Disparities In Services Research Articles

Research on efficiency measurement and spatiotemporal disparity of rural public health services in China.

ObjectiveBased on the rural public health services of 29 regions in China, a service efficiency evaluation index system consisting of input and output dimensions was constructed, and the coupling, coordination and disparity efficiencies of rural public health services in China were studied, providing information to redress the imbalance in the interregional coordinated development.MethodsThe efficiency, spatiotemporal disparity pattern, spatial correlation and evolutionary trend of the coordinated development of rural public health services of 29 regions in China from 2004 to 2018 were analyzed using efficiency and spatial analysis methods such as Data Envelopment Analysis (DEA), kernel density estimation and Moran’s Ⅰ analysis.ResultNowadays, there are problems of unbalanced and insufficient development between the fields and regions in the development of rural public health services in China. The development level of rural public health services in various regions shows a distribution pattern that the service efficiency is “high in the middle”, “middle in the east” and “low in the west”, indicating a spatial cluster effect.

Reasons for delay in seeking healthcare among women with acute coronary syndrome from rural and urban areas in Jordan

We aimed to explore reasons for delay in seeking healthcare among women with acute coronary syndrome (ACS) for the first time from urban and rural areas in Jordan. A qualitative descriptive design was used through face-to-face interviews with 33 women. Themes that explained why women delayed seeking healthcare when experiencing ACS were: Knowledge deficit about coronary artery disease; the effect of disparity in healthcare services on women decision; and life priorities of women during the ACS attack. Educational needs should be addressed based on variations in both areas. Supplemental data for this article is available online at https://doi.org/10.1080/07399332.2021.1955889 .

Mapping out regional disparities of reproductive health care services (RHCS) across Pakistan: an exploratory spatial approach

Mapping out regional disparities of reproductive health care services (RHCS) across Pakistan: an exploratory spatial approach

Mental health care among marginalized populations in the United States

Mental health care among marginalized populations in the United States

Spatial key performance indicators on the statewide ambulance service coverage of multiple regional classifications

AbstractThe total population covered by the current ambulance service under threshold response time and policy is one of the major concerns for policymakers and ambulance service designers. This study investigates the statewide service coverage based on regional types of urban, rural, and frontier to address emergency medical service (EMS) disparity. A statewide ambulance coverage case study is conducted for the state of North Dakota. This study revisited the spatial key performance indicators (SKPIs) of EMS and proposed innovative spatial modeling for statewide EMS coverage in view of service users, providers, and public health designers. Statewide ground ambulance service coverages were mapped to three types of indicators, including: (a) geographical backup coverages; (b) predicted response and travel time distance at census block level; and (c) the ratio of population being covered by the threshold response time coverage at the county level using GIS. The study demonstrated that the service shortage and multiple service areas are clearly explained using the suggested SKPIs, and the underserved areas are drilled down into expected response and travel time for each census block and the population‐covered ratio for each county for further investigation.

Dismantling Systemic Inequities in School Psychology: Cultural Humility as a Foundational Approach to Social Justice

School psychology has faced longstanding challenges in advancing equity and parity due to persistent oppression, racism, and colonialism in the field. These challenges have contributed to critical shortages of faculty and practitioners who are Black, Indigenous, and People of Color (BIPOC), racial disparities in educational and mental health services for children, and White hegemony in school psychology research and scholarship. The purpose of this commentary is to outline and advocate for a cultural humility framework as the foundation of social justice to improve discourse, practices, and service delivery by engaging in ongoing self-awareness (e.g., critical reflexivity, understanding of power and privilege), and sustained actions (e.g., social justice advocacy, alliances with communities) to improve outcomes of the individual and community (e.g., relational empowerment). Implications of incorporating cultural humility for trainers, researchers, and practitioners are discussed as continuing efforts to improve institutional and professional accountability are needed to facilitate systemic change. Impact Statement The field of school psychology continues to face challenges advancing equity in research, practice, and policy. We present a cultural humility framework as a foundation for antiracism and anticolonialism. School psychologists engage in critical reflexivity, acknowledge their power and privilege, act to remove structural barriers, and use relational empowerment to partner with communities.

Service Delivery and Accountability of Urban Officials: Evidence from Urban-based Local Government in Bangladesh

This study compares the state of city government service delivery for communities living in different areas with different level of affluence in Rajshahi City in Bangladesh. Based on the results of a qualitative study, we found a significant service disparity between the affluent and the poor communities. This disparity is due to the inability of the poor to hold service providers accountable, attributable to a lack of knowledge about services and a lack of social status. Lack of quality monitoring and a marked bias in the quality of interactions between the poor and the affluent contribute to the service disparity This disparity is largely invisible to the poor who, instead of comparing themselves with the affluent citizens, compare themselves with a similar class of people.

Characteristics of Patients Who Attended Behavioral Health Services After Primary Care Referral With Referral Management Support.

This study examined whether documented disparities in access to behavioral health specialty care persisted in a novel integrated primary care model situated in a large health system when triage and referral management supports were provided by a centralized resource center for patients with behavioral health needs. Patients triaged and referred to specialty behavioral health care who did or did not attend a specialty care visit (N=1,450) were compared in terms of various demographic and clinical characteristics by using binary logistic regression. Among patients with attendance data, financially unstable individuals were more likely than financially stable counterparts to miss their first appointment with a specialty behavioral health provider after referral from primary care. Previously documented attendance disparities based on race, ethnicity, and illness severity were not observed. These findings can inform targeted strategies to increase attendance among patients with financial insecurity and reduce disparities in outpatient behavioral health services.

Addressing the Disparity in Refugee Mental Health Services: a Pilot Study of a Traumatic Stress Intervention Utilizing a Language-Free mHealth Application

After resettlement, an overwhelming number of refugees struggle with chronic traumatic stress (CTS), the persistence of traumatic events (e.g., re-experiencing past trauma; news of on-going war) coupled with daily post-migration stressors (e.g., poverty, lack of transportation). CTS significantly increases the burden of mental health challenges experienced by refugees. Evidence-based mental health treatments often rely on worksheets, mobile applications, websites, or telephone calls to facilitate the management of distress outside of treatment sessions. Language barriers prevent these strategies from being incorporated into mental health treatment for refugees, which results in a significant disparity in care. Treatments delivered via mobile devices can address this barrier through the use of intuitive images that eliminate the need for text or language-based instruction. A 6-week pilot study assessing the effectiveness of group intervention utilizing a language free, culturally relevant mobile health (mHealth) application was conducted in a sample of Somali-Bantu and Nepali-Bhutanese adult refugee men and women (N = 18). Paired-samples t-tests were conducted to compare pre- and post-intervention levels of psychosocial distress, anxiety, depression, and traumatic stress, on the Refugee Health Screener (RHS-15) and an investigator generated coping measure. Results indicated significant reduction (p < .001) in symptoms related to traumatic stress, anxiety, depression, and somatic complaints in addition to a significant increase (p < .001) in the use of coping skills. The use of a mobile mental health app, in combination with in-person therapy, was effective in reducing mental health symptomology and in increasing the use of coping skills in Somali-Bantu and Nepali-Bhutanese refugees.

Racial Disparities in Developmental Delay Diagnosis and Services Received in Early Childhood.

Racial disparities in diagnosis and receipt of services for early childhood developmental delay (DD) are well known but studies have had difficulties distinguishing contributing patient, healthcare system, and physician factors from underlying prevalence. We examine rates of physician diagnoses of DD by preschool and kindergarten entry controlling for a child's objective development via scoring on validated developmental assessment along with other child characteristics. We used data from the preschool and kindergarten entry waves of the Early Childhood Longitudinal Study, Birth Cohort. Dependent variables included being diagnosed with DD by a medical provider and receipt of developmental services. Logistic regression models tested whether a child's race was associated with both outcomes during preschool and kindergarten while controlling for the developmental assessments, as well as other contextual factors. Among 7950 children, 6.6% of preschoolers and 7.5% of kindergarteners were diagnosed with DD. Of preschool children with DD, 66.5% were receiving developmental services, while 69.1% of kindergarten children with DD were receiving services. Children who were Black, Asian, spoke a primary language other than English and had no health insurance were less likely to be diagnosed with DD despite accounting for cognitive ability. Black and Latinx children were less likely to receive services. Racial minority children are less likely to be diagnosed by their pediatric provider with DD and less likely to receive services despite accounting for a child's objective developmental assessment. The pediatric primary care system is an important target for interventions to reduce these disparities.

Yunjong Wang Comments on COVID-19 in Korea: Success Based on Past Failure

Yunjong Wang Comments on COVID-19 in Korea: Success Based on Past Failure

Consultation-liaison psychiatry in Japan: a nationwide retrospective observational study

BackgroundConsultation-liaison psychiatry (CLP)—professional psychiatric care provided to coordinate with surgical or medical treatment of inpatients with psychiatric disorders—was included in universal health coverage in Japan in 2012. Despite evidence of benefits of CLP, basic data and geographic distribution information regarding CLP at the national level remain unclear. This study aimed to 1) identify the geographic disparity of CLP in Japan and 2) investigate the association between number of consultations per CLP patient and region.MethodsWe retrospectively analyzed anonymized data retrieved from the Japanese administrative inpatient database regarding inpatients who were provided CLP between April 2012 and March 2017. Demographic characteristics were summarized and geographic disparity by prefecture was visualized for fiscal years 2012 and 2016; we also summarized the data according to region. Multivariate linear regression analysis was used to investigate association between the number of consultations per CLP patient and region after adjusting for covariates.ResultsData from a total of 46,171 patients who received 138,866 CLP services were included. Results revealed more patients aged 75–84 years received CLPs than any other age group (29.7%) and the overall male/female ratio was 53:47 in 2016. In 2012 and 2016, 24.2 and 30.7% of CLP patients, respectively, were transferred to other hospitals; 9.7 and 8.8%, respectively, discharged due to the death. CLP services were provided in 14 prefectures in 2012 and 33 by 2016; 14 prefectures had no available CLP services. After adjusting for covariates, Tohoku (β = − 0.220, p < 0.034), Chugoku (β = − 0.160, p < 0.026), and Shikoku (β = − 0.555, p < 0.001) had a significant negative correlation with the number of consultations per CLP patient compared with Hokkaido region (an adjusted R square (R2) = 0.274).ConclusionsOur study clarified the characteristics of patients in Japan who received CLPs and the geographic disparity in CLP services. Although 5 years had passed since CLP was introduced, the results imply wide availability of CLP nationally. The analysis data provided may inform future policies to improve CLP services.

Bilateral severe microphthalmos with bilateral colobomatus orbitopalpebral cyst: accessibility of speciality eye-care and rehabilitation services in low and middle-income countries

A 12-year-old girl presented with an unusually large mass under the right lower eyelid and a smaller mass under the left lower lid since the last 6 months. The parents...

Racial and Ethnic Disparities in Reproductive Health Services and Outcomes, 2020

(Abstracted from Obstet Gynecol 2021;137(2):225–233) Racial-ethnic disparities in access and outcomes in the context of women's reproductive health continue to be pervasive in the United States. Contraceptive use, sexually transmitted infection care, human papillomavirus vaccination among younger women aged 18 to 25 years, reproductive cancers, preterm deliveries, and low-birth-weight neonates, as well as maternal morbidity and mortality, continue to have documented disparities.

Global Disparities in Skin Cancer Services at HIV Treatment Centers across 29 Countries

Global Disparities in Skin Cancer Services at HIV Treatment Centers across 29 Countries

Health Systems and Services During COVID-19: Lessons and Evidence From Previous Crises: A Rapid Scoping Review to Inform the United Nations Research Roadmap for the COVID-19 Recovery.

This rapid scoping review has informed the development of the November 2020 United Nations Research Roadmap for the COVID-19 Recovery, by providing a synthesis of available evidence on the impact of pandemics and epidemics on (1) essential services and (2) health systems preparedness and strengthening. Emerging findings point to existing disparities in health systems and services being further exacerbated, with marginalized populations and low- and middle-income countries burdened disproportionately. More broadly, there is a need to further understand short- and long-term impacts of bypassed essential services, quality assurance of services, the role of primary health care in the frontline, and the need for additional mechanisms for effective vaccine messaging and uptake during epidemics. The review also highlights how trust-of institutions, of science, and between communities and health systems-remains central to a successful pandemic response. Finally, previous crises had repeatedly foreshadowed the inability of health systems to handle upcoming pandemics, yet the reactive nature of policies and practices compounded by lack of resources, infrastructure, and political will have resulted in the current failed response to COVID-19. There is therefore an urgent need for investments in implementation science and for strategies to bridge this persistent research-practice gap.

Identifying the regional disparities of ecosystem services from a supply-demand perspective

Ecosystem services (ES) play a vital role in sustaining human society's operations. Integrated ES assessment is the foundation for effective ES management. Most previous studies focused on the supply side of ES with fewer concerns on ES demand. Taking the Yangtze River Delta (YRD) as an example, this study analyzed the dynamics of ES from both supply and demand perspectives. The ES supplies of three critical ESs (water yield, carbon fixation, and food provision) have increased from 2000 to 2018, while soil conservation decreased. Water yield, carbon fixation, and soil conservation had positive and negative correlations with precipitation and artificial land area, and there were synergies among the three ESs. In contrast, food provision had no significant correlations with the above two factors and ESs. In 2018, most cities were short of carbon fixation service, and about one-third of municipalities needed more water yield and food provision. There was a distinct spatial mismatch between ES supply and demand. The east region of YRD was the hot spot for each ES's demand. Four suggestions were proposed to improve regional ES management, including enhancing integrated ES assessment, improving climate change resilience, strengthen land-use management, and establishing mechanisms to balance ES supply and demand. Our research indicates the necessity of incorporating ES demand into ES assessment.

Disparities in Service and Clinical Outcomes in State-Wide Advanced Practice Physiotherapist-Led Services.

This study explored variations in the primary service and clinical outcomes of a state-wide advanced practice physiotherapist-led service embedded in public medical specialist orthopaedic and neurosurgical outpatient services across Queensland, Australia. An audit of the service database over a six-year period was taken from 18 service facilities. The primary service and clinical outcomes were described. Variations in these outcomes between facilities were explored with a regression analysis adjusting for known patient- and service-related characteristics. The findings showed substantial positive impacts of the advanced practice model across all facilities, with 69.4% of patients discharged without a need for medical specialist review (primary service outcome), consistent with 68.9% of patients reporting clinically important improvements in their condition (primary clinical outcome). However, 15 facilities significantly varied from the state average for the primary service outcome (despite only three facilities varying in the primary clinical outcome). While this disparity in the primary service outcomes appears to be influenced by potentially modifiable differences in the service-related processes between facilities, these process differences only explained part of the variation. This study described the subsequent development of a new, more comprehensive set of service evaluation metrics to better inform future service planning.

The Affordable Care Act: policy predictors of integrated care between Hispanic-serving and mainstream mental health organizations

BackgroundThe Patient Protection and Affordable Care Act increased funding for integrated care to improve access to quality health care among underserved populations. There is evidence that integrated care decreases inequities in access and quality of mental health care among Hispanic clients. Increasing integrated care at Hispanic-Serving Organizations may help to eliminate mental health service disparities among Hispanic clients.MethodUsing organizational responses from the 2014 and 2016 waves of the National Mental Health Service survey, this study conducted multivariate logistic analyses to assess whether the ACA policies related to integrated care increased the provision of integrated addictions treatment and primary care at mental health Hispanic-Serving Organizations, relative to Mainstream Organizations.ResultsFindings showed that Hispanic-Serving Organizations (54.4%) were less likely to provide integrated health services than Mainstream Organizations (59.1%) after the ACA. However, federal funding to help organizations transition into integrated care services (AOR = 1.74, p = 0.01) and accepting Medicaid payments (AOR = 1.59, p = 0.01) increased the provision of integrated care services at Hispanic-Serving Organizations over time.ConclusionsHealth care policies that increase funding to adopt integrated health services at community Hispanic-Serving Organizations may help decrease inequities in mental health access for Hispanics in the United States.

Discrimination against the elderly in health-care services: a systematic review.

Ageism in health-care services is a cardinal public health concern in geriatric health. It is important to know the types and extent of discrimination experienced by elderly individuals while seeking health care. This systematic review aimed to explore the available research to identify discrimination of elderly individuals in health-care services. MEDLINE through PubMed, Web of Science, PsycInfo, and Cochrane Database were searched by using a comprehensive search strategy in September 2020 with no limitation in the year of publication and types of publication. Articles published in English focusing on disparities in health-care service among the elderly were included. Two independent authors screened, extracted, and assessed the quality of data using the Joanna Briggs Institute Critical Appraisal Tool. A narrative synthesis was conducted followed by qualitative content analysis to identify themes from the extracted outcomes of the included studies. Of 3117 articles retrieved from the initial search, 21 articles were included. A total of 611 608 participants from 38 countries in four geographic regions were reported. Articles were published between 2003 and 2020. Most of the studies (n = 19) were cross-sectional in design, and the remaining two studies were qualitative. Major themes of discrimination were age-related discrimination, racial discrimination, gender discrimination, wealth-related discrimination, and technology-related discrimination. This systematic review identified the major perspectives on disparities faced by the elderly in accessing health services. There is a huge research gap on this issue. Specific strategies should be incorporated to address the varying types of discrimination experienced by elderly individuals.