Use Of Preventive Health Services Research Articles

Comparison of hospital treatments of the Roma settlements’ inhabitants in Slovenia

Abstract Background Roma ethnic minority in Slovenia was recognized as a vulnerable group with worse health indicators and significantly shorter life expectancy. The vast majority of Roma population in Slovenia have health insurance. We were investigating the use of hospital services in Roma population according to their age and comparing it with the rest of the population. Methods We determined the inhabitants of Roma settlements from the Slovenian register on residents. The data on hospital treatments used were from Slovenian national register on hospital treatments for the period 2018 to 2022. We compared different ratios according to certain hospital treatments within age categories of patients and co-pared those two groups. The frequency statistics, ANOVA and comparison of column proportion tests were used (p-value<0.005, 95% CI). Results Inhabitants of Roma settlements were more often treating in hospitals that rest of population. If comparing the frequency of hospital treatments between age groups only in Roma population, the percentage of hospital treatments steeply declines with age as well as the number of persons in age groups. The highest percentages and numbers of services are in the youngest age group of 0-15 years, and the lowest in the oldest group (75+). Therefore, significantly higher ratios of hospital treatments were detected in younger then in older age groups. Conclusions Roma children and youngsters (0-15 years old) had the highest rate of hospital treatments and it declined with the age. It was consistent with age pyramid of Roma as young population as well as emphasized care for children in culture. The steady decline rate of hospital treatments with age could be explain with delayed seeking of health care services in adult age and higher premature mortality that leads to smaller adult population. Additional and in-depth research is necessary to explain the root causes of higher premature mortality and use of primary and preventive health services. Key messages • Higher use of hospital treatments was caused by higher morbidity. It is necessary to explore the leading causes of hospital treatments and premature mortality. • It is necessary to explore the use of primary health care service, preventive service and level of health literacy of inhabitants of Roma settlements.

Do behavioral drivers matter for healthcare decision-making during crises? A study of low-income women in El Salvador during the COVID-19 pandemic

Understanding health-seeking behaviors and their drivers is key for governments to manage health policies. A growing body of research explores the role of cognitive biases and heuristics in health and care-seeking behaviors, but little is known about how a context of heightened anxiety and uncertainty might influence these behavioral drivers. This study analyzes the association between four behavioral predictors—internal locus of control, impatience, optimism bias, and aspirations—and healthcare decisions among low-income women in El Salvador, controlling for other factors. We find positive associations between internal locus of control and preventive health behaviors during the COVID-19 pandemic. For instance, a one standard deviation increase in locus of control is associated with a 10% increase in an index measuring the use of masks, distancing, hand washing, and vaccination. Locus of control was also associated with women’s use of preventive health services (one standard deviation improves the likelihood of having a hypertension test in the last six months by 5.8 percentage points). In a sub-sample of mothers, we find significant relationships between the four behavioral drivers and the decisions the mothers make for their children. However, we find these associations are less robust compared to the decisions they make for themselves. Some associations were stronger during the pandemic, suggesting that feelings of uncertainty and stress could amplify behavioral drivers’ influence on health-related behaviors. This novel finding is relevant for designing policy responses for future shocks.JEL CodesI12, D10, D91, I30.

IJCM_240A: A cross sectional study to assess the health literacy among adults attending outpatient clinics at a government tertiary care hospital in urban Bangalore.

Background: WHO defines health literacy as cognitive and social skills that determine the motivation and ability of people to understand, gain access and use the information to obtain good health. Inadequate health literacy has been linked to increased hospital admissions, poorer physical and mental health, lower use of preventive health services like vaccinations and screening tests. These ultimately lead to higher healthcare costs. This study was conducted to assess health literacy among adults attending outpatient clinics at a government tertiary care hospital in urban Bangalore. Objectives: To estimate proportion of inadequate health literacy and its associated factors among adults attending outpatient clinics at a government tertiary care hospital in urban Bangalore. Methodology: A cross-sectional study was conducted among adult attendees (i.e., patients and companions) of outpatient clinics of a government tertiary care hospital in urban Bangalore. Based on a study done by Almaleh. R et al. (P = 34.3%) with 7% absolute precision, the sample size was calculated as 200. A total of 200 adults attending outpatient clinics at the government tertiary care hospital were selected using simple random sampling. Data was collected using a pre-tested, semi-structured questionnaire for sociodemographic factors and HLS-EU-Q16 (European Health Literacy Survey Questionnaire short version) for assessing health literacy. The data collected was entered in MS Excel and analysed using SPSS 21.0. Results: The proportion of inadequate health literacy among study participants was observed to be 38%. Factors like educational status, age, and gender were found to have an association with it. Health literacy was found to be least in lower-educated individuals. Conclusion: From the present study, it was found that a large part of adult population had limited health literacy. It should be addressed through proper interventions, like ensuring basic education and health awareness programmes.

The effects of a large-scale home visiting programme for child development on use of health services in Brazil.

Partnership between early childhood development interventions and primary health care services can help catalyse health care uptake by socially vulnerable families. This study aimed to assess the real-life effects of a large-scale home visiting programme [Primeira Infância Melhor (PIM)] in Brazil on the use of preventive (prenatal visits, well child visits, dentist visits and vaccination) and recovery (emergency room visits and hospitalization) health services. A quasi-experiment nested in a population-based birth cohort study was conducted. The intervention group was firstly defined as all children enrolled in PIM up to age 6 months, and afterwards stratified between those enrolled during pregnancy or after birth up to 6 months. Children receiving PIM were matched with controls on propensity scores based on 27 confounders to estimate effects on health service use from prenatal to age 2 years. Double adjustment was applied in outcome Quasi-Poisson regressions. No evidence was found for effects of PIM starting anytime up to 6 months (262 pairs), or for the children enrolled only after birth (133 pairs), on outcomes occurring after age 6 months. When the programme started during pregnancy (129 pairs), there was a 13% higher prevalence of adequate prenatal visits (prevalence ratio = 1.13; 95% confidence interval 1.01-1.27), but no effect on use of any other health service. Sensitivity analyses suggested longer participation in the programme with reduced visitor turnover might improve its impact on prenatal visits. Integration between PIM and primary health care was not adequate to affect overall patterns of contacts with health services. Nevertheless, prenatal home visits showed potential to increase health service contact during a sensitive period of development, indicating the need to start such programmes before birth, when there is more time for maternal care, and family engagement in a network of services is facilitated.

Lessons Learned From a Community-Based Men's Health Fair.

Strategies are needed to promote the uptake of preventive health services among Black, Hispanic, and rural men because these men underutilize health services. Previous research indicates that men prefer community-based health promotion programming, such as health fairs; however, specific guidance on how to tailor health fairs for Black, Hispanic, and rural men are lacking. The present seeks to study provides that guidance. A multisectoral team developed, implemented, and evaluated a men's health fair in a county of South Carolina with a sizeable Black, Hispanic, and rural-dwelling population. Although the health fair was open to all men in the county, specific outreach campaigns were implemented to attract Black and Hispanic men. The health fair occurred on Father's Day weekend in 2023 and consisted of health screenings, health information, and other resources (eg, condoms, research studies). Participants who attended the health fair were asked to complete a check-in survey (N = 103) that assessed demographic information and how they heard about the health fair, followed by a survey (N = 58) that assessed facilitators/barriers to participation in a men's health fair. Results were stratified by the gender of respondent. The results highlight the facilitators/barriers experienced by men to attending health fairs and also highlight important differences in facilitators/barriers for men to attend a health fair as perceived by men and women. These findings have implications for the design and implementation of future men's health fairs to promote preventive health service use among Black, Hispanic, and rural men.

Abstract A008: Addressing medical distrust among African Americans and adherence to cancer screening recommendations during COVID-19

Abstract Cancer is a leading cause of death in the United States especially among racial and ethnic minorities, and other medically underserved populations. Cancer disparities are an important public health issue with health communication implications particularly for African Americans. African Americans have the highest mortality rate and shortest survival rate for most cancers. Reducing the cancer burden depends on early detection through preventative screening and addressing social determinants of health that drive cancer health inequities. Despite the evidence that adherence to providers’ recommendation of cancer screening guidelines decreases incidence and mortality rates, participation in cancer screening remain low among African Americans due to social and economic factors. The reasons for cancer-related health disparities are multifactorial and encompass physician and patient barriers. Medical distrust has emerged as a significant issue impacting cancer prevention especially during the coronavirus disease (COVID-2019) pandemic. Mistrust of the medical and research communities reflects the history of abuse and discrimination in the U.S., and has resulted in disparate health outcomes, as well as less frequent use of preventive health services. It is critical that populations at increased cancer risk have access to trusted, credible cancer health information and medical services to promote adherence to screening recommendations. To address this need, this cross-sectional study will examine the patient-provider communication practices among African American adults receiving primary care in the District of Columbia and their adherence to breast, cervical, colon and prostate cancer screening recommendations during the COVID era. The study is guided by an understanding of the social determinants of health. Specifically, the study will examine the relationship of trust, structural racism, and religiosity on cancer prevention behavior. The project will describe the perceptions of health inequities within the healthcare system and trust in cancer information sources that influence cancer screening behaviors among African Americans. This project is relevant to the reduction of cancer disparities and cancer prevention for African Americans. Patient-provider communication is a known barrier and facilitator of cancer screening behavior where an awareness of historical distrust of medical institutions, systemic racism, and religiosity are important factors in providing culturally appropriate care. The results of this pilot project will be used to inform best practices for patient-provider communication for cancer prevention. Findings will be used to develop culturally tailored interventions to promote compliance for cancer screening during the COVID era and beyond. Citation Format: Finie Hunter-Richardson, Pamela L. Carter-Nolan, Carla D. Williams, Mark S. Johnson. Addressing medical distrust among African Americans and adherence to cancer screening recommendations during COVID-19 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A008.

Understanding and Promoting Preventive Health Service Use Among Black Men: Community-Driven and Informed Insights.

Black men experience high rates of adverse health that can be prevented or mitigated by the regular use of preventive health services. Efforts are urgently needed to promote this type of health service use among Black men. The U.S. Preventive Services Task Force and the Institute of Medicine indicate that such efforts must align with Black men's values, perspectives, and preferences. However, little guidance exists on how to align these efforts for Black men. The present qualitative study was developed to understand factors associated with preventive health service use among Black men and community-informed strategies to promote preventive health service use among these men. An approach rooted in community-based participatory research and ecological theory was used. A core leadership team consisting of five Black men from the area guided the project's development, implementation, and evaluation. The core leadership team conducted 22 interviews with Black men from their communities. Four themes emerged from these interviews: (1) holistic well-being challenges faced by Black men: interaction of mental, physical, and societal forces; (2) the interplay of financial, informational, and gendered barriers/facilitators to using preventative health services among Black men; (3) the importance of shared identity in peer health education about preventive health service use; and (4) the need for community-centered initiatives to improve preventive health service use among Black men that prioritize accessibility and information. Findings of the present study can be used to tailor preventive health service use efforts for Black men. Such efforts have the potential to promote health and mitigate health disparities.

The effect of non-medical cannabis retailer proximity on use of mental health services for psychotic disorders in Ontario, Canada.

Cannabis is associated with the onset and persistence of psychotic disorders. Evidence suggests that accessibility of substances is associated with an increased risk of use-related harms. We sought to examine the effect of residing in proximity to non-medical cannabis retailers on the prevalence of health service use for psychosis. We conducted a cross-sectional study using linked health administrative data, and used geospatial analyses to determine whether people in Ontario, Canada (aged 14-60 years) resided within walking (1.6 km) or driving (5.0 km) distance of non-medical cannabis retailers (open as of February-2020). We identified outpatient visits, emergency department (ED) visits, and hospitalizations for psychotic disorders between 01-April-2019 and 17-March-2020. We used zero-inflated Poisson regression models and gamma generalized linear models to estimate the association between cannabis retailer proximity and indicators of health service use. Non-medical cannabis retailers were differentially located in areas with high levels of marginalization and pre-existing health service use for psychosis. People residing within walking or driving distance of a cannabis retailer had a higher rate of psychosis-related outpatient visits, ED visits, and hospitalizations, compared to people living outside these areas. This effect was stronger among those with no prior service use for psychosis. Proximity to a non-medical cannabis retailer was associated with higher health service use for psychosis, even after adjustment for prior health service use. These findings suggest that opening of non-medical cannabis retailers could worsen the burden of psychosis on mental health services in areas with high-risk populations.

Faktor-faktor yang Mempengaruhi Pemanfaatan Pelayanan Kesehatan di Poli Lansia Puskesmas Pejagoan Kabupaten Kebumen Tahun 2022

The increase in the elderly population needs attention. This is because the morbidity rate in the elderly is higher compared to other age groups. Health service coverage for the elderly is still low. The use of preventive and curative health services at the Pejagoan Health Center Elderly Polyclinic in 2022 is still not optimal and is experiencing a decline. This study aims to identify the factors that influence the utilization of health services in the elderly in the working area of the Pejagoan Health Center. This research is a quantitative analytic study with a cross-sectional research design. The research sample is 104 people. Sampling was carried out using proportional random sampling. The instrument used is a questionnaire. Data analysis was performed using univariate analysis, bivariate analysis through chi square test, and multivariate analysis through multiple logistic regression tests.The results showed that 45.2% of the elderly had used health services at the Elderly Poly. Factors related to the utilization of health services in the Elderly Poly are education, employment, income, health insurance, accessibility, family support, and perceptions of illness. The factor that has the most influence on the utilization of health services at the Pejagoan Health Center Elderly Poly is the ownership of health insurance.Ownership of health insurance is the factor that most influences the utilization of services at the Pejagoan Health Center Elderly Poly.

PCR1 Racial Disparities Among Adults Receiving Preventive Health Services for Cardiovascular Disease (CVD) in the United States

Cardiovascular diseases are the leading cause of death in the United States even though they are largely preventable and studies in. the US have established disparities in health outcomes. This study aimed to explore factors influencing racial and ethnic disparities in the use of preventive health services for CVD amongst adults in the US.

Multimorbidade e uso de serviços de saúde na população brasileira: Pesquisa Nacional de Saúde 2019

ABSTRACT Objective To describe the prevalence of health service use due to multimorbidity according to sociodemographic and health characteristics of the Brazilian population; to analyze the relationship between multimorbidity and the use of health services. Methods This was a cross-sectional study using data from the 2019 National Health Survey. The outcomes were seeking health services in the last 15 days, medical consultation and hospitalization in the previous 12 months. Multimorbidity was defined as ≥ 2 chronic diseases. Associations were assessed using Poisson regression. Results Of the 81,768 individuals, prevalence of seeking health services among individuals with multimorbidity was 38.0% higher (95%CI 1.31;1.45), medical appointments, 11.0% higher (95%CI 1.10;1.12), and 56.0% higher for hospitalizations (95%CI 1.44;1.70), compared to those without multimorbidity. This relationship was higher for seeking health services and medical appointments among male. Conclusion The use of health services was higher among those with multimorbidity, but different between the types of health services used and sexes.

Facilitators and barriers to colorectal cancer screening using the immunochemical faecal occult blood test among an average-risk population in semi-rural Malaysia: A qualitative study.

Colorectal cancer (CRC) incidence in Malaysia is increasing, and most CRC patients are diagnosed at a late stage. This study investigated participant awareness of CRC and their perceptions and views about CRC screening, barriers, benefits, and facilitators towards CRC screening participation as well as health-seeking behaviour and the use of preventative health services. Eleven focus group discussions (FGDs) were conducted with a purposive sample of 89 participants aged > 50 from the major ethnic groups in the Segamat District, Johor State. FGDs were audiotaped, transcribed verbatim, and translated into English. Data were analysed using thematic analysis. We identified trust in doctors as a key reason for whether or not to seek health care. Generally, the participants had low awareness of CRC sign/symptoms and screening. Emotional and logistic concerns about sending a stool sample to a clinic emerged as the main barriers to screening. Simplified illustrated instructions about stool collection in Malay, Chinese and Tamil, free screening at health clinics and reminders to complete the iFOBT test were perceived to facilitate engagement in screening, and posited as strategies that were likely to increase iFOBT uptake. Primary care physicians play a crucial role in terms of reducing patient's misperceptions, recommending screening to patients, enhancing attendance, and improving uptake of CRC screening. There is a need for further research to investigate ways in which to reduce identified barriers and implement and test potential facilitative strategies as well as examine adherence by doctors to clinical guidelines about CRC screening.

Israeli COVID lockdowns mildly reduced overall use of preventive health services, but exacerbated some disparities

BackgroundDuring 2020, Israel experienced two COVID-19-related lockdowns that impacted the provision of primary and secondary preventive care.MethodsWe examined the month-by-month performance of selected preventive care services using data from Israel’s national Quality Indicators in Community Healthcare program. Process of care measures included hemoglobin A1c (HbA1c) testing, cholesterol testing, colon cancer screening and mammography. Intermediate outcome measures included low-density lipoprotein control and HbA1c control. Measures were stratified by sex and by area-level socioeconomic position (SEP). Diabetes and mammography are presented in this abstract due to space limitations.ResultsAnnual HbA1c testing among persons with diabetes decreased from 90.9% in 2019 to 88.0% in 2020. Performance of HbA1c tests during lockdown months was as low as half the usual amount. There were compensatory increases in testing during post-lockdown months that did not quite make up for the missed tests. In 2019, 9.0% of Israelis with diabetes had poor glycemic control (HbA1c ≥ 9.0); in 2020, it was 8.8%. In total, 4.5% fewer mammograms were performed in 2020 compared with 2019. Women in the lowest SEP level performed 10.4% fewer mammograms in 2020 than in 2019, while women in the highest SEP level performed 3.1% more mammograms.ConclusionsProlonged COVID lockdowns in 2020 were associated with marked decreases in the performance of preventive health services during those months. Compensatory spikes following the end of lockdowns partly, but did not completely, make up for the missed care. COVID lockdowns may have exacerbated socioeconomic disparities in some preventive health services.

Impact of the affordable care act's medicaid expansion on presentation stage and perioperative outcomes of colorectal cancer.

Medicaid expansion has improved healthcare coverage and preventive health service use. To what extent this has resulted in earlier stage colorectal cancer diagnoses and impacted perioperative outcomes is unclear. This was a retrospective difference-in-difference study using the National Cancer Database on adults (40-64) with Medicaid or no insurance, diagnosed with colorectal adenocarcinomas before (2010-2013) and after (2015-2018) expansion. The primary outcome was early-stage (American Joint Committee on Cancer Stage 0-1) diagnosis. The secondary outcomes were rate of local excision, emergency surgery, postoperative length of stay, rates of minimally invasive surgery, postoperative mortality, and overall survival (OS). Medicaid expansion was associated with an increase in early-stage diagnoses for patients with colorectal cancers (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.15-1.43), an increase in local excision (OR: 1.39, 95% CI: 1.13-1.69), and a decreased rate of emergent surgery (OR: 0.85, 95% CI: 0.75-0.97) and 90-day mortality (OR: 0.75, 95% CI: 0.59-0.97). Additionally, patients in expansion states postexpansion had an improved 5-year OS (hazard ratio: 0.88, 95% CI: 0.83-0.94). Insurance coverage expansion may be particularly important for optimizing stage of diagnosis, subsequent survival, and perioperative outcomes for socioeconomically vulnerable patients.

Preventive health therapy and behavior outcomes from a brown bag medication review for older adults.

Morbidity and mortality associated with preventable diseases can be reduced with the use of preventive health services. We evaluated the uptake and retention of preventive health behaviors and management of accidental medication poisonings in older adults after a health prevention educational component was combined with a brown bag medication review. This study used a cohort design and was conducted in six urban senior centers and three independent senior living communities in Detroit, Michigan. Participants included 85 older adults (>60 years old) taking five or more medications with 63 participants returning follow up materials. Pharmacy personnel conducted brown bag medication reviews that were combined with a preventive health education component. Information was collected on medications, vaccinations, supplement use, and accidental medication poisoning management. Participants were given written recommendations on prescription medications and preventive health therapies to improve health and medication use. An investigator developed program satisfaction survey was administered immediately after the review. An investigator-developed follow-up preventive health implementation survey was conducted at least 3 months later to assess recommendation implementation. Participants' mean age was 75.9 ± 8.5 years. Fifty-six older adults had 124 recommendations in preventive health in total (1-5/participant). Eleven participants had no recommendations. Sixty-three participants (74%) returned follow-up preventive health surveys. Twenty-three percent of recommendations were already implemented with 34% planned to be done in the future. Poisoning management knowledge increased for 13 participants, reporting they would call the poison control center. The program was well received, with participants reporting high satisfaction scores (4.8 ± 0.7 out of 5). Brown bag medication reviews can be an effective method to promote the uptake of preventive health behaviors among older adults, but additional accidental medication poisoning management education is still needed.

Preventive health behaviors among people with suicide ideation using nationwide cross-sectional data in South Korea

This study aimed to investigate the association between suicide ideation and health-related behaviors and preventive health service use behaviors. We used data from the 2017 Korea National Health and Nutrition Examination Survey (KNHANES), a nationally representative survey. The final sample included 4486 participants aged 40 years or older. Preventive health behaviors were assessed for smoking, high-risk drinking, physical activities, regular meal intake, influenza vaccination, general health examination, and cancer screening. Logistic regression was used to examine the association between suicide ideation and preventive health behaviors with a series of adjustments for covariates. In general, suicide ideation was associated with unfavorable outcomes of preventive health behaviors, except for flu vaccination. For example, the crude prevalence of suicide ideation and non-suicide ideation groups were 54.3% vs. 43.7% for flu vaccination, 23.1% vs. 41.6% for physical activity, and 24.8% vs. 18.6% for high-risk alcohol drinking. After adjustment for covariates, the associations of suicide ideation with behaviors remained significant for physical activity (OR 0.52, 95% CI 0.34–0.81) and high-risk alcohol drinking (OR 2.22, 95% CI 1.34–3.69). Suicide ideation leads to the disruption of self-management of health behaviours, especially for physical activity and high-risk alcohol drinking, independently of depressive feelings.

Factors associated with the utilization of community-based health services among older adults in China\u2014an empirical study based on Anderson\u2019s health behavior model

Taking the modified Anderson health behavior model as the analysis framework and relying on 1136 empirical research data of S District in Foshan City, Guangdong Province of China, this study explores the influence of predisposing factors, enabling factors and need factors on the utilization of community-based health services among older adults in China. The results show that three variables have a significant impact on the use of family health services, which are whether the pension is the main source of living, income surplus, and major expenditure items. Seven variables have a significant impact on the use of preventive health services, which are household registration type, the basic endowment insurance coverage, the nature of the working unit before retirement, the self-rated health status, chronic diseases, self-care ability in daily life, and preventive health care needs.

Health literacy of cardiology patients: determinants and effects on patient outcomes

ABSTRACT Health literacy is important for the management of chronic cardiovascular diseases. Comprehensive studies related to health literacy of cardiac patients are limited. The aims of this study were to determine the determinants of health literacy and its effects on patient outcomes in cardiology patients. The European Health Literacy Survey Questionnaire (HLS-EU-Q- 47 items) was applied to 530 patients who presented to cardiology polyclinics of a university hospital in Ankara. Correlation coefficients, univariate and multi-linear regression analyses were used in the study. Determinants of health literacy were sex, education level, place of residence and perception of social status (p < .05). Although adjustments were made based on relevant control variables in multivariate analyses, health literacy was found to affect 14 of 26 patient outcomes within the scope of the study (p < .05). Higher education level and perception of social status, residing in the city center and being female were among the determinants of high health literacy. Higher health literacy was associated with more positive patient outcomes. Health literacy affected health behaviors and risks, drug use habits, health status, use of preventive health services and patient satisfaction.

Factors Associated with Treatment Among Older Adults Diagnosed with Chronic Lymphocytic Leukemia: An Analysis Using Medicare Claims Data

INTRODUCTION: Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults in the US. Sixty-seven percent of patients diagnosed with CLL are age 65 years or older. While new agents and treatment combinations have been approved for CLL and treatment guidelines take into consideration age, frailty, and comorbidity status, limited information exists on current prescribing patterns or the demographic and clinical characteristics of individuals receiving them. The objectives of this study were to: 1) characterize CLL treatment patterns and timing of treatment; 2) identify factors associated with the receipt of CLL treatment in the US Medicare population.METHODS: The study sample included Medicare beneficiaries diagnosed with CLL from 2017 to 2019 using the Chronic Conditions Data Warehouse. Medicare beneficiaries were identified using billing diagnosis codes. Patients who were not treated for CLL during a continuous 6-month period (i.e., baseline period), continuously enrolled in Medicare Parts A, B, and D at baseline with no evidence of enrollment in Medicare Advantage, and age 65 or older at the index date were included. The index date was defined as the date of the first claim with a CLL diagnosis code during the cohort identification period (7/1/2017-6/30/2019). Individuals were followed from the index date until loss of eligibility, death, or end of the study period on 12/31/2019, whichever occurred first. We characterized CLL treatments using National Comprehensive Cancer Network guidelines and grouped individuals based on the first treatment received. The CLL treatments included: rituximab monotherapy, ibrutinib monotherapy, bendamustine/rituximab (BR), obinutuzumab, and other treatments. We reported the proportion of individuals who received the first course of treatment (COT), the top-ranked regimens within the first COT, and the median time to starting the first COT. Time-to-initiation was calculated as the time (in days) from the index date until the first evidence of treatment receipt. We utilized EventFlow visual analytics software to characterize longitudinal patterns of CLL treatments received from the index date (Day 0) until the end of follow-up. EventFlow facilitates exploratory, visual analyses of temporal event sequences using patient-level information about single events (e.g., infusion date), interval events (prescription start and end date), and the end-of-study indicator. We characterized the sample using the following baseline measures: age, race/ethnicity, gender, Charlson Comorbidity Index score, and use of preventive health services, among other measures. We identified factors associated with receipt of CLL treatment using a logistic regression model and reported the covariate-adjusted odds ratio (AOR). An AOR<1 indicates the comparison was negatively associated with receipt of CLL treatment.RESULTS: After applying the inclusion/exclusion criteria, 3,440 CLL patients were identified. Sixteen percent (n=556) of individuals received CLL treatment and the median follow up time was 540 days. Overall, the mean (standard error) age was 77 (8); 49% male. Among the 556 treated patients, the distribution of first COT was 35% ibrutinib, 34% rituximab, 12% BR, 4% obinutuzumab, and 14% other treatment. The median (interquartile range, mean) time to receipt of CLL treatment was 61 (224, 166) days. The median time to receipt of ibrutinib, rituximab, BR, or obinutuzumab was 109, 49, 53, and 140 days, respectively. The EventFlow graphic (Figure 1) illustrates treatments received (prescriptions or chemotherapy administrations) post-index date and through the end of the study period. Less than half of the patients in the BR group completed six doses of BR. Compared to patients in the rituximab group, a larger proportion of patients in the ibrutinib and BR groups remained on the first COT over time. In the logistic regression model age (≥85 vs 65-74; AOR=0.69; 95% CI:0.53-0.91) and gender (male vs female; AOR=1.28; 95% CI: 1.06 - 1.54) were statically significant; no other statistically significant differences based on baseline measures were observed.CONCLUSIONS: Among Medicare beneficiaries diagnosed with CLL, less than 2 out of 10 patients received CLL treatment. The most common treatments administered during this time period were ibrutinib or rituximab. Younger age and male gender were factors associated with increased receipt of treatment. [Display omitted] DisclosuresOnukwugha: BeiGene, Ltd.: Research Funding; Sanofi Aventis: Other: Faculty mentor on a pre-doctoral fellowship. Cooke: BeiGene, Ltd.: Research Funding. Yang: BeiGene, Ltd.: Current Employment. Liu: BeiGene, Ltd.: Current Employment. Tang: BeiGene, Ltd.: Current Employment.

Health Literacy and Access to Care in Cancer Screening Among Korean Americans.

Background:Health literacy and access to care are critical facilitators for preventive health behaviors. After the passage of the Affordable Care Act in March 2010, little has been studied about how improved health insurance coverage has impacted the use of preventive health services among Korean Americans.Objective:The study assessed the impact of access to care, use of services, and health literacy on cancer screening among Korean Americans.Methods:A descriptive cross-sectional study of 377 Korean Americans age 18 years and older was conducted with a survey and convenient sampling in Texas.Key Results:Although 79% of the sample had health insurance, 32% had never visited a health care provider, and 14% were delayed in care in the past 12 months. Only 11.6% were confident to complete medical forms, and 69.5% had limited levels of confidence. Cancer screening compliance rates were: mammography (50.4% at age 40–54 years; 46.6% at age 55 years and older), a Pap smear (29.4% at age 21–29 years; 78.4% at age 30–65 years; 72.2% at age 66 years and older), and colorectal cancer screening at age 45 years and older (stool tests 15.1%; sigmoidoscopy 27%; colonoscopy 51.3%). Multiple logistic regression analyses revealed that household income, gender, health insurance, and health literacy were significantly associated with self-reported cancer screening.Conclusions:Korean Americans who participated in this study are characterized by marginalized health literacy, underused health care services, and significantly lower cancer screening compliance than the goals of Healthy People 2020. The following interventions are suggested to improve health literacy and health insurance literacy on cancer screening: culturally sensitive and linguistically appropriate education for the guidelines concordant with cancer screening, effective communication skills with health care providers, support for navigating the health care system, and development of internet- or social media-based health education programs to meet the preferred communication methods of this population. [HLRP: Health Literacy Research and Practice. 2021;5(4):e310–e318.]Plain Language Summary:Despite having improved health insurance coverage, Korean Americans of this study have marginalized health literacy, limited health insurance literacy, low cancer screening compliance, and underused health care services. The results of this study suggest several strategies to improve health literacy and health insurance literacy for Korean Americans, which may also apply to other groups with similar barriers.