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Care Access (care + access)
Kinds of Care Access Selected AbstractsThe Effects of Child-Only Insurance Coverage and Family Coverage on Health Care Access and Use: Recent Findings among Low-Income Children in CaliforniaHEALTH SERVICES RESEARCH, Issue 1 2006Sylvia Guendelman Objective. To compare the extent with which child-only and family coverage (child and parent insured) ensure health care access and use for low income children in California and discuss the policy implications of extending the State Children's Health Insurance Program (California's Healthy Families) to uninsured parents of child enrollees. Data Sources/Setting. We used secondary data from the 2001 California Health Interview Survey (CHIS), a representative telephone survey. Study Design. We conducted a cross-sectional study of 5,521 public health insurance,eligible children and adolescents and their parents to examine the effects of insurance (family coverage, child-only coverage, and no coverage) on measures of health care access and utilization including emergency room visits and hospitalizations. Data Collection. We linked the CHIS adult, child, and adolescent datasets, including the adolescent insurance supplement. Findings. Among the sampled children, 13 percent were uninsured as were 22 percent of their parents. Children without insurance coverage were more likely than children with child-only coverage to lack a usual source of care and to have decreased use of health care. Children with child-only coverage fared worse than those with family coverage on almost every access indicator, but service utilization was comparable. Conclusions. While extending public benefits to parents of children eligible for Healthy Families may not improve child health care utilization beyond the gains that would be obtained by exclusively insuring the children, family coverage would likely improve access to a regular source of care and private sector providers, and reduce perceived discrimination and breaks in coverage. These advantages should be considered by states that are weighing the benefits of expanding health insurance to parents. [source] Providing a Dental Home for Pregnant Women: A Community Program to Address Dental Care Access , A Brief CommunicationJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 3 2008Peter Milgrom Abstract Objective: This paper describes a community-based intervention to provide a dental home for women covered by Medicaid in Klamath County, Oregon. In 2001, 8.8 percent of pregnant women served by Medicaid in Oregon received care. The long-term goal of the program is to promote preventive oral care for both mothers and their new infants. Methods: Pregnant women received home/Women, Infant and Children visits and were assigned a dental home under a dental managed care program [Dental Care Organization (DCO)]. All initial care was provided at the Oregon Institute of Technology Dental Hygiene Clinic under the contract with the DCO. Emergency, preventive, and restorative care was provided. Results: Between February 2004 and January 2006, 503 pregnant women were identified; 421 women were contactable. Of these, 339 received home visits (339/421, 80.5 percent) and 235 received care (235/339, 69.3 percent). Overall, 55.8 percent of eligible women received care (235/421). Most who did not have a visit either moved or were not the caretaker of the baby. The missed appointment rate was 9 percent. Conclusion: A community health partnership led to a successful and sustainable model extending care to pregnant women and is being extended to promote preventive care for both new mothers and their offspring. [source] Health Perception and Health Care Access: Sex Differences in Behaviors and AttitudesAMERICAN JOURNAL OF ECONOMICS AND SOCIOLOGY, Issue 2 2010Marta Gil-Lacruz This article analyzes the link between men's and women's perceptions of health and the demand for health goods and services. The study examines access to the health care system in a community characterized by social and economic variance. The data have been taken from a health survey carried out in a suburb of the city of Zaragoza in Spain. The sample (1,032 people over the age of 15) was selected according to specifications of sex, age, and place of residence. The sample shows a confidence interval of 95.5 percent with a ±3 margin of error. Descriptive and inferential statistical techniques are used. Sex differences are reflected in social conditions, lifestyles, health perception, and health care behaviors. The research describes how differences in health attitudes can be contextualized by the neighborhood. The results of this type of research are essential for the design of preventive strategies that are better adapted to need. [source] Income Inequality, Unequal Health Care Access, and Mortality in ChinaPOPULATION AND DEVELOPMENT REVIEW, Issue 3 2006Zhongwei Zhao First page of article [source] The Emergency Medical Treatment and Labor Act as a Federal Health Care Safety Net ProgramACADEMIC EMERGENCY MEDICINE, Issue 11 2001W. Wesley Fields MD Abstract Despite the greatest economic expansion in history during the 1990s, the number of uninsured U.S. residents surpassed 44 million in 1998. Although this number declined for the first time in recent years in 1999, to 42.6 million, the current economic slow-down threatens once again to increase the ranks of the uninsured. Many uninsured patients use hospital emergency departments as a vital portal of entry into an access-improverished health care system. In 1986, Congress mandated access to emergency care when it passed the Emergency Medical Treatment and Labor Act (EMTALA). The EMTALA statute has prevented the unethical denial of emergency care based on inability to pay; however, the financial implications of EMTALA have not yet been adequately appreciated or addressed by Congress or the American public. Cuts in payments from public and private payers, as well as increasing demands from a larger uninsured population, have placed unprecedented financial strains on safety net providers. This paper reviews the financial implications of EMTALA, illustrating how the statute has evolved into a federal health care safety net program. Future actions are proposed, including the pressing need for greater public safety net funding and additional actions to preserve health care access for vulnerable populations. [source] The Effects of Child-Only Insurance Coverage and Family Coverage on Health Care Access and Use: Recent Findings among Low-Income Children in CaliforniaHEALTH SERVICES RESEARCH, Issue 1 2006Sylvia Guendelman Objective. To compare the extent with which child-only and family coverage (child and parent insured) ensure health care access and use for low income children in California and discuss the policy implications of extending the State Children's Health Insurance Program (California's Healthy Families) to uninsured parents of child enrollees. Data Sources/Setting. We used secondary data from the 2001 California Health Interview Survey (CHIS), a representative telephone survey. Study Design. We conducted a cross-sectional study of 5,521 public health insurance,eligible children and adolescents and their parents to examine the effects of insurance (family coverage, child-only coverage, and no coverage) on measures of health care access and utilization including emergency room visits and hospitalizations. Data Collection. We linked the CHIS adult, child, and adolescent datasets, including the adolescent insurance supplement. Findings. Among the sampled children, 13 percent were uninsured as were 22 percent of their parents. Children without insurance coverage were more likely than children with child-only coverage to lack a usual source of care and to have decreased use of health care. Children with child-only coverage fared worse than those with family coverage on almost every access indicator, but service utilization was comparable. Conclusions. While extending public benefits to parents of children eligible for Healthy Families may not improve child health care utilization beyond the gains that would be obtained by exclusively insuring the children, family coverage would likely improve access to a regular source of care and private sector providers, and reduce perceived discrimination and breaks in coverage. These advantages should be considered by states that are weighing the benefits of expanding health insurance to parents. [source] Mental Illness and Length of Inpatient Stay for Medicaid Recipients with AIDSHEALTH SERVICES RESEARCH, Issue 5 2004Donald R. Hoover Objective. To examine the associations between comorbid mental illness and length of hospital stays (LOS) among Medicaid beneficiaries with AIDS. Data Source and Collection/Study Setting. Merged 1992,1998 Medicaid claims and AIDS surveillance data obtained from the State of New Jersey for adults with ,1 inpatient stay after an AIDS diagnosis from 1992 to 1996. Study Design. Observational study of 6,247 AIDS patients with 24,975 inpatient visits. Severe mental illness (SMI) and other less severe mental illness (OMI) diagnoses at visits were ascertained from ICD,9 Codes. About 4 percent of visits had an SMI diagnosis; 5 percent had an OMI diagnosis; 43 percent did not have a mental illness diagnosis, but were patients who had been identified as having an SMI or OMI history; and 48 percent were from patients with no identified history of mental illness. Principal Findings. The overall mean hospital LOS was 12.7 days. After adjusting for measures of HIV disease severity and health care access in multivariate models, patients presenting with primary and secondary severe mental illness (SMI) diagnoses had ,32 percent and ,11 percent longer LOS, respectively, than did similar patients without a mental illness history (p<0.001 for each). But in these adjusted models of length of stay: (1) diagnosis of OMI was not related to LOS, and (2) in the absence of a mental illness diagnosed at the visit, an identified history of either SMI or OMI was also not related to LOS. In adjusted models of time to readmission for a new visit, current diagnosis of SMI or OMI and in the absences of a current diagnosis, history of SMI or OMI all tended to be associated with quicker readmission. Conclusions. This study finds greater (adjusted) LOS for AIDS patients diagnosed with severe mental illness (but not for those diagnosed with less severe mental comorbidity) at a visit. The effect of acute severe mental illness on hospitalization time may be comparable to that of an acute AIDS opportunistic illness. While previous research raises concerns that mental illness increases LOS by interfering with treatment of HIV conditions, the associations here may simply indicate that extra time is needed to treat severe mental illnesses or arrange for discharge of afflicted patients. [source] Provider Characteristics Related to Antidepressant Use in Older PeopleJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2006Gerda G. Fillenbaum PhD OBJECTIVES: To determine whether the characteristics of the usual medical care providers of older antidepressant users changed between 1986 and 1997 with the introduction of selective serotonin reuptake inhibitors. DESIGN: Longitudinal study. SETTING: Five-county Piedmont area of North Carolina. PARTICIPANTS: Stratified random sample of African-American (n=2,261) and white (n=1,875) community residents aged 65 to 105. MEASUREMENTS: Sample members provided information on prescription medications, demographic and health status, and usual medical care provider (matched to North Carolina Health Professions Data Systems files to ascertain provider characteristics) in 1986/87, 1989/90, 1992/93, and 1996/97. Most (77.5%) named a provider (name unmatchable for 4.1%). Sample member characteristics were aggregated into probability (propensity) scores summarizing predisposing (demographic), enabling (medical care access), and need (health status) categories. Along with wave of study and whether a provider was named, these were entered as control variables in generalized estimating equation models that examined the association between provider race (white vs nonwhite), sex, age, location of practice, and primary versus specialist care and antidepressant use. RESULTS: The characteristics of the usual medical care providers remained stable over the decade, although prevalence of antidepressant use increased. Two provider characteristics,race and area of practice (but not the interaction between them),were significantly associated with patients' use of antidepressants. Patients of white physicians and of physicians with urban practices were more likely to use antidepressants. CONCLUSION: Although use of antidepressants has increased over time, there has been little change in the characteristics of users' usual medical care providers. [source] Sustainability of change with quality general practitioner education in adolescent health: a 5-year follow-upMEDICAL EDUCATION, Issue 6 2005Lena Sanci Objective, To determine whether improvements gained in general practitioners' (GPs') self-perceived competency, attitudes and knowledge after an intervention in adolescent health care designed with evidence-based strategies in continuing medical education, are maintained longterm, 5 years post intervention. The intervention was designed with evidence-based strategies in continuing medical education. Design, We carried out a follow-up postal survey of the cohort of metropolitan Australian GPs trained in the intervention 5 years previously. Measures, Subsets of the original measures, used in the randomised controlled trial of the intervention, were selected to re-assess the GPs by postal survey. Self-perceived competency, attitude and knowledge were measured. Doctors were also asked about further training in adolescent health over the 5 years since the intervention and about self-reported practice. Results, A total of 46 of 54 (85%) of the original intervention group returned a questionnaire. Scores at 5 years were all higher than at baseline (P < 0.01) and improvements were sustained in all measures from 12 months to 5 years after the intervention. In all, 25/46 (54%) doctors had received further training in related areas over the 5 years, but this did not improve sustainability. A total of 45/46 (98%) reported maintaining their clinical approach to youth and 22/46 (46%) reported maintaining practices to address systemic barriers to adolescent health care access. Conclusions, Quality education designed according to evidence-based strategies of effectiveness has advantages for longterm sustainability. [source] The health of California's immigrant hired farmworkersAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 4 2010Don Villarejo BS Abstract Background Hispanic immigrant workers dominate California's hired farm workforce. Little is known about their health status; even less is known about those lacking employment authorization. Methods The California Agricultural Workers Health Survey (CAWHS) was a statewide cross-sectional household survey conducted in 1999. Six hundred fifty-four workers completed in-person interviews, comprehensive physical examinations, and personal risk behavior interviews. Results The CAWHS PE Sample is comprised mostly of young Mexican men who lack health insurance and present elevated prevalence of indicators of chronic disease: overweight, obesity, high blood pressure, and high serum cholesterol. The self-reported, cumulative, farm work career incidence of paid claims for occupational injury under workers compensation was 27% for males and 11% for females. Conclusions The survey finds elevated prevalence of indicators of chronic disease but lack of health care access. Participants without employment authorization reported a greater prevalence of high-risk behaviors, such as binge drinking, and were less knowledgeable about workplace protections. Am. J. Ind. Med. 53:387,397, 2010. © 2010 Wiley-Liss, Inc. [source] Promoting ecologic health resilience for minority youth: Enhancing health care access through the school health centerPSYCHOLOGY IN THE SCHOOLS, Issue 3 2003Caroline C.C. Clauss-Ehlers Ethnic minority youth experience problems in access to healthcare, yet little is known about how to enhance utilization. This article will discuss the demographic realities of children of color in the United States, with a focus on health care needs and access issues that have an enormous influence on health status. The article will consider health policy as it describes the considerable barriers to quality health care for minority youth such as a lack of a usual source of care and limited health insurance. An ecologic model is presented that incorporates cultural values and community structures into the school health center. Enhancing access and utilization through the school setting is viewed as promoting ecologic resilience in youth. © 2003 Wiley Periodicals, Inc. Psychol Schs 40: 265,278, 2003. [source] The Visiting Specialist Model of Rural Health Care Delivery: A Survey in MassachusettsTHE JOURNAL OF RURAL HEALTH, Issue 4 2006Jacob Drew BA ABSTRACT:,Context: Hospitals in rural communities may seek to increase specialty care access by establishing clinics staffed by visiting specialists. Purpose: To examine the visiting specialist care delivery model in Massachusetts, including reasons specialists develop secondary rural practices and distances they travel, as well as their degree of satisfaction and intention to continue the visiting arrangement. Methods: Visiting specialists at 11 rural hospitals were asked to complete a mailed survey. Findings: Visiting specialists were almost evenly split between the medical (54%) and surgical (46%) specialties, with ophthalmology, nephrology, and obstetrics/gynecology the most common specialties reported. A higher proportion of visiting specialists than specialists statewide were male (P = .001). Supplementing their patient base and income were the most important reasons visiting specialists reported for having initiated an ancillary clinic. There was a significant negative correlation between a hospital's number of staffed beds and the total number of visiting specialists it hosted (r =,0.573, P = .032); study hospitals ranged in bed size from 15 to 129. Conclusions: The goal of matching supply of health care services with demand has been elusive. Visiting specialist clinics may represent an element of a market structure that expands access to needed services in rural areas. They should be included in any enumeration of physician availability. [source] Dental Services for Migrant and Seasonal Farmworkers in US Community/Migrant Health CentersTHE JOURNAL OF RURAL HEALTH, Issue 3 2006Sherri M. Lukes RDH ABSTRACT:,Context: Migrant and seasonal farmworkers are recognized as a medically underserved population, yet little information on need, access, and services is available,particularly with regard to oral health care. Purpose: This study describes the facilities, services, staffing, and patient characteristics of US dental clinics serving migrant and seasonal farmworkers, and identifies trends and issues that may impede or improve dental care access and service. Methods: National databases were used to identify community and migrant health centers providing oral health care to migrant and seasonal farmworkers. Mailed surveys collected information on clinic history, operational details, services provided, patient demographics, employment and resource needs, and perceived barriers to care. Findings: Among the 81 respondents (response rate 41%), hours of operation varied from 1 evening a week to more than 40 hours a week; 52% had no evening hours. Almost all the clinics offered preventive, diagnostic, and basic restorative dental services, and roughly two thirds also offered complex restorative services. Patients most frequently sought emergency dental care (44%) followed by basic restorative services (32%) and preventive services (26%). The dentist position was the most difficult to fill, and new funding sources were cited as the most important resource need. Respondents perceived cost of services, lack of transportation, and limited clinic hours as primary barriers to care. Conclusions: While some barriers to care have been almost universally addressed (eg, language), there is evidence that some impediments remain and may present significant obstacles to a broad improvement in oral health care for migrant and seasonal farmworkers. [source] Unmet Need Among Rural Medicaid Beneficiaries in MinnesotaTHE JOURNAL OF RURAL HEALTH, Issue 3 2002Sharon K. Long Ph.D. Given the vulnerabilities of rural residents and the health care issues faced by the Medicaid population generally, the combined effects of being on Medicaid and living in a rural area raise important questions about access to health care services. This study looks at a key dimension of health care access: unmet need for health care services. The study relies on data from a 1998 survey of rural Minnesota Medicaid beneficiaries. An overall response rate of 70% was obtained. For this study, the sample is limited to women who were on Medicaid for the full 12 months prior to the survey, resulting in 900 respondents. The study finds that the rural Medicaid beneficiaries face high levels of unmet need: more than 1 in 3 reported either delaying or not getting doctor, hospital, or specialist care that they felt they needed. Although the study lacks direct measures of the consequences of the high levels of unmet need, there is evidence that greater emergency room use is associated with unmet need. The survey data cannot necessarily be generalized to other rural areas, and like all surveys, this one is subject to nonresponse bias as well as potential biases because of respondent recall and self-assessment of medical needs. Nevertheless, these findings are suggestive of negative consequences of unmet need for both Medicaid beneficiaries and program costs. [source] Who Will Consent to Emergency Treatment Trials for Subarachnoid Hemorrhage?ACADEMIC EMERGENCY MEDICINE, Issue 4 2009Angela Del Giudice MD Abstract Objectives:, Aneurysmal subarachnoid hemorrhage (SAH) is a devastating disorder that still requires much clinical study. However, the decision to participate in a randomized clinical trial, particularly a neuroemergency trial, is a complex one. The purposes of this survey were to determine who would participate in a randomized clinical trial that intended to examine transfusion practices after SAH, to identify who could serve as potential proxy decision-makers, and to find which patient characteristics were associated with the decision to participate. Methods:, This was a cross-sectional study using a self-administered questionnaire, composed of a brief description of the proposed trial followed by questions about participation using a 5-point Likert scale. Information sought included potential decision-maker, demographic data, setting and reason for current health care access, and personal or family history of neurologic injury. Results:, Nine-hundred five subjects were enrolled during emergency department (ED) visits, office visits, hospital admissions, or online, during a 1-month period: 63% were women and 46% were white. Nonneurologic problems were the leading reason (90%) for health care access, but 45% had a personal or family history of neurologic injury. Overall, 54% (95% confidence interval [CI] = 51% to 57%) of subjects stated they would definitely or probably consent to participate. No subject characteristics were associated with this decision: age (p = 0.28), sex (p = 0.16), race/ethnicity (p = 0.07), education (p = 0.44), religion (p = 0.42), clinical setting (p = 0.14), reason for visit (p = 0.58), and/or history of neurologic injury (p = 0.33). The vast majority (88%) identified a family member as the proxy decision-maker, again without differences among groups. Conclusions:, Greater than half of respondents stated they would participate in a proposed emergency treatment trial for SAH. Our survey suggests that the decision to participate is highly individualized, because no demographic, pathologic, historical, or access-related predictors of choice were found. Educational materials designed for this type of trial would need to be broad-based. Family members should be considered as proxy decision-makers where permitted by federal and local regulations. [source] An analysis of the skin care patient mix attending a primary care-based nurse-led NHS Walk-in CentreBRITISH JOURNAL OF DERMATOLOGY, Issue 5 2005S.J. Ersser Summary Background, NHS Walk-in Centres (WiCs) are a new and expanding point of nurse-led primary care access for patients requiring skin care. Little is known about the dermatology case profile of such patients. Objectives, To investigate the skin care patient mix attending a WiC and the feasibility and usefulness of retrieving data from the NHS Clinical Assessment System (CAS), as used by NHS Direct. Methods, Patients over 2 years of age presenting to a WiC in southern England with a nurse-assessed skin condition were recruited over a 12-week period (n = 233). A data set was extracted from CAS and analysed using Excel. Results, Of the total 31 591 patients attending the WiC in the first 2 years, 21% had a skin-related problem. During the 12-week study period, 88 of 233 eligible patients (38%) consented to participate. The typical patient profile was of female patients, 17,35 years (27%) attending during the week before 9 a.m. (35%) or after 5 p.m. (27%) from the locality (72%). CAS employs generic algorithms to specify clinical problems (e.g. rash) rather than medical diagnoses. Most patients presented with a rash (89%). No physical treatment was required in 77% of patients, although this was advised for 46%; 49% were advised to seek help but not return to the WiC; 16% were recommended to contact their general practitioner. There were practical difficulties accessing data from CAS software for research due to research governance requirements. Conclusions, A significant number of patients with dermatological conditions could be seeking primary care through new NHS WiCs. Detailed dermatological appraisal of the patient mix is difficult due to the system of clinical categorization. There is scope to investigate further the nature of dermatological need and the patient education given. CAS is a cumbersome data extraction tool for research. [source] | |||||||||||||