Journal of Health Care for the Poor and Underserved

Journal of Health Care for the Poor and Underserved
Volume 15, Number 2, May 2004

CONTENTS

Association of Clinicians for the Underserved (ACU) Column

Guest Editorials

    Sorensen, Todd D.
    Song, John.
    Westberg, Sarah M.
  • The Limitations of Good Intentions: Prescribing Medications for the Uninsured
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    Subject Headings:
    • Drugs -- Prescribing -- United States.
    • Medically uninsured persons -- Medical care -- United States.
    • Health services accessibility -- United States.
    Abstract:
      Identifying affordable drug therapy options for individuals who lack prescription drug insurance is a problem frequently encountered by prescribers. Medication samples and manufacturer-sponsored assistance programs represent sources often used to address affordability issues. However, these sources have the potential to introduce health disparities through various mechanisms, including reduced access to the drug of choice, consistencies with access, and drug regimen complexities that adversely affect adherence. Prescribers should consider all sources of affordable medications and openly discuss treatment options and the anticipated outcomes of each with patients to ensure the prescribing of agents that optimize outcomes while balancing patient affordability.
    Keywords:
      uninsured, underinsured, drug therapy, prescribing, health disparities.

Brief Communications

    Bolin, Kenneth A.
    Shulman, Jay D.
  • A Nationwide Survey of Dentist Recruitment and Salaries in Community Health Centers
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    Subject Headings:
    • Community dental services -- United States.
    • Dentists -- Supply and demand -- United States.
    • Dentists -- Salaries, etc. -- United States.
    • Dentists -- Job satisfaction -- United States.
    Abstract:
      Recruitment of dentists continues to be a problem in community health center (CHC) dental practices. This study was carried out to quantify the scope of the problem and to determine CHC dentist salaries and benefits. Community health center executive directors nationwide were surveyed regarding dentist vacancies, recruiting issues, and salary and benefit information. Of 345 surveys mailed, 159 responses were received (46.1%). Slightly fewer than half of the responding executive directors (47.8%) reported one vacant dentist position. An additional 11.9% of executive directors reported a second vacancy. The overall vacancy rate was 17.6%. Median salaries ranged from $78,000 for entry-level dentists to $90,000 for dentists with 10 or more years of experience, not including benefits. There are difficulties in recruiting dentists to CHC dental practices. Mean salaries in CHCs are slightly higher than in academic positions, but less than in private practice employment or ownership. Caution should be used when comparing salaried positions with substantial benefits to self-employment or sole proprietorships.
    Keywords:
      Community health centers, job satisfaction, community dentistry, salaries, fringe benefits.
    Kim, Young O. Rhee.
  • Access to Hepatitis B Vaccination among Korean American Children in Immigrant Families
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    Subject Headings:
    • Hepatitis B -- Vaccination -- United States.
    • Vaccination of children -- United States.
    • Korean American children -- Health and hygiene -- Social aspects.
    Abstract:
      This study examined social determinants affecting successful completion of the hepatitis B vaccination protocol among Korean American children in immigrant families. The effects of family characteristics, social support from support network, barriers to immunizations, and health beliefs concerning hepatitis B vaccination were examined using logistic regression analysis. Information support concerning parenting and child health (adjusted odds ratio [aOR] 2.55, 95% confidence interval [CI] 1.11-7.02) and perception that hepatitis B was a difficult disease from which to recover (aOR 2.11, 95% CI 1.20-3.72) appear to be the most important factors for vaccination compliance after adjusting for family income, mother's education level, and health insurance coverage. The burden of paying for immunizations (aOR 0.50, 95% CI 0.22-0.90) also had an impact on the vaccination status. These findings suggest that identifying the children at risk of undervaccination against hepatitis B may be aided by focusing on these social determinants in addition to provider and sociodemographic characteristics.
    Keywords:
      access to immunization, barriers, social determinants, Korean Americans.
    Kiely, Sharon C.
    Grzybicki, Dana M.
    Sepulveda, Antonia.
    Capitano, Marc.
    Toborowsky, Elizabeth J.
  • Chronic Abdominal Complaints and Helicobacter pylori in a Haitian Population
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    Subject Headings:
    • Helicobacter pylori infections -- Haiti.
    • Abdominal pain -- Haiti.
    • Public health -- Haiti.
    Abstract:
      The objective of this study was to examine demographic, clinical, and pathologic variables, including Helicobacter pylori infection and malignancy, associated with chronic abdominal pain in a rural Haitian population. One hundred four patients underwent esophagogastroduodenoscopy, with biopsy only in those with gross findings. Associations between demographic, clinical, and pathologic variables were examined using the chi-square test. P values less than or equal to 0.05 were considered statistically significant. The majority (n = 66; 63%) required biopsy. Of these, 62% were positive for H. pylori. The associations between (1) chest complaints and esophageal disease, (2) female gender and benign esophageal disease, and (3) chronic active gastritis and presence of H. pylori were significant. There was one malignancy. H. pylori gastritis was common; malignancy was rare. Demographic and clinical variables poorly predicted pathologic diagnosis, which is consistent with previous studies. Further study is needed to assess the influence of other variables, including the African enigma, on disease progression in this population.
    Keywords:
      Helicobacter pylori, Haiti, chronic gastritis, abdominal pain, African enigma.

Original Papers

    Allison, Michael.
    Rivers, Patrick A.
    Fottler, Myron D.
  • Can Community Health Center Funding Enhance Health Services for Native American Tribes and Organizations?
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    Subject Headings:
    • Community health services -- Law and legislation -- United States.
    • Indians of North America -- Medical care -- Arizona.
    • Medical care -- Arizona -- Finance.
    Abstract:
      This paper reports on the applicability of the Public Health Service Act (42 USC, 254b) Section 330 Community Health Center program to Arizona Native American tribes and organizations. Data review and analysis consisted of a review of two federal government documents concerning the funding of Community Health Center applications and a review of questionnaire responses received from the Arizona Native American health care community. Findings indicate a general lack of knowledge among the Arizona Native American health care community about the program as well as a need for capacity building among Arizona Native American tribes and organizations. As currently designed, the program has built-in barriers that prevent Native American tribes and organizations from applying for funding. Changes must be made to the existing program and local-level seminars must be offered to make this program and funding more readily available to Arizona Native American tribes and organizations.
    Keywords:
      Funding, financing, Indian Health Service, tribes, community health services.
    Rosen, Daniel.
    Tolman, Richard M.
    Warner, Lynn A.
  • Low-Income Women's Use of Substance Abuse and Mental Health Services
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    Subject Headings:
    • Poor women -- Substance abuse -- United States.
    • Poor women -- Mental health services -- United States.
    • Public welfare -- United States.
    Abstract:
      This paper examines the utilization of mental health, alcohol, and drug treatment in a sample of low-income women. We analyze data from the Women's Employments Study, a study examining the barriers to employment for welfare recipients, and compare prevalence rates of mental health disorders and service utilization with the National Comorbidity Survey. Fewer than one in five of the respondents with a current mental health and/or substance dependence problem in the Women's Employment Study (WES) received treatment in the past 12 months. A logistic regression model of the association among demographic variables, risk factors, and service utilization in the WES found that having a co-occurring substance dependence and mental health disorder was significantly associated with receiving treatment. Those respondents with an increased number of barriers were significantly less likely to receive treatment. The authors argue that the success of welfare reform may hinge on low-income women's access to and utilization of appropriate services.
    Keywords:
      mental health services, substance abuse, low-income women, welfare.
    Frick, Kevin.
    Scanlon, Dennis P.
    Bandeen-Roche, Karen.
    Kasper, Judith.
    Simonsick, Eleanor M.
    Sullivan, Erin M.
  • Influenza Vaccination by Race among Disabled Community Dwelling Older Women
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    Subject Headings:
    • Influenza -- Vaccination -- United States.
    • Minority people with disabilities -- Medical care -- United States.
    • Older women -- Medical care -- United States.
    Abstract:
      Disabled older adults have been shown to be at risk for underutilization of some preventive services relative to able-bodied individuals. The Women's Health and Aging Study surveyed female Medicare enrollees in Baltimore, Maryland, who were among the most disabled community-dwelling women at the start of the study. Longitudinal survey data from the study were used to test for the existence or emergence of racial variation in influenza vaccination rates, for which racial variation has been shown in the general population. The primary analysis, using data on the same women before and after Medicare flu shot coverage began, suggested that influenza vaccination rates increased after Medicare coverage began and that there was no difference by race. A secondary analysis using data on women who were interviewed only after Medicare flu shot coverage began showed some racial variation, although the difference may have been larger prior to coverage. The utilization rate did not approach the Healthy People 2010 target.
    Sutton, Janet P.
    Stensland, Jeffrey.
  • Promoting Accountability: Hospital Charity Care in California, Washington and Texas
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    Subject Headings:
    • Medically uninsured persons -- Hospital care -- Washington (State)
    • Medically uninsured persons -- Hospital care -- California.
    • Medically uninsured persons -- Hospital care -- Texas.
    Abstract:
      Debate as to whether private hospitals meet their charitable obligations is heated. This study examines how alternative state approaches for ensuring hospital accountability to the community affects charitable expenditures and potentially affects access to care for the uninsured. Descriptive and multivariate analyses were used to compare private California hospitals' charity care expenditures with those of hospitals in Texas and Washington state. The key finding from this study is that net of hospital characteristics, market characteristics and community need, Texas hospitals were estimated to provide over 3 times more charity care and Washington hospitals were estimated to provide 66% more charity care than California hospitals. This finding suggests that more prescriptive community benefit or charity care requirements may be necessary to ensure that private hospitals assume a larger role in the care of the uninsured.
    Keywords:
      uninsured, hospital charity care, community benefits, nonprofit, California, Washington, Texas.
    Davis, Juliet A.
    Lapane, Kate L.
  • Do Characteristics Associated With Nursing Home Residents Vary by Race/Ethnicity?
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    Subject Headings:
    • Nursing homes -- United States.
    • Minorities -- Long-term care -- United States.
    Abstract:
      This study identifies differences in the predisposing, enabling, and need characteristics of racial/ethnic minorities and non-Hispanic white men and women upon nursing home admission. The data come from the 1999 National Nursing Home Survey of Current Residents and contain 3,798 women of color, 3,787 men of color, 18,719 non-Hispanic white men, and 36,900 non-Hispanic white women. We estimated prevalence differences and 95% confidence intervals for the absolute differences in prevalence. Women of color in nursing homes are more likely than non-Hispanic white women in nursing homes to be bedfast and require assistance with dressing and money management. Men of color in nursing homes are more likely than non-Hispanic white men in nursing homes to require assistance with eating, care of possessions, managing money, securing personal items, and using the telephone. The overall finding suggests that people of color in nursing homes have greater impairments than non-Hispanic whites in nursing homes, and that men of color in nursing homes have greater impairment than any other race or gender categories.
    Keywords:
      Nursing homes, race, ethnicity, men, women
    Ma, Grace Xueqin, 1962-
    Shive, Steven E.
    Tan, Yin.
    Feeley, Rosemary M.
  • The Impact of Acculturation on Smoking in Asian American Homes
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    Subject Headings:
    • Asian Americans -- Cultural assimilation.
    • Asian Americans -- Tobacco use.
    • Asian Americans -- Social life and customs.
    Abstract:
      This study examined the relationship between acculturation and smoking in Asian American homes and the factors that predict whether Asian Americans have family members or visitors smoking in the home. A sample of 1,374 participants was selected using a stratified-cluster proportional sampling technique. Overall, 38.3% were exposed to secondhand smoke in their home and 33.7% allowed smoking by visitors. Vietnamese had the significantly highest rates of smoking in the home (44.9%), followed by Cambodians (43.8%), Koreans (42.0%), and Chinese (29.7%). The independent variables that predicted smoking in the home were living in the United States five or fewer years, less acculturation, being female, being foreign born, having a family size of four or more, being Korean, Vietnamese, or Cambodian, and being smokers. The same variables predicted allowing visitors to smoke in the home, excluding being female. Protective factors included being more educated, being older, and having children under 18 at home.
    Keywords:
      Acculturation, smoking in the home, Asian Americans
    Christman, Lisa K.
    Abdulla, Rania.
    Jacobsen, Paul B.
    Cantor, Alan (Alan B.)
    Mayhew, Dionne Y.
    Thompson, Keva S.
    Krischer, Jeffrey P.
    Roetzheim, Richard G.
  • Colorectal Cancer Screening among a Sample of Community Health Center Attendees
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    Subject Headings:
    • Colon (Anatomy) -- Cancer -- United States -- Prevention.
    • Medical screening -- United States.
    • Community health services -- United States.
    Abstract:
      To determine the rate of colorectal cancer screening in patients attending a sample of community health centers, medical records of 1,176 patients from eight community health centers were abstracted. Among the patients studied, 43.8% of patients had undergone at least one of the three colorectal screening tests (fecal occult blood test, colonoscopy, or flexible sigmoidoscopy) in the recommended interval. Colorectal screening in this community health center population was predicted by male gender, being African American, older age, having a greater number of chronic illnesses, a family history of colorectal cancer, and by having engaged in other preventive cancer screenings in the previous year. Although screening rates certainly were not optimal, they compare favorably to rates reported in national surveys for the general population. Our results add to a growing body of evidence that community health centers, despite serving disadvantaged populations, are able to deliver preventive care at rates comparable to health facilities used by the general population.
    Keywords:
      colorectal neoplasms, vulnerable populations, cancer screening, community health centers.
    Bonds, Denise E.
    Foley, Kristie Long.
    Dugan, Elizabeth.
    Hall, Mark A., 1955-
    Extrom, Pam.
  • An Exploration of Patients' Trust in Physicians in Training
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    Subject Headings:
    • Physician and patient -- United States.
    • Trust -- United States.
    • Physicians -- In-service training -- United States.
    • Primary care (Medicine) -- United States.
    Abstract:
      Several characteristics associated with patient trust are identified. To determine the level of trust patients from disadvantaged circumstances have in their primary care resident physician, and to determine patient and physician characteristics that predict trust, we administered a survey to randomly selected primary care patients of an academic medical center staffed by internal medicine residents after a visit to their primary care provider. Participants were adults. The group was racially diverse (50% non-white), English-speaking, and from lower socioeconomic groups. The 10-page survey consisted of 7 sections (Physician Trust Scale, Patient Demographics, Patient Health and Well-Being, Patient-Physician Relationship Characteristics, Global Doctor Trust Scale, and Physician Characteristics). The average trust score for primary care providers was 42.70 (standard deviation [SD] 6.20, maximum possible 50). Patient trust was associated with female gender of the participant, higher education level, male physician, and gender concordance between physician and patient, and was inversely related to patient age. Trust in the doctors and nurses at the hospital in which the clinic was located also had a positive association with trust. These patients from lower socioeconomic groups had relatively high levels of trust compared with patients from higher socioeconomic groups discussed in the literature.
    Keywords:
      Patient trust, primary care, doctor-patient relationship.

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