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Access Barriers (access + barrier)
Selected AbstractsBarriers and strategies affecting the utilisation of primary preventive services for people with physical disabilities: a qualitative inquiryHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2006Thilo Kroll PhD Abstract Individuals with physical disabilities are less likely to utilise primary preventive healthcare services than the general population. At the same time they are at greater risk for secondary conditions and as likely as the general population to engage in health risk behaviours. This qualitative exploratory study had two principal objectives: (1) to investigate access barriers to obtaining preventive healthcare services for adults with physical disabilities and (2) to identify strategies to increase access to these services. We conducted five focus group interviews with adults (median age: 46) with various physically disabling conditions. Most participants were male Caucasians residing in Virginia, USA. Study participants reported a variety of barriers that prevented them from receiving the primary preventive services commonly recommended by the US Preventive Services Task Force. We used a health services framework to distinguish structural,environmental (to include inaccessible facilities and examination equipment) or process barriers (to include a lack of disability-related provider knowledge, respect, and skilled assistance during office visits). Participants suggested a range of strategies to address these barriers including disability-specific continuing education for providers, the development of accessible prevention-focused information portals for people with physical disabilities, and consumer self-education, and assertiveness in requesting recommended services. Study findings point to the need for a more responsive healthcare system to effectively meet the primary prevention needs of people with physical disabilities. The authors propose the development of a consumer- and provider-focused resource and information kit that reflects the strategies that were suggested by study participants. [source] Language and Regional Differences in Evaluations of Medicare Managed Care by HispanicsHEALTH SERVICES RESEARCH, Issue 2 2008Robert Weech-Maldonado Objectives. This study uses the Consumer Assessments of Healthcare Providers and Systems (CAHPS®) survey to examine the experiences of Hispanics enrolled in Medicare managed care. Evaluations of care are examined in relationship to primary language (English or Spanish) and region of the country. Data Sources. CAHPS 3.0 Medicare managed care survey data collected in 2002. Study Design. The dependent variables consist of five CAHPS multi-item scales measuring timeliness of care, provider communication, office staff helpfulness, getting needed care, and health plan customer service. The main independent variables are Hispanic primary language (English or Spanish) and region (California, Florida, New York/New Jersey, and other states). Ordinary least squares regression is used to model the effect of Hispanic primary language and region on CAHPS scales, controlling for age, gender, education, and self-rated health. Data Collection/Extraction Methods. The analytic sample consists of 125,369 respondents (82 percent response rate) enrolled in 181 Medicare managed care plans across the U.S. Of the 125,369 respondents, 8,463 (7 percent) were self-identified as Hispanic. The survey was made available in English and Spanish, and 1,353 Hispanics completed one in Spanish. Principal Findings. Hispanic English speakers had less favorable reports of care than whites for all dimensions of care except provider communication. Hispanic Spanish speakers reported more negative experiences than whites with timeliness of care, provider communication, and office staff helpfulness, but better reports of care for getting needed care. Spanish speakers in all regions except Florida had less favorable scores than English-speaking Hispanics for provider communication and office staff helpfulness, but more positive assessments for getting needed care. There were greater regional variations in CAHPS scores among Hispanic Spanish speakers than among Hispanic English speakers. Spanish speakers in Florida had more positive experiences than Spanish speakers in other regions for most dimensions of care. Conclusions. Hispanics in Medicare managed care face barriers to care; however, their experiences with care vary by language and region. Spanish speakers (except FL) have less favorable experiences with provider communication and office staff helpfulness than their English-speaking counterparts, suggesting language barriers in the clinical encounter. On the other hand, Spanish speakers reported more favorable experiences than their English-speaking counterparts with the managed care aspects of their care (getting needed care and plan customer service). Medicare managed care plans need to address the observed disparities in patient experiences among Hispanics as part of their quality improvement efforts. Plans can work with their network providers to address issues related to timeliness of care and office staff helpfulness. In addition, plans can provide incentives for language services, which have the potential to improve communication with providers and staff among Spanish speakers. Finally, health plans can reduce the access barriers faced by Hispanics, especially among English speakers. [source] Reflective practice in nursing ethics education: international collaborationJOURNAL OF ADVANCED NURSING, Issue 2 2004Carol J. Leppa PhD RN Background., The Internet provides the opportunity for international comparative study and collaboration when learning about ethics in clinical nursing practice. Aim., This paper aims to discuss Internet links developed between US and UK postregistration nursing students who were reflecting on clinical practice in order to explore how political and organizational structures of the health care system affect ethical decision-making. Discussion., An analysis is presented of the stages in developing an exchange course for students from these countries, which involved various combinations of classroom-based teaching, on-line discussions and international visits by students and teachers during its evolution. The strengths and weaknesses of the different methods are considered, and future developments identified. Conclusion., The Internet collaboration resulted in postregistration nursing students using reflection on practice in the study of ethics in clinical practice and an understanding of how systems structures and procedures affect ethical decision making. Internet-assisted teaching offers opportunities for collaboration, and student participants demonstrate sophisticated critical thinking in ethical decision-making. Issues of access barriers and motivation remain challenges to wider use. [source] Diffusion of treatment research: does open access matter?JOURNAL OF CLINICAL PSYCHOLOGY, Issue 7 2008David J. Hardisty Abstract Advocates of the Open Access movement claim that removing access barriers will substantially increase the diffusion of academic research. If successful, this movement could play a role in efforts to increase utilization of psychotherapy research by mental health practitioners. In a pair of studies, mental health professionals were given either no citation, a normal citation, a linked citation, or a free access citation and were asked to find and read the cited article. After 1 week, participants read a vignette on the same topic as the article and gave recommendations for an intervention. In both studies, those given the free access citation were more likely to read the article, yet only in one study did free access increase the likelihood of making intervention recommendations consistent with the article. © 2008 Wiley Periodicals, Inc. J Clin Psychol/In Session 64: 1,19, 2008. [source] Southern Rural Access Program: An OverviewTHE JOURNAL OF RURAL HEALTH, Issue 5 2003Michael Beachler MPH ABSTRACT: Rural residents experience significant disparities in health status and access to care. These disparities and access barriers are particularly prevalent in rural communities in the South. The Southern Rural Access Program, a national program of the Robert Wood Johnson Foundation, was designed as a long-term effort to improve access to basic health care in 8 of the most underserved states in the country. The program was launched in 1998 with 3 goals: (1) to increase the supply of providers in underserved areas, (2) to strengthen the health care infrastructure, and (3) to build capacity at the state and community level to solve problems. The first 3-year phase of the program made $23.8 million available to communities in the 8 target states, and a January 2002 reauthorization of the program will make an additional $18.9 million available in the next 4 years. This article will provide an overview of the Southern Rural Access Program, focusing on the development and evolution of the program during its first 3-year phase. The article will also highlight some of the refinements that the foundation has made during the 2002,2006 second phase of the program. [source] Southern Rural Access Program: An OverviewTHE JOURNAL OF RURAL HEALTH, Issue 2003Michael Beachler MPH These disparities and access barriers are particularly prevalent in rural communities in the South. The Southern Rural Access Program, a national program of the Robert Wood Johnson Foundation, was designed as a long-term effort to improve access to basic health care in 8 of the most underserved states in the country. The program was launched in 1998 with 3 goals: (1) to increase the supply of providers in underserved areas, (2) to strengthen the health care infrastructure, and (3) to build capacity at the state and community level to solve problems. The first 3-year phase of the program made £13.8 million available to communities in the 8 target states, and a January 2002 reauthorization of the program will make an additional £18.9 million available in the next 4 years. This article will provide an overview of the Southern Rural Access Program, focusing on the development and evolution of the program during its first 3-year phase. The article will also highlight some of the refinements that the foundation has made during the 2002,2006 second phase of the program [source] CONGESTIVE CARDIAC FAILURE: URBAN AND RURAL PERSPECTIVES IN VICTORIAAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 6 2003Mohammad Z. Ansari ABSTRACT Objective:,Effective and timely care for congestive cardiac failure (CCF) should reduce the risks of hospitalisation. The purpose of this study is to describe variations in rates of hospital admissions for CCF in Victoria as an indicator of the adequacy of primary care services. Detailed analyses identify trends in hospitalisations, urban/rural differentials and variations by the Primary Care Partnerships (PCP). Setting:,Acute care hospitals in Victoria. Design:,Routine analyses of age and sex standardised admission rates of CCF in Victoria using the Victorian Admitted Episodes Dataset from 1993,1994 to 2000,2001. Subjects:,All patients admitted to acute care hospitals in Victoria with the principal diagnosis of CCF between 1993,1994 and 2000,2001. Results:,There were 8359 admissions for CCF in Victoria with an average of 7.37 bed days in 2000,2001. There was a significantly higher admission rate for CCF in rural areas compared to metropolitan in 2000/2001 ,(2.53/1000 (2.44,2.62) and 1.80/1000 (1.75,1.85)) , respectively. Small area analyses identified 17 PCP (14 of which were rural) with significantly higher admission rate ratios of CCF compared to Victoria. Conclusion:,Small area analyses of CCF have identified significant gaps in the management of CCF in the community. This may be a reflection of deficit in primary care availability, accessibility, or appropriateness. Detailed studies may be needed to determine the relative importance of these factors in Victoria for targeting specific interventions at the PCP level. What does this study add?:,Congestive cardiac failure is a major public health problem. In Australia, there is a lack of studies identifying long-term hospitalisation trends of CCF, as well as small area analyses, especially in regard to rural and urban variations. This study has identified significant variations over an eight year period in admission rates of CCF in rural and urban Victoria. Small area analyses (e.g. at the level of primary care partnerships) have identified rural communities with significantly higher admission rates of CCF compared to the Victorian average. For the first time in Australia, this study has provided a new approach for generating evidence on quality of primary care services in rural and urban areas, and offers opportunities for targeting public health and health services interventions that can decrease access barriers, improve the adequacy of primary care, and reduce demand on the hospital system in Victoria. [source] | ||||||||||