Facilitate Access To Health Care Research Articles

The central role of housing key workers in supporting healthcare interactions for people experiencing homelessness and implications for palliative care: a qualitative study

BackgroundPeople experiencing homelessness access specialist palliative care late in their illness trajectory, if at all. There is also little evidence they receive generalist palliative care or are given opportunities to engage in Advance Care Planning. This qualitative study describes the central role of key workers in supporting access to healthcare in homeless communities and identifies implications for improving palliative care provision.MethodsQualitative data were collected via focus groups and individual interviews with staff working for a key provider of support and housing/accommodation for people experiencing homelessness in an urban area of Aotearoa New Zealand.ResultsThe ability to provide palliative care for people experiencing homelessness is dependent upon supporting engagement with mainstream health services. It is here that we identified the key worker role as central due to the complex and expert work they undertake to facilitate healthcare access for their clients. As a result of the high burden of chronic conditions this community experiences, most of this work related to support managing serious conditions, as well as death and dying. Key workers often went ‘above and beyond’ to support their clients in engaging with mainstream health services, during outpatient appointments, hospital admissions and in emergency department settings. They felt clinicians in these settings did not recognise the knowledge they held about the person, or their skills in terms of providing trauma informed care. The inflexibility of current care provision, as well as people experiencing homelessness feeling stigmatised, and neither valued nor respected in these settings, also created barriers to receiving care.ConclusionsNew models of palliative care are required which recognise the central role of non-health care key support staff and engage them more actively in supporting people experiencing homelessness when they interact with mainstream health services. Such models will need to be responsive to the nature and complexity of palliative care need in this population and facilitate support for people who typically do not see healthcare spaces as safe. The trusted relationships key workers have developed over time are crucial resources for identifying palliative care need and supporting access to palliative care for people experiencing homelessness.

COVID-19 and social care screening for older adults in social housing: a CP@clinic adaptation

BackgroundCOVID-19 has changed healthcare access and delivery, especially impacting older adults. The Community Paramedicine at Clinic (CP@clinic) program is a chronic disease prevention, management, and health promotion program for community-dwelling low-income older adults. We investigated a telephone-based CP@clinic program adaptation during the pandemic.MethodsCommunity paramedics delivered CP@clinic via telephone to residents of 36 social housing buildings. They conducted screening for COVID-19, emergency preparedness, and social health factors. Community paramedics provided education on staying safe, self-isolating, self-monitoring, and preparing for pandemics using governmental infographics. Descriptive analysis was conducted on assessments completed between March and June 2020. Paramedic documentation was thematically analyzed to identify common themes.ResultsAll 191 participants had ≥ 1 telephone visit and 34.6% had ≥ 2 telephone visits, 82.8% were aged 65 years and older, 30.9% had internet access, and 57.9% had cable TV (limiting exposure to COVID-19 information). The CP@clinic program infrastructure provided a platform for paramedics to swiftly contact many vulnerable older adults to screen for COVID-19, educate on safe practices, and facilitate healthcare access. One-quarter of participants screened positive for social isolation. Thematic analysis described participants’ experiences adapting to daily life in the pandemic, emotional experience during the pandemic, and paramedics supporting participants during the pandemic.ConclusionsPublic health interventions are needed for low-income or hard-to-reach older adults, especially during pandemics. Community paramedics were able to support vulnerable older adults living in social housing through the unique CP@clinic adaptation. This innovative program delivery increased vulnerable populations’ access to public health services and information at a time of great health need.

Access to Healthcare Among Young Adult Probationers Participating in a Pilot Health-Focused Reentry Program.

Justice-involved adults experience disparities in healthcare access. This pilot study examines healthcare access among young adult probationers (n = 66) receiving 6-months of Service Navigation and Health Coaching support implemented between 2017 and 2021. Data are from baseline, 6-month follow-up and satisfaction surveys. Between baseline and follow-up, the proportion of insured young adult participants (66%-88%; p < .001) and those using healthcare services (36%-71%; p < .001) increased significantly; report of unmet physical healthcare needs decreased significantly (44%-26%; p = .003). Satisfaction data revealed increased self-efficacy, motivation, focus, and improved organizational, goal setting, and communication skills. The program improved healthcare access by increasing health insurance and recent use of healthcare services. Longitudinal studies are needed to assess maintenance of these outcomes and potential impacts on disparities in health status and access to care indicators. Integrating navigation and coaching supports to advance the well-being of justice-involved young adults is a promising mechanism to facilitate healthcare access.

COMMUNITY–CLINICAL LINKAGE MODELS FOR COMMUNITY-DWELLING OLDER ADULTS: A RAPID SCOPING REVIEW

Abstract About 10% of older adults (OA) have unmet healthcare needs. Community-clinic linkage models (CCLM) aim to facilitate healthcare access by linking the community and health sectors. However, research on community-based linkages for community-dwelling OA into the healthcare sector is nascent. CCLM implemented for the general adult population are not necessarily age-friendly. This scoping review aims to characterize programs that are designed to facilitate community-dwelling OA’s access to healthcare through community sector-based linkages. In order to comprehensively survey CCLM designed for community-dwelling OA, the AgeLine (EBSCO) database was searched to review the academic and grey literature regarding programs that link community-dwelling OA from community to clinical sectors. AgeLine focuses on OA, indexing academic and grey literature from disciplines including health sciences, social work, and public policy. 470 publications were included for title/abstract screening; 24 were assessed for full-text eligibility by two independent reviewers. Data were extracted from two publications; exclusions were due to ineligible intervention (n=9) or setting (n=2); insufficient detail (n=6); full text unavailable (n=5). The sole empirical publication (2021) found that pilot implementation of a pilot linkage program between OA and clinicians was significantly associated with improved medication self-management. A final report (1993) on implementation of a supportive service pilot program in New Hampshire public housing found that OA residents and managers benefitted from the program. Results suggest the benefits of age-friendly CCLM for OA but highlight an existing gap in the literature. The results of this review underscore the need for age-friendly CCLM research, practice and innovation.

Overcoming Communication Barriers to Facilitate Healthcare Access for People with Intellectual Disability

Communication barriers are one of the many reasons why People with Intellectual Disability (PWID) are prevented from accessing appropriate healthcare services. As a result, the health of this population is poorer than the general population in many countries around the world. Understanding the nature of the limitations faced by PWID in language learning and communication forms the basis of creatively developing strategies to overcome them. Building bridges of understanding between the clinician and the PWID increases the chances of accurate diagnoses of health conditions, effective treatment, and an overall improved quality of life for the patient.

Barriers and Facilitators to Accessing Rehabilitation Health Care: A Veterans Affairs Traumatic Brain Injury Model Systems Qualitative Study

ObjectiveTo compare barriers and facilitators to accessing health care services among service members and veterans (SMVs) by traumatic brain injury (TBI) severity groups. DesignQualitative descriptive study guided by an access to health care services conceptual framework. SettingFive Veterans Affairs (VA) polytrauma rehabilitation centers. ParticipantsSMVs (N=55, including 10 caregivers as proxies) ≥2 years post-TBI recruited from the VA TBI Model Systems and grouped by TBI severity (mild/moderate, severe). Main Outcome MeasuresBarriers and facilitators accessing care. ResultsThe main facilitators included ease of communicating with providers to help SMVs identify and utilize appropriate health care, family advocates who promoted engagement in health care, ability to use government and community facilities, and online resources or equipment. Distance to services was uniformly identified as a main barrier for both patient groups. However, facilitators and barriers to health care access differed by TBI severity. SMVs with severe TBI highlighted the role of nonprofit organizations in promoting health care engagement and the availability of VA specialty residential programs in meeting health care needs. Having unrecognized health care needs in chronic stages and communication difficulties with providers were more commonplace for those with greater TBI severity and affected quality of care. Those with mild/moderate TBI highlighted challenges associated with paying for services in the community and scheduling of services. ConclusionsBarriers and facilitators exist across multiple dimensions of a health care access framework and vary by TBI severity. Results suggest possible mechanistic links between health care access and SMV health outcomes. Findings support current policy and practice efforts to facilitate health care access for SMVs with TBI but highlight the need for tailored approaches for those with greater disability.

Remote Management of Osteoporosis.

Purpose of ReviewOsteoporosis management has evolved significantly over the past decade, with telehealth emerging as an effective tool to manage bone health in a growing patient population. This review explores the advantages and disadvantages of telehealth use for osteoporosis management while highlighting recent studies of clinical importance.Recent FindingsA wide variety of telehealth approaches are used today, from phone or video telemedicine appointments with physicians and advanced practice providers, to electronic systems for triage and consultation with osteoporosis specialists. Contemporary studies show that telehealth can facilitate health care access to underserved communities and enhance physician–patient communication, as well as provide patient education. However, barriers such as inexperience or lack of access to technology, suboptimal patient-clinician relationship building process, and difficulties with follow-up have limited the use of telehealth to certain situations.SummaryTelehealth has proven to be an effective resource for managing and treating osteoporosis patients. As its use continues to grow, important limitations must be accounted for to avoid lapses in care. Further research should keep these factors in mind as the use of this technology progresses.

A qualitative assessment of barriers to healthcare and HIV prevention services among men who have sex with men in non-metropolitan areas of the south

ABSTRACT HIV cases are increasing in the rural Southern United States, especially among men who have sex with men (MSM). To facilitate healthcare access and encourage HIV prevention for non-metropolitan MSM, it is essential to examine their barriers to care. This qualitative study conducted semi-structured interviews with 20 MSM living in non-metropolitan areas of the South. Analysis revealed that MSM experience multiple barriers accessing healthcare in non-metropolitan areas such as finding knowledgeable and affirming providers with desired characteristics and beliefs and communicating with providers about sexual health and HIV prevention. To aid in identification, many respondents expressed a desire for providers to publicly signal that they provide care for sexual and gender minority patients and are an inclusive clinical space. Overall, results suggest that MSM face unique healthcare-related challenges, beyond those typically experienced by the broader population in non-metropolitan areas, because of tailored identity-based needs. To better support MSM in non-metropolitan areas, especially in the South where increased experiences of stigma are found, providers should seek further training regarding sexual health communication and HIV prevention, indicate on websites and in offices that they support sexual and gender minority patients, and provide telehealth services to MSM living in more geographically isolated areas.

AUTHOR REPLY

We examined the intersection of race and insurance status to better understand the issues driving delays in care for certain patient populations. The interplay of multiple contextual factors, both inside and outside the hospital system, make it challenging for many of our patients to schedule elective urologic surgeries. Future efforts to facilitate healthcare access and ease logistical barriers such as transport and childcare will require strong cooperation between healthcare and municipal administrations.

Exploring the Role of Social Networks in Facilitating Health Service Access Among Low-Income Women in the Philippines: A Qualitative Study.

Despite efforts to implement universal health care coverage (UHC) in the Philippines, income poor households continue to face barriers to health care access and use. In light of recent UHC legislation, the aim of this study was to explore how gender and social networks shape health care access and use among women experiencing poverty in Negros Occidental, Philippines. Semi-structured interviews were conducted with women (n = 35) and health care providers (n = 15). Descriptive statistical analyses were performed to report demographic information. Interview data were analyzed thematically using a hybrid deductive-inductive approach and guided by the Patient-Centred Access to Health Care framework. Women’s decisions regarding health care access were influenced by their perceptions of illness severity, their trust in health care facilities, and their available financial resources. Experiences of health care use were shaped by interactions with health professionals, resource availability at facilities, health care costs, and health insurance acquisition. Women drew upon social networks throughout their lifespan for social and financial support to facilitate healthcare access and use. These findings indicate that social networks may be an important complement to formal supports (eg, UHC) in improving access to health care for women experiencing poverty in the Philippines.

A preliminary study on the psychosocial impact of COVID-19 lockdown in post-bariatric surgery women: the importance of eating behavior, health care access, and social support.

This study aims to characterize the psychosocial impact of COVID-19 lockdown for post-bariatric surgery (≥ 36 months) women and its association with disordered eating and psychological distress. The medium to long-time follow up is a period of increased susceptibility for poorer weight outcomes which might be triggered by the lockdown. Twenty-four participants responded to an online questionnaire and a telephone interview. About half (n = 14; 58.3%) reported perceived weight gain during the lockdown, 13 (54.1%) limited access to social support, and 12 (50%) limited access to medical care. Co-habiting with a higher number of persons during lockdown was associated with fewer difficulties in dealing with emotionally activating situations, less fear of gaining weight, less fear of losing control over eating, and less disordered eating. The global perceived psychosocial impact of lockdown was significantly correlated with difficulties in dealing with emotionally activating situations and stress symptoms. Results highlight the need to monitor post-bariatric patients, facilitate health care access, and promote social support during the lockdown period.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12144-021-01529-6.

320 Obstetric clinician needs assessment for a postpartum patient navigation program for low-income patients

Patient navigation, or the use of trained non-clinician personnel to reduce barriers and facilitate health care access, has been demonstrated to improve health and reduce disparities in non-obstetric populations, but is not yet widely used in obstetric and postpartum care. Our objective was to understand obstetric clinician perspectives on how to implement navigation to optimize care for low-income patients. In this qualitative study, focus groups were conducted with obstetrician faculty, fellows, residents, nurses, and social workers who care for low-income pregnant and postpartum patients in a tertiary healthcare center. Semi-structured interview guides were used to conduct focus groups on clinicians’ views about navigation and navigators, their recommendations for navigator training, and their perspectives on how navigators can be most effective. Analysis of themes from transcribed sessions was based on the constant comparative method. Twenty-six obstetric providers participated in 6 focus groups in which they discussed key elements for a successful obstetric or postpartum navigation program. Major navigation implementation themes included ideal navigator attributes, the training that would be most beneficial, and the services they could render (Table). Specifically, key navigator attribute themes included consistency, relatability, supportive manner, and advocacy. Training recommendations included learning the healthcare system, identifying where to obtain resources, and learning basic health education. Suggested services were broad, ranging from traditional care coordination to specific educational and resource-driven tasks. Clinicians also offered a framework for a flexible patient risk assessment to promote tailored navigation services (Figure). Obstetric clinicians perceive patient navigation to be a potentially beneficial resource to support low-income patients and offered recommendations on navigator training and services. Understanding clinician needs and preferences is essential to integration of patient navigator programs into obstetrical practice.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Risk factors associated with epilepsy in children and adolescents: A case-control study from Syria

IntroductionEpilepsy is a major public health concern in low-income countries (LIC) as they contain 80% of total cases worldwide. Syria has been in war since 2011 which made it difficult to prevent epilepsy risk factors which made this the first study on that matter. MethodsThis is a case-control study from 3 medical centers in Damascus, Syria. Data were collected using questionnaires introduced by trained doctors. The control group included patients from a general practice clinic while the cases were taken from the three pediatric neurology clinics. ResultsThe sample consisted of 334 patients with 167 cases and 167 controls. Multivariable analysis confirmed the association between positive family history (FH) in 1st degree (OR, 3.37, 95%CI 1.2–9.47) and 2nd degree relatives (OR, 3.98, 95%CI 1.84–8.62), febrile seizures whether they were simple (OR, 15.08, 95%CI 3.27–69.5) or complex (OR, 13.32, 95%CI 1.58–112.32), developmental delay/regression (OR, 14.31, 95%CI 6.3–32.49), and central nervous system (CNS) infection (OR, 34.05, 95%CI 2.02–573.92). Head trauma, parental factors, consanguinity, asphyxia parameters, and other risk factors were not found to be significantly associated with epilepsy (P > 0.05). ConclusionWhile some results were similar to other studies, others were not. Efforts should be made to facilitate healthcare access and proper diagnosis.

Refugee Escape Room©: a new gamification tool to deepen learning about Migration and Health

Abstract Background The aim of gamification is to provide an experiential exercise that invokes emotions to deepen learning. MyHealth project is interested in developing tools that facilitate healthcare access to newly arrived immigrants in Europe. One important barrier is the low levels of intercultural competency among healthcare professionals and the pervasiveness of negative health-related stereotypes. Methods We aim to demonstrate the educational value and social impact of the Refugee Escape Room©, to 1) raise awareness about the social and health challenges faced by vulnerable migrants and 2) provide an effective intercultural competence and self-efficacy training for hosting community. The game was created in 2017 by healthcare professionals and university students with personal migratory experience. It is divided in two parts. The first part addresses knowledge gaps about relevant aspects of Migration and Health. The second part is a fictional border control exercise with multiple bureaucratic challenges that participants, organized as “families”, must overcome to succeed. A pre-post pilot was executed to test for tool effectiveness. The piloting phase involved carrying out multiple instances of the activity for separate target groups. A questionnaire was developed with items related to knowledge, self-efficacy and intercultural competence. The questionnaire was filled by participants at baseline and post intervention to assess for statistically significant changes in all outcomes. Results while the piloting phase is still ongoing preliminary results show a high level of acceptability and engagement with the tool. Conclusions Refugee Escape Room© is a newly created tool that posits as a promising awareness-raising, competency-building gamification tool that is easily adaptable to multiple settings and participants. Key messages Gamification provides an experiential exercise that invokes emotions to deepen learning. Refugee Escape Room© is a promising tool for raising awareness about challenges faced by vulnerable migrants.

The Asylum Seeker Integrated Healthcare Pathway: a collaborative approach to improving access to primary health care in South Eastern Melbourne, Victoria, Australia.

It is important to address the health needs of asylum seekers within the early stages of their arrival in Australia, as this impacts all aspects of their resettlement. However, asylum seekers face a range of barriers to accessing timely and appropriate health care in the community. In 2012, the increasing number of asylum seekers in Australia placed additional demand on health and social services in high-settlement regions. Health providers experienced a substantial increase in Medicare ineligible clients and avoidable presentations to Emergency Departments, and the health needs of new asylum seeker arrivals were not being fully addressed. In response, South Eastern Melbourne Medicare Local, Monash Health, the Australian Red Cross and local settlement support agencies collaborated to develop an integrated healthcare pathway in South Eastern Melbourne to facilitate healthcare access for asylum seekers released from detention. From September 2012 to December 2014, a total of 951 asylum seekers transitioned through the pathway. Seventy-eight percent required primary healthcare assistance, and were provided with a service appointment within 3 weeks of their arrival in Melbourne. This initiative has demonstrated the value of partnership and collaboration when responding to emergent asylum seeker health needs.

Immigrants, Place, and Health: Destination Area Health Contexts and Routine Physician and Dental Care for Children of Mexican Immigrants

Notable healthcare disparities are shown among the children of Mexican immigrants across different Hispanic immigrant destinations. A hostile local immigrant-receptivity climate and alternative institutional community context indicators are integrated with individual-level data on physician and dental care from the 1996 and 2001 Survey of Income and Program Participation to explain this variation. Mexican immigrants’ children in new Hispanic immigrant destinations are 20 percent less likely to see a doctor, and a negative receptivity climate explains about half of this effect. Community health clinic availability and greater state leniency toward immigrant child public health insurance eligibility facilitate healthcare access.

Assessing the feasibility of community health insurance in Uganda: A mixed-methods exploratory analysis

Community health insurance (CHI) aims to provide financial protection and facilitate health care access among poor rural populations. Given common operational challenges that hamper the full development of the scheme, there is need to undertake systematic feasibility studies. These are scarce in the literature and usually they do not provide a comprehensive analysis of the local context.The present research intends to adopt a mixed–methods approach to assess ex-ante the feasibility of CHI. In particular, eight preconditions are proposed to inform the viability of introducing the micro insurance. A case study located in rural northern Uganda is presented to test the effectiveness of the mixed–methods procedure for the feasibility purpose. A household survey covering 180 households, 8 structured focus group discussions, and 40 key informant interviews were performed between October and December 2016 in order to provide a complete and integrated analysis of the feasibility preconditions. Through the data collected at the household level, the population health seeking behaviours and the potential insurance design were examined; econometric analyses were carried out to investigate the perception of health as a priority need and the willingness to pay for the scheme. The latter component, in particular, was analysed through a contingent valuation method.The results validated the relevant feasibility preconditions. Econometric estimates demonstrated that awareness of catastrophic health expenditures and the distance to the hospital play a critical influence on household priorities and willingness to pay. Willingness is also significantly affected by socio–economic status and basic knowledge of insurance principles. Overall, the mixed-methods investigation showed that a comprehensive feasibility analysis can shape a viable CHI model to be implemented in the local context.

Improving Health Care for Spanish-Speaking Rural Dairy Farm Workers.

Dartmouth Geisel Migrant Health (DGMH) is a medical student group that provides on-site health services for Spanish-speaking dairy workers in rural Vermont and New Hampshire in conjunction with a federally qualified health center (FQHC). This project was undertaken to evaluate and improve the services provided by DGMH and the FQHC and to refine understanding of the target population. We surveyed 25 workers at 6 collaborating dairy farms to identify health priorities and concerns and perceived barriers and facilitators to health care for these workers. Surveys were administered over 2 weeks in July 2015. Interpreter-mediated appointment and sliding-fee-scale data from a period 7 months that spanned survey administration were also assessed. Diabetes and hypertension were the most common health concerns. Thirty-two percent of participants reported 10 or more days of depressed mood in the past month. Insurance and language were the most common barriers to health care and employers and on-site clinics were the most common facilitators. Appointments most often addressed women's health, gastrointestinal problems, health maintenance, diabetes, and back pain. Thirty FQHC sliding-fee-scale applications were completed by workers. These Spanish-speaking dairy-farm workers have many health concerns and perceive substantial barriers to health care. Collaboration between medical students, a rural FQHC, and farm employers provides important services that facilitate health care access among this population.

Exploring Community Health Center and Faith-based Partnerships: Community Residents' Perspectives

Community health centers (CHCs) play a critical role in the primary care safety net. Partnerships between CHCs and faith-based organizations are promoted as a way to increase outreach to underserved populations and support health-promoting behaviors and effective disease management. Through six focus groups (totaling 58 participants), we explored low-income residents' perspectives (African American, Latino, and White) of their communities, the meaning of health, the role of spirituality, and their experiences with and preferences for congregation-based health programming to inform future outreach efforts of a CHC. We found that community perspectives varied based on race/ethnicity and neighborhood, but health concerns tended to cluster by race/ethnicity alone. We also found that spirituality was deemed important for health by all racial-ethnic groups, but attendance at religious services, religious affiliation, and preferences for congregation-based health programming varied across and within groups. Community health center-faith based partnerships could facilitate health care access in underserved communities but may have limited reach among certain subgroups and individuals.

Engaging Patients via Mobile Phone Technology to Assist Follow-Up After Hospitalization in Quito, Ecuador

Disease management following hospital discharge is difficult in most low-resourced areas, posing a major obstacle to health equity. Although mobile phones are a ubiquitous and promising technology to facilitate healthcare access, few studies have tested the acceptability and feasibility of patients themselves using the devices for assisting linkages to healthcare services. We hypothesized that patients would use mobile phones to help manage postdischarge problems, if given a communication protocol. We developed a mobile phone-based program and investigated its acceptability and feasibility as a method of delivering posthospitalization care. A consecutive cohort of adult patients in a public hospital in Quito, Ecuador was enrolled over a 1-month period. A hospital-based nurse relayed patients' discharge instructions to a community-based nurse. Patients corresponded with this nurse via text messaging and phone calls according to a protocol to initiate and participate in follow-up. Eighty-nine percent of eligible patients participated. Ninety-seven percent of participants completed at least one contact with the nurse; 81% initiated contact themselves. Nurses completed 262 contacts with 32 patients, clarifying discharge instructions, providing preventive education, and facilitating clinic appointments. By this method, 87% of patients were successfully linked to follow-up appointments. High levels of patient participation and successful delivery of follow-up services indicate the mobile phone program's acceptability and feasibility for facilitating posthospitalization follow-up. Patients actively used mobile phones to interact with nurses, enabling the provision of posthospitalization medical advice and facilitate community-based care via mobile phone.