Difficulty Accessing Healthcare Services Research Articles

Clinical audit of the inclusion of the Lester Tool details in discharge documents at Foss Park Hospital, York

AimsPatients with serious mental health illnesses die on average 15–20 years before the rest of the general population. Anti-psychotic medication, lifestyle and difficulty accessing healthcare services all have a detrimental effect on their life expectancy. To improve outcomes for these patients the Lester Tool; a method to assess the cardiovascular health of patients and implement change, was developed. Including the Lester Tool information in discharge letters allows transfer of information to other care providers (mainly GP's) who can implement and monitor any interventions made, improving outcomes for our patients. With this in mind, discharge documents should contain all of the information listed in the Lester Tool.We aimed to check if 100% of data required by the Lester Tool is included in discharge documents of the inpatients at Foss Park Hospital.Method20 patients from each of the male and female wards at Foss Park hospital, discharged in September or October 2020, were identified. A review of the discharge documents established whether the smoking status, BMI, ECG, blood pressure and blood results of each patient were recorded.ResultOf the 40 discharges, none had 100% compliance. On average across both wards; only 23% of the Lester tool information was included in the documents. On the female ward, 40% had none of data recorded, while on the male ward, 15% had none of the data recorded. Across both wards, not a single patient had details about their cholesterol ratio recorded, only 50% of BMI's were recorded and only 27% had a smoking status included.ConclusionOur results have shown that compliance with the Lester Tool falls short of what is expected. As a result, information about the physical health of our patients is not being communicated effectively with other care providers. This in turn can prevent patients being offered interventions needed to improve their cardiovascular health.Identifying this shortcoming in the transfer of information will allow us to educate the staff in our organisation and ensure that all the necessary physical health details will be included in future discharge documents. The result being improved outcomes and longer life expectancy of patients with serious mental illnesses, satisfying the purpose of the Lester Tool.

A national survey of caregiver\u2019s own experiences and perceptions of U.S. health care system when addressing their health and caring for an older adult

BackgroundCaregiving is a demanding role that can negatively impact a person’s health and well-being. As such, adequate access to health care is important for maintaining the family caregiver’s own personal health. The aims of this study were to identify if family caregivers of older adults had more difficulty accessing health care services than non-caregivers and to identify if family caregivers felt access to additional services would be beneficial for maintaining their own personal health care.MethodsNational survey of 3026 US adults aged 30 to 89 years old. Participants were grouped based on self-reported caregiving experience. Survey asked about access to care, importance of health care services and whether caregivers had support needed. Descriptive statistics were used to compare caregiver and non-caregiver’s responses. Multivariate logistic regression model assessed correlates of caregivers not having the support they needed.ResultsCaregivers were older, female, lower educational attainment, lower income, had more multiple chronic health conditions and health condition or disability that impacts their daily life. Caregivers reported difficulty accessing mental health services, dental services, medications, and supportive services at home. Caregivers felt it was important to have care coordinator, long-term relationship with primary care provider and access to house calls, telemedicine, and medications delivered to the home. Age, ethnicity, chronic conditions and confidence in finances were factors influencing whether caregiver had support needed to provide assistance to older care recipient.ConclusionCaregivers provide needed support and care to older adults while also needing support for themselves. Health care services delivered in the home were highly desirable to caregivers and could help them maintain their health and well-being.

Difficulties experienced in diagnosis and follow-up of diabetes mellitus patients during the covid-19 pandemic period: 3 case reports

Pandemic periods are one of the reasons patients have difficulty accessing healthcare services. Even diseases such as diabetes mellitus with a high prevalence and easy to diagnose today may delay the diagnosis of patients. Likewise, difficulties may be experienced in the follow-up of these patients due to pandemic period restrictions. We presented 1 diabetes mellitus patient delayed in diagnosis during the COVID-19 pandemic period and 2 diabetes mellitus patients who had difficulties in follow-up due to pandemic restrictions in this case reports. © 2017 AOS-Estratagia and Inovacao. All rights reserved.

Perception, Attitudes, and Experiences Regarding Mental Health Problems and Web Based Mental Health Information Amongst Young People with and without Migration Background in Germany. A Qualitative Study.

Mental illnesses in adolescence and young adulthood are steadily increasing. Thus, mental disorders represent an individual and societal challenge and an enormous health economic burden, creating an urgent need for research and action. Mental health problems are omnipresent in the life of young people and the internet is the first resource, which helps them to understand their situation. Young people with migration background often have more difficulties accessing health care services. Digital technologies offer an ideal opportunity for a low-threshold platform that addresses the needs of young people. The current project “GeKo:mental” aims to design a multilingual website for Cologne-based adolescents and young adults that will enable them to obtain comprehensive information about mental illness and health, treatment options and first contact points. To design this website, this study aims to find out what kind of health information is needed and how it should best be presented. Nine focus group discussions with adolescents and young adults with and without migration background (N = 68) were conducted; the focus group discussions took place at schools, in an association for social youth work and in an cultural association, which is linked to a mosque in Cologne, Germany. A qualitative content analysis was conducted on the gathered material. The participants reported concrete challenges and needs. The results will form the basis for the development and design of a website.

Accessing health services in India: experiences of seasonal migrants returning to Nepal

BackgroundMigration to India is a common livelihood strategy for poor people in remote Western Nepal. To date, little research has explored the degree and nature of healthcare access among Nepali migrant workers in India. This study explores the experiences of returnee Nepali migrants with regard to accessing healthcare and the perspectives of stakeholders in the government, support organizations, and health providers working with migrant workers in India.MethodsSix focus group discussions (FGDs) and 12 in-depth interviews with returnee migrants were conducted by trained moderators in six districts in Western Nepal in late 2017. A further 12 stakeholders working in the health and education sector were also interviewed. With the consent of the participants, FGDs and interviews were audio-recorded. They were then transcribed and translated into English and the data were analysed thematically.ResultsThe interviewed returnee migrants worked in 15 of India’s 29 states, most as daily-wage labourers. Most were from among the lowest castes so called-Dalits. Most migrants had had difficulty accessing healthcare services in India. The major barriers to access were the lack of insurance, low wages, not having an Indian identification card tied to individual biometrics so called: Aadhaar card. Other barriers were unsupportive employers, discrimination at healthcare facilities and limited information about the locations of healthcare services.ConclusionsNepali migrants experience difficulties in accessing healthcare in India. Partnerships between the Nepali and Indian governments, migrant support organizations and relevant stakeholders such as healthcare providers, government agencies and employers should be strengthened so that this vulnerable population can access the healthcare they are entitled to.

Respiratory patient experience of measures to reduce risk of COVID-19: findings from a descriptive cross-sectional UK wide survey

ObjectivesTo assess the experience of people with long-term respiratory conditions regarding the impact of measures to reduce risk of COVID-19.DesignAnalysis of data (n=9515) from the Asthma UK and British Lung...

COVID-19 vulnerability among people who use drugs: recommendations for global public health programmes and policies.

COVID-19 vulnerability among people who use drugs: recommendations for global public health programmes and policies.

Use of Standardized Patients in Endocrinology Fellowship Programs to Teach Competent Transgender Care

PurposeTransgender and gender-nonconforming individuals have unique health care needs and have difficulty accessing health care services because of a lack of qualified health care providers, insurance coverage, mistreatment, and bias by the medical community. Medical trainees and physicians report a lack of education in, and exposure to, the clinical care and unique aspects of this field. We assessed the use of a standardized patient as a tool to evaluate 4 core medical competencies (patient care, medical knowledge, professionalism, and interpersonal communication) of endocrinology fellows at a single training program.MethodsEndocrine fellows were evaluated by faculty in different aspects of transgender care and completed a self-assessment before and after the exercise. Faculty viewed the fellows during the Objective Clinical Structured Examination. Fellows were provided feedback by a faculty member and the standardized patient after the exercise.ResultsDeficits were found in patient care and professionalism. Fellows scored well in medical knowledge. Fellows did not report an improvement in comfort and communication skills after the exercise. Interestingly, fellows’ self-assessment scores in several domains declined after the standardized patient encounter, highlighting an occasion for self-reflection and growth within the realms of cultural competency and medical knowledge.Main conclusionsWe conclude that use of standardized patients to teach medical competencies in transgender medicine may be one approach to improve exposure to, and training in, transgender medicine. Endocrine fellows still had discomfort treating transgender individuals after the standardized patient encounter and require other training activities that may include didactics and clinical case discussions.

Does health guidance concerning lifestyle disease prevention spread to spouses? A qualitative study.

To describe how a health guidance programme provided to one person influences change in their spouse's health behaviours. Individuals are indirectly affected by the health behaviours of those close to them; therefore, it is likely that guidance on the prevention of lifestyle disease modifies the behaviour of targeted individuals and their family members. In a previous study, approximately 30% of families displayed positive health changes because one individual family member received health guidance. This study used an inductive, exploratory, qualitative design. Semi-structured interviews were conducted with spouses of persons who participated in a health guidance programme for lifestyle-related disease prevention. Data were analysed from 11 spouses (all women; Mage =61.0±9.1years) using a modified grounded theory approach. This study was conducted according to the consolidated criteria for reporting qualitative research (COREQ; see Appendix S1). The process of change in each spouse was a result of their partner's influence, which changed from a stage of assisting, where the spouse contemplated {I am just a supporter} to the partner, to a stage where the spouse thought {I am also a player}, and she engaged in her own health improvement practices. For a spouse to change from assisting their partner to becoming a practitioner of their own health improvement, the spouse needed to experience a sense of surprise at the changes in her partner, through calm observation of the partner's attitude. Through the spreading effect of health guidance utilisation, indirect encouragement could be expected, even when people have difficulty accessing healthcare services. This type of spreading effect from one participant to a family member could perhaps assist health guidance provisions so that disease prevention becomes more efficient.

\u201cAntibiotics kill things very quickly\u201d - consumers\u2019 perspectives on non-prescribed antibiotic use in Saudi Arabia

BackgroundIn recent decades, the Kingdom of Saudi Arabia has seen an exponentially growing antibiotic resistance, which is exacerbated by the use of antibiotics without a prescription and other various factors. However, no published data are available on factors influencing non-prescription use of antibiotics among the general public in Saudi Arabia using an in-depth interview technique.MethodsSemi-structured interviews were carried out with 40 Saudi participants from the Eastern Province of Saudi Arabia, selected via snowball sampling technique. Participants were enrolled based on the following inclusion criteria: 18 years of age or older and had self-medicated themselves with antibiotics in the past two years. Data collection was continued until data saturation was attained. Interviews were audiotaped, transcribed verbatim and analysed using NVivo 10 software.ResultsParticipants (80% female) had a mean (SD) age of 30 years (10.2). Self-medication with antibiotics was associated with various inappropriate antibiotic use behaviours and negative outcomes such as antibiotic resistance, treatment failures and adverse events. Interviews revealed that different reasons contribute to the rise of self-medication with antibiotics, ranging from difficulty accessing healthcare services, participant’s cultural beliefs and practices, lack of knowledge about antibiotics and antibiotic resistance, and weak regulatory enforcement.ConclusionsThe findings of the present study will aid in generating data that may provide an insight when designing future interventions to promote public health awareness regarding safe and effective use of antibiotics.

Immigrants’ access to health care: Problems identified in a high-risk tuberculosis population

IntroductionImmigrants may utilize health care services differently than other residents and may also have a greater risk for tuberculosis (TB). ObjectiveIdentify barriers to healthcare access by immigrants, factors associated with these barriers, and discuss strategies that may reduce these barriers. Material and methodsAnonymous questionnaires were given to immigrants at National Immigrant Support Centres between 2015 and 2016. Barriers to healthcare were identified using logistic regression. ResultsOne-hundred and nineteen questionnaires were administered to immigrants, 9 of whom (8%) presented with TB while in Portugal. Twenty-one percent of immigrants reported barriers to healthcare access, and 69% had general practitioners (GPs). The presence of barriers to healthcare access was negatively associated with having a GP and with being married or in a de facto union. ConclusionsA considerable proportion of immigrants reported having difficulties accessing healthcare services in Portugal where legally these barriers are nonexistent. Certain factors were associated with these difficulties.

Work-related illness, work-related accidents, and lack of social security in Colombia

The impacts of neoliberal or market-based social security reforms in health have been extensively studied. How such reforms transformed employment-related insurance and entitlements, however, has received significantly less attention. This study aims to understand how the employment insurance system operates in Colombia and to assess how the experience of workers seeking social security entitlements relates to the system's structure. We conducted an ethnographic study of the Colombian Occupational Risk System between May 2014 and March 2016, with two main components: 1) analysis of the system itself through in-depth interviews with 32 people working in leadership positions and a systematic review of the system's most important legislation, and 2) a study of people who experienced problems receiving entitlements and were challenging the assessment of their work-related illness or accident. We conducted in-depth interviews with 22 people, followed up with half of them, and reviewed their case files. We found that difficulties accessing health care services, payments for medical leave, job reassignments, severance packages, and filing for pension benefits were common to all cases and resulted from overwhelming bureaucratic and administrative demands. Regional and national evaluation bodies dictate whether a given illness or accident is work-related, and establish a percentage of Loss of Wage Earning Capacity (LWEC). People's disabled bodies rarely reached the threshold of 50% LWEC to qualify for disability pensions. The lengthy process that workers were forced to endure to obtain work-related entitlements always involved the judiciary. The three competing for-profit financial sectors (health insurance, pension funds, and Occupational Risk Administrators) actively challenged workers' demands in order to increase their profits. We conclude that these for-profit sectors work contrary to the principles that sustain social security. Indeed, they push sick and disabled workers to unemployment, informality, economic dependence, and ultimately dire poverty.

Cohort profile: a data linkage cohort to examine health service profiles of people with intellectual disability in New South Wales, Australia

PurposePeople with intellectual disability are a minority group who experience poorer physical and mental health than the general population and have difficulty accessing healthcare services. There is lack of knowledge...

Access to care and use of the Internet to search for health information: results from the US National Health Interview Survey.

BackgroundThe insurance mandate of the Affordable Care Act has increased the number of people with health coverage in the United States. There is speculation that this increase in the number of insured could make accessing health care services more difficult. Those who are unable to access care in a timely manner may use the Internet to search for information needed to answer their health questions.ObjectiveThe aim was to determine whether difficulty accessing health care services for reasons unrelated to insurance coverage is associated with increased use of the Internet to obtain health information.MethodsSurvey data from 32,139 adults in the 2011 National Health Interview Study (NHIS) were used in this study. The exposure for this analysis was reporting difficulty accessing health care services or delaying getting care for a reason unrelated to insurance status. To define this exposure, we examined 8 questions that asked whether different access problems occurred during the previous 12 months. The outcome for this analysis, health information technology (HIT) use, was captured by examining 2 questions that asked survey respondents if they used an online health chat room or searched the Internet to obtain health information in the previous 12 months. Several multinomial logistic regressions estimating the odds of using HIT for each reported access difficulty were conducted to accomplish the study objective.ResultsOf a survey population of 32,139 adults, more than 15.90% (n=5109) reported experiencing at least one access to care barrier, whereas 3.63% (1168/32,139) reported using online health chat rooms and 43.55% (13,997/32,139) reported searching the Internet for health information. Adults who reported difficulty accessing health care services for reasons unrelated to their health insurance coverage had greater odds of using the Internet to obtain health information. Those who reported delaying getting care because they could not get an appointment soon enough (OR 2.2, 95% CI 1.9-2.5), were told the doctor would not accept them as a new patient or accept their insurance (OR 2.1, 95% CI 1.7-2.5 and OR 2.1, 95% CI 1.7-2.5, respectively), or because the doctor’s office was not open when they could go (OR 2.2, 95% CI 1.9-2.7) had more than twice the odds of using the Internet to obtain health information compared to those who did not report such access difficulties.ConclusionsPeople experiencing trouble accessing health care services for reasons unrelated to their insurance status are more likely to report using the Internet to obtain health information. Improving the accuracy and reliability of health information resources that are publicly available online could help those who are searching for information due to trouble accessing health care services.

Supportive and palliative care for patients with chronic mental illness including dementia.

People with preexisting mental illness are known to have difficulty accessing healthcare services including palliative care and people with dementia have similar issues accessing palliative care. The review addressed the time period from January 2013 to March 2014. There were few articles addressing issues for palliative and supportive care for patients with preexisting mental health issues. The main factor that would improve care is interdisciplinary working between mental healthcare teams and palliative care teams. In contrast, there were many published articles on the palliative and supportive care needs for people with dementia. These articles included consensus statements, models of care; studies of why models of care, for example Advanced Care Planning were not being implemented; and carer reports of care in the last year of life. Urgent research is required as to how support for people with preexisting mental illness who require palliative care can be improved--excellent liaison between mental health and palliative care teams is essential. There is much research on palliative care needs for people with dementia but an apparent lack of innovative approaches to care including care of people within their family home.

The impact of the medical home on access to care for children with autism spectrum disorders.

Children with autism spectrum disorders (ASD) experience difficulty accessing health care services. Using parent-reported data from the 2009-2010 National Survey of Children with Special Health Care Needs, we examined whether having a medical home reduces unmet need for specialty care services for children with ASD (n=3,055). Descriptive statistics and Chi square tests identified sample characteristics and examined the relationship between unmet needs and a standardized measure of medical home. Logistic regression models explored the individual impact of demographic, condition-specific and medical home variables on unmet need. Parents reported that nearly all children had a need for specialty services, 36% had an unmet need, and 23.9% had a medical home. Children who had fewer unmet needs were more likely to have received family-centered and coordinated care through a medical home, and this relationship remained significant even when demographic and condition-specific variables were taken into account. These findings suggest ways to improve access to care for children with ASD through enhanced family-centered and coordinated care within the medical home.

Health Care Providers' Perceptions of Maternal Health Concerns in the Solomon Islands.

The objective of this study was to explore the maternal health risk factors and sentinel events among women in the Solomon Islands, from the viewpoints of health care providers in the Solomon Islands. Three focus group interviews were conducted in July and August 2011 at a secondary referral hospital in an urban area. The study consisted of 10 registered nurses and 11 skilled birth assistants. Thematic analysis was used for this qualitative data analysis. Six major themes were emerged from the data: (a) environmental hazard: malaria, (b) malnutrition: iron deficiency anemia, (c) adolescent pregnancy, (d) betel nut chewing, (e) cultural beliefs influencing women's health, and (f) difficulty accessing health care services. The results of this study provide a useful first step toward identifying specific maternal health risks among women in the Solomon Islands. The findings may assist the health sector and midwives/antenatal educators to better understand the health risks and reduce the disease burden among pregnant women in South Pacific countries. The results may also contribute to the development of policies to improve maternal health and to accelerate progress toward the fifth target goal of UNICEF's Millennium Development Goals.

British adults with chronic health conditions or impairments face significant barriers to accessing health services

To quantify the extent to which adults with chronic health conditions or impairments in Great Britain experience barriers to accessing health services in comparison to adults without impairments. Secondary analysis of cross-sectional population-based survey data from the Life Opportunities Survey. The Life Opportunities Survey interviewed a nationally representative sample of 37,513 individuals age 16 or older from 19,951 households. A subset of questions addressed disability status, health conditions and impairments, and participation restrictions in accessing public services. Simple bivariate and multivariate logistic regression (controlling for age, gender, and ethnicity) analyses were undertaken to estimate the risk that specific condition/impairment types were associated with barriers to accessing health care. Individuals with chronic health conditions or impairments were significantly more likely to report difficulties accessing health care services. Additionally, individuals in each condition/impairment group had significantly higher odds of experiencing a variety of barriers, including discrimination by healthcare staff, inexperienced or unhelpful staff, lack of help with communication, lack of information, problems with transportation, difficulty getting into buildings, difficulty using facilities, and lack of confidence or anxiety. Individuals with chronic health conditions or impairments are significantly more likely than their non-impaired peers to experience barriers in accessing health care. These barriers are likely to exacerbate disability and may increase the likelihood of developing additional preventable health conditions. As a result, they may contribute towards the health inequalities experienced by disabled people. The existence of these barriers also suggests that health care provision in Great Britain is failing to meet its statutory requirement to provide 'reasonable adjustments' to ensure equality of access for disabled adults.

Specialty Care Programme for autism spectrum disorders in an urban population: A case-management model for health care delivery in an ASD population

Subjects with autism spectrum disorders (ASD) have more medical needs and more difficulties accessing health care services than the general population. Their verbal and non-verbal communication difficulties and particular behaviors, along with lack of expertise on the part of physicians and failure of the services to make adjustments, make it difficult for them to obtain an appropriate health care. PurposeTo describe a model for health care delivery in an ASD population. MethodReview of relevant literature and a discussion process with stakeholders leading to the design of a service to meet the specialty health needs of subjects of all ages with ASD for a region with a population of 6,000,000. ResultsA service was designed centred around the concepts of case management, individualization, facilitation, accompaniment, continuous training and updating, and quality management. Five hundred and thirteen patients with ASD have been seen over a period of 18 months. The programme generated 1566 psychiatric visits and 1052 visits to other specialties (mainly Nutrition, Stomatology, Neurology, and Gastroenterology) in the same period. ConclusionPersons with ASD may benefit from adjustments of health care services in order to improve their access to adequate health care at the quality level of the rest of the population.

Physical comorbidity in mental illness in paediatric population: need for an integrated health care approach to paediatrics and child psychiatry

It has long been recognised that adult subjects with severe mental disorders have more medical needs than the general population. In many instances, this is paired with greater difficulties accessing health care services, constituting an added burden to the mental disease. Mental disorders are complex disorders that often affect not only the brain, but also other parts of the body. This, along with other factors such as more common unhealthy life styles, may be one of the causes that explain the higher medical morbidity in subjects with mental disorders. It is also clear that difficulties in detecting and correctly diagnosing them are an added problem in patients who have cognitive impairments, are disorganised, have verbal communication problems, have a higher pain threshold, complain of atypical symptoms, and experience difficulties describing subjective experiences and symptoms. This is also the case for children and adolescents with mental disorders. For instance, at least half of children with anxiety disorders may have a comorbid physical illness— most commonly allergies and asthma [1]—and up to 80% of children suffering from autism spectrum disorders suffer from gastrointestinal disorders, sleep disorders or epilepsy [5]. In addition, in many cases, behavioural problems, active lack of cooperation, and difficulties helping with differential diagnoses make the detection of a physical disease difficult for paediatricians. The side effects of psychotropic drugs are another cause for increased medical morbidity in this paediatric population. This has been clearly shown with antipsychotics [2] but is also the case for all other psychotropics. Finally, some mental disorders are direct causes of medical complications. That is the case for conditions such as eating disorders, drug abuse or dependence, and the risk-taking behaviours seen in conditions such as conduct disorders and personality disorders in adolescents. The comorbidity between physical and mental illnesses itself causes considerable impairment and unique needs that may complicate routine care. The view of severe mental disorders, such as schizophrenia, as systemic diseases is not new [4]. In this issue, in an elegant study, Imeraj et al. [3] simultaneously recorded 24-h heart rates and activity patterns in 30 non-medicated children with ADHD and 30 healthy controls over a 5-day period. Heart rate levels in children with ADHD were significantly higher, especially during the afternoon and night-time hours, than in control children after controlling for many confounders. Of course the nature of the study precludes testing if the finding is related to or a consequence of the psychophysiology of the disease. There is a clear need for effective co-ordination of services involving child psychiatrists and paediatricians [7]. Otherwise children and adolescents with mental disorders are in a poorer position with regard to access to proper medical care. Special health facilities have now been developed in European countries to address these inequalities and to facilitate access to public health care in children and adolescents affected with severe mental disorders [5]. Another important issue is the stigma associated with these disorders, even among medical professionals. The health care system, including paediatricians, should be targeted for programmes aimed at reducing the stigma of mental illness. As previously mentioned, another source of physical problems in many adolescents with mental disorders is the use C. Arango (&) Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Maranon, Centro de Investigacion Biomedica en Red de Salud Mental, CIBERSAM, c/Ibiza, 43, 28009 Madrid, Spain e-mail: carango@hggm.es