of public hospitals that cope with understaffing, deficits, drug shortage and basic medical supplies. Moreover, health promotion policies are constrained, inhibiting thus the relevant initiatives toward disease prevention and health promotion education practices. Overall, the current economic situation in Greece and its impact on real life and health care is quite concerning. Policy makers should not disregard the implications that austerity and fiscal policies have on the health sector. Greater attention is needed in order to ensure that individuals would continue getting public health care and having access to preventive and social support services. To face the economic hardship, policy makers are expected to implement human-centered approaches, safeguarding the human dignity and the moral values. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The importance of human resources management in health care: a global context.

PubMed

Kabene, Stefane M; Orchard, Carole; Howard, John M; Soriano, Mark A; Leduc, Raymond

2006-07-27

This paper addresses the health care system from a global perspective and the importance of human resources management (HRM) in improving overall patient health outcomes and delivery of health care services. We explored the published literature and collected data through secondary sources. Various key success factors emerge that clearly affect health care practices and human resources management. This paper will reveal how human resources management is essential to any health care system and how it can improve health care models. Challenges in the health care systems in Canada, the United States of America and various developing countries are examined, with suggestions for ways to overcome these problems through the proper implementation of human resources management practices. Comparing and contrasting selected countries allowed a deeper understanding of the practical and crucial role of human resources management in health care. Proper management of human resources is critical in providing a high quality of health care. A refocus on human resources management in health care and more research are needed to develop new policies. Effective human resources management strategies are greatly needed to achieve better outcomes from and access to health care around the world.

The importance of human resources management in health care: a global context

PubMed Central

Kabene, Stefane M; Orchard, Carole; Howard, John M; Soriano, Mark A; Leduc, Raymond

2006-01-01

Background This paper addresses the health care system from a global perspective and the importance of human resources management (HRM) in improving overall patient health outcomes and delivery of health care services. Methods We explored the published literature and collected data through secondary sources. Results Various key success factors emerge that clearly affect health care practices and human resources management. This paper will reveal how human resources management is essential to any health care system and how it can improve health care models. Challenges in the health care systems in Canada, the United States of America and various developing countries are examined, with suggestions for ways to overcome these problems through the proper implementation of human resources management practices. Comparing and contrasting selected countries allowed a deeper understanding of the practical and crucial role of human resources management in health care. Conclusion Proper management of human resources is critical in providing a high quality of health care. A refocus on human resources management in health care and more research are needed to develop new policies. Effective human resources management strategies are greatly needed to achieve better outcomes from and access to health care around the world. PMID:16872531

Health care informatics.

PubMed

Siau, Keng

2003-03-01

The health care industry is currently experiencing a fundamental change. Health care organizations are reorganizing their processes to reduce costs, be more competitive, and provide better and more personalized customer care. This new business strategy requires health care organizations to implement new technologies, such as Internet applications, enterprise systems, and mobile technologies in order to achieve their desired business changes. This article offers a conceptual model for implementing new information systems, integrating internal data, and linking suppliers and patients.

Quarantine, Isolation, and Health Care Workers.

PubMed

Webb, Adam

2015-12-01

Although Ebola virus disease and other hemorrhagic fevers are not generally considered infectious diseases of the nervous system, neurologists may be asked to participate in the management of patients with these and other dangerous communicable illnesses, including possible bioterrorism agents. It is essential for all health professionals to understand the public health, legal, and ethical frameworks behind autonomy-limiting interventions such as quarantine and isolation. Health care professionals represent the front line of defense during public health emergencies. They are often disproportionately affected by the illnesses themselves as well as by the public health interventions intended to prevent spread. The global health crisis caused by the spread of Ebola virus disease has been instructional for examining these ethical issues.

Roles and responsibilities of family physicians on geriatric health care teams: Health care team members' perspectives.

PubMed

Wright, Bruce; Lockyer, Jocelyn; Fidler, Herta; Hofmeister, Marianna

2007-11-01

To examine the beliefs and attitudes of FPs and health care professionals (HCPs) regarding FPs' roles and responsibilities on interdisciplinary geriatric health care teams. Qualitative study using focus groups. Calgary Health Region. Seventeen FPs and 22 HCPs working on geriatric health care teams. Four 90-minute focus groups were conducted with FPs, followed by 2 additional 90-minute focus groups with HCPs. The FP focus groups discussed 4 vignettes of typical teamwork scenarios. Discussions were transcribed and the 4 researchers analyzed and coded themes and subthemes and developed the HCP focus group questions. These questions asked about HCPs' expectations of FPs on teams, experiences with FPs on teams, and perspectives on optimal roles on teams. Several meetings were held to determine themes and subthemes. Family physicians identified patient centredness, role delineation for team members, team dynamics, and team structure as critical to team success. Both FPs and HCPs had a continuum of beliefs about the role FPs should play on teams, including whether FPs should be autonomous or collaborative decision makers, the extent to which FPs should work within or outside teams, whether FPs should be leaders or simply members of teams, and the level of responsibility implied or explicit in their roles. Comments from FPs and HCPs identified intraprofessional and interprofessional tensions that could affect team practice and impede the development of high-functioning teams. It will be important, as primary care reform continues, to help FPs and HCPs learn how to work together effectively on teams so that patients receive the best possible care.

Effect of social media in health care and orthopedic surgery.

PubMed

Saleh, Jenine; Robinson, Brooke S; Kugler, Nathan W; Illingworth, Kenneth D; Patel, Pranay; Saleh, Khaled J

2012-04-01

With the growth of social media platforms, their potential to affect health care, and orthopedics specifically, continues to expand. We reviewed the literature to obtain all pertinent information on social media in health care and examined its strengths and weaknesses from patient and physician perspectives. Health care professionals have slowly begun to use social media to stay connected with patients. The recent use of networking sites aims to improve education, provide a forum to discuss relevant medical topics, and allow for improved patient care. The use of social media, with the understanding of its limitations, may help promote patient happiness and safety and serve as an educational platform. Copyright 2012, SLACK Incorporated.

Which features of primary care affect unscheduled secondary care use? A systematic review

PubMed Central

Huntley, Alyson; Lasserson, Daniel; Wye, Lesley; Morris, Richard; Checkland, Kath; England, Helen; Salisbury, Chris; Purdy, Sarah

2014-01-01

Objectives To conduct a systematic review to identify studies that describe factors and interventions at primary care practice level that impact on levels of utilisation of unscheduled secondary care. Setting Observational studies at primary care practice level. Participants Studies included people of any age of either sex living in Organisation for Economic Co-operation and Development (OECD) countries with any health condition. Primary and secondary outcome measures The primary outcome measure was unscheduled secondary care as measured by emergency department attendance and emergency hospital admissions. Results 48 papers were identified describing potential influencing features on emergency department visits (n=24 studies) and emergency admissions (n=22 studies). Patient factors associated with both outcomes were increased age, reduced socioeconomic status, lower educational attainment, chronic disease and multimorbidity. Features of primary care affecting unscheduled secondary care were more complex. Being able to see the same healthcare professional reduced unscheduled secondary care. Generally, better access was associated with reduced unscheduled care in the USA. Proximity to healthcare provision influenced patterns of use. Evidence relating to quality of care was limited and mixed. Conclusions The majority of research was from different healthcare systems and limited in the extent to which it can inform policy. However, there is evidence that continuity of care is associated with reduced emergency department attendance and emergency hospital admissions. PMID:24860000

Do health literacy and patient empowerment affect self-care behaviour? A survey study among Turkish patients with diabetes

PubMed Central

Eyüboğlu, Ezgi; Schulz, Peter J

2016-01-01

Objective This study aimed to assess the impact of health literacy and patient empowerment on diabetes self-care behaviour in patients in metropolitan Turkish diabetes centres. The conceptual background is provided by the psychological health empowerment model, which holds that health literacy without patient empowerment comes down to wasting health resources, while empowerment without health literacy can lead to dangerous or suboptimal health behaviour. Design, setting and participants A cross-sectional study was conducted with 167 patients over the age of 18 from one of two diabetes clinics in a major Turkish City. Self-administered questionnaires were distributed to eligible outpatients who had an appointment in one of the clinics. Health literacy was measured by a newly translated Turkish version of the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Chew self-report scale. Patient empowerment was measured by a 12-item scale based on Spreitzer's conceptualisation of psychological empowerment in the workplace. Self-care behaviour was measured by the Self-care behaviours were measured by the Summary of Diabetes Self-Care Activities Measure (SDSCA). Level of diabetes knowledge was measured by Diabetes Knowledge Test. Results Two subscales of empowerment, impact and self-determination, predicted self-reported frequency of self-care behaviours. Neither health literacy nor diabetes knowledge had an effect on self-care behaviours. Conclusions Health literacy might be more effective in clinical decisions while empowerment might exert a stronger influence on habitual health behaviours. PMID:26975936

The Environment and Children's Health Care in Northwest China.

PubMed

Trasande, Leonardo; Niu, Jingping; Li, Juansheng; Liu, Xingrong; Zhang, Benzhong; Li, Zhilan; Ding, Guowu; Sun, Yingbiao; Chen, Meichi; Hu, Xiaobin; Chen, Lung-Chi; Mendelsohn, Alan; Chen, Yu; Qu, Qingshan

2014-03-27

Industrialization in the northwest provinces of the People's Republic of China is accelerating rapid increases in early life environmental exposures, yet no publications have assessed health care provider capacity to manage common hazards. To assess provider attitudes and beliefs regarding the environment in children's health, determine self-efficacy in managing concerns, and identify common approaches to managing patients with significant exposures or environmentally-mediated conditions, a two-page survey was administered to pediatricians, child care specialists, and nurses in five provinces (Gansu, Shaanxi, Xinjiang, Qinghai, and Ningxia). Descriptive and multivariable analyses assessed predictors of strong self-efficacy, beliefs or attitudes. 960 surveys were completed with <5% refusal; 695 (72.3%) were valid for statistical analyses. The role of environment in health was rated highly (mean 4.35 on a 1-5 scale). Self-efficacy reported with managing lead, pesticide, air pollution, mercury, mold and polychlorinated biphenyl exposures were generally modest (2.22-2.52 mean). 95.4% reported patients affected with 11.9% reporting seeing >20 affected patients. Only 12.0% reported specific training in environmental history taking, and 12.0% reported owning a text on children's environmental health. Geographic disparities were most prominent in multivariable analyses, with stronger beliefs in environmental causation yet lower self-efficacy in managing exposures in the northwestern-most province. Health care providers in Northwest China have strong beliefs regarding the role of environment in children's health, and frequently identify affected children. Few are trained in environmental history taking or rate self-efficacy highly in managing common hazards. Enhancing provider capacity has promise for improving children's health in the region.

Health spending and political influence: the case of earmarks and health care facilities.

PubMed

Leider, Jonathon P; Tung, Greg; Castrucci, Brian; Sprague, James B

2015-01-01

Earmarks, otherwise known as Congressionally directed spending requests, are a historically significant means of political influence over budgets. In this brief, we report on the results of a longitudinal study of federal earmarks affecting health care facilities and public health. We analyzed 10 years of earmark for health care facilities and examined the correlates of being in the top 50% of earmark recipients for each year. Having representatives or senators serving on the respective Appropriations committees were shown to have increased odds of being a top earmark recipient, as was being in jurisdictions with greater poverty. However, health-related measures of need were not significantly associated with being a top earmark recipient.

Attitude of Health Care Workers (HCWs) toward Patients Affected by HIV/AIDS and Drug Users: A Cross-Sectional Study.

PubMed

Ledda, Caterina; Cicciù, Francesca; Puglisi, Beatrice; Ramaci, Tiziana; Nunnari, Giuseppe; Rapisarda, Venerando

2017-03-09

Caring for HIV/AIDS patients and/or drug users requires health care workers (HCWs) to have good knowledge of the issues. Cultural differences in HCWs, combined with professional ethics and personal beliefs, could also result in conflicting attitudes, leading to difficulties related to looking after people affected by HIV/AIDS or drug users. A cross-sectional study was carried out to assess the attitude towards HIV/AIDS patients and/or drug users in a sample of workers operating in a large university hospital in southern Italy. A total of 736 workers were surveyed from May to November 2016. During the periodic occupational health surveillance, a questionnaire was administered about attitudes of discrimination, acceptance and fear towards these patients. Respondents showed average levels of acceptance to HIV/AIDS and drug user patients. As years of experience and professional training increased, scores for discrimination, acceptance of HIV/AIDS, acceptance of drug users and fear decreased. Factors positively influencing levels of attitudes were being female and younger. Supplementary education is needed to strengthen the awareness of HCWs.

Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

PubMed

Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R

2017-01-01

Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

Financing health care in the United Arab Emirates.

PubMed

Taha, Nabila Fahed; Sharif, Amer Ahmad; Blair, Iain

2013-01-01

Newcomers to the United Arab Emirates (UAE) health care system often enquire about the way in which UAE health services are financed particularly when funding issues affect eligibility for treatment. The UAE ranks alongside many western counties on measures of life expectancy and child mortality but because of the unique population structure spends less of its national income on health. In the past as a wealthy country the UAE had no difficulty ensuring universal access to a comprehensive range of services but the health needs of the UAE population are becoming more complex and like many countries the UAE health system is facing the twin challenges of quality and cost. To meet these challenges new models of health care financing are being introduced. In this brief article we will describe the evolution of UAE health financing, its current state and likely future developments.

Mental Health Screening in Child Care: Impact of a Statewide Training Session

ERIC Educational Resources Information Center

Gleason, Mary Margaret; Heller, Sherryl Scott; Nagle, Geoffrey A.; Boothe, Allison; Keyes, Angela; Rice, Janet

2012-01-01

Child care settings may provide an optimal setting for identification of early childhood mental health problems. However, little is known about child care providers' attitudes or knowledge about screening for children's mental health problems. Both attitudes and perceived knowledge could affect the successful implementation of mental health…

Managing change in health care organizations.

PubMed

Margulies, N

1977-08-01

The forces for change seem more potent today than ever before; increased technological advancement and rapid "societal upheavals" create a more critical need for change and a more significant need for skills to manage and channel change toward meaningful ends. The area of health care delivery is probably one of the fields most impinged upon and most affected by these turbulent times. Organizational development is presented herein as an approach to assist people in health care organizations with the problems of adaptation and change. A specific change strategy, action research, is discussed and a concrete case example is presented to illustrate the ways in which the action research model can be applied. Advantages and pitfalls are discussed in the concluding section.

Identification of Causes of the Occupational Stress for Health Providers at Different Levels of Health Care.

PubMed

Trifunovic, Natasa; Jatic, Zaim; Kulenovic, Alma Dzubur

2017-06-01

To identify and compare the stressors in the work environment experienced by employees in primary health care and secondary health care, amongphysiciansand nurses. The survey was conducted to identify types of stressors by assessing health care workers employed in the primary and secondary health care services of the Public Institution, the Health Centre of the Sarajevo Canton, using a questionnaire about stress in the workplace. Among all study participants stressors connected to the organization of work, finance and communication were found to affect their mental health most strongly. The results show a significant difference between primary and secondary health care in experience of stressors related to the organization of work, communication, and stressors related to the emotional and physical risks. Primary health care physicians report a significantly higher experience of stress and impact on mental health compared with other physicians related to emotional difficulties when working in the field of palliative care. Our results also indicate a significant difference between primary and secondary health providers in experiencing stressors related to the organization of work, such as: on-call duty shifts, an inadequate working environment and in the assessment of administrative work overload. The survey identified the most intense stressors for doctors and nurses at primary and secondary levels of health care services. The results of the study indicate that doctors and nurses have a different hierarchy of stressors, as well as subjects at Primary and Secondary Health Care. The results of the study indicate that subjects et Primary Health Care perceive more stressful organizational, emotional and communicational problems.

[Family care provided by immigrant women and its impact on the quality of care and health].

PubMed

Casado-Mejía, Rosa; Ruiz-Arias, Esperanza; Solano-Parés, Ana

2012-01-01

To understand the effects of care within the family provided by live-in female immigrants on elderly dependents and their families and the carers themselves in Seville (Spain). We designed a qualitative study using in-depth interviews of key informants, immigrant care workers, elderly dependents and their families, and discussion groups composed of health professionals. The study was carried out in Seville between 2006 and 2008. The observation unit consisted of the families of elderly dependents with a live-in female immigrant care worker. The analysis units were health, care, dependence, gender, ethnicity and social class. Category analysis was carried out using QSR-NUD*ISTVivo1.3. After saturation, we triangulated among disciplines, researchers, sources and techniques to validate the results. The most important factors for carers' health were the migration process and care tasks. Interpersonal relationships constituted the principal factor affecting the health of all involved. The care tasks provided by immigrant women, together with the migration process, have an important impact on their health. Good and egalitarian interpersonal relationships are a protective factor for health. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

Applying justice and commitment constructs to patient-health care provider relationships.

PubMed

Holmvall, Camilla; Twohig, Peter; Francis, Lori; Kelloway, E Kevin

2012-03-01

To examine patients' experiences of fairness and commitment in the health care context with an emphasis on primary care providers. Qualitative, semistructured, individual interviews were used to gather evidence for the justice and commitment frameworks across a variety of settings with an emphasis on primary care relationships. Rural, urban, and semiurban communities in Nova Scotia. Patients (ages ranged from 19 to 80 years) with varying health care needs and views on their health care providers. Participants were recruited through a variety of means, including posters in practice settings and communication with administrative staff in clinics. Individual interviews were conducted and were audiotaped and transcribed verbatim. A modified grounded theory approach was used to interpret the data. Current conceptualizations of justice (distributive, procedural, interpersonal, informational) and commitment (affective, normative, continuance) capture important elements of patient-health care provider interactions and relationships. Justice and commitment frameworks developed in other contexts encompass important dimensions of the patient-health care provider relationship with some exceptions. For example, commonly understood subcomponents of justice (eg, procedural consistency) might require modification to apply fully to patient-health care provider relationships. Moreover, the results suggest that factors outside the patient-health care provider dyad (eg, familial connections) might also influence the patient's commitment to his or her health care provider.

The effectiveness of health care cost management strategies: a review of the evidence.

PubMed

Fronstin, P

1994-10-01

This Issue Brief discusses the evolution of the health care delivery and financing systems and its effects on health care cost management and describes the changes in the health care delivery system as they pertain to managed care. It presents empirical evidence on the effectiveness of managed care and concludes with an analysis of the potential of future health care reform to influence the evolution of the health care delivery system and affect health care costs. Between 1987 and 1993, total enrollment in health maintenance organizations (HMOs) increased from 28.6 million to 39.8 million, representing an additional 11.2 million individuals, or 4 percent of the U.S. population. At the same time, new forms of managed care organizations emerged. Enrollment in preferred provider organizations increased from 12.2 million individuals in 1987 to 58 million in 1992, and enrollment in point-of-service plans increased from virtually none in 1987 to 2.3 million individuals in 1992. In addition, the percentage of traditional fee-for-service plans with some form of utilization review increased to 95 percent in 1990 from 41 percent in 1987. Measuring the effects of the changing delivery system on the costs and quality of health care services has been a difficult task, resulting in considerable disagreement as to whether or not costs have been affected. In a recent report, the Congressional Budget Office recognizes two new major findings. First, managed care can provide cost-effective health care at a level of quality comparable with the care typically provided by a fee-for-service plan. Second, independent practice associations can be as effective as group- or staff-model HMOs under certain conditions. In the future, we are likely to see a continued movement of Americans into managed care arrangements, an increase in the number of physicians forming networks, a reduction in the number of insurers, an increase in the number of employers joining coalitions to purchase health care

The U.S. Presidential Election and Health Care Workforce Policy

PubMed Central

McHugh, Matthew D.; Aiken, Linda H.; Cooper, Richard A.; Miller, Phillip

2009-01-01

The candidates for the 2008 presidential election have offered a range of proposals that could bring significant changes in health care. Although few are aimed directly at the nurse and physician workforce, nearly all of the proposals have the potential to affect the health care workforce. Furthermore, the success of the proposed initiatives is dependent on a robust nurse and physician workforce. The purpose of this article is to outline the current needs and challenges for the nurse and physician workforce and highlight how candidates’ proposals intersect with the adequacy of the health care workforce. Three general themes are highlighted for their implications on the physician and nurse workforce supply, including (a) expansion of health care coverage, (b) workforce investment, and (c) cost control and quality improvement. PMID:18436702

Masked ball: ethics, laws and financial contradictions in Hungarian health care.

PubMed

Szebik, Imre

2003-01-01

Corruption is a major problem in the societies of the post-communist Central European countries. Corruption in health care has some unique characteristics undermining the efficacy of and respect for Hungarian health care. One of the forms of corruption is tipping. This highly contested phenomenon is present in most of the patient/health professional's interactions in a sophisticated manner, raising serious ethical and legal dilemmas. The present paper analyzes tipping and other corruption-related factors, such as financial conflict of interest between industry and health care and argues that since ethical and legal considerations are often ignored in the country, patient care and clinical research are affected by these controversial issues to a great extent.

Primary care nursing activities with patients affected by physical chronic disease and common mental disorders: a qualitative descriptive study.

PubMed

Girard, Ariane; Hudon, Catherine; Poitras, Marie-Eve; Roberge, Pasquale; Chouinard, Maud-Christine

2017-05-01

To describe nursing activities in primary care with patients affected by physical chronic disease and common mental disorders. Patients in primary care who are affected by physical chronic disease and common mental disorders such as anxiety and depression require care and follow-up based on their physical and mental health condition. Primary care nurses are increasingly expected to contribute to the care and follow-up of this growing clientele. However, little is known about the actual activities carried out by primary care nurses in providing this service in the Province of Quebec (Canada). A qualitative descriptive study was conducted. Data were obtained through semistructured individual interviews with 13 nurses practising among patients with physical chronic disease in seven Family Medicine Groups in Quebec (Canada). Participants described five activity domains: assessment of physical and mental health condition, care planning, interprofessional collaboration, therapeutic relationship and health promotion. The full potential of primary care nurses is not always exploited, and some activities could be improved. Evidence for including nurses in collaborative care for patients affected by physical chronic disease and common mental disorders has been shown but is not fully implemented in Family Medicine Groups. Future research should emphasise collaboration among mental health professionals, primary care nurses and family physicians in the care of patients with physical chronic disease and common mental disorders. Primary care nurses would benefit from gaining more knowledge about common mental disorders and from identifying the resources they need to contribute to managing them in an interdisciplinary team. © 2016 John Wiley & Sons Ltd.

How Does Sensitivity Training of Health Care Workers Impact Patient Satisfaction?

ERIC Educational Resources Information Center

De Vinci, Katrina Marie

2010-01-01

Health care of the 21st century is undergoing major changes due to a myriad of social factors affecting every level of society. From financial desperation due to the high cost of health care to the increased awareness of a generation asking for better services, the importance of patient satisfaction is paramount. The Centers for Medicare and…

Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities.

PubMed

Chen, Jie; Mullins, C Daniel; Novak, Priscilla; Thomas, Stephen B

2016-02-01

Designing culturally sensitive personalized interventions is essential to sustain patients' involvement in their treatment and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and self-determination for their own health and health care. We propose a patient-centered, multilevel activation and empowerment framework (individual-, health care professional-, community-, and health care delivery system-level) to inform the development of culturally informed personalized patient activation and empowerment (P-PAE) interventions to improve population health and reduce racial and ethnic disparities. We discuss relevant Affordable Care Act payment and delivery policy reforms and how they affect patient activation and empowerment. Such policies include Accountable Care Organizations and value-based purchasing, patient-centered medical homes, and the community health benefit. Challenges and possible solutions to implementing the P-PAE are discussed. Comprehensive and longitudinal data sets with consistent P-PAE measures are needed to conduct comparative effectiveness analyses to evaluate the optimal P-PAE model. We believe the P-PAE model is timely and sustainable and will be critical to engaging patients in their treatment, developing patients' abilities to manage their health, helping patients express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient-provider partnerships through shared decision making. © 2015 Society for Public Health Education.

Health Insurance Coverage and Use of Family Planning Services among Current and Former Foster Youth: Implications of the Health Care Reform Law

PubMed Central

Dworsky, Amy; Ahrens, Kym; Courtney, Mark

2013-01-01

This research uses data from a longitudinal study to examine how two provisions in the Patient Protection and Affordable Care Act could affect health insurance coverage among young women who have aged out of foster care. It also explores how allowing young people to remain in foster care until age twenty-one affects their health insurance coverage, use of family planning services, and information about birth control. We find that young women are more likely to have health insurance if they remain in foster care until their twenty-first birthday and that having health insurance is associated with an increase in the likelihood of receiving family planning services. Our results also suggest that many young women who would otherwise lack health insurance after aging out of foster care will be eligible for Medicaid under the health care reform law. Because having health insurance is associated with use of family planning services, this increase in Medicaid eligibility may result in fewer unintended pregnancies among this high-risk population. PMID:23262773

Exploring Health Care Providers' Views About Initiating End-of-Life Care Communication.

PubMed

Nedjat-Haiem, Frances R; Carrion, Iraida V; Gonzalez, Krystana; Ell, Kathleen; Thompson, Beti; Mishra, Shiraz I

2017-05-01

Numerous factors impede effective and timely end-of-life (EOL) care communication. These factors include delays in communication until patients are seriously ill and/or close to death. Gaps in patient-provider communication negatively affect advance care planning and limit referrals to palliative and hospice care. Confusion about the roles of various health care providers also limits communication, especially when providers do not coordinate care with other health care providers in various disciplines. Although providers receive education regarding EOL communication and care coordination, little is known about the roles of all health care providers, including nonphysician support staff working with physicians to discuss the possibility of dying and help patients prepare for death. This study explores the perspectives of physicians, nurses, social workers, and chaplains on engaging seriously ill patients and families in EOL care communication. Qualitative data were from 79 (medical and nonmedical) providers practicing at 2 medical centers in Central Los Angeles. Three themes that describe providers' perceptions of their roles and responsibility in talking with seriously ill patients emerged: (1) providers' roles for engaging in EOL discussions, (2) responsibility of physicians for initiating and leading discussions, and (3) need for team co-management patient care. Providers highlighted the importance of beginning discussions early by having physicians lead them, specifically due to their medical training and need to clarify medical information regarding patients' prognosis. Although physicians are a vital part of leading EOL communication, and are at the center of communication of medical information, an interdisciplinary approach that involves nurses, social workers, and chaplains could significantly improve patient care.

Primary Health Care: care coordinator in regionalized networks?

PubMed

Almeida, Patty Fidelis de; Santos, Adriano Maia Dos

2016-12-22

To analyze the breadth of care coordination by Primary Health Care in three health regions. This is a quantitative and qualitative case study. Thirty-one semi-structured interviews with municipal, regional and state managers were carried out, besides a cross-sectional survey with the administration of questionnaires to physicians (74), nurses (127), and a representative sample of users (1,590) of Estratégia Saúde da Família (Family Health Strategy) in three municipal centers of health regions in the state of Bahia. Primary Health Care as first contact of preference faced strong competition from hospital outpatient and emergency services outside the network. Issues related to access to and provision of specialized care were aggravated by dependence on the private sector in the regions, despite progress observed in institutionalizing flows starting out from Primary Health Care. The counter-referral system was deficient and interprofessional communication was scarce, especially concerning services provided by the contracted network. Coordination capacity is affected both by the fragmentation of the regional network and intrinsic problems in Primary Health Care, which poorly supported in its essential attributes. Although the health regions have common problems, Primary Health Care remains a subject confined to municipal boundaries. Analisar o alcance da coordenação do cuidado pela Atenção Primária à Saúde em três regiões de saúde. Trata-se de estudo de caso, com abordagem quantitativa e qualitativa. Foram realizadas 31 entrevistas semiestruturadas com gestores municipais, regionais e estaduais e estudo transversal com aplicação de questionários para médicos (74), enfermeiros (127) e amostra representativa de usuários (1.590) da Estratégia Saúde da Família em três municípios-sede de regiões de saúde do estado da Bahia. A função de porta de entrada preferencial pela Atenção Primária à Saúde deparava-se com forte concorrência de servi

Holistic health care: Patients' experiences of health care provided by an Advanced Practice Nurse

PubMed Central

Lindblad, Monica; Möller, Ulrika

2017-01-01

Abstract Introduction Advanced Practice Nurse (APN) is a fairly new role in the Swedish health care system. Aim To describe patients' experiences of health care provided by an APN in primary health care. Methods An inductive, descriptive qualitative approach with qualitative open‐ended interviews was chosen to obtain descriptions from 10 participants regarding their experiences of health care provided by an APN. The data were collected during the spring 2012, and a qualitative approach was used for analyze. Results The APNs had knowledge and skills to provide safe and secure individual and holistic health care with high quality, and a respectful and flexible approach. The APNs conveyed trust and safety and provided health care that satisfied the patients' needs of accessibility and appropriateness in level of care. Conclusion The APNs way of providing health care and promoting health seems beneficial in many ways for the patients. The individual and holistic approach that characterizes the health care provided by the APNs is a key aspect in the prevailing change of health care practice. The transfer of care and the increasing number of older adults, often with a variety of complex health problems, call for development of the new role in this context. PMID:29071766

Holistic health care: Patients' experiences of health care provided by an Advanced Practice Nurse.

PubMed

Eriksson, Irene; Lindblad, Monica; Möller, Ulrika; Gillsjö, Catharina

2018-02-01

Advanced Practice Nurse (APN) is a fairly new role in the Swedish health care system. To describe patients' experiences of health care provided by an APN in primary health care. An inductive, descriptive qualitative approach with qualitative open-ended interviews was chosen to obtain descriptions from 10 participants regarding their experiences of health care provided by an APN. The data were collected during the spring 2012, and a qualitative approach was used for analyze. The APNs had knowledge and skills to provide safe and secure individual and holistic health care with high quality, and a respectful and flexible approach. The APNs conveyed trust and safety and provided health care that satisfied the patients' needs of accessibility and appropriateness in level of care. The APNs way of providing health care and promoting health seems beneficial in many ways for the patients. The individual and holistic approach that characterizes the health care provided by the APNs is a key aspect in the prevailing change of health care practice. The transfer of care and the increasing number of older adults, often with a variety of complex health problems, call for development of the new role in this context. © 2017 The Authors. International Journal of Nursing Practice Published by John Wiley & Sons Australia, Ltd.

Integrated primary care: patient perceptions and the role of mental health stigma.

PubMed

Miller-Matero, Lisa R; Khan, Shehryar; Thiem, Rachel; DeHondt, Tiffany; Dubaybo, Hala; Moore, Daniel

2018-06-19

Some patients are more willing to see a behavioral health provider within primary care. The purpose of this study was to evaluate the patients' perspectives of having access to a psychologist within primary care and to investigate whether mental health stigma affected preferences. In total, 36 patients completed questionnaires after seeing a psychologist in primary care. Patients were satisfied with having a primary care psychologist involved in their care. Most patients were more likely to see the psychologist in primary care and those who preferred this indicated higher levels of mental health stigma. The overarching theme for why patients saw a psychologist in primary care was convenience. Mental health stigma may also have played a role. Results suggest that providing integrated services may reach patients who may not have otherwise sought services in a behavioral health clinic. Findings from this study encourage the continued integration of behavioral health services.

Oral Health Care Delivery Within the Accountable Care Organization.

PubMed

Blue, Christine; Riggs, Sheila

2016-06-01

The accountable care organization (ACO) provides an opportunity to strategically design a comprehensive health system in which oral health works within primary care. A dental hygienist/therapist within the ACO represents value-based health care in action. Inspired by health care reform efforts in Minnesota, a vision of an accountable care organization that integrates oral health into primary health care was developed. Dental hygienists and dental therapists can help accelerate the integration of oral health into primary care, particularly in light of the compelling evidence confirming the cost-effectiveness of care delivered by an allied workforce. A dental insurance Chief Operating Officer and a dental hygiene educator used their unique perspectives and experience to describe the potential of an interdisciplinary team-based approach to individual and population health, including oral health, via an accountable care community. The principles of the patient-centered medical home and the vision for accountable care communities present a paradigm shift from a curative system of care to a prevention-based system that encompasses the behavioral, social, nutritional, economic, and environmental factors that impact health and well-being. Oral health measures embedded in the spectrum of general health care have the potential to ensure a truly comprehensive healthcare system. Published by Elsevier Inc.

Integrating Social impacts on Health and Health-Care Systems in Systemic Seismic Vulnerability Analysis

NASA Astrophysics Data System (ADS)

Kunz-Plapp, T.; Khazai, B.; Daniell, J. E.

2012-04-01

This paper presents a new method for modeling health impacts caused by earthquake damage which allows for integrating key social impacts on individual health and health-care systems and for implementing these impacts in quantitative systemic seismic vulnerability analysis. In current earthquake casualty estimation models, demand on health-care systems is estimated by quantifying the number of fatalities and severity of injuries based on empirical data correlating building damage with casualties. The expected number of injured people (sorted by priorities of emergency treatment) is combined together with post-earthquake reduction of functionality of health-care facilities such as hospitals to estimate the impact on healthcare systems. The aim here is to extend these models by developing a combined engineering and social science approach. Although social vulnerability is recognized as a key component for the consequences of disasters, social vulnerability as such, is seldom linked to common formal and quantitative seismic loss estimates of injured people which provide direct impact on emergency health care services. Yet, there is a consensus that factors which affect vulnerability and post-earthquake health of at-risk populations include demographic characteristics such as age, education, occupation and employment and that these factors can aggravate health impacts further. Similarly, there are different social influences on the performance of health care systems after an earthquake both on an individual as well as on an institutional level. To link social impacts of health and health-care services to a systemic seismic vulnerability analysis, a conceptual model of social impacts of earthquakes on health and the health care systems has been developed. We identified and tested appropriate social indicators for individual health impacts and for health care impacts based on literature research, using available European statistical data. The results will be used to

Budgeting in health care systems.

PubMed

Maynard, A

1984-01-01

During the last decade there has been a recognition that all health care systems, public and private, are characterised by perverse incentives (especially moral hazard and third party pays) which generate inefficiency in the use of scarce economic resources. Inefficiency is unethical: doctors who use resources inefficiently deprive potential patients of care from which they could benefit. To eradicate unethical and inefficient practices two economic rules have to be followed: (i) no service should be provided if its total costs exceed its total benefits; (ii) if total benefits exceed total costs, the level of provision should be at that level at which the additional input cost (marginal cost) is equal to the additional benefits (marginal benefit). This efficiency test can be applied to health care systems, their component parts and the individuals (especially doctors) who control resource allocation within them. Unfortunately, all health care systems neither generate this relevant decision making data nor are they flexible enough to use it to affect health care decisions. There are two basic varieties of budgeting system: resource based and production targeted. The former generates obsession with cash limits and too little regard of the benefits, particularly at the margins, of alternative patterns of resource allocation. The latter generates undue attention to the production of processes of care and scant regard for costs, especially at the margins. Consequently, one set of budget rules may lead to cost containment regardless of benefits and the other set of budget rules may lead to output maximization regardless of costs. To close this circle of inefficiency it is necessary to evolve market-like structures. To do this a system of client group (defined broadly across all existing activities public and private) budgets is advocated with an identification of the budget holder who has the capacity to shift resources and seek out cost effective policies. Negotiated

Health Care Delivery.

ERIC Educational Resources Information Center

Starfield, Barbara

1987-01-01

The article reviews emerging health care delivery options for handicapped children. Cost structures, quality of care, and future prospects are considered for Health Maintenance Organizations, Preferred Provider Organizations, Tax Supported Direct Service Programs, Hospital-Based Services, and Ambulatory Care Organizations. (Author/DB)

Health Care Indicators

PubMed Central

Donham, Carolyn S.; Sensenig, Arthur L.

1994-01-01

This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data. PMID:10142373

The impact of comparative effectiveness research on health and health care spending☆, ☆☆

PubMed Central

Basu, Anirban; Jena, Anupam B.; Philipson, Tomas J.

2011-01-01

Comparative effectiveness research (CER) is thought to identify what works and does not work in health care. We interpret CER as infusing evidence on product quality into markets, shifting the relative demand for products in CER studies. We analyze how shifts in demand affect health and health care spending and demonstrate that CER may raise or lower overall health when treatments have heterogeneous effects, but payers respond with product-specific coverage policies. Among patients with schizophrenia, we calibrate that subsidy policies based on the clinical trial CATIE may have reduced overall health by inducing some patients to switch away from schizophrenia treatments that were effective for them towards winners of the CER. PMID:21696840

75 FR 39022 - Submission for OMB Review; Comment Request; Survey of Health Care Professionals' Awareness and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-07

...; Comment Request; Survey of Health Care Professionals' Awareness and Perceptions of the National Cancer... of Health Care Professionals' Awareness and Perceptions of the National Cancer Institute's Intramural...: Yearly. Affected Public: Individual adults. Type of Respondents: Health care providers (AMA members who...

CMS Innovation Center Health Care Innovation Awards

PubMed Central

Berry, Sandra H.; Concannon, Thomas W.; Morganti, Kristy Gonzalez; Auerbach, David I.; Beckett, Megan K.; Chen, Peggy G.; Farley, Donna O.; Han, Bing; Harris, Katherine M.; Jones, Spencer S.; Liu, Hangsheng; Lovejoy, Susan L.; Marsh, Terry; Martsolf, Grant R.; Nelson, Christopher; Okeke, Edward N.; Pearson, Marjorie L.; Pillemer, Francesca; Sorbero, Melony E.; Towe, Vivian; Weinick, Robin M.

2013-01-01

Abstract The Center for Medicare and Medicaid Innovation within the Centers for Medicare & Medicaid Services (CMS) has funded 108 Health Care Innovation Awards, funded through the Affordable Care Act, for applicants who proposed compelling new models of service delivery or payment improvements that promise to deliver better health, better health care, and lower costs through improved quality of care for Medicare, Medicaid, and Children's Health Insurance Program enrollees. CMS is also interested in learning how new models would affect subpopulations of beneficiaries (e.g., those eligible for Medicare and Medicaid and complex patients) who have unique characteristics or health care needs that could be related to poor outcomes. In addition, the initiative seeks to identify new models of workforce development and deployment, as well as models that can be rapidly deployed and have the promise of sustainability. This article describes a strategy for evaluating the results. The goal for the evaluation design process is to create standardized approaches for answering key questions that can be customized to similar groups of awardees and that allow for rapid and comparable assessment across awardees. The evaluation plan envisions that data collection and analysis will be carried out on three levels: at the level of the individual awardee, at the level of the awardee grouping, and as a summary evaluation that includes all awardees. Key dimensions for the evaluation framework include implementation effectiveness, program effectiveness, workforce issues, impact on priority populations, and context. The ultimate goal is to identify strategies that can be employed widely to lower cost while improving care. PMID:28083297

An Integrative Behavioral Health Care Model Using Automated SBIRT and Care Coordination in Community Health Care.

PubMed

Dwinnells, Ronald; Misik, Lauren

2017-10-01

Efficient and effective integration of behavioral health programs in a community health care practice emphasizes patient-centered medical home principles to improve quality of care. A prospective, 3-period, interrupted time series study was used to explore which of 3 different integrative behavioral health care screening and management processes were the most efficient and effective in prompting behavioral health screening, identification, interventions, and referrals in a community health practice. A total of 99.5% ( P < .001) of medical patients completed behavioral health screenings; brief intervention rates nearly doubled to 83% ( P < .001) and 100% ( P < .001) of identified at-risk patients had referrals made using a combination of electronic tablets, electronic medical record, and behavioral health care coordination.

[Primary Health Care in the coordination of health care networks: an integrative review].

PubMed

Rodrigues, Ludmila Barbosa Bandeira; Silva, Patricia Costa Dos Santos; Peruhype, Rarianne Carvalho; Palha, Pedro Fredemir; Popolin, Marcela Paschoal; Crispim, Juliane de Almeida; Pinto, Ione Carvalho; Monroe, Aline Aparecida; Arcêncio, Ricardo Alexandre

2014-02-01

Health systems organized in health care networks and coordinated by Primary Health Care can contribute to an improvement in clinical quality with a positive impact on health outcomes and user satisfaction (by improving access and resolubility) and a reduction in the costs of local health systems. Thus, the scope of this paper is to analyze the scientific output about the evidence, potential, challenges and prospects of Primary Health Care in the coordination of Health Care Networks. To achieve this, the integrative review method was selected covering the period between 2000 and 2011. The databases selected were Medline (Medical Literature Analysis and Retrieval System online), Lilacs (Latin American Literature in Health Sciences) and SciELO (Scientific Electronic Library Online). Eighteen articles fulfilled the selection criteria. It was seen that the potential impacts of primary care services supersede the inherent weaknesses. However, the results revealed the need for research with a higher level of classification of the scientific evidence about the role of Primary Healh Care in the coordination of Health Care Networks.

The Shifting Landscape of Health Care: Toward a Model of Health Care Empowerment

PubMed Central

2011-01-01

In a rapidly changing world of health care information access and patients’ rights, there is limited conceptual infrastructure available to understand how people approach and engage in treatment of medical conditions. The construct of health care empowerment is defined as the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty regarding health care. I present a model in which health care empowerment is influenced by an interplay of cultural, social, and environmental factors; personal resources; and intrapersonal factors. The model offers a framework to understand patient and provider roles in facilitating health care empowerment and presents opportunities for investigation into the role of health care empowerment in multiple outcomes across populations and settings, including inquiries into the sources and consequences of health disparities. PMID:21164096

Children's environmental health: an under-recognised area in paediatric health care

PubMed Central

Gavidia, Tania G; Pronczuk de Garbino, Jenny; Sly, Peter D

2009-01-01

The knowledge that the environment in which we live, grow and play, can have negative or positive impacts on our health and development is not new. However the recognition that adverse environments can significantly and specifically affect the growth and development of a child from early intrauterine life through to adolescence, as well as impact their health later in adulthood, is relatively recent and has not fully reached health care providers involved in paediatric care. Over the past 15 years, world declarations and statements on children's rights, sustainable development, chemical safety and most recently climate change, have succeeded in cultivating a global focus on children's health and their right to a healthy environment. Many international calls for research in the area, have also been able to identify patterns of environmental diseases in children, assess children's exposures to many environmental toxicants, identify developmental periods of vulnerability, and quantify the cost benefits to public health systems and beyond, of addressing environmentally related diseases in children. Transferring this information to front-line health care providers and increasing their awareness about the global burden of disease attributed to the environment and children's especial vulnerability to environmental threats is the salient aim of this commentary. PMID:19196484

Health Care and Public Transportation Use by Poor and Frail Elderly People.

ERIC Educational Resources Information Center

Rittner, Barbara; Kirk, Alan B.

1995-01-01

Presents survey data on low-income elderly people. Examined sociocultural and quality-of-life variables as they affected use of health care and transportation services. More than half of respondents did not receive medical care despite reporting multiple symptoms. Most participants relied upon public transportation to obtain health services. (RJM)

The roles of federal legislation and evolving health care systems in promoting medical-dental collaboration.

PubMed

Edelstein, Burton L

2014-01-01

Recent federal health care legislation contains explicit and implicit drivers for medical-dental collaboration. These laws implicitly promote health care evolution through value-based financing, "big data" and health information technology, increased number of care providers and a more holistic approach. Additional changes--practice aggregation, consumerism and population health perspectives--may also influence dental care. While dentistry will likely lag behind medicine toward value-based and accountable care organizations, dentists will be affected by changing consumer expectations.

Health Communication and the HIV Continuum of Care.

PubMed

Vermund, Sten H; Mallalieu, Elizabeth C; Van Lith, Lynn M; Struthers, Helen E

2017-01-01

Health communication is a broad term that applies to the fundamental need for practitioners, policy makers, patients, and community members to understand one another around health promotion and health care issues. Whether in a consultation between nurse and patient, a health clinic director's engagement with the health ministry, or a community campaign for encouraging HIV testing, all have critical health communication elements. When people's needs are not perceived by them to be addressed or clients/patients do not understand what is being communicated, they are unmotivated to engage. Health communication may be deployed at multiple levels to encourage positive behavior change and affect HIV treatment outcomes. As countries move to treatment for all as soon as possible after testing, health communication can help address significant losses at each stage of the HIV continuum of care, thereby contributing to achieving the 90-90-90 global treatment goals. This JAIDS supplement presents compelling studies that are anchored on the health communication exigencies in highly diverse HIV and AIDS contexts in low and middle income settings. Our special focus is health communication needs and challenges within the HIV continuum of care. We introduce the supplement with thumbnails summaries of the work presented by an experienced array of public health, behavioral, and clinical scientists.

What about Us? Economic and Policy Changes Affecting Rural HIV/AIDS Services and Care.

PubMed

Albritton, Tashuna; Martinez, Isabel; Gibson, Crystal; Angley, Meghan; Grandelski, Valen R

2017-01-01

Health care budgets and policies are chief drivers in the delivery and access to health services. Place is also a factor that affects patient and provider experiences within the health care system. We examine the impact of policy changes and subsequent budget cuts on rural HIV/AIDS care, support services, and prevention. We interviewed 11 social workers, case managers, and outreach workers who serve rural people living with HIV/AIDS. We conducted telephone interviews inquiring about the effect of economics and policies on direct practice with rural clients. We analyzed data using a content analysis approach. We found several themes from the data. Ryan White funding and policy changes shifted direct practice to a medical case management model. Changes in federal and state poverty levels affected client eligibility for the AIDS Drugs Assistance Program. Policy banning financial support for syringe service programs hindered prevention efforts to reduce HIV/AIDS transmission. Ancillary services were reduced, such as housing assistance, transportation, and emergency financial assistance. In conclusion, we highlight the importance of place-based policies to improve access to healthcare and services. We also provide recommendations for greater inclusion in HIV/AIDS-related policy development, care, and service planning for rural workers.

Canadian physicians’ responses to cross border health care

PubMed Central

2014-01-01

-sanctioned and patient-initiated), and how they affect the Canadian health system, can contribute to a more informed debate about the role of cross-border health care in the future, and how it might be organized and regulated. PMID:24708810

Canadian physicians' responses to cross border health care.

PubMed

Runnels, Vivien; Labonté, Ronald; Packer, Corinne; Chaudhry, Sabrina; Adams, Owen; Blackmer, Jeff

2014-04-03

The idea for this survey emanated from desk research and two meetings for researchers that discussed medical tourism and out-of-country health care, which were convened by some of the authors of this article (VR, CP and RL). A Cross Border Health Care Survey was drafted by a number of the authors and administered to Canadian physicians via the Canadian Medical Association's e-panel. The purpose of the survey was to gain an understanding of physicians' experiences with and views of their patients acquiring health care out of country, either as medical tourists (paying out-of-pocket for their care) or out-of-country care patients funded by provincial/territorial public health insurance plans. Quantitative and qualitative results of the survey were analyzed. 631 physicians responded to the survey. Diagnostic procedures were the top-ranked procedure for patients either as out-of-country care recipients or medical tourists. Respondents reported that the main reason why patients sought care abroad was because waiting times in Canada were too long. Some respondents were frustrated with a lack of information about out-of-country procedures upon their patients' return to Canada. The majority of physician respondents agreed that it was their responsibility to provide follow-up care to medical travellers on return to Canada, although a substantial minority disagreed that they had such a responsibility. Cross-border health care, whether government-sanctioned (out-of-country-care) or patient-initiated (medical tourism), is increasing in Canada. Such flows are thought likely to increase with aging populations. Government-sanctioned outbound flows are less problematic than patient-initiated flows but are constrained by low approval rates, which may increase patient initiation. Lack of information and post-return complications pose the greatest concern to Canadian physicians. Further research on both types of flows (government-sanctioned and patient-initiated), and how they affect

Which features of primary care affect unscheduled secondary care use? A systematic review.

PubMed

Huntley, Alyson; Lasserson, Daniel; Wye, Lesley; Morris, Richard; Checkland, Kath; England, Helen; Salisbury, Chris; Purdy, Sarah

2014-05-23

To conduct a systematic review to identify studies that describe factors and interventions at primary care practice level that impact on levels of utilisation of unscheduled secondary care. Observational studies at primary care practice level. Studies included people of any age of either sex living in Organisation for Economic Co-operation and Development (OECD) countries with any health condition. The primary outcome measure was unscheduled secondary care as measured by emergency department attendance and emergency hospital admissions. 48 papers were identified describing potential influencing features on emergency department visits (n=24 studies) and emergency admissions (n=22 studies). Patient factors associated with both outcomes were increased age, reduced socioeconomic status, lower educational attainment, chronic disease and multimorbidity. Features of primary care affecting unscheduled secondary care were more complex. Being able to see the same healthcare professional reduced unscheduled secondary care. Generally, better access was associated with reduced unscheduled care in the USA. Proximity to healthcare provision influenced patterns of use. Evidence relating to quality of care was limited and mixed. The majority of research was from different healthcare systems and limited in the extent to which it can inform policy. However, there is evidence that continuity of care is associated with reduced emergency department attendance and emergency hospital admissions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Engaging Survivors of Human Trafficking: Complex Health Care Needs and Scarce Resources.

PubMed

Judge, Abigail M; Murphy, Jennifer A; Hidalgo, Jose; Macias-Konstantopoulos, Wendy

2018-05-01

Human trafficking, also known as modern-day slavery, is an egregious human rights violation associated with wide-ranging medical and mental health consequences. Because of the extensive health problems related to trafficking, health care providers play a critical role in identifying survivors and engaging them in ongoing care. Although guidelines for recognizing affected patients and a framework for developing response protocols in health care settings have been described, survivors' ongoing engagement in health care services is very challenging. High rates of disengagement, lost contact, premature termination, and attrition are common outcomes. For interventions to be effective in this marginalized population, challenges in engaging survivors in long-term therapeutic primary and mental health care must be better understood and overcome. This article uses the socioecological model of public health to identify barriers to engagement; offers evidence- and practice-based recommendations for overcoming these barriers; and proposes an interdisciplinary call to action for developing more flexible, adaptable models of care.

Care for the Health Care Provider.

PubMed

Kunin, Sharon Brown; Kanze, David Mitchell

2016-03-01

Pretravel care for the health care provider begins with an inventory, including the destination, length of stay, logistical arrangements, type of lodging, food and water supply, team members, personal medical needs, and the needs of the community to be treated. This inventory should be created and processed well in advance of the planned medical excursion. The key thing to remember in one's planning is to be a health care provider during one's global health care travel and not to become a patient oneself. This article will help demonstrate the medical requirements and recommendations for such planning. Copyright © 2016 Elsevier Inc. All rights reserved.

Applying justice and commitment constructs to patient–health care provider relationships

PubMed Central

Holmvall, Camilla; Twohig, Peter; Francis, Lori; Kelloway, E. Kevin

2012-01-01

Abstract Objective To examine patients’ experiences of fairness and commitment in the health care context with an emphasis on primary care providers. Design Qualitative, semistructured, individual interviews were used to gather evidence for the justice and commitment frameworks across a variety of settings with an emphasis on primary care relationships. Setting Rural, urban, and semiurban communities in Nova Scotia. Participants Patients (ages ranged from 19 to 80 years) with varying health care needs and views on their health care providers. Methods Participants were recruited through a variety of means, including posters in practice settings and communication with administrative staff in clinics. Individual interviews were conducted and were audiotaped and transcribed verbatim. A modified grounded theory approach was used to interpret the data. Main findings Current conceptualizations of justice (distributive, procedural, interpersonal, informational) and commitment (affective, normative, continuance) capture important elements of patient–health care provider interactions and relationships. Conclusion Justice and commitment frameworks developed in other contexts encompass important dimensions of the patient–health care provider relationship with some exceptions. For example, commonly understood subcomponents of justice (eg, procedural consistency) might require modification to apply fully to patient–health care provider relationships. Moreover, the results suggest that factors outside the patient–health care provider dyad (eg, familial connections) might also influence the patient’s commitment to his or her health care provider. PMID:22423030

Health Care in China.

PubMed

Younger, David S

2016-11-01

China has recently emerged as an important global partner. However, like other developing nations, China has experienced dramatic demographic and epidemiologic changes in the past few decades. Population discontent with the health care system has led to major reforms. China's distinctive health care system, including its unique history, vast infrastructure, the speed of health reform, and economic capacity to make important advances in health care, nonetheless, has incomplete insurance coverage for urban and rural dwellers, uneven access, mixed quality of health care, increasing costs, and risk of catastrophic health expenditures. Copyright © 2016 Elsevier Inc. All rights reserved.

The Youth Health Care measure-satisfaction, utilization, and needs (YHC-SUN)-development of a self-report version of the Child Health Care (CHC-SUN) proxy-measure.

PubMed

Schmidt, Silke; Thyen, Ute; Herrmann-Garitz, Carsten; Bomba, Franziska; Muehlan, Holger

2016-05-20

The transition of health care of youth (age 15-25) with chronic conditions requires the assessment of adolescents' access, use and needs as well as satisfaction with the health services they use. The aim of this study was to test the adolescent adaptation of the parent version "Child Health Care Questionnaire - Satisfaction, Utilization and Needs" (CHC-SUN) concerning its psychometric performance and appropriateness for adolescents and young adults. The Youth Health Care Measure (YHC-SUN) was designed to allow self-report of youth and it was pilot-tested in a small sample using cognitive debriefing. A cross-sectional survey in a sample of youth with chronic conditions in the transition period was carried out. One hundred eighty-two ambulatory care patients with three conditions participated in the survey. The subscales of the section on satisfaction with care showed excellent internal consistencies, uni-dimensionality and fit to the model of the parent version. There was no impact of gender and education on satisfaction with care. Associations with age, diagnosis, experiences with care and health literacy affecting the satisfaction with care indicate discriminatory and content validity. Potential applications of the new instrument are evaluations of health care services for adolescents and young adults using self-reports and evaluations of transition programs and interventions such as patient education.

Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review.

PubMed

Williamson, Heather J; Contreras, Graciela M; Rodriguez, Erica S; Smith, Jennifer M; Perkins, Elizabeth A

2017-10-01

Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study's purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment.

Predicting Health Care Utilization in Marginalized Populations: Black, Female, Street-based Sex Workers

PubMed Central

Varga, Leah M.; Surratt, Hilary L.

2014-01-01

Background Patterns of social and structural factors experienced by vulnerable populations may negatively affect willingness and ability to seek out health care services, and ultimately, their health. Methods The outcome variable was utilization of health care services in the previous 12 months. Using Andersen’s Behavioral Model for Vulnerable Populations, we examined self-reported data on utilization of health care services among a sample of 546 Black, street-based female sex workers in Miami, Florida. To evaluate the impact of each domain of the model on predicting health care utilization, domains were included in the logistic regression analysis by blocks using the traditional variables first and then adding the vulnerable domain variables. Findings The most consistent variables predicting health care utilization were having a regular source of care and self-rated health. The model that included only enabling variables was the most efficient model in predicting health care utilization. Conclusions Any type of resource, link, or connection to or with an institution, or any consistent point of care contributes significantly to health care utilization behaviors. A consistent and reliable source for health care may increase health care utilization and subsequently decrease health disparities among vulnerable and marginalized populations, as well as contribute to public health efforts that encourage preventive health. PMID:24657047

Health Care Services

Science.gov Websites

State Employees Health Care Services DHSS State of Alaska Home Divisions and Agencies Alaska Pioneer Homes Behavioral Health Office of Children's Services Office of the Commissioner Office of Substance Misuse and Addiction Prevention Finance & Management Services Health Care Services Juvenile Justice

Health and Functioning of Families of Children With Special Health Care Needs Cared for in Home Care, Long-term Care, and Medical Day Care Settings.

PubMed

Caicedo, Carmen

2015-06-01

To examine and compare child and parent or guardian physical and mental health outcomes in families with children with special health care needs who have medically complex technology-dependent needs in home care, long-term care (LTC), and medical day care (MDC) settings. The number of children requiring medically complex technology-dependent care has grown exponentially. In this study, options for their care are home care, LTC, or MDC. Comparison of child and parent/guardian health outcomes is unknown. Using repeated measures data were collected from 84 dyads (parent/guardian, medically complex technology-dependent child) for 5 months using Pediatric Quality of Life Inventory Generic Core Module 4.0 and Family Impact Module Data analysis: χ(2), RM-ANCOVA. There were no significant differences in overall physical health, mental health, and functioning of children by care setting. Most severely disabled children were in home care; moderately disabled in MDC; children in vegetative state LTC; however, parents perceived children's health across care setting as good to excellent. Parents/guardians from home care reported the poorest physical health including being tired during the day, too tired to do the things they like to do, feeling physically weak, or feeling sick and had cognitive difficulties, difficulties with worry, communication, and daily activities. Parents/guardians from LTC reported the best physical health with time and energy for a social life and employment. Trends in health care policy indicate a movement away from LTC care to care in the family home where data indicate these parents/guardians are already mentally and functionally challenged.

Digital health care--the convergence of health care and the Internet.

PubMed

Frank, S R

2000-04-01

The author believes that interactive media (the Internet and the World Wide Web) and associated applications used to access those media (portals, browsers, specialized Web-based applications) will result in a substantial, positive, and measurable impact on medical care faster than any previous information technology or communications tool. Acknowledging the dynamic environment, the author classifies "pure" digital health care companies into three business service areas: content, connectivity, and commerce. Companies offering these services are attempting to tap into a host of different markets within the health care industry including providers, payers, pharmaceutical and medical products companies, employers, distributors, and consumers. As the fastest growing medium in history, and given the unique nature of health care information and the tremendous demand for content among industry professionals and consumers, the Internet offers a more robust and targeted direct marketing opportunity than traditional media. From the medical consumer's standpoint (i.e., the patient) the author sees the Internet as performing five critical functions: (1) Disseminate information, (2) Aid informed decision making, (3) Promote health, (4) Provide a means for information exchange and support--the community concept, and (5) Increase self-care and manage demand for health services, lowering direct medical costs. The author firmly submits the Web will provide overall benefits to the health care economy as health information consumers manage their own health problems that might not directly benefit from an encounter with a health professional. Marrying the Internet to other interactive technologies, including voice recognition systems and telephone-based triage lines among others, holds the promise of reducing unnecessary medical services.

Health and Health Care Access of Rural Women Veterans: Findings From the National Survey of Women Veterans.

PubMed

Cordasco, Kristina M; Mengeling, Michelle A; Yano, Elizabeth M; Washington, Donna L

2016-09-01

Disparities in health and health care access between rural and urban Americans are well documented. There is evidence that these disparities are mirrored within the US veteran population. However, there are few studies assessing this issue among women veterans (WVs). Using the 2008-2009 National Survey of Women Veterans, a population-based cross-sectional national telephone survey, we examined rural WVs' health and health care access compared to urban WVs. We measured health using the Medical Outcomes Study Short-Form (SF-12); access using measures of regular source of care (RSOC), health care utilization, and unmet needs; and barriers to getting needed care. Rural WVs have significantly worse physical health functioning compared to urban WVs (mean physical component score of 43.6 for rural WVs versus 47.2 for urban WVs; P = .007). Rural WVs were more likely to have a VA RSOC (16.4% versus 10.6%; P = .009) and use VA health care (21.7% versus 12.9%; P < .001), and had fewer non-VA health care visits compared with urban WVs (mean 4.2 versus 5.9; P = .021). They had similar overall numbers of health care visits (mean 5.8 versus 7.1; P = .11 ). Access barriers were affordability for rural WVs and work release time for urban WVs. Rural WVs additionally reported that transportation was a major factor affecting health care decisions. Our findings demonstrate VA's crucial role in addressing disparities in health and health care access for rural WVs. As VA continues to strive to optimally meet the needs of all WVs, innovative care models need to account for their high health care needs and persistent barriers to care. © 2016 National Rural Health Association.

Chemotherapy versus supportive care alone in pediatric palliative care for cancer: comparing the preferences of parents and health care professionals.

PubMed

Tomlinson, Deborah; Bartels, Ute; Gammon, Janet; Hinds, Pamela S; Volpe, Jocelyne; Bouffet, Eric; Regier, Dean A; Baruchel, Sylvain; Greenberg, Mark; Barrera, Maru; Llewellyn-Thomas, Hilary; Sung, Lillian

2011-11-22

The choice between palliative chemotherapy (defined as the use of cytotoxic medications delivered intravenously for the purpose of our study) and supportive care alone is one of the most difficult decisions in pediatric oncology, yet little is known about the preferences of parents and health care professionals. We compared the strength of these preferences by considering children's quality of life and survival time as key attributes. In addition, we identified factors associated with the reported preferences. We included parents of children whose cancer had no reasonable chance of being cured and health care professionals in pediatric oncology as participants in our study. We administered separate interviews to parents and to health care professionals. Visual analogue scales were shown to respondents to illustrate the anticipated level of the child's quality of life, the expected duration of survival and the probability of cure (shown only to health care professionals). Respondents were then asked which treatment option they would favour given these baseline attributes. In addition, respondents reported what factors might affect such a decision and ranked all factors identified in order of importance. The primary measure was the desirability score for supportive care alone relative to palliative chemotherapy, as obtained using the threshold technique. A total of 77 parents and 128 health care professionals participated in our study. Important factors influencing the decision between therapeutic options were child quality-of-life and survival time among both parents and health care professionals. Hope was particularly important to parents. Parents significantly favoured chemotherapy (42/77, 54.5%) compared with health care professionals (20/128, 15.6%; p < 0.0001). The opinions of the physician and child significantly influenced the parents' desire for supportive care; for health care professionals, the opinions of parents and children were significant factors

Negative and positive affect are independently associated with patient-reported health status following percutaneous coronary intervention.

PubMed

Versteeg, Henneke; Pedersen, Susanne S; Erdman, Ruud A M; van Nierop, Josephine W I; de Jaegere, Peter; van Domburg, Ron T

2009-10-01

We examined the association between negative and positive affect and 12-month health status in patients treated with percutaneous coronary intervention (PCI) with drug-eluting stents. Consecutive PCI patients (n = 562) completed the Global Mood Scale at baseline to assess affect and the EuroQoL-5D (EQ-5D) at baseline and 12-month follow-up to assess health status. Negative affect [F(1, 522) = 17.14, P < .001] and positive affect [F(1, 522) = 5.11, P = .02] at baseline were independent associates of overall health status at 12-month follow-up, adjusting for demographic and clinical factors. Moreover, there was a significant interaction for negative by positive affect [F(1, 522) = 6.11, P = .01]. In domain-specific analyses, high negative affect was associated with problems in mobility, self-care, usual activities, pain/discomfort, and anxiety/depression with the risk being two to fivefold. Low positive affect was only associated with problems in self-care (OR: 8.14; 95% CI: 1.85-35.9; P = .006) and usual activities (OR: 1.87; 95% CI: 1.17-3.00; P = .009). Baseline negative and positive affect contribute independently to patient-reported health status 12 months post PCI. Positive affect moderated the detrimental effects of negative affect on overall health status. Enhancing positive affect might be an important target to improve patient-centered outcomes in coronary artery disease.

Adolescents' Right to Participate: Opportunities and Challenges for Health Care Professionals.

PubMed

Todres, Jonathan; Diaz, Angela

Health care professionals and patients are partners in health care delivery, and this partnership is critical in the treatment of adolescents. International children's rights law establishes that all children have a right to participate in decisions that affect their lives. Fulfillment of that right is as critical in health care settings as any other area of children's lives. In this article we examine the right to participate under international children's rights law, its relevance to health care settings, and how health care professionals can foster adolescents' participation to fulfill children's rights and improve health care outcomes. The Convention on the Rights of the Child establishes a legal mandate-where ratified-that adolescents have the right to express their views in health care settings and that such views must be given due consideration. In many health care settings, adolescents are not adequately consulted or have limited opportunities to express their views. A review of research finds that both processes and outcomes can improve when youth participation is cultivated. Health care providers and organizations have numerous opportunities to cultivate adolescent's participation rights and in doing so improve health care delivery and outcomes. Health care providers and organizations should further develop structures and processes to ensure opportunities for children and adolescents to be heard on matters relevant to their health care and health status. Creating opportunities for adolescents to realize their right to participate means engaging youth at every stage in the process, beginning with the design of such opportunities. It also means addressing all aspects of health care, from the built environment to patient-provider communication to follow-up services, so that the entire process fosters an environment conductive to meaningful participation by adolescents. Copyright © 2017 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All

On duty all the time: health and quality of life among immigrant parents caring for a child with complex health needs.

PubMed

Gravdal Kvarme, Lisbeth; Albertini-Früh, Elena; Brekke, Idunn; Gardsjord, Ragnhild; Halvorsrud, Liv; Liden, Hilde

2016-02-01

To provide knowledge about how immigrant parents of children with complex health needs manage their family lives and how this affects their own health and quality of life. Caregivers of children with complex health needs have additional risk for general health problems and mental health problems and immigrant parents may be more vulnerable to mental distress and failing health and quality of life. This qualitative study used an exploratory design with individual and focus group interviews. Data collection and analysis followed phenomenological hermeneutic guidelines. Individual and group interviews with 27 parents: 18 mothers and 9 fathers from Pakistan, Poland and Vietnam. Immigrant parents of children with complex health needs experience their own health and quality of life challenges. They described the burden of dealing with their child's needs and special care, which affects their sleep and physical and mental health. Single mothers are particularly vulnerable. Parents reported positive and negative effects of their caregiving experience that may affect their health and quality of life. Mothers were the primary caregivers and reported more health problems than did fathers. The lack of respite care, social networks and support impacted maternal health. Immigrant parents struggle to access resources for their child with complex health needs. Hospital nurses, schools and community health care can play a valuable role in supporting the parents of children with complex health needs. It is important that parents are informed about their rights and receive a coordinator and interdisciplinary group to ensure that their needs are met with assistance and respite care. That maternal health was worse in this sample implies that health care professionals should pay more attention to reducing stress among these caregivers. © 2016 John Wiley & Sons Ltd.

US Health Care Reform and Transplantation, Part II: impact on the public sector and novel health care delivery systems.

PubMed

Axelrod, D A; Millman, D; Abecassis, M M

2010-10-01

The Patient Protection and Affordable Care Act passed in 2010 will result in dramatic expansion of publically funded health insurance coverage for low-income individuals. It is estimated that of the 32 million newly insured, 16 million will obtain coverage through expansion of the Medicaid Program, and the remaining 16 million will purchase coverage through their employer or newly legislated insurance exchanges. While the Act contains numerous provisions to improve access to private insurance as discussed in Part I of this analysis, public sector coverage will significantly be affected. The cost of health care reform will be borne disproportionately by Medicare, which faces nearly $500 billion in cuts to be identified by a new independent board. Transplant centers should be concerned about the impact of the reform on the financial aspects of transplantation. In addition, this legislation also utilizes the Medicare Program to drive reform of the health care delivery system, by encouraging the development of integrated Accountable Care Organizations, experimentation with new 'models' of healthcare delivery, and expanded support for Comparative Effectiveness Research. Transplant providers, including transplant centers and physicians/surgeons need to lead this movement, drawing on our experience providing comprehensive multidisciplinary care under global budgets with publically reported outcomes.

Operations management in health care.

PubMed

Henderson, M D

1995-01-01

Health care operations encompass the totality of those health care functions that allow those who practice health care delivery to do so. As the health care industry undergoes dramatic reform, so will the jobs of those who manage health care delivery systems. Although health care operations managers play one of the most vital and substantial roles in the new delivery system, the criteria for their success (or failure) are being defined now. Yet, the new and vital role of the operations manager has been stunted in its development, which is primarily because of old and outdated antipathy between hospital administrators and physicians. This article defines the skills and characteristics of today's health care operations managers.

Democratic and Republican physicians provide different care on politicized health issues.

PubMed

Hersh, Eitan D; Goldenberg, Matthew N

2016-10-18

Physicians frequently interact with patients about politically salient health issues, such as drug use, firearm safety, and sexual behavior. We investigate whether physicians' own political views affect their treatment decisions on these issues. We linked the records of over 20,000 primary care physicians in 29 US states to a voter registration database, obtaining the physicians' political party affiliations. We then surveyed a sample of Democratic and Republican primary care physicians. Respondents evaluated nine patient vignettes, three of which addressed especially politicized health issues (marijuana, abortion, and firearm storage). Physicians rated the seriousness of the issue presented in each vignette and their likelihood of engaging in specific management options. On the politicized health issues-and only on such issues-Democratic and Republican physicians differed substantially in their expressed concern and their recommended treatment plan. We control for physician demographics (like age, gender, and religiosity), patient population, and geography. Physician partisan bias can lead to unwarranted variation in patient care. Awareness of how a physician's political attitudes might affect patient care is important to physicians and patients alike.

Democratic and Republican physicians provide different care on politicized health issues

PubMed Central

Hersh, Eitan D.; Goldenberg, Matthew N.

2016-01-01

Physicians frequently interact with patients about politically salient health issues, such as drug use, firearm safety, and sexual behavior. We investigate whether physicians’ own political views affect their treatment decisions on these issues. We linked the records of over 20,000 primary care physicians in 29 US states to a voter registration database, obtaining the physicians’ political party affiliations. We then surveyed a sample of Democratic and Republican primary care physicians. Respondents evaluated nine patient vignettes, three of which addressed especially politicized health issues (marijuana, abortion, and firearm storage). Physicians rated the seriousness of the issue presented in each vignette and their likelihood of engaging in specific management options. On the politicized health issues—and only on such issues—Democratic and Republican physicians differed substantially in their expressed concern and their recommended treatment plan. We control for physician demographics (like age, gender, and religiosity), patient population, and geography. Physician partisan bias can lead to unwarranted variation in patient care. Awareness of how a physician’s political attitudes might affect patient care is important to physicians and patients alike. PMID:27698126

Mental health care treatment initiation when mental health services are incorporated into primary care practice.

PubMed

Kessler, Rodger

2012-01-01

Most primary care patients with mental health issues are identified or treated in primary care rather than the specialty mental health system. Primary care physicians report that their patients do not have access to needed mental health care. When referrals are made to the specialty behavioral or mental health care system, rates of patients who initiate treatment are low. Collaborative care models, with mental health clinicians as part of the primary care medical staff, have been suggested as an alternative. The aim of this study is to examine rates of treatment startup in 2 collaborative care settings: a rural family medicine office and a suburban internal medicine office. In both practices referrals for mental health services are made within the practice. Referral data were drawn from 2 convenience samples of patients referred by primary care physicians for collaborative mental health treatment at Fletcher Allen Health Care in Vermont. The first sample consisted of 93 consecutively scheduled referrals in a family medicine office (sample A) between January 2006 and December 2007. The second sample consisted of 215 consecutive scheduled referrals at an internal medicine office (sample B) between January 2009 and December 2009. Referral data identified age, sex, and presenting mental health/medical problem. In sample A, 95.5% of those patients scheduling appointments began behavioral health treatment; in sample B this percentage was 82%. In sample B, 69% of all patients initially referred for mental health care both scheduled and initiated treatment. When referred to a mental health clinician who provides on-site access as part of a primary care mental health collaborative care model, a high percentage of patients referred scheduled care. Furthermore, of those who scheduled care, a high percentage of patients attend the scheduled appointment. Findings persist despite differences in practice type, populations, locations, and time frames of data collection. That the

Across the health-social care divide: elderly people as active users of health care and social care.

PubMed

Roberts, K

2001-03-01

Several ways in which elderly people may assume an active role when using welfare services are discussed here. Selected findings are presented from a study that explored the experience and behaviour of elderly people on discharge from inpatient care with regard to criteria indicating user influence or control (namely participation, representation, access, choice, information and redress). Data were collected via semistructured interviews with service users (n = 30) soon after their return home from hospital. A number of differences were revealed between health care and social care in relation to users being provided with opportunities to assume an active role and in being willing and able to assume an active role. These differences were manifest in elderly service users accessing services, seeking information, exercising choice and acting independently of service providers. It appeared paradoxical that contact points were more easily defined with regard to health care yet users were more likely to exercise choice and act independently in securing social care. It is suggested that social care needs and appropriate service delivery are more easily recognised than making the link between perceived health care needs and appropriate services. In addition, it appeared that informal and private providers are more widely available and accessible for social care. If comprehensive continuing care is to be provided, incorporating both health and social care elements, greater uniformity appears to be required across the welfare sector. Lessons for social care provision from the delivery of health care suggest the clear definition of contact points to facilitate service use. Making health care more accessible, however, does not appear to be easily attainable due to the monopoly provision of health care and the lack of direct purchasing power by potential users.

Women’s perspectives on quality of maternal health care services in Malawi

PubMed Central

Machira, Kennedy; Palamuleni, Martin

2018-01-01

Despite promotion by many stakeholders to improve maternal health outcome in many developing countries including Malawi, many analysts agree that the utmost success in maternal health will arise if maternal health care services are an unparallel led source for women’s health care solutions for any problem related to childbirth. Health advocates worldwide claim that even though maternal services are provided, women’s utilization of such services has not been ascertained. The objective of this study was to explore women’s perspectives on the quality of health care service delivery in Malawi. This article therefore investigates women’s perspectives on the quality of maternal health care services in Malawi. We used six focus group discussions in six health facilities that were selected across Malawi. We found that erratic availability of medical resources and unethical practices among health workers adversely affected quality of maternal health care service delivery. We concluded that the expensive routine operational audits of medical resources and service delivery across health facilities are imperative if women’s health outcomes are to be enhanced in Malawi. PMID:29386917

Transformational change in health care systems: an organizational model.

PubMed

Lukas, Carol VanDeusen; Holmes, Sally K; Cohen, Alan B; Restuccia, Joseph; Cramer, Irene E; Shwartz, Michael; Charns, Martin P

2007-01-01

The Institute of Medicine's 2001 report Crossing the Quality Chasm argued for fundamental redesign of the U.S. health care system. Six years later, many health care organizations have embraced the report's goals, but few have succeeded in making the substantial transformations needed to achieve those aims. This article offers a model for moving organizations from short-term, isolated performance improvements to sustained, reliable, organization-wide, and evidence-based improvements in patient care. Longitudinal comparative case studies were conducted in 12 health care systems using a mixed-methods evaluation design based on semistructured interviews and document review. Participating health care systems included seven systems funded through the Robert Wood Johnson Foundation's Pursuing Perfection Program and five systems with long-standing commitments to improvement and high-quality care. Five interactive elements appear critical to successful transformation of patient care: (1) Impetus to transform; (2) Leadership commitment to quality; (3) Improvement initiatives that actively engage staff in meaningful problem solving; (4) Alignment to achieve consistency of organization goals with resource allocation and actions at all levels of the organization; and (5) Integration to bridge traditional intra-organizational boundaries among individual components. These elements drive change by affecting the components of the complex health care organization in which they operate: (1) Mission, vision, and strategies that set its direction and priorities; (2) Culture that reflects its informal values and norms; (3) Operational functions and processes that embody the work done in patient care; and (4) Infrastructure such as information technology and human resources that support the delivery of patient care. Transformation occurs over time with iterative changes being sustained and spread across the organization. The conceptual model holds promise for guiding health care

Care management process of breast cancer in primary health-care system, Golestan Province, Iran, 2013-2014.

PubMed

Hajiebrahimi, Zahra; Mahmoodi, Ghahraman; Abedi, Ghasem

2017-01-01

Health-care service processes need to be assessed over time. We aimed to assess the breast cancer care process in primary health system of Golestan Province, North Iran. To perform a descriptive cross-sectional study, information on breast cancer care processes in primary health-care system was collected using a "collecting form" from 234 health houses, 29 health posts, 44 urban health centers, and 80 rural health centers in Golestan Province. Registered data in the centers and patients' journal were used in data collection. Moreover, we collected data on all women who were diagnosed with breast cancer in 2014 to know the characteristics of the patients. Around 50% of health workers at rural or urban area were trained on breast cancer. Moreover, 2% of women from general population in rural area and around 6% of them in urban area have been trained on breast cancer. Mean age of women diagnosed with breast cancer was 48 ± 10 years and 40.2% of them were affected at age between 43 and 52 years. The results showed that 18.9% of women have received their information through self-study before the diagnosis of breast cancer while 53.8% of them received their information from the private clinics after diagnosis of breast cancer. The process of breast cancer care in Golestan Province needs to be improved in the primary health-care level. Both inter- and multi-disciplinary activities are needed.

How Will Repealing the ACA Affect Medicaid? Impact on Health Care Coverage, Delivery, and Payment.

PubMed

Rosenbaum, Sara; Rothenberg, Sara; Schmucker, Sara; Gunsalus, Rachel; Beckerman, J. Zoë

2017-03-01

ISSUE: The Affordable Care Act enhanced Medicaid's role as a health care purchaser by expanding eligibility and broadening the range of tools and strategies available to states. All states have embraced delivery and payment reform as basic elements of their programs. GOAL: To examine the effects of reducing the size and scope of Medicaid under legislation to repeal the ACA. FINDINGS AND CONCLUSIONS: Were the ACA's Medicaid expansion to be eliminated and were federal Medicaid funding to experience major reductions through block grants or per capita caps, the effects on system transformation would be significant. Over 70 percent of Medicaid spending is driven by enrollment in a program that covers 74 million people; on a per capita basis Medicaid costs less than Medicare or commercial insurance. States would need to absorb major financial losses by reducing the number of people served, reducing the scope of services covered, introducing higher cost-sharing, or further reducing already low payments. Far from improving quality and efficiency, these changes would cause the number of uninsured to rise while depriving health care providers and health plans of the resources needed to care for patients and invest in the tools that are essential to system transformation

Differences in Health Care Needs, Health Care Utilization, and Health Care Outcomes Among Children With Special Health Care Needs in Ohio: A Comparative Analysis Between Medicaid and Private Insurance.

PubMed

Sarkar, Madhurima; Earley, Elizabeth R; Asti, Lindsey; Chisolm, Deena J

This study explores comparative differentials in health care needs, health care utilization, and health status between Medicaid and private/employer-sponsored insurance (ESI) among a statewide population of children with special health care needs (CSHCN) in Ohio. We used data from the 2012 Ohio Medicaid Assessment Survey to examine CSHCN's health care needs, utilization, status, and health outcomes by insurance type. Adjusted multivariable logistic regression models were used to explore associations between public and private health insurance, as well as the utilization and health outcome variables. Bivariate analyses indicate that the Medicaid population had higher care coordination needs (odds ratio [OR] = 1.6; 95% confidence interval [CI], 1.1-2.2) as well as need for mental/educational health care services (OR = 1.5; 95% CI; 1.1-2.0). They also reported higher unmet dental care needs (OR = 2.2; 95% CI, 1.2-4.0), higher emergency department (ED) utilization (OR = 2.3; 95% CI, 1.7-3.2), and worse overall health (OR = 0.6; 95% CI, 0.4-0.7), oral health (OR = 0.4; 95% CI, 0.3-0.5), and vision health (OR = 0.4; 95% CI, 0.2-0.6). After controlling for demographic variables, CSHCN with Medicaid insurance coverage were more likely to need mental health and education services (adjusted odds ratio [AOR] = 1.8; 95% CI; 1.2-2.6), had significantly more ED visits (AOR = 2.3; 95% CI, 1.5-3.5), and were less likely to have excellent overall health (AOR = 0.64; 95% CI, 0.4-0.9), oral health (AOR = 0.43; 95% CI, 0.3-0.7), and vision health (AOR = 0.38; 95% CI, 0.2-0.6) than those with private insurance/ESI. The CSHCN population is a highly vulnerable population. While Ohio's Medicaid provides greater coverage to CSHCN, disparities continue to exist within access and services that Medicaid provides versus the ones provided by private insurance/ESI.

Health care in Brazil.

PubMed Central

Haines, A

1993-01-01

Brazil has great geopolitical importance because of its size, environmental resources, and potential economic power. The organisation of its health care system reflects the schisms within Brazilian society. High technology private care is available to the rich and inadequate public care to the poor. Limited financial resources have been overconcentrated on health care in the hospital sector and health professionals are generally inappropriately trained to meet the needs of the community. However, recent changes in the organisation of health care are taking power away from federal government to state and local authorities. This should help the process of reform, but many vested interests remain to be overcome. A link programme between Britain and Brazil focusing on primary care has resulted in exchange of ideas and staff between the two countries. If primary care in Brazil can be improved it could help to narrow the health divide between rich and poor. Images p503-a p504-a p505-a PMID:8448465

Predicting health care utilization in marginalized populations: Black, female, street-based sex workers.

PubMed

Varga, Leah M; Surratt, Hilary L

2014-01-01

Patterns of social and structural factors experienced by vulnerable populations may negatively affect willingness and ability to seek out health care services, and ultimately, their health. The outcome variable was utilization of health care services in the previous 12 months. Using Andersen's Behavioral Model for Vulnerable Populations, we examined self-reported data on utilization of health care services among a sample of 546 Black, street-based, female sex workers in Miami, Florida. To evaluate the impact of each domain of the model on predicting health care utilization, domains were included in the logistic regression analysis by blocks using the traditional variables first and then adding the vulnerable domain variables. The most consistent variables predicting health care utilization were having a regular source of care and self-rated health. The model that included only enabling variables was the most efficient model in predicting health care utilization. Any type of resource, link, or connection to or with an institution, or any consistent point of care, contributes significantly to health care utilization behaviors. A consistent and reliable source for health care may increase health care utilization and subsequently decrease health disparities among vulnerable and marginalized populations, as well as contribute to public health efforts that encourage preventive health. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Trends in Health Care Financial Burdens, 2001 to 2009

PubMed Central

BLUMBERG, LINDA J; WAIDMANN, TIMOTHY A; BLAVIN, FREDRIC; ROTH, JEREMY

2014-01-01

Context: Over the past decade, health care spending increased faster than GDP and income, and decreasing affordability is cited as contributing to personal bankruptcies and as a reason that some of the nonelderly population is uninsured. We examined the trends in health care affordability over the past decade, measuring the financial burdens associated with health insurance premiums and out-of-pocket costs and highlighting implications of the Affordable Care Act for the future financial burdens of particular populations. Methods: We used cross sections of the Medical Expenditure Panel Survey Household Component (MEPS-HC) from 2001 to 2009. We defined financial burden at the health insurance unit (HIU) level and calculated it as the ratio of expenditures on health care—employer-sponsored insurance coverage (ESI) and private nongroup premiums and out-of-pocket payments—to modified adjusted gross income. Findings: The median health care financial burden grew on average by 2.7% annually and by 21.9% over the period. Using a range of definitions, the fraction of households facing high financial burdens increased significantly. For example, the share of HIUs with health care expenses exceeding 10% of income increased from 35.9% to 44.8%, a 24.8% relative increase. The share of the population in HIUs with health care financial burdens between 2% and 10% fell, and the share with burdens between 10% and 44% rose. Conclusions: We found a clear trend over the past decade toward an increasing share of household income devoted to health care. The ACA will affect health care spending for subgroups of the population differently. Several groups’ burdens will likely decrease, including those becoming eligible for Medicaid or subsidized private insurance and those with expensive medical conditions. Those newly obtaining coverage might increase their health spending relative to income, but they will gain access to care and the ability to spread their expenditures over

Declining amenable mortality: a reflection of health care systems?

PubMed

Gianino, Maria Michela; Lenzi, Jacopo; Fantini, Maria Pia; Ricciardi, Walter; Damiani, Gianfranco

2017-11-15

Some studies have analyzed the association of health care systems variables, such as health service resources or expenditures, with amenable mortality, but the association of types of health care systems with the decline of amenable mortality has yet to be studied. The present study examines whether specific health care system types are associated with different time trend declines in amenable mortality from 2000 to 2014 in 22 European OECD countries. A time trend analysis was performed. Using Nolte and McKee's list, age-standardized amenable mortality rates (SDRs) were calculated as the annual number of deaths over the population aged 0-74 years per 100,000 inhabitants. We classified health care systems according to a deductively generated classification by Böhm. This classification identifies three dimensions that are not entirely independent of each other but follow a clear order: the regulation dimension is first, followed by the financing dimension and finally service provision. We performed a hierarchical semi-log polynomial regression analysis on the annual SDRs to determine whether specific health care systems were associated with different SDR trajectories over time. The results showed a clear decline in SDRs in all 22 health care systems between 2000 and 2014 although at different annual changes (slopes). Regression analysis showed that there was a significant difference among the slopes according to provision dimension. Health care systems with a private provision exhibited a slowdown in the decline of amenable mortality over time. It therefore seems that ownership is the most relevant dimension in determining a different pattern of decline in mortality. All countries experienced decreases in amenable mortality between 2000 and 2014; this decline seems to be partially a reflection of health care systems, especially when affected by the provision dimension. If the private ownership is maintained or promoted by health systems, these findings might be

Computers in health care for the 21st century.

PubMed

O'Desky, R I; Ball, M J; Ball, E E

1990-03-01

As the world enters the last decade of the 20th Century, there is a great deal of speculation about the effect of computers on the future delivery of health care. In this article, the authors attempt to identify some of the evolving computer technologies and anticipate what effect they will have by the year 2000. Rather than listing potential accomplishments, each of the affected areas: hardware, software, health care systems and communications, are presented in an evolutionary manner so the reader can better appreciate where we have been and where we are going.

Assessing Private Sector Involvement in Health Care and Universal Health Coverage in Light of the Right to Health.

PubMed

Hallo De Wolf, Antenor; Toebes, Brigit

2016-12-01

The goal of universal health coverage is to "ensure that all people obtain the health services they need without suffering financial hardship when paying for them." There are many connections between this goal and the state's legal obligation to realize the human right to health. In the context of this goal, it is important to assess private actors' involvement in the health sector. For example, private actors may not always have the incentives to deal with externalities that affect the availability, accessibility, acceptability, and quality of health care services; they may not be in a position to provide "public goods"; or they may operate under imperfect information. This paper sets out to answer the question, what legal human rights obligations do states have in terms of regulating private sector involvement in health care?

Health care worker perspectives of their motivation to reduce health care-associated infections.

PubMed

McClung, Laura; Obasi, Chidi; Knobloch, Mary Jo; Safdar, Nasia

2017-10-01

Health care-associated infections (HAIs) are largely preventable, but are associated with considerable health care burden. Given the significant cost of HAIs, many health care institutions have implemented bundled interventions to reduce HAIs. These complex behavioral interventions require considerable effort; however, individual behaviors and motivations crucial to successful and sustained implementation have not been adequately assessed. We evaluated health care worker motivations to reduce HAIs. This was a phenomenologic qualitative study of health care workers in different roles within a university hospital, recruited via a snowball strategy. Using constructs from the Consolidated Framework for Implementation Research model, face-to-face semi-structured interviews were used to explore perceptions of health care worker motivation to follow protocols on HAI prevention. Across all types of health care workers interviewed, patient safety and improvement in clinical outcomes were the major motivators to reducing HAIs. Other important motivators included collaborative environment that valued individual input, transparency and feedback at both organizational and individual levels, leadership involvement, and refresher trainings and workshops. We did not find policy, regulatory considerations, or financial penalties to be important motivators. Health care workers perceived patient safety and clinical outcomes as the primary motivators to reduce HAI. Leadership engagement and data-driven interventions with frequent performance feedback were also identified as important facilitators of HAI prevention. Published by Elsevier Inc.

Vacation health care

MedlinePlus

... page: //medlineplus.gov/ency/article/001937.htm Vacation health care To use the sharing features on this page, ... and help you avoid problems. Talk to your health care provider or visit a travel clinic 4 to ...

Equity in health care.

PubMed

La Rosa-Salas, Virginia; Tricas-Sauras, Sandra

2008-01-01

It has long been known that a segment of the population enjoys distinctly better health status and higher quality of health care than others. To solve this problem, prioritization is unavoidable, and the question is how priorities should be set. Rational priority setting would seek equity amongst the whole population, the extent to which people receive equal care for equal needs. Equity in health care is an ethical imperative not only because of the intrinsic worth of good health, or the value that society places on good health, but because, without good health, people would be unable to enjoy life's other sources of happiness. This paper also argues the importance of the health care's efficiency, but at the same time, it highlights how any innovation and rationalization undertaken in the provision of the health system should be achieved from the consideration of human dignity, making the person prevail over economic criteria. Therefore, the underlying principles on which this health care equity paper is based are fundamental human rights. The main aim is to ensure the implementation of these essential rights by those carrying out public duties. Viewed from this angle, equity in health care means equality: equality in access to services and treatment, and equality in the quality of care provided. As a result, this paper attempts to address both human dignity and efficiency through the context of equity to reconcile them in the middle ground.

Health Status and Health Care Experiences among Homeless Patients in Federally Supported Health Centers: Findings from the 2009 Patient Survey

PubMed Central

Lebrun-Harris, Lydie A; Baggett, Travis P; Jenkins, Darlene M; Sripipatana, Alek; Sharma, Ravi; Hayashi, A Seiji; Daly, Charles A; Ngo-Metzger, Quyen

2013-01-01

Objective To examine health status and health care experiences of homeless patients in health centers and to compare them with their nonhomeless counterparts. Data Sources/Study Setting Nationally representative data from the 2009 Health Center Patient Survey. Study Design Cross-sectional analyses were limited to adults (n = 2,683). We compared sociodemographic characteristics, health conditions, access to health care, and utilization of services among homeless and nonhomeless patients. We also examined the independent effect of homelessness on health care access and utilization, as well as factors that influenced homeless patients' health care experiences. Data Collection Computer-assisted personal interviews were conducted with health center patients. Principal Findings Homeless patients had worse health status—lifetime burden of chronic conditions, mental health problems, and substance use problems—compared with housed respondents. In adjusted analyses, homeless patients had twice the odds as housed patients of having unmet medical care needs in the past year (OR = 1.98, 95 percent CI: 1.24–3.16) and twice the odds of having an ED visit in the past year (OR = 2.00, 95 percent CI: 1.37–2.92). Conclusions There is an ongoing need to focus on the health issues that disproportionately affect homeless populations. Among health center patients, homelessness is an independent risk factor for unmet medical needs and ED use. PMID:23134588

Effect of Medicaid Managed Care on racial disparities in health care access.

PubMed

Cook, Benjamin Lê

2007-02-01

To evaluate the impact of Medicaid Managed Care (MMC) on racial disparities in access to care consistent with the Institute of Medicine (IOM) definition of racial disparity, which excludes differences stemming from health status but includes socioeconomic status (SES)-mediated differences. Secondary data from the Adult Samples of the 1997-2001 National Health Interview Survey, metropolitan statistical area (MSA)-level Medicaid Health Maintenance Organization (MHMO) market share from the 1997 to 2001 InterStudy MSA Trend Dataset, and MSA characteristics from the 1997 to 2001 Area Resource File. I estimate multivariate regression models to compare racial disparities in doctor visits, emergency room (ER) use, and having a usual source of care between enrollees in MMC and Medicaid Fee-for-Service (FFS) plans. To contend with potential selection bias, I use a difference-in-difference analytical strategy and assess the impact of greater MHMO market share at the MSA level on Medicaid enrollees' access measures. To implement the IOM definition of racial disparity, I adjust for health status but not SES factors using a novel method to transform the distribution of health status for minority populations to approximate the white health status distribution. MMC enrollment is associated with lowered disparities in having any doctor visit in the last year for blacks, and in having any usual source of care for both blacks and Hispanics. Increasing Medicaid HMO market share lowered disparities in having any doctor visits in the last year for both blacks and Hispanics. Although disparities in most other measures were not much affected, black-white ER use disparities exist among MMC enrollees and in areas of high MHMO market share. MMC programs' reduction of some disparities suggests that recent shifts in Medicaid policy toward managed care plans have benefited minority enrollees. Future research should investigate whether black-white disparities in ER use within MMC groups

Behavioral health and health care reform models: patient-centered medical home, health home, and accountable care organization.

PubMed

Bao, Yuhua; Casalino, Lawrence P; Pincus, Harold Alan

2013-01-01

Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient-Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools-accountability measures and payment designs-to improve access to and quality of care for patients with behavioral health needs.

Vaccinating Health Care Workers Against Influenza: The Ethical and Legal Rationale for a Mandate

PubMed Central

Wu, Joel T.; Poland, Gregory A.; Jacobson, Robert M.; Koenig, Barbara A.; Tilburt, Jon C.

2011-01-01

Despite improvements in clinician education, symptom awareness, and respiratory precautions, influenza vaccination rates for health care workers have remained unacceptably low for more than three decades, adversely affecting patient safety. When public health is jeopardized, and a safe, low-cost, and effective method to achieve patient safety exists, health care organizations and public health authorities have a responsibility to take action and change the status quo. Mandatory influenza vaccination for health care workers is supported not only by scientific data but also by ethical principles and legal precedent. The recent influenza pandemic provides an opportunity for policymakers to reconsider the benefits of mandating influenza vaccination for health care workers, including building public trust, enhancing patient safety, and strengthening the health care workforce. PMID:21228284

Vaccinating health care workers against influenza: the ethical and legal rationale for a mandate.

PubMed

Ottenberg, Abigale L; Wu, Joel T; Poland, Gregory A; Jacobson, Robert M; Koenig, Barbara A; Tilburt, Jon C

2011-02-01

Despite improvements in clinician education, symptom awareness, and respiratory precautions, influenza vaccination rates for health care workers have remained unacceptably low for more than three decades, adversely affecting patient safety. When public health is jeopardized, and a safe, low-cost, and effective method to achieve patient safety exists, health care organizations and public health authorities have a responsibility to take action and change the status quo. Mandatory influenza vaccination for health care workers is supported not only by scientific data but also by ethical principles and legal precedent. The recent influenza pandemic provides an opportunity for policymakers to reconsider the benefits of mandating influenza vaccination for health care workers, including building public trust, enhancing patient safety, and strengthening the health care workforce.

Health-Care Access during the Ebola Virus Epidemic in Liberia.

PubMed

McQuilkin, Patricia A; Udhayashankar, Kanagasabai; Niescierenko, Michelle; Maranda, Louise

2017-09-01

The Ebola virus disease (EVD) epidemic, which began in West Africa in December 2013, claimed more than 11,000 lives, with more than 4,800 of these deaths occurring in Liberia. The epidemic had an additional effect of paralyzing the health-care systems in affected countries, which led to even greater mortality and morbidity. Little is known about the impact that the epidemic had on the provision of basic health care. During the period from March to May 2015, we undertook a nationwide, community-based survey to learn more about health-care access during the EVD epidemic in Liberia. A cluster sampling strategy was used to administer a structured in-person survey to heads of households located within the catchment areas surrounding all 21 government hospitals in Liberia. A total of 543 heads of household from all 15 counties in Liberia participated in the study; more than half (67%) of urban respondents and 46% of rural respondents stated that it was very difficult or impossible to access health care during the epidemic. In urban areas, only 20-30% of patients seeking care during the epidemic received care, and in rural areas, only 70-80% of those seeking care were able to access it. Patients requiring prenatal and obstetric care and emergency services had the most difficulty accessing care. The results of this survey support the observation that basic health care was extremely difficult to access during the EVD epidemic in Liberia. Our results underscore the critical need to support essential health-care services during humanitarian crises to minimize preventable morbidity and mortality.

How children with special health care needs affect the employment decisions of low-income parents.

PubMed

Loprest, Pamela; Davidoff, Amy

2004-09-01

To better understand the impact of having a child with special health care needs (CSHCN), on low-income parents' employment decisions. Using data from the 1999 and 2000 National Health Interview Survey (NHIS), we estimate multivariate statistical regressions (logit and tobit models) to estimate the relationship between having a CSHCN and the likelihood of employment and hours of employment for a sample-of low-income single parents. Controlling for differences in demographic and family characteristics, we find no significant association between having a CSHCN and the probability of work or the number of hours worked among low-income single-parent families. Separate analysis of different dimensions of special health care needs shows that parents of children with activity limitations are significantly less likely to work and work fewer hours. This result does not hold true for the group of children defined based on elevated or special service use, or for the group of children with specific chronic conditions. These results indicate that only a specific subset of children with special needs present difficulties for low-income parents' work. This suggests that policies to help low-income single parents of children with disabilities move into work should target this specific subset of children with special health care needs.

Extending health insurance in Ghana: effects of the National Health Insurance Scheme on maternity care.

PubMed

Brugiavini, Agar; Pace, Noemi

2016-12-01

There is considerable interest in exploring the potential of social health insurance in Africa where a number of countries are currently experimenting with different approaches. Since these schemes have been introduced recently and are continuously evolving, it is important to evaluate their effectiveness in the enhancement of health care utilization and reduction of out-of-pocket expenses for potential policy suggestions. To investigate how the National Health Insurance Schemes (NHIS) in Ghana affects the utilization of maternal health care services and medical out-of-pocket expenses. We used nationally-representative household data from the Ghana Demographic and Health Survey (GDHS). We analyzed the 2014 GDHS focusing on four outcome variables, i.e. antenatal check up, delivery in a health facility, delivery assisted by a trained person and out-of-pocket expenditure. We estimated probit and bivariate probit models to take into account the issue of self selection into the health insurance schemes. The results suggest that, also taking into account the issue of self selection into the health insurance schemes, the NHIS enrollment positively affects the probability of formal antenatal check-ups before delivery, the probability of delivery in an institution and the probability of being assisted during delivery by a trained person. On the contrary, we find that, once the issue of self-selection is taken into account, the NHIS enrollment does not have a significant effect on out-of-pocket expenditure at the extensive margin. Since a greater utilization of health-care services has a strong positive effect on the current and future health status of women and their children, the health-care authorities in Ghana should make every effort to extend this coverage. In particular, since the results of the first step of the bivariate probit regressions suggest that the educational attainment of women is a strong determinant of enrollment, and those with low education and unable

Conflict, health care and professional perseverance: a qualitative study in the West Bank.

PubMed

Sousa, Cindy; Hagopian, Amy

2011-01-01

The past three decades have been a time of considerable global conflict, affecting over 50 countries and causing substantial impacts on civilian health. While many effects are direct results of violence, conflict also impinges on health through indirect means. The restricted mobility of health care staff and patients, targeting of health care workers, and stressful working conditions disrupt the ability of health care workers in conflict zones to function effectively. This paper explores the challenges experienced by health care workers in West Bank, Palestine, as well as their strategies of persistence. Research activities included participant observation and interviews with health care providers, which were then analysed for common themes. Results demonstrated that the Israeli military occupation of the West Bank considerably impacts civilians' access to both urgent and preventive care. While attempting to deliver care, providers encountered disruptions, harassment and violence, which interrupted care and contributed to job stress. Professional perseverance was evident, but its influence was limited by enduring constraints. This study thus underscores the importance of accountability to international law regarding the rights of civilians to health care in conflict zones. Health professionals may play a particular role in advocating for just and dignified resolutions to conflicts.

Religiosity, Social Support and Care Associated with Health in Older Mexicans with Diabetes

PubMed Central

2016-01-01

The main purpose of this study was to examine the relationships between religiosity, social support, diabetes care and control and self-rated health of people living in Mexico who have been diagnosed with diabetes. Structural equation modeling was used to examine these associations using the Mexican Health and Aging Study, a national representative survey of older Mexicans. Findings indicate that emotional support from one’s spouse/partner directly affects diabetes care and control and health. Although there is no direct relationship between religiosity and health, religiosity was positively associated with diabetes care and control, but not significantly related to health. PMID:26316196

The Language of Caring: Nurse's Aides' Use of Family Metaphors Conveys Affective Care

ERIC Educational Resources Information Center

Berdes, Celia; Eckert, John M.

2007-01-01

Purpose: Using a conceptual framework from the field of care work and the theory of boundary work, we explore the use of family metaphors by nurse's aides to describe their affective care for nursing home residents. We focus on how nurse's aides can express affective care in spite of experiencing racial abuse. Methods: Using the technique of…

Antenatal and obstetric care in Afghanistan--a qualitative study among health care receivers and health care providers.

PubMed

Rahmani, Zuhal; Brekke, Mette

2013-05-06

Despite attempts from the government to improve ante- and perinatal care, Afghanistan has once again been labeled "the worst country in which to be a mom" in Save the Children's World's Mothers' Report. This study investigated how pregnant women and health care providers experience the existing antenatal and obstetric health care situation in Afghanistan. Data were obtained through one-to-one semi-structured interviews of 27 individuals, including 12 women who were pregnant or had recently given birth, seven doctors, five midwives, and three traditional birth attendants. The interviews were carried out in Kabul and the village of Ramak in Ghazni Province. Interviews were taped, transcribed, and analyzed according to the principles of Giorgi's phenomenological analysis. Antenatal care was reported to be underused, even when available. Several obstacles were identified, including a lack of knowledge regarding the importance of antenatal care among the women and their families, financial difficulties, and transportation problems. The women also reported significant dissatisfaction with the attitudes and behavior of health personnel, which included instances of verbal and physical abuse. According to the health professionals, poor working conditions, low salaries, and high stress levels contributed to this matter. Personal contacts inside the hospital were considered necessary for receiving high quality care, and bribery was customary. Despite these serious concerns, the women expressed gratitude for having even limited access to health care, especially treatment provided by a female doctor. Health professionals were proud of their work and enjoyed the opportunity to help their community. This study identified several obstacles which must be addressed to improve reproductive health in Afghanistan. There was limited understanding of the importance of antenatal care and a lack of family support. Financial and transportation problems led to underuse of available care

Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization

PubMed Central

Bao, Yuhua; Casalino, Lawrence P.; Pincus, Harold Alan

2012-01-01

Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools – accountability measures and payment designs – to improve access to and quality of care for patients with behavioral health needs. PMID:23188486