Twenty-seven pediatric residents were assessed for knowledge, attitudes, and behaviors regarding rights of immigrant families. A program documenting immigrant rights was reinforced in the clinic with posters and individual consultations on immigrant children's needs. This brief program was effective in instructing residents on health and nutritional services for immigrant patients.
This report describes a clinic run by a federally-qualified health center and an academic medical center. The clinic expands the community's primary care capacity, combining advantages of big and small settings, and of its dual affiliation. Survey data suggest the clinic prevents health care delays and lowers emergency department use.
The HealthSTAT model of professional development uses team-based leadership and peer-to-peer learning to cultivate inter-professional collaboration and community partnership in service to the poor and underserved of Georgia.
Racial and ethnic disparities in health care have been attributed in part to cultural and linguistic dissonance between certain patient populations and the health care system. Yet in the long term, structural solutions for ameliorating health care disparities have not been forthcoming. One strategy for increasing access to care for cultural and linguistic minorities is ethnicity-specific subsystems of care. The historical experiences of the Chinese community in San Francisco are used to reconstruct the evolution of its ethnicity-specific health care infrastructure and to create an organizational development model for ethnicity-specific health care organizations and infrastructures. The four stages of the model include developing and recruiting a bicultural and bilingual health care workforce, structuring health care resources for maximum accessibility, expanding health care organizations, and integrating ethnicity-specific health care resources into the mainstream health care system. Policy recommendations to develop ethnicity-specific subsystems of care are presented.
Framed messaging has emerged as an important means of promoting a number of health behaviors, including breast cancer screening. However, studies of message framing have infrequently considered race and income as possible moderators of framing effects, despite their importance to screening behavior. The current study examined whether demographic characteristics moderated participant responses to message framing. In the study, 102 Black and 42 White low-income, low-screening women were randomized to a loss, gain, or empowerment frame telephone intervention and re-contacted at 6 and 12 months. Contrary to expectation, there was no main effect for framing condition, although both loss and empowerment conditions elicited superior screening than the gain condition at 12 months. Income proved an important moderator of framing effects, interacting with both condition and race to influence screening. Message frames may differ in the amount of time they require to manifest in behavioral outcomes and may lead to changes in different screening outcomes. Understanding how framing effects vary as a function of key demographic characteristics such as race and income is likely to prove important as such variables facilitate targeting of frames.
This article describes the development of a theory-based, data-driven replacement for the Health Professional Shortage Area (HPSA) and Medically Underserved Area (MUA) designation systems. Data describing utilization of primary medical care and the distribution of practitioners were used to develop estimates of the effects of demographic and community characteristics on use of primary medical care. A scoring system was developed that estimates each community's effective access to primary care. This approach was reviewed and contributed to by stakeholder groups. The proposed formula would designate over 90% of current geographic and low-income population HPSA designations. The scalability of the method allows for adjustment for local variations in need and was considered acceptable by stakeholder groups. A data-driven, theory-based metric to calculate relative need for geographic areas and geographically-bounded special populations can be developed and used. Its use, however, requires careful explanation to and support from affected groups.
Although areas designated as Health Professional Shortage Areas (HPSAs) have fewer primary care physicians than non-HPSAs, few studies have tested whether HPSA designation is related to health status and medical service access. This study examined whether residents living in HPSAs were more likely to report worse health status and to be more likely to have difficulty in getting access medical services than residents living in non-HPSAs, with survey data of 10,940 adult West Virginians. Multiple regression results indicate that HPSA is associated with worse general health status and poor physical health, and less access to medical services (measured by had usual place for medical care, experienced not getting needed health care and had outpatient care) but not to inpatient care. These findings indicate that the current HPSA designation system does capture the significant differences between residents of HPSAs and residents of non-HPSAs in health status and medical services access.
Depressive symptoms are common among patients with diabetes and may have a significant impact on self-management and health outcomes. The prevalence of both depression and diabetes varies by race. We examined whether race is also an effect modifier in the association between mental health rated "not good" and diabetes using the national Behavioral Risk Factor Surveillance System (BRFSS) data from 2002 to 2005. We found that the prevalence of diabetes among Native American respondents was almost double that among Whites. Respondents with at least two weeks of mental health rated "not good" are significantly higher among diabetic patients than among non-diabetic patients. Native Americans (NAs) with at least two weeks of mental health rated "not good" were more likely to have diabetes. This association is stronger in NAs than in Whites. Future research should focus on a better understanding of the pathophysiological mechanisms underlying this plausible association between poor mental health and diabetes.
This study identifies factors predicting health insurance coverage of TANF recipients leaving Medicaid programs. A sample of 785 Medicaid spells of enrollment by able-bodied, non-elderly adults is drawn from a national survey. Employing event history analysis and multinomial logistic regression, the study finds that those who left Medicaid were three times more likely to become uninsured than to become privately insured. Recipients leaving TANF were 24 times more likely to leave Medicaid than to remain on Medicaid. The impact of leaving TANF upon becoming uninsured was moderated by restrictive TANF policies. Recipients who were White and employed part-time were 41–42% more likely to become uninsured than were their counterparts. A high unemployment rate increased a recipient's chance of becoming uninsured by 27.5%. Married people, African Americans, those with full-time jobs, and those with earnings above the poverty line were at least 32% more likely to acquire private coverage than their respective counterparts.
A convenience sample of city-dwelling African American women (n=246) was interviewed during each woman's postpartum stay at one of five hospitals in Washington, D.C. to determine their perceptions of factors influencing their prenatal care utilization. The Kotelchuck Adequacy of Prenatal Care Utilization Index was used to classify prenatal care utilization as either adequate (Adequate Plus and Adequate groups combined) or inadequate (Intermediate and Inadequate groups combined). Of the 246 women studied, 40% (99) had adequate prenatal care utilization. Using Classification and Regression Trees analysis, the following risk groups for inadequate prenatal care utilization were identified: women who reported psychosocial problems as barriers and who were not participants in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) (percent adequate=8.8); women who reported psychosocial problems as barriers, were participants of the WIC program, and reported substance use (percent adequate=13.8); and women who reported psychosocial problems as barriers, were participants of the WIC program, denied substance use, and reported childcare problems as barriers (percent adequate=20.0).
This article explores e government inequalities to searching Medicare and Medicaid information online. Telehealth, a branch of e government, can bring public health service and insurance information to the citizen. The Centers for Medicare and Medicaid Services website, among others, has critical information for potential beneficiaries and recipients of services.
Using Pew survey data and multivariate regression analysis we find people in most need of Medicare and Medicaid information online (the elderly and poor) are accessing it, and people with years of online experience are strong proponents of online searches. Despite being less likely to have broadband services, individuals in rural areas were not found to be less likely to search for information online.
In conclusion, some disparities are narrowing as the elderly and poor in need of access to public health insurance are searching for it online. However, people without Internet access and experience (perhaps the oldest and poorest) remain disadvantaged with respect to accessing critical information that can link them to needed health care services.
Because racial/ethnic disparities in breast cancer survival have persisted, we investigated differences in breast cancer treatment among American Indian, Hispanic, and non-Hispanic White (NHW) women. Surveillance, Epidemiology and End Results data linked to Medicare claims in New Mexico and Arizona (1987–1997) among enrollees aged 65 and older were used to identify treatment, treatment interval, and mortality risk associated with delays in care. We identified 2,031 women (67 American Indian, 333 Hispanic and 1,631 NHW women with time to treatment information. Treatment intervals from diagnosis to surgery (all stages, 18 versus 4 days, p<.001) and surgery to radiation (stages I/II, 69 versus 35 days, p<.01), were significantly greater for American Indian women than for NHW women. This disparity remained statistically significant after adjustment for age, stage, grade, year of diagnosis, poverty, and distance to care. There was no statistically significant difference in treatment among Hispanic women. Further, American Indian women without surgery within 6 months experienced a 5.6-fold higher breast cancer mortality (p<.05). The duration of time to surgery and radiation has not been previously reported for American Indian women. These results suggest older American Indian women experience significant delays in cancer treatment, resulting in greater breast cancer mortality.
This study explores whether being met at the gate by a case manager is associated with more health-seeking behavior during the six months post-release among HIV-infected inmates transitioning from the facility to the community. Case managers documented whether clients were met at the gate upon release. Clients (N=226) underwent a structured interview at approximately six months post-release. One hundred and four clients were met at the gate upon release (46%). Results indicate that clients who were met at the gate were more likely to participate in drug or alcohol treatment (p≤.01) and not engage in sex exchange during the subsequent six months (p≤.05). Health-seeking behavior prior to incarceration, facility type, and state were controlled for. Being met at the gate was not significantly associated with reduced emergency room use or using street drugs. Findings offer support for the importance of establishing early post-release contact with a case manager among HIV-infected ex-offenders.
Background. About one-third of HIV-infected people in the U.S. have a history of injection drug use (IDU). To examine disparities in health care, we compared health care utilization and morbidity of IDUs and non-IDUs. Methods. A large national cohort of people receiving HIV care was used to compare IDU and non-IDU inpatient, outpatient, and emergency room (ER) visits and other standards of care. We also compared prevalence of HIV-related illnesses. Results. Injection drug users were older and more frequently female, non-White, and publicly insured than non-IDUs. Injection drug users were more than twice as likely to have one or more ER visits annually and almost twice as likely to be hospitalized. CD4 and viral load testing was half as likely to be performed for IDUs in a six-month period. Injection drug users were significantly more likely to have HIV-related morbidity. Conclusions. Health care associated with injection drug use may not be adequately addressed in the outpatient setting. The benefits of broadening the scope of primary HIV care should be examined.
Development of a global HIV vaccine will require enrollment of a large number of adults and adolescents in clinical trials. Involvement of homeless young adults in these trials will be particularly important because they often practice high-risk behaviors and are disproportionately infected by HIV. This qualitative study explores factors that might affect future participation of homeless 18- to 24-year-olds of diverse racial/ethnic backgrounds in HIV vaccine trials (HIVVTs). Twenty males and females attended focus groups. Participants expressed concern about seroconversion, the trustworthiness of the researchers and/or government agencies conducting trials, vaccine side effects, and possible negative behavior change as a result of being vaccinated. Understanding the personal perspectives of high-risk young adults will enable researchers to tailor protocols to their individual needs and cultural values and, in so doing, potentially enhance willingness to participate in HIVVTs.
The research objectives of this study are to describe the re-entry experiences of people recently released from jail who were living with HIV/AIDS, and to identify factors that influence their access to primary care and adherence to a treatment regimen. The research used a mixed-method, qualitative and quantitative research design. The findings indicate that the overall instability in the lives of many of the former inmates studied hampered their ability to attend to their HIV/AIDS-related health care needs. Most former inmates returned to the community with co-occurring problems related to housing and substance abuse. Complicating their access to health care were fragmented health care and correctional systems. The study highlights the need for coordination and collaboration between correctional facilities and community-based health care and human service providers that leads to a deliberative and planned transition from jail to service systems in the community.