Special Health Care (special + health_care)

Distribution by Scientific Domains

Selected Abstracts

Managed Care Quality of Care and Plan Choice in New York SCHIP

Hangsheng Liu
Objective. To examine whether low-income parents of children enrolled in the New York State Children's Health Insurance Program (SCHIP) choose managed care plans with better quality of care. Data Sources. 2001 New York SCHIP evaluation data; 2001 New York State Managed Care Plan Performance Report; 2000 New York State Managed Care Enrollment Report. Study Design. Each market was defined as a county. A final sample of 2,325 new enrollees was analyzed after excluding those in markets with only one SCHIP plan. Plan quality was measured using seven Consumer Assessment of Health Plans Survey (CAHPS) and three Health Plan Employer Data and Information Set (HEDIS) scores. A conditional logit model was applied with plan and individual/family characteristics as covariates. Principle Findings. There were 30 plans in the 45 defined markets. The choice probability increased 2.5 percentage points for each unit increase in the average CAHPS score, and the association was significantly larger in children with special health care needs. However, HEDIS did not show any statistically significant association with plan choice. Conclusions. Low-income parents do choose managed care plans with higher CAHPS scores for their newly enrolled children, suggesting that overall quality could improve over time because of the dynamics of enrollment. [source]

Parent-Identified Barriers to Pediatric Health Care: A Process-Oriented Model

Elisa J. Sobo
Objective. To further understand barriers to care as experienced by health care consumers, and to demonstrate the importance of conjoining qualitative and quantitative health services research. Data Sources. Transcripts from focus groups conducted in San Diego with English- and Spanish-speaking parents of children with special health care needs. Study Design. Participants were asked about the barriers to care they had experienced or perceived, and their strategies for overcoming these barriers. Using elementary anthropological discourse analysis techniques, a process-based conceptual model of the parent experience was devised. Principal Findings. The analysis revealed a parent-motivated model of barriers to care that enriched our understanding of quantitative findings regarding the population from which the focus group sample was drawn. Parent-identified barriers were grouped into the following six temporally and spatially sequenced categories: necessary skills and prerequisites for gaining access to the system; realizing access once it is gained; front office experiences; interactions with physicians; system arbitrariness and fragmentation; outcomes that affect future interaction with the system. Key to the successful navigation of the system was parents' functional biomedical acculturation; this construct likens the biomedical health services system to a cultural system within which all parents/patients must learn to function competently. Conclusions. Qualitative analysis of focus group data enabled a deeper understanding of barriers to care,one that went beyond the traditional association of marker variables with poor outcomes ("what") to reveal an understanding of the processes by which parents experience the health care system ("how,""why") and by which disparities may arise. Development of such process-oriented models furthers the provision of patient-centered care and the creation of interventions, programs, and curricula to enhance such care. Qualitative discourse analysis, for example using this project's widely applicable protocol for generating experientially based models, can enhance our knowledge of the parent/patient experience and aid in the development of more powerful conceptualizations of key health care constructs. [source]

Primary care health issues among men who have sex with men

Royal Gee MSN
Abstract Purpose: The purpose of the article is to examine "appropriate" health care for men who have sex with men (MSM), which is not to suggest "special" health care. As a group, MSM are at increased risk for sexually transmitted infections, anal cancer, and mental health disorders. Focus areas in this article will address health issues that the primary care nurse practitioner (NP) may encounter in clinical practice: anal carcinoma, sexually transmitted diseases (STDs), high-risk sexual practices, depression, and substance abuse were topics chosen for inclusion in this article. These topics were among those highlighted in the Healthy People 2010 Companion Document for LGBT Health, which served to examine the healthcare disparities and lack of access to needed services related to sexual orientation. Data source: Extensive literature review of research articles, journals, clinical practice guidelines, books, and public health department Internet Web sites. Conclusions: There are unique health disparities that exist for MSM related to social, emotional, and mental health factors, in addition to physical issues such as STDs. There is an increasing need for primary care providers to be aware of these disparities, as well as the factors that influence these disparities, in order to provide multidimensional care and health counseling that is unique to NP practice. Implications for practice: Both the primary care NP and the patient should be aware of the unique healthcare issues among MSM that should be incorporated into the patient's routine health maintenance program. As primary care providers, it is within the standards of practice for NPs to provide culturally competent care, along with health promotion and disease prevention for MSM. [source]

Health and Safety Needs in Early Care and Education Programs: What do Directors, Child Health Records, and National Standards Tell Us?

Abbey Alkon
ABSTRACT Objective: To identify the overlapping and unique health and safety needs and concerns identified by early care and education (ECE) directors, health records, and observed compliance with national health and safety (NHS) standards. Design and Sample: Cross-sectional study. 127 ECE programs from 5 California counties participated in the study, including 118 directors and 2,498 children's health records. Measures: Qualitative data were collected using standardized ECE directors' interviews to identify their health and safety concerns; and objective, quantitative data were collected using child health record reviews to assess regular health care, immunizations, health insurance, special health care needs, and screening tests and an observation Checklist of 66 key NHS standards collected by research assistants. Results: The overlapping health and safety needs and concerns identified by the directors and through observations were hygiene and handwashing, sanitation and disinfection, supervision, and the safety of indoor and outdoor equipment. Some of the health and safety needs identified by only one assessment method were health and safety staff training, medical plans for children with special health care needs and follow-up on positive screening tests. Conclusions: Comprehensive, multimethod assessments are useful to identify health and safety needs and develop public health nursing interventions for ECE programs. [source]

Do Children in Rural Areas Still Have Different Access to Health Care?

Results from a Statewide Survey of Oregon's Food Stamp Population
ABSTRACT:,Purpose: To determine if rural residence is independently associated with different access to health care services for children eligible for public health insurance. Methods: We conducted a mail-return survey of 10,175 families randomly selected from Oregon's food stamp population (46% rural and 54% urban). With a response rate of 31%, we used a raking ratio estimation process to weight results back to the overall food stamp population. We examined associations between rural residence and access to health care (adjusting for child's age, child's race/ethnicity, household income, parental employment, and parental and child's insurance type). A second logistic regression model controlled for child's special health care needs. Findings: Compared with urban children (reference = 1.00), rural children were more likely to have unmet medical care needs (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.07-2.04), problems getting dental care (OR 1.36, 95% CI 1.03-1.79), and at least one emergency department visit in the past year (OR 1.42, 95% CI 1.10-1.81). After adjusting for special health care needs (more prevalent among rural children), there was no rural-urban difference in unmet medical needs, but physician visits were more likely among rural children. There were no statistically significant differences in unmet prescription needs, delayed urgent care, or having a usual source of care. Conclusions: These findings suggest that access disparities between rural and urban low-income children persist, even after adjusting for health insurance. Coupled with continued expansions in children's health insurance coverage, targeted policy interventions are needed to ensure the availability of health care services for children in rural areas, especially those with special needs. [source]

Adolescent Transition to Adult Care in Solid Organ Transplantation: A consensus conference report

L. E. Bell
Transition of care from pediatric to adult-oriented health care providers is difficult for children with special health care needs. Children who have received solid organ transplants and their providers experience the same difficulties and frustrations as children with other major illnesses. A consensus conference was organized by several transplant organizations to identify major issues in this area and recommend possible approaches to easing the process of transition for solid organ transplant recipients. This report summarizes the discussions and recommendations. [source]