Recent Doctor Visit Research Articles

Disparities in Screening for Adverse Childhood Experiences.

Screening for adverse childhood experiences (ACEs) in the clinical setting is set to become more commonplace with continued efforts to reimburse clinicians for screening. However, an examination of disparities in ACEs screening and related attitudes and beliefs is needed. Using the 2021 California Health Interview Survey (CHIS), this study examined if several measures of socioeconomic status, access to care and identities were associated with 3 outcomes: 1) getting screened for ACEs by a clinician; 2) beliefs about the importance of screening and 3) satisfaction with efforts to address the impacts of ACEs. Logistic regressions were used to estimate odds of the outcomes. Black, Latinx, and Asian individuals had lower odds of being screened for ACEs than non-Hispanic Whites. A recent doctor's visit, higher burden of ACEs, and serious psychological distress were associated with higher odds of being screened. Latinx individuals, women, bisexual individuals, those with a recent doctor's visit and those with serious psychological distress had higher odds of believing clinicians asking about ACEs was very important, relative to their counterparts. Latinx individuals, American Indian or Alaska native individuals, Asian individuals, those with higher educational attainment and those with serious psychological distress had lower odds of being very satisfied with providers' efforts to address the impact of ACEs, relative to their counterparts. Efforts to expand ACEs screening should consider the disparities in screening that currently exist. Given the wide-ranging impacts that ACEs have on health, an equitable approach to screening is necessary.

Interventions to Eliminate Cervical Cancer in Nicaragua: An Integrative Review of the Literature.

Introduction: Nicaragua has one of the highest cervical cancer death rates (19.4 per 100,000) compared to other Central American countries. This integrative review of the literature synthesizes cervical cancer prevention interventions in Nicaragua. Methods: The literature search was performed through Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Embase, PubMed, and Scopus. The six articles included in this integrative review were appraised using the Quality Assessment Tool for Quantitative Studies (QAQTS). Results: Greater knowledge of Pap smears, the human papillomavirus (HPV), and cervical cancer was significantly associated with positive screening beliefs. Barriers to cervical cancer screening included access to Pap smears, preference for female providers, and the length of time to receive screening results and treatment. The probability of having a Pap smear was 94% higher among those who had a recent doctor's visit compared to those who had not. While clinician samples are more accurate in detecting HPV or cervical cancer, self-sampling was stated by the participants to be preferred. Conclusion: A focus on the higher efficacy of clinician sampling and providing more factual information about cervical cancer and its screening through trusted community-based efforts, such as charlas, would be more likely to encourage testing and thereby reduce the rate of cervical cancer in Nicaragua.

A crowdsourced intervention to decrease hepatitis B stigma in men who have sex with men in China: A cohort study.

Stigma against people with hepatitis B virus (HBV) is a barrier to prevention, diagnosis and treatment of HBV in China. Our study examined an innovative intervention to reduce HBV stigma among men who have sex with men (MSM) in China. We extracted data from a randomized controlled trial conducted in May 2018, where the intervention consisted of crowdsourced images and videos to promote viral hepatitis testing and reduce HBV stigma. HBV stigma was assessed using a 20-item scale at baseline and four weeks post-enrolment. Participants were divided into three groups based on their exposure to intervention: full exposure, partial exposure and no exposure. Linear regression was used to determine associations between baseline stigma and participant characteristics. Data from 470 MSM were analysed. Mean participant age was 25years old and 56% had less education than a college bachelor's degree. Full exposure to intervention was associated with significant stigma reduction (adjusted beta=-3.49; 95% CI=-6.11 to -0.87; P=.01), while partial exposure led to stigma reduction that was not statistically significant. The mean stigma score was 50.6 (SD±14.7) at baseline, and stigma was most prominent regarding physical contact with HBV carriers. Greater HBV stigma was associated with not having a recent doctor's visit (adjusted beta=4.35, 95% CI=0.19 to 8.52; P=.04). In conclusion, crowdsourcing can decrease HBV stigma among MSM in China and may be useful in anti-stigma campaigns for vulnerable populations in low- and middle-income countries.

Tree analysis modeling of the associations between PHQ-9 depressive symptoms and doctor diagnosis of depression in primary care.

The aim of this study was to explore the relationship between patient self-reported Patient Health Questionnaire-9 (PHQ-9) symptoms and doctor diagnosis of depression using a tree analysis approach. This was a secondary analysis on a dataset obtained from 10 179 adult primary care patients and 59 primary care physicians (PCPs) across Hong Kong. Patients completed a waiting room survey collecting data on socio-demographics and the PHQ-9. Blinded doctors documented whether they thought the patient had depression. Data were analyzed using multiple logistic regression and conditional inference decision tree modeling. PCPs diagnosed 594 patients with depression. Logistic regression identified gender, age, employment status, past history of depression, family history of mental illness and recent doctor visit as factors associated with a depression diagnosis. Tree analyses revealed different pathways of association between PHQ-9 symptoms and depression diagnosis for patients with and without past depression. The PHQ-9 symptom model revealed low mood, sense of worthlessness, fatigue, sleep disturbance and functional impairment as early classifiers. The PHQ-9 total score model revealed cut-off scores of >12 and >15 were most frequently associated with depression diagnoses in patients with and without past depression. A past history of depression is the most significant factor associated with the diagnosis of depression. PCPs appear to utilize a hypothetical-deductive problem-solving approach incorporating pre-test probability, with different associated factors for patients with and without past depression. Diagnostic thresholds may be too low for patients with past depression and too high for those without, potentially leading to over and under diagnosis of depression.

The Affordable Care Act Appears to Have Narrowed Racial and Ethnic Disparities in Insurance Coverage and Access to Care Among Young Adults.

Prior to the Affordable Care Act, one in three young adults aged 19 to 25 years were uninsured, with substantial racial/ethnic disparities in coverage. We analyzed the separate and cumulative changes in racial/ethnic disparities in coverage and access to care among young adults after implementation of the Affordable Care Act's 2010 dependent coverage provision and 2014 Medicaid and Marketplace expansions. We find that the dependent coverage provision was associated with similar gains across racial/ethnic groups, but the 2014 expansion was associated with larger gains in coverage among Hispanics and Blacks relative to Whites. After the 2014 expansion, coverage increased by 11.0 and 10.1 percentage points among Hispanics and Blacks, respectively, compared with a 5.6 percentage point increase among Whites. The percentage with a usual source of care and a recent doctor's visit also increased more for Blacks relative to Whites. Increases in coverage were larger in Medicaid expansion compared with nonexpansion states for most racial/ethnic groups.

Recent HIV Testing Prevalence, Determinants, and Disparities Among U.S. Older Adult Respondents to the Behavioral Risk Factor Surveillance System.

Although routine human immune deficiency virus (HIV) testing during health care visits is recommended for most adults, many older adults (i.e., ages 50-64 years) do not receive it. This study identified factors associated with HIV testing in the past 12 months (i.e., recent HIV testing) among US adults in the 3 categories of older adulthood (50-54, 55-59, and 60-64 years) for which routine HIV testing is recommended. This was a cross-sectional analysis of data from US older adult respondents to the 2010 Behavioral Risk Factor Surveillance System. We calculated prevalence (proportions) of HIV testing by age category and race/ethnicity. Using multiple logistic regression, we identified predisposing, enabling, and need factors associated with recent HIV testing within and across age categories, by race/ethnicity and controlling for covariates. HIV testing prevalence was low (<5%), varied by race/ethnicity, and decreased with age. Within and across age categories, the odds of testing were highest among blacks (odds ratio [OR], 3.47; 95% confidence interval [CI], 2.82-4.25) and higher among Latinos (OR, 2.06; 95% CI, 1.50-2.84) and the oldest and youngest categories of American Indians/Alaska Natives (OR, 2.48; 95% CI, 1.11-5.55; OR, 2.98; 95% CI, 1.49-5.95) than among whites. Those reporting a recent doctor visit (OR, 2.32; 95% CI, 1.92-2.74) or HIV risk behaviors (OR, 3.50; 95% CI, 2.67-4.59) had higher odds of HIV testing. Regardless of risk, the oldest older adults, whites, and older women may forego HIV testing. Doctor visits may facilitate HIV testing. Additional research is needed to understand why eligible older adults seen by providers may not be screened for HIV infection.

Childhood obesity perceptions among African American caregivers in a rural Georgia community: a mixed methods approach.

Given the pivotal role of African American caregiver's perceptions of childhood obesity in rural areas, the inclusion of caregiver's perceptions could potentially reduce childhood obesity rates. The objective of the current study was to explore childhood obesity perceptions among African Americans in a rural Georgia community. This concurrent mixed methods study utilized two theoretical frameworks: Social Cognitive Theory and Social Ecological Model. Using a convenience sample, caregivers ages 22-65 years completed a paper-based survey (n = 135) and a face-to-face interview (n = 12) to explore perceptions of obesity risk factors, health complications, weight status, built environment features, and obesity prevention approaches. Descriptive statistics were generated and a six-step process was used for qualitative analysis. Participants commonly cited behavioral risk factors; yet, social aspects and appearance of the community were not considered contributing factors. Chronic diseases were reported as obesity health complications. Caregivers had a distorted view of their child's weight status. In addition, analysis revealed that caregivers assessed child's weight and height measurements by the child's appearance or a recent doctor visit. Environmental barriers reported by caregivers included safety concerns and insufficient physical activity venues and programs. Also, caregivers conveyed parents are an imperative component of preventing obesity. Although this study found caregivers were aware of obesity risk factors, health complications, built environment features, and prevention approaches their obesity perceptions were not incorporated into school or community prevention efforts. Findings suggest that children residing in rural areas are in need of tailored efforts that address caregiver perceptions of obesity.

Socioeconomic determinants of cervical cancer screening in Latin America

To assess the impact of health care access and socioeconomic determinants on Pap smear screening in Latin America. Individual-level data was collected from the Demographic and Health Surveys in Bolivia, Brazil, Dominican Republic, Ecuador, Guatemala, Nicaragua, Peru, and Trinidad and Tobago between 1987 and 2008. Multivariate logistic regression analyses were used to identify socioeconomic and health care determinants of two outcomes: knowledge of Pap smears and recent Pap smear screening. In all countries, the proportion of women with a recent Pap smear screening remained below 55%. Key determinants of knowledge of Pap smears were age, education, and recent doctor's visit. For recent Pap smear screening, key determinants were wealth and recent doctor's visit. Women were between 1.47 and 3.44 times more likely to have received a recent Pap smear if they had a recent doctor's visit. Even the poorest women with a recent doctor's visit were more likely to screen than the richest women without a recent visit. These data suggest that visiting a doctor is an important determinant of cervical cancer screening in Latin America. Because screening may coincide with other medical visits, physicians could effectively encourage screening.

Abstract P251: Cardiovascular Risk Perception in African Americans

Substantial racial disparities exist in heart disease. African Americans have the highest rates of cardiovascular disease (CVD). The prevalence of cardiovascular risk factors is greatest among racial minorities. African Americans are more likely to be diabetic, physically inactive, and overweight compared to whites. Additionally, African Americans participate in cardiovascular risk reduction behaviors such as diet control, exercise, and weight management at lower rates compared to individuals from other racial groups. Primary prevention of CVD through the adoption of healthy diet and physical activity behaviors is recommended to reduce the risk of developing CVD. According to health behavior theories, people must perceive themselves as susceptible to disease to adopt a preventive behavior. Few studies have examined psychological and sociocultural factors that influence cardiovascular risk perception in African Americans. As part of a randomized trial comparing the effects of integrated versus disease specific risk education in a community-based sample of African Americans, we (1) evaluated perceived risk of developing CVD and (2) identified factors having significant independent association with risk perception. The sample consisted of 199 African American adults who were on average 45.0 years (± 9.9) old. The participants were 53% male and 47% female. Approximately 23% of the participants were at intermediate or high risk for CVD. Most (83%) participants received medical care in a doctor’s office, clinic, or community health center and had a recent visit (≤ 1 year) to a doctor (84%). More than half (62%) of participants did not perceive themselves to be at increased CVD risk. In the multivariate model that controlled for age, objective risk (β=1.85, p=0.03), a family history of CVD (β=0.47, p=0.006), a recent doctor visit (β=1.90, p=0.03), and usual source of health care (β=-2.24, p=0.008) had a significant association with risk perception. Our results suggest that usual source of health care is important to perceived risk of developing CVD. This could be because provider interaction is important in appropriate CVD risk perception. Future research is needed to evaluate the content of patient-provider discussions about CVD in different settings.

Behavior and Beliefs About Influenza Vaccine Among Adults Aged 5064 Years

To examine demographics and beliefs about influenza disease and vaccine that may be associated with influenza vaccination among 50- to 64-year-olds. A national sample of adults aged 50-64 years surveyed by telephone. Variables associated with receiving influenza vaccination included age, education level, recent doctor visit, and beliefs about vaccine effectiveness and vaccine safety. Beliefs about influenza vaccination varied by race/ethnicity, age, education, and gender. The finding of demographic differences in beliefs suggests that segmented communication messages designed for specific demographic subgroups may help to increase influenza vaccination coverage.

High HIV Prevalence, Suboptimal HIV Testing, and Low Knowledge of HIV-Positive Serostatus Among Injection Drug Users in St. Petersburg, Russia

The purpose of this analysis was to estimate human immunodeficiency virus (HIV) prevalence and testing patterns among injection drug users (IDUs) in St. Petersburg, Russia. HIV prevalence among 387 IDUs in the sample was 50%. Correlates of HIV-positive serostatus included unemployment, recent unsafe injections, and history/current sexually transmitted infection. Seventy-six percent had been HIV tested, but only 22% of those who did not report HIV-positive serostatus had been tested in the past 12 months and received their test result. Correlates of this measure included recent doctor visit and having been in prison or jail among men. Among the 193 HIV-infected participants, 36% were aware of their HIV-positive serostatus. HIV prevalence is high and continuing to increase in this population. Adequate coverage of HIV testing has not been achieved, resulting in poor knowledge of positive serostatus. Efforts are needed to better understand motivating and deterring factors for HIV testing in this setting.

Influenza and Pneumococcal Vaccination of Adults Aged ≥65: Racial/Ethnic Differences

Influenza and pneumococcal polysaccharide vaccination (PPV) rates among persons aged > or = 65 years are significantly below national objectives of 90%, particularly among blacks and Hispanics. This study of the 2002-2003 influenza season examines factors that may be associated with low coverage. A national sample of 1839 community-dwelling adults aged > or = 65 years was surveyed by telephone during January-May 2003. Outcomes analyzed in 2004-2005 included self-reported influenza vaccination and PPV; place of vaccination; and among the unvaccinated, main reasons for nonvaccination, awareness of vaccination, and receipt of provider recommendation for vaccination. Influenza vaccine coverage was 67.8%, and PPV coverage was 60%. Coverage among blacks and Hispanics was > or = 15 percentage points below that of whites. Half (52%) of persons who had not received PPV were aware it was recommended for persons their age, and < 10% had received a recent physician recommendation for PPV. Concern about side effects and not thinking that they needed the vaccine were the most frequently cited reasons for not receiving an influenza vaccination. In each racial/ethnic group, prevalence of potential missed opportunities (recent doctor visit, but no vaccine recommendation from provider and no influenza vaccination) was higher than prevalence of potential vaccine refusal (recent doctor visit and vaccine recommendation from provider, but no vaccine): blacks, 26.9% versus 7.9%; Hispanics, 19.9% versus 12.1%; and white non-Hispanics, 16.2% versus 6.1%. Improved adherence to vaccination guidelines by healthcare providers could substantially raise coverage in all racial/ethnic groups. Multiple factors contribute to racial/ethnic disparities, and their relative contributions should be further quantified.

Health insurance markets and income inequality: findings from an international health policy survey

Objective: To assess disparities in access to health care, financial burden of medical bills and perceived quality of care between those with above average incomes and those with below average incomes in five nations and to examine the relationship of inequities in care experi-ences to health insurance coverage. Design: Cross-sectional analysis of a random survey of adults in 1998. Subjects: 5059 adults ages 18 and over in five English-speaking countries: Australia, Britain, Canada, New Zealand and the United States (≈1000 per country) Main outcome measures: Failure to receive needed care, difficulty getting care, waiting time for elective surgery, problems paying medical bills, failure to fill prescriptions due to cost, perceived quality of medical care received and of most recent doctor visit. Results: There were two to three-fold differences between those with above and below average incomes on measures of access to care in the US, Australia and New Zealand. In Britain and Canada indicators of access to care were similar for the two income groups. Problems paying medical bills were most prevalent in the US, yet significant differences by income also existed in Australia, Canada and New Zealand. Those with below average incomes were more likely to have not filled a prescription due to cost in Australia, Canada, New Zealand and the US, with gaps by income most severe in the US. Ratings of quality of doctor visit were significantly different for the two income groups in the US, but not other countries. Conclusions: The analysis finds striking differences among countries in the relative equity of health care experiences. In general, care experiences are more unequal in three countries such as the US, Australia and New Zealand where systems have relatively greater reliance on private health insurance and markets. Greater inequality in care experiences is also associated with more divided public opinion regarding the need for system reform and the direction of recent policy changes. In Canada and Britain where care experiences are more equal, views of the health system are similar across income groups. Reliance on private insurance and patient user fees appears to lead to more divided views of the overall health system as well as inequity in access to care.

MEDICAL PRACTITIONERS AND HEALTH PROMOTION: RESULTS FROM A COMMUNITY SURVEY IN SYDNEY'S WESTERN SUBURBS

A health survey of 484 persons aged 14 to 89 years was conducted in Sydney's western suburbs in May 1987. Its aims included a description of preventive activities undertaken by medical practitioners and an assessment of the community's perception of the doctor's role in health promotion. Ninety‐three per cent reported visiting a doctor in the previous year and 31 per cent of respondents reported having contact with a general practitioner the fortnight before the survey, either for their own health or that of another. Eighty per cent of respondents reported having had their blood pressure measured in the previous year and 63 per cent of female respondents aged 18 years and over who had not had a hysterectomy reported having had a Pap smear in the last five years. However, few respondents reported receiving any lifestyle‐related advice at their most recent doctor visit and 77 per cent said that the food they are was rarely or never discussed with their doctor. Despite this low level of advice, doctors and nurses were perceived to be the most important source of health information by nearly half the respondents. Strategies for increasing the involvement of doctors in health promotion are discussed.

Satisfaction with medical care in a low income population

A household survey was undertaken in the fall of 1969 among low-income residents of Raleigh, North Carolina. Data were collected on utilization and satisfaction with medical services from 254 adult respondents. The satisfaction questionnaire was constructed in accordance with the Equal Appearing Intervals technique of Thurstone. Three elements of attitudes toward physicians and medical care were tapped: professional competence, personal qualities and cost/convenience. Respondents received a total score as well as a score reflecting their level of satisfaction or dissatisfaction with each content area. The distribution of scores is significantly more favorable on personal qualities (mean value 65.2) as compared to cost/convenience (mean 49.1). Scores on professional competence had an intermediate distribution (mean 58.5). These means were significantly different from each other as shown by the correlated t test, confirming the hypothesis that attitudes vary toward the different elements of care. With the exception of the cost/convenience content area, attitudes were favorable, since the mean values were higher than the neutral value of 55. Several characteristics of the respondents and their interaction with the medical care system were associated with level of satisfaction. Increased satisfaction with professional competence was associated with higher educational and occupational levels. Increased family size resulted in decreased satisfaction with costs and convenience. Having hospital insurance, a regular doctor and a recent doctor visit were correlated with higher total satisfaction scores. This consistent pattern of associations in which the differences occurred in the ‘expected’ direction, tends to confirm the construct validity of the research instrument.