Access To Health Care For People Research Articles

Colocating Syringe Services, COVID-19 Vaccination, And Infectious Disease Testing: Baltimore's Experience.

People who inject drugs face many challenges that contribute to poor health outcomes, including drug overdose, HIV, and hepatitis C infections. These conditions require high-quality prevention and treatment services. Syringe services programs are evidence-based harm reduction programs, and they have established track records with people who inject drugs, earning them deep trust within this population. In Baltimore, Maryland, although many syringe support services were limited during the COVID-19 pandemic, the health department's syringe services programs remained operational, allowing for the continuation of harm reduction services, including naloxone distribution. This evaluation describes a collaborative effort to colocate infectious disease testing and COVID-19 vaccination with a syringe services program. Our evaluation demonstrated that colocation of important services with trusted community partners can facilitate engagement and is essential for service uptake. Maintaining adequate and consistent funding for these services is central to program success. Colocation of other services within syringe services programs, such as medications for opioid use disorder, wound care, and infectious disease treatment, would further expand health care access for people who inject drugs.

Experiences with health care services and HIV testing after sexual assault in cisgender gay, bisexual and other men who have sex with men and transgender people.

This qualitative sub-study aimed to explore how cisgender gay, bisexual, and other men who have sex with men (cis-GBMSM) and transgender people who reported non-consensual sex (NCS) accessed health care services, what barriers they faced, and how this experience influenced subsequent HIV testing. SELPHI is an online randomized controlled trial evaluating both acceptability and efficiency of HIV-self testing among cis-GBMSM and transgender people. Semi-structured interviews were conducted, audio-recorded, transcribed, and analysed through a framework analysis, as a qualitative sub-study. We identified narratives of NCS from interviews and investigated experiences of cis-GBMSM and transgender people accessing health care services following sexual assault. Of 95 participants, 15 (16%) spontaneously reported NCS. Participants reported a broad range of NCS, including partner's coercive behaviours, non-consensual removal of condoms, and rapes. All feared HIV transmission, leading them to test for HIV, underlining a marked lack of awareness of post-exposure prophylaxis (PEP). Most had negative experiences in communicating with reception staff in sexual health clinics following these incidents. A lack of confidentiality and empathy was described in these situations of psychological distress. Clinic visits were primarily focused on testing for HIV and sexually transmitted infection, and generally no specific psychological support was offered. Getting a negative HIV result was a key step in regaining control for people who experienced NCS. Sexual health care providers should take care to more fully address the issue of NCS with cis-GBMSM and transgender people when it arises. Recognizing and managing the emotional impact of NCS on affected patients would prevent negative experiences and increase confidence in care.

Barriers and facilitators to health care access for people experiencing homelessness in four European countries: an exploratory qualitative study

BackgroundPeople experiencing homelessness (PEH) are known to be at higher risk of adverse health outcomes and premature mortality when compared to the housed population and often face significant barriers when attempting to access health services. This study aimed to better understand the specific health care needs of PEH and the barriers and facilitators associated with their timely and equitable access to health services in the European context.MethodsWe conducted an exploratory cross-national qualitative study involving people with lived experience of homelessness and health and social care professionals in Austria, Greece, Spain, and the UK. A total of 69 semi-structured interviews comprising 15 social care professionals, 19 health care professionals, and 35 PEH were completed, transcribed, and analysed thematically.ResultsFindings were organised into three overarching themes relating to the research question: (a) Health care needs of PEH, (b) Barriers to health care access, and (c) Facilitators to health care access. Overall, the general health of PEH was depicted as extremely poor, and mainstream health services were portrayed as ill-equipped to respond to the needs of this population. Adopting tailored approaches to care, especially involving trusted professionals in the delivery of care, was identified as a key strategy for overcoming existing barriers.ConclusionsThe results of this study indicate there to be a high degree of consistency in the health care needs of PEH and the barriers and facilitators associated with their access to health care across the various European settings. Homelessness in itself is recognized to represent an essential social determinant of health, with PEH at risk of unequal access to health services. Changes are thus required to facilitate PEH’s access to mainstream primary care. This can also be further complemented by investment in ‘in-reach’ services and other tailored and person-centred forms of health care.Trial registrationThis study was registered retrospectively on June 6, 2022, in the registry of ClinicalTrials.gov under the number NCT05406687.

Landscape of Pregnancy Care in US Community Health Centers.

Community health centers (CHCs) provide critical health care access for people who experience high risks during and after pregnancy, however it is unclear to what extent they provide prenatal care. This study seeks to describe clinic and patient characteristics associated with longitudinal prenatal care delivery in CHC settings. This retrospective cohort study utilized electronic health record (EHR) data from the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) between 2018 to 2019 to describe prenatal care provision among CHCs (n = 408), and pregnant CHC patients (n = 28,578) and compared characteristics of patients who received longitudinal prenatal care at CHCs versus those who did not. 41% of CHCs provided longitudinal prenatal care; these CHCs were more likely to be larger, have multidisciplinary teams, and serve higher proportions of nonwhite or non-English speaking patients. Patients who received longitudinal prenatal care at CHCs were racially and ethnically diverse and many had comorbidities. Patients who received longitudinal prenatal care at CHCs (compared with pregnant patients who did not) were more likely to be white or Latinx and more likely to have non-English language preference. Many CHCs in this national network provide prenatal care and serve pregnant patients at high risk of pregnancy-related complications, including people of color, those with low income, and those with comorbidities. CHCs provide critical access to care for vulnerable populations and will be an important partner in work addressing inequities in maternal morbidity and mortality.

“You have to believe the patient”: What do people with fibromyalgia find helpful (and hindering) when accessing health care?

ABSTRACT Background Fibromyalgia (FM) is a complex, still poorly understood, and difficult-to-treat chronic pain condition for which many people struggle to find adequate care. Aims This study investigated the research question, “What do people accessing health care services for fibromyalgia perceive as helpful, hindering, and absent but desired?” with the aim of identifying clear, implementable changes for clinical practice. Materials and methods This study used the enhanced critical incident technique (ECIT), a qualitative research method that focuses on helping, hindering, and desired factors, to explore the health care experiences of 14 individuals (12 women and 2 men) diagnosed with FM. Results Using qualitative data analysis, results identified three categories of health care experiences: (1) systemic navigation, including financial and economic security; accessibility, flexibility, and continuity of care; and diversity of treatment options; (2) clinician–patient alliance, including invalidation and prejudice; therapeutic bond; and clinician–patient alignment on treatment plan; and (3) patient self-management strategies, including information-seeking and education, self-advocacy, social supports, symptom management strategies, and other coping strategies. Participants tended to conceptualize their health care concerns as a multilayered systemic problem. Conclusions Participants described a medical system they perceived as poorly equipped to support their needs and tended to invalidate their health concerns. Helping experiences tended to be the result of unique efforts on the part of individual clinicians. Findings emphasize the importance of recognizing the complexities and psychological impact of pain, trusting clinician–patient relationships, multidisciplinary/interdisciplinary care within a biopsychosocial framework, and improved education and awareness around psychosocial aspects of FM and effective management of chronic pain.

Agent-based Simulation of the Pharmaceutical Parallel Trade Market: A Case Study

The pharmaceutical parallel trade market emerged as a consequence of the European single market for pharmaceuticals, involving multiple players that partake in different types of competitions. These competitions not only affect players’ profit, but also have a significant impact on European people's healthcare access and welfare. Hence, modeling the pharmaceutical parallel trade market provides a way to study the market and to offer valuable decision support to authorities, people, and players involved in the market. Agent-based modeling offers a computational methodology to study macro-level outcomes emerging from individual behaviors while offering to relax conventional assumptions of standard mathematical economic models. Here, we demonstrate a use case of an agent-based model of the European pharmaceutical parallel trade market and investigate its abilities by analyzing various market scenarios.

“Magnitude of community-based health insurance utilization and associated factors in Bassona Worena District, North Shoa Zone, Ethiopia: a community-based cross-sectional study”

IntroductionThe health insurance system has been proven to offer effective and efficient health care for the community, particularly community-based health insurance is expected to ensure health care access for people with low economic status and vulnerable groups. Despite the significance of evidence-based systems and implementation, there is a limited report about the magnitude of CBHI utilization. Therefore, this study was done to assess factors associated with community-based health insurance utilization in Basona Worena District, North Shewa Zone, Ethiopia.MethodA community-based cross-sectional study was employed. We have included 530 households from 6 randomly selected kebeles. The data was entered using Epi-Data V 3.1 and exported to SPSS version 20.0 for statistical analysis. Bi-variable and multivariable logistic regression analyses were computed to determine factors associated with community-based health insurance utilization.ResultThe study finding shows that 58.6% of the respondents were members of community-based health insurance. Respondents who had primary and secondary education levels were 2 times more likely to be members than those who had no formal education. As compared to those who had awareness, respondents who had no awareness about CBHI were 0.27 times less likely to be insured. Respondents who did not experience illness were 0.27 times less likely to be members than respondents who experienced illness.ConclusionEducational status, awareness about CBHI, perception of CBHI scheme and illness experience of family influence CBHI utilization. There is a need to strengthen awareness creation to improve the CBHI utilization.

'I Am Not The Doctor For You': Physicians' Attitudes About Caring For People With Disabilities.

People with disabilities face barriers when attempting to gain access to health care settings. Using qualitative analysis of three physician focus groups, we identified physical, communication, knowledge, structural, and attitudinal barriers to care for people with disabilities. Physicians reported feeling overwhelmed by the demands of practicing medicine in general and the requirements of the Americans with Disabilities Act of 1990 specifically; in particular, they felt that they were inadequately reimbursed for accommodations. Some physicians reported that because of these concerns, they attempted to discharge people with disabilities from their practices. Increasing health care access for people with disabilities will require increasing the accessibility of space and the availability of proper equipment, improving the education of clinicians about the care of people with disabilities, and removing structural barriers in the health care delivery system. Our findings also suggest that physicians' bias and general reluctance to care for people with disabilities play a role in perpetuating the health care disparities they experience.

Health Narratives as a Therapeutic Tool for Health Care Access for People with Intellectual and Developmental Disabilities

Individuals with intellectual and developmental disabilities (IDD) have unique and complex health care needs that require health care access. Barriers, such as decreased health literacy and a lack of experienced physicians working with this population, make access to inclusive health care increasingly difficult. Therefore, it is important for occupational therapists to intentionally create opportunities to improve healthcare access and utilization for this population. This paper describes the collaborative health narrative development process as well as the inclusion of three examples created by co-authors with intellectual or developmental disability.

Evaluating A Nonemergency Medical Transportation Benefit For Accountable Care Organization Members.

Nonemergency medical transportation benefits, often using smartphone application-based ridesharing services, are increasingly being offered as part of population health management programs. However, the impact of these programs on health care use and costs remains understudied. We conducted a mixed-methods evaluation of a nonemergency medical transportation benefit offered to members of a Medicare accountable care organization (ACO) within a large academic health system, the UNC Health Alliance ACO. Participation in the transportation program was associated with a greater number of per person per year outpatient visits (9.2) and higher outpatient spending ($4,420) than in a comparison group. However, there was no difference in inpatient admissions or emergency department visits, and the program was not cost saving. Qualitative analyses revealed that participants were highly satisfied with the program, reporting that it eased financial burdens and made them feel safer, more empowered, and better able to take control of their health. These findings suggest that although transportation programs are commonly introduced as ways to contain health care spending, it may be better to think of them as programs to improve health care access for people facing difficult circumstances.

Effects of the COVID‐19 pandemic on healthcare and community‐based service use for people living with dementia: Perspectives from dementia care professionals

BackgroundDementia care and healthcare delivery systems have changed substantially as a result of the COVID‐19 pandemic (Wang et al., 2020). Experts have identified a number of barriers to health care access for people living with dementia (PLWD) during the pandemic, including difficulty implementing telemedicine practices, discontinuation of home care services, increased caregiver burden and financial hardship (Brown et al., 2020; Greenberg et al., 2020). Assessment of dementia care providers’ perceptions of the change in use of healthcare and community‐based services by PLWD is needed to identify gaps and to improve care for this vulnerable population during the COVID‐19 pandemic.MethodsWe designed an online survey asking about changes to PLWD and caregiver use of 14 healthcare and community‐based services during the COVID‐19 pandemic and about 15 factors that may have contributed to these changes. The survey was distributed to a network of dementia care professionals across the state of Wisconsin between August 28th and October 9th, 2020.ResultA total of 102 individuals completed the survey. Most respondents worked in the Wisconsin Department of Health Services dementia care specialist system, were employed by Aging and Disability Resource Centers (53.5%), identified as female, White race and worked in rural settings. Services most frequently reported as no longer in use included senior center programs, adult day programs, and companion/friendly visitor services, while meal delivery was reported as having increased use by PLWD. Factors identified most frequently as barriers to service use included changes in access to caregiver support/respite services, access to natural supports, compassion fatigue/caregiver burnout and both knowledge of and access to technology/virtual tools.ConclusionThe results highlight the increased demand for certain services like meal delivery and the need to find alternatives to in‐person enrichment/recreational and caregiver respite opportunities such as senior center and adult day programs that are being used less. Access to and knowledge of technology and increased stress on caregivers and support systems were identified as some of the more frequent barriers to service use, thus allocating resources towards these areas may be particularly impactful towards improving service use for PLWD during the COVID‐19 pandemic.

The impact of COVID-19 on self-management behaviours and healthcare access for people with inflammatory arthritis

BackgroundInflammatory arthritis (IA) patients have been identified as at greater risk of severe illness from COVID-19. It is likely that lockdown restrictions (enforced by the UK government in response to the COVID-19 pandemic) and subsequent changes made to healthcare provision could impact patients’ abilities to effectively manage their condition. The aim of this study was to qualitatively explore the impact of COVID-19 on self-management behaviours and healthcare access for people with IA.MethodsSemi-structured interviews were conducted with 21 IA patients in June-July 2020, with nine follow-up interviews in November 2020. Interview schedules were developed with a Patient Research Partner and explored participants’ experiences of the COVID-19 pandemic. Interviews were conducted via telephone and analysed using inductive thematic analysis.ResultsParticipants were aged between 24 and 79 years (mean = 50.1, SD = 15.8), largely female (71%) and White British (86%). Four initial themes were identified: (1) Impact of COVID-19 on medication adherence, (2) Impact of COVID-19 on physical activity, (3) Impact of COVID-19 on diet, and (4) Impact of COVID-19 on healthcare access and delivery. Subthemes focused on positive and negative changes made to these areas, as well as behaviours which remained consistent. Follow-up interviews highlighted differences in participants’ experiences during the two lockdown periods.ConclusionCOVID-19 has affected patients’ abilities to manage their IA. Healthcare professionals need to recognise the ongoing impact of COVID-19 on patient self-management and healthcare access to ensure that adequate understanding and support is available to patients who may have inadequate disease control as a result.

New draft guideline addresses healthcare access for people experiencing homelessness in the UK

New draft guideline addresses healthcare access for people experiencing homelessness in the UK

COVID-19-associated mortality across the countries of the Gulf Cooperation Council and how it compares to Europe: A comparative study.

Introduction: In late 2019, a novel strain of coronavirus, discovered in the city of Wuhan, China, was found to cause a disease later named coronavirus disease 2019, or COVID-19. In January 2020, COVID-19 first reached the Gulf region. Afterwards, the disease spread rapidly across the countries of the Gulf and the number of COVID-19 cases rose significantly. Now, more than a year later, there are only a limited number of studies regarding COVID-19 and its behavior in this region. In this article, we aim to assess the mortality caused by the disease in the Gulf region by calculating the Case Fatality Rates (CFR) for all of the Gulf Cooperation countries and comparing the results with those of Europe.Methods: Data was obtained from the official statistics of the World Health Organization (WHO) from January to May 2020. From the data, the CFR was calculated for every Gulf and European country included in the study. Following the calculation, the results were compared and analyzed. To make our comparison more accurate, we added the total number of COVID-19 tests per 1000 population and the Health Access and Quality index for each individual country.Results: CFRs in the Gulf region to May 12, 2020 were: United Arab Emirates (1.06%), Kuwait (0.69%), Saudi Arabia (0.62%), Oman (0.45%), Bahrain (0.15%), and Qatar (0.06%). Within Europe over the same time period, 10 countries had CFRs above 10%, with the majority above 3%.Conclusions: Compared to Europe, the COVID-19 mortality rate in the Gulf region has been much lower. The difference in age groups between the Gulf region and Europe may be the most important factor, mainly due to a younger population and a smaller elderly demographic in the Gulf region. Although age is a strong factor for the lower CFR in the Gulf, other factors must also be considered. These include the number of COVID-19 tests conducted per population, different country capabilities, and varying criteria for reporting COVID-19 deaths(Table–1)(Table–2).

Access of chilean deaf women to healthcare information and reproductive care

The COVID-19 pandemic threatened the accessibility and response of healthcare systems worldwide. People with disabilities face specific access challenges to healthcare services and to healthcare information in accessible formats. To explore how deaf women acceded to information and sexual and reproductive health care during the first wave of COVID-19. Sixty-one women with a median age of 32 years diagnosed with deafness and hearing loss were surveyed using an online questionnaire about access to healthcare information and midwifery care during the COVID-19 pandemic. Forty-nine percent of respondents lived in the Metropolitan Region. Sixty-eight percent of respondents mentioned that information about COVID-19 was not accessible for them. The main source of information that they used to learn about the pandemic were videos made by deaf people available on the internet. Seventy-five percent of women reported that they had not received accessible information about sexual and reproductive health, and 70.0% of women requiring midwife care could not book an appointment. The pandemic generated a crisis in the Chilean healthcare system that demands a new strategy to ensure people's healthcare access. People with disabilities such as those herein studied are marginalized when these new policies are being discussed and implemented. Decision-makers and sexual and reproductive health services must improve their strategies to allow women with disabilities, particularly deaf women gain access.

Covid-19 pandemic impact on maternal and child health services access in Nampula, Mozambique: a mixed methods research

BackgroundThe Covid-19 pandemic has so far infected more than 30 million people in the world, having major impact on global health with collateral damage. In Mozambique, a public state of emergency was declared at the end of March 2020. This has limited people’s movements and reduced public services, leading to a decrease in the number of people accessing health care facilities. An implementation research project, The Alert Community for a Prepared Hospital, has been promoting access to maternal and child health care, in Natikiri, Nampula, for the last four years. Nampula has the second highest incidence of Covid-19. The purpose of this study is to assess the impact of Covid-19 pandemic Government restrictions on access to maternal and child healthcare services. We compared health centres in Nampula city with healthcare centres in our research catchment area. We wanted to see if our previous research interventions have led to a more resilient response from the community.MethodsMixed-methods research, descriptive, cross-sectional, retrospective, using a review of patient visit documentation. We compared maternal and child health care unit statistical indicators from March–May 2019 to the same time-period in 2020. We tested for significant changes in access to maternal and child health services, using KrushKall Wallis, One-way Anova and mean and standard deviation tests.We compared interviews with health professionals, traditional birth attendants and patients in the two areas. We gathered data from a comparable city health centre and the main city referral hospital. The Marrere health centre and Marrere General Hospital were the two Alert Community for a Prepared Hospital intervention sites.ResultsComparing 2019 quantitative maternal health services access indicators with those from 2020, showed decreases in most important indicators: family planning visits and elective C-sections dropped 28%; first antenatal visit occurring in the first trimester dropped 26%; hospital deliveries dropped a statistically significant 4% (p = 0.046), while home deliveries rose 74%; children vaccinated down 20%.ConclusionOur results demonstrated the negative collateral effects of Covid-19 pandemic Government restrictions, on access to maternal and child healthcare services, and highlighted the need to improve the health information system in Mozambique.

Mental Illness: Level II Fieldwork Exposure and OT Students’ Attitudes

Abstract Date Presented 04/12/21 Stigma is a barrier to health care access for people with mental illness; OTs work with these individuals in all treatment settings. This study explored how a Level II fieldwork setting affects students' attitudes toward mental illness. Mental health settings were related to positive attitudes; pediatric settings were related to stigmatizing attitudes. Integrating mental health into the broader OT curriculum or classroom and clinic, in any fieldwork setting, may positively affect students' attitudes. Primary Author and Speaker: Christine A. Linkie Contributing Authors: Abigail Herman, Mairead Gormley, Erica Di Meo, Jessica Leonard

Police brutality, medical mistrust and unmet need for medical care.

Police brutality is asocial determinant of healththat can directly impact health status. Social determinants of health can also impact health indirectly by shaping how people access health care. In this study, we describe the relationship between perceived police brutality and an indicator of access to care, unmet need. We also examine medical mistrust as a potential mechanism through which perceived police brutality affects unmet need. Using data from the 2018 Survey of the Health of Urban Residents (N=4,345), direct effects of perceived police brutality on unmet need and indirect effects through medical mistrust were obtained using the Karlson-Holm-Breen method of effect decomposition. Experiencing police brutality was associated with greater odds of unmet need. Controlling for covariates, 18 percent of the total effect of perceived police brutality on unmet need was explained by medical mistrust. Experiences outside of the health care system matter for access to care. Given the association between police brutality and unmet need for medical care, addressing unmet need among marginalized populations requires public health leaders to engage in conversations about reform of police departments. The coronavirus pandemic makes this even more critical as both COVID-19 and police brutality disproportionately impact Black, Indigenous, Latinx and other communities of color.

Integrated care by community health workers in Malawi: Rehabilitation and blood pressure monitoring.

BackgroundCommunity health workers (CHWs) are essential providers of integrated care for people in low-resourced settings with a high burden from noncommunicable diseases (NCDs).AimsThe purpose of this study was to evaluate a CHW training program in rural Malawi integrating blood pressure (BP) monitoring into rehabilitation care.MethodsThis was a retrospective cross-sectional study. The participants were a convenience sample of home-based palliative care CHWs at the local hospital (n = 59). Data collected included: a written pre- and post-knowledge test, skills competency checklist and a post-training program survey. Descriptive frequencies and paired t-tests (a = 0.05) were used for quantitative analyses. Themes in narrative responses in the post-training survey were analyzed qualitatively.ResultsParticipant knowledge regarding BP monitoring procedures improved significantly on the post-test (M = 8.24, SD = 1.654) compared to the pre-test (M = 6.59, SD = 1.683), Z (49) = −5.569, p < 0.001. The pre-and post-tests were scored 0–10 points. All participants demonstrated competency in 100% of the skills. Participants reported the lack of transportation, teamwork and resources as barriers to their work. They reported trainings and opportunities to collaborate as facilitators to their work.DiscussionThis study demonstrated the effectiveness of a training program for CHWs which integrated BP monitoring with rehabilitation care for people with NCDs. This retention of knowledge and application to clinical practice serve as strong indicators of the feasibility and sustainability of the CHW training and care delivery program in resource-limited settings.ConclusionOur findings help demonstrate that training CHWs can be an effective way to help bridge the gap in health care access for people with disabilities in resource-limited countries.

Access to health care for people with disabilities in rural Malawi: what are the barriers?

BackgroundPeople with disabilities experience significant health inequalities. In Malawi, where most individuals live in low-income rural settings, many of these inequalities are exacerbated by restricted access to health care services. This qualitative study explores the barriers to health care access experienced by individuals with a mobility or sensory impairment, or both, living in rural villages in Dowa district, central Malawi. In addition, the impact of a chronic lung condition, alongside a mobility or sensory impairment, on health care accessibility is explored.MethodsUsing data from survey responses obtained through the Research for Equity And Community Health (REACH) Trust’s randomised control trial in Malawi, 12 adult participants, with scores of either 3 or 4 in the Washington Group Short Set (WGSS) questions, were recruited. The WGSS questions concern a person’s ability in core functional domains (including seeing, hearing and moving), and a score of 3 indicates ‘a lot of difficulty’ whilst 4 means ‘cannot do at all’. People with cognitive impairments were not included in this study. All who were selected for the study participated in an individual in-depth interview and full recordings of these were then transcribed and translated.ResultsThrough thematic analysis of the transcripts, three main barriers to timely and adequate health care were identified: 1) Cost of transport, drugs and services, 2) Insufficient health care resources, and 3) Dependence on others. Attitudinal factors were explored and, whilst unfavourable health seeking behaviour was found to act as an access barrier for some participants, community and health care workers’ attitudes towards disability were not reported to influence health care accessibility in this study.ConclusionsThis study finds that health care access for people with disabilities in rural Malawi is hindered by closely interconnected financial, practical and social barriers. There is a clear requirement for policy makers to consider the challenges identified here, and in similar studies, and to address them through improved social security systems and health system infrastructure, including outreach services, in a drive for equitable health care access and provision.