Regular Source Of Medical Care Research Articles

Access to primary care and cognitive impairment: results from a national community study of aging Americans

BackgroundDespite a growing burden of Alzheimer’s Disease and related dementias (ADRD) in the US, the relationship between health care and cognitive impairment prevention is unclear. Primary care manages risk causing conditions and risk reducing behaviors for dementia, so we examine the association between individual and area-level access to primary care and cognitive impairment in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.MethodsREGARDS participants with a cognitive assessment and vascular measurements at their baseline visit were included in this cross-sectional analysis. Cognitive impairment was defined as a Six-Item Screener (SIS) score < 5. Primary care supply, primary care utilization and emergency department (ED) utilization were measured at the primary care service area (PCSA) level based on participant’s address. Individual access to care was self-reported. Models were adjusted for confounding by demographics, socioeconomic status and behavioral risk factors.ResultsAmong 25,563 adults, living in a PCSA with low primary care supply was associated with 25% higher odds of cognitive impairment (OR 1.25 CI 1.07-1.45). Not having a regular source of medical care was associated with 14% higher odds of cognitive impairment (OR 1.14 CI 1.02-1.28), and living in a PCSA with high emergency department utilization was associated with 12% higher odds of cognitive impairment (OR 1.12 CI 1.02-1.23).ConclusionsOur results are an important first step in understanding how health care may prevent cognitive impairment. They highlight the importance of primary care and suggest future work clarifying its role in preventing cognitive decline is imperative.

54 The Rapid Evaluation of COVID-19 Vaccination in Emergency Departments for Underserved Patients Study

Emergency departments (EDs) often serve vulnerable populations who may lack primary care and have suffered disproportionate COVID-19 pandemic effects. Comparing patients having and lacking a regular source of medical care and other ED patient characteristics, we assessed COVID-19 vaccine hesitancy, reasons for not wanting the vaccine, perceived access to vaccine sites and willingness to get the vaccine as part of ED care.

The Rapid Evaluation of COVID-19 Vaccination in Emergency Departments for Underserved Patients Study

Study objectiveEmergency departments (EDs) often serve vulnerable populations who may lack primary care and have suffered disproportionate COVID-19 pandemic effects. Comparing patients having and lacking a regular source of medical care and other ED patient characteristics, we assessed COVID-19 vaccine hesitancy, reasons for not wanting the vaccine, perceived access to vaccine sites, and willingness to get the vaccine as part of ED care.MethodsThis was a cross-sectional survey conducted from December 10, 2020, to March 7, 2021, at 15 safety net US EDs. Primary outcomes were COVID-19 vaccine hesitancy, reasons for vaccine hesitancy, and sites (including EDs) for potential COVID-19 vaccine receipt.ResultsOf 2,575 patients approached, 2,301 (89.4%) participated. Of the 18.4% of respondents who lacked a regular source of medical care, 65% used the ED as their usual source of health care. The overall rate of vaccine hesitancy was 39%; the range among the 15 sites was 28% to 58%. Respondents who lacked a regular source of medical care were more commonly vaccine hesitant than those who had a regular source of medical care (47% versus 38%, 9% difference, 95% confidence interval 4% to 14%). Other characteristics associated with greater vaccine hesitancy were younger age, female sex, Black race, Latinx ethnicity, and not having received an influenza vaccine in the past 5 years. Of the 61% who would accept a COVID-19 vaccine, 21% stated that they lacked a primary physician or clinic at which to receive it; the vast majority (95%) of these respondents would accept the COVID-19 vaccine as part of their care in the ED.ConclusionED patients who lack a regular source of medical care are particularly hesitant regarding COVID-19 vaccination. Most COVID-19 vaccine acceptors would accept it as part of their care in the ED. EDs may play pivotal roles in COVID-19 vaccine messaging and delivery to highly vulnerable populations.

Health insurance coverage is associated with access to substance use treatment among individuals with injection drug use: Evidence from a 12-year prospective study

ObjectiveUnderstand how insurance impacts access to services among people who have injected drugs. Methods1748 adults who have injected drugs were assessed at twice-annual study visits between 2006 and 2017 (18,869 visits). Use of specialty substance use treatment, receipt of buprenorphine, and having a regular source of medical care were assessed for association with concurrent insurance coverage. Random intercept logistic regression was used to adjust for potential confounders. ResultsWhen participants acquired insurance, they were more likely to report specialty substance use treatment (aOR 2.0, 95% CI 1.6 to 2.5), a buprenorphine prescription (aOR 3.3, 95% CI 2.0 to 5.5), and a regular source of medical care (aOR 6.3, 95% CI 5.1 to 7.8). ConclusionInsurance is associated with increased use of three important services for individuals who inject drugs. ImplicationsExpanding insurance may facilitate access to substance use treatment and other needed health services.

US Health Care Reform and Rural America: Results From the ACA's Medicaid Expansions

Medicaid expansions, prompted by the Affordable Care Act, generated generally positive effects on coverage and alleviated much of the financial burden associated with seeking health care. We do not know if these shifts also extend to the nation's rural populations. Using 2011-2015 Behavioral Risk Factor Surveillance System data, this study compares trend changes for coverage, access to care, and health care utilization in response to Medicaid expansion among urban and rural residents using a difference-in-differences regression approach. Following Medicaid expansion, low-income rural and urban residents both experienced reductions in uninsurance; however, the coverage uptake in rural settings (8.5 percentage points [pp], P < .01) was much larger than the uptake in coverage in more urban settings (4.1 pp, P > .10). In spite of larger uptakes in coverage among rural residents, reductions in cost-related barriers to medical care were slightly larger among urban residents, and access to a regular source of medical care (5.2 pp, P < .05) and doctor visitation (4.5 pp, P < .01) were only statistically significant among urban residents. The ACA Medicaid expansions produced larger gains in coverage for rural residents than urban residents; however, it appears there remain opportunities to improve access to care among potentially vulnerable rural residents.

Self-reported medical care seeking behaviour of doctors in Nigeria

BackgroundThere is need for information on the medical care seeking behaviour of Nigerian doctors. PurposeThis work was therefore designed to study the medical care seeking behaviour of Nigerian doctors in Nigeria. MethodsIt was a cross-sectional survey among doctors in Nigeria. ResultsData from 522 doctors were included in the analysis. Majority of them (80.5%) had one form of illness or the other in the year preceding the survey. Only 35% of them reportedly consulted another doctor during their illness. Most of the consultations (61.2%) were informal in the form of over the phone (45.6%), Corridor (33.3%) and home visit (21.1%) and just 18.4% of the consultations occurred within 24h of onset of illness. A low 19.5% of them had a regular source of medical care. Screening for illnesses was generally below expectation. Just 6 out of the 436 (1.4%) male doctors had screened for prostate cancer while 39 out of 86 (45.3%) females had screened for cervical cancer. A significantly higher proportion of general practitioners (p=0.01) and doctors above 45 years of age (P=0.004) consulted informally. Higher proportion of general practitioners and resident doctors based their consultations on their familiarity with the doctors consulted (p=0.001) and privacy during consultation (p=0.001). Delay in consultation for more than 24h after onset of illness was more likely in those above below the age of 45 years (p=0.001). ConclusionThis study has shown that Nigerian doctors are often reluctant patients who frequently tend to delay medical care. The teaching of appropriate medical care seeking behaviour should be incorporated into medical curriculum in Nigeria.

Examining CAM use disclosure using the Behavioral Model of Health Services Use

To improve understanding of factors that may influence disclosure of complementary and alternative medicine (CAM) use in the U.S. Cross-sectional survey. Data are from the 2001 Health Care Quality Survey (HCQS), a nationally representative study of adults aged 18 and older living in the continental United States. Using the Behavioral Model of Health Services Use, we conducted multivariate logistic regressions to identify factors associated with disclosing CAM use among the sub-sample of recent CAM users (n=1995). Disclosure of CAM use. Most CAM users (71.0%) disclosed their use of CAM to their doctors. Contextual, individual, and health behavior factors were associated with CAM use disclosure. Of particular interest, disclosure was significantly more likely among those who perceived high quality relationships with their providers (AOR=1.59, CI: 1.01, 2.49) and among those who had a regular source of medical care (AOR=1.54, CI: 1.03, 2.29). The odds of disclosure were also higher among those who used practitioner-provided CAM, with (AOR=2.02, CI: 1.34, 3.06) or without (AOR=1.52, CI: 1.05, 2.20) concurrent herbal medicine use, compared to those who used herbal medicines only. The Behavioral Model of Health Services Use is a useful framework for examining factors that may influence disclosure of CAM use. Further research should examine these relationships using more comprehensive measures.

Impact of Health Insurance Status and a Diagnosis of Serious Mental Illness on Whether Chronically Homeless Individuals Engage in Primary Care

We evaluated the impact of a diagnosis of serious mental illness on use of a primary care provider (vs the emergency department [ED]) as a source of care by people who were chronically homeless. We used data from 750 chronically homeless adults enrolled in the 11-site Collaborative Initiative to Help End Chronic Homelessness and identified demographic and clinical characteristics independently associated with using a primary care provider rather than an ED. The factor most strongly associated with using the ED as a regular source of medical care was previous-year lack of health insurance. Despite high rates of serious mental illness, neither a diagnosis of serious mental illness nor increased severity of psychiatric symptoms was associated with such use. Findings suggest that people who are chronically homeless and have chronic medical illness would be more likely to access care if they had health insurance. Individual states' deciding not to expand Medicaid coverage will likely have a tremendous impact on the health outcomes and health care costs associated with this and other vulnerable populations.

New roles for public health in cancer screening

Screening tests for the early detection of breast, cervical, and colorectal cancer are prioritized clinical preventive services that can reduce the burden of cancer in the United States. 1 While significant progress has been made in this area, screening rates for breast and cervical cancers have not improved in almost a decade and rates for colorectal cancer are unacceptably low. Lack of insurance has traditionally been the main factor preventing adults from obtaining cancer screening. 2 Components of the Patient Protection and Affordable Care Act will help address this through Medicaid expansion, subsidized state insurance exchanges, and the elimination of cost sharing. However, access to health insurance and medical care are not the only factors that limit participation in cancer screening. Many people who currently have health insurance and regular access to medical care are not being screened. Based on 2010 National Health Interview Survey data, among adults aged 50 to 75 years with a regular source of medical care, only 62% were up to date with screening for colorectal cancer and only 75% of women in this age range had received a mammogram within the preceding 2 years. 3 Analyses of national Medicare data revealed that, despite coverage of cancer screening services, only 66% of eligible women had undergone a mammogram within the past 2 years 4 and only 47% of adults had insurance claims documenting adequate screening for colorectal cancer. 5 To realize the full potential of anticipated improvements in access to care, public health must provide leadership to ensure that cancer screening is proactive, organized, and equitable.

Behavioral and Socioeconomic Correlates of Dental Problem Experience and Patterns of Health Care-Seeking

To recognize and better understand barriers to dental care, the authors studied behavioral and socioeconomic factors specific to low-income and minority populations that contribute to patterns of professional health care-seeking. A stratified random sample of 27,002 Maryland households participated in a cross-sectional telephone survey. The authors targeted respondents who were low-income non-Hispanic white, non-Hispanic black or Hispanic who had experienced a dental problem or injury during the previous 12 months, as well as similar people with higher incomes for comparison. A total of 94.8 percent (401 of 423) of eligible people completed the survey. Logistic regression modeling (95 percent confidence interval) revealed that the respondents' race or ethnicity and sex were associated with the number of dental problems experienced during the previous 10 years, and that having a regular source of medical care and the type of dental problem experienced were associated with earlier health care-seeking. The first choice of treatment site (physician's office, emergency department or dentist's office) was associated with the respondents' income, pain level, number of problems experienced in the past 10 years and the degree to which their problem was a burden. The authors found that predisposing, enabling and need-based factors were associated with dental problem experience and patterns of professional health care service use.

Knowledge and use of ethnomedical treatments for asthma among Puerto Ricans in an urban community.

Puerto Ricans have higher lifetime and current asthma prevalence than other racial and ethnic groups in the United States. A great many Hispanics use ethnomedical therapies for asthma. This study elicited participant knowledge of ethnomedical therapies, developed a typology of the therapies, and considered whether some types are used or deemed efficacious based, in part, on information source. Eligible participants were randomly selected from the medical records of an inner-city primary care clinic serving a predominantly Hispanic community in Buffalo, New York. Thirty adult Puerto Ricans who had asthma or were care-givers of children with asthma were interviewed in person using a semistructured instrument. Qualitative data analysis followed a content-driven immersion-crystallization approach. Outcome measures were ethnomedical treatments for asthma known to participants, whether these treatments were used or perceived effective, and the participant's information source about the treatment. Participants identified 75 ethnomedical treatments for asthma. Behavioral strategies were significantly more likely to be used or perceived effective compared with ingested and topical remedies (P <.001). Among information sources for ingested and topical remedies, those recommended by community members were significantly less likely to be used or perceived effective (P <.001) compared with other sources. This sample of Puerto Ricans with a regular source of medical care was significantly more likely to use or perceive as effective behavioral strategies compared with ingested and topical remedies. Allopathic clinicians should ask Puerto Rican patients about their use of ethnomedical therapies for asthma to better understand their health beliefs and to integrate ethnomedical therapies with allopathic medicine.

Access to Medical Care, Use of Preventive Services, and Chronic Conditions Among Adults in Substance Abuse Treatment

Few studies have examined access to a regular source of medical care and preventive medical care among adults being treated for substance abuse. This report describes the prevalence of a usual source of care, use of preventive care services, and self-reported chronic conditions among adults in a publicly funded substance abuse treatment program. The investigators partnered with a large behavioral health organization in Los Angeles County to conduct an interviewer-administered survey during June 2008. A total of 254 clients completed the survey. Fifty percent reported having a usual source of medical care, and 70% reported at least one visit to a physician within the prior 12 months. Participants reported low receipt of most preventive care screening measures. Half had at least one chronic condition, with hypertension, asthma, and arthritis most often reported. Although this middle-aged sample with substantial medical need reported having access to care, receipt of preventive care was low and unaddressed health concerns were reported.

Prevalence, Diagnosis, and Treatment of Depression and Generalized Anxiety Disorder in a Diverse Urban Community

This study assessed the prevalence, diagnosis, and treatment of major depressive disorder and generalized anxiety disorder among New York City adults. As part of the first community-specific Health and Nutrition Examination Survey in the United States, depression and anxiety were assessed in a representative sample of 1,817 noninstitutionalized adults in 2004. A total of 8% had major depressive disorder and 4% had generalized anxiety disorder. Respondents with depression were more likely to be formerly married, publicly insured, younger, and U.S. born. Only 55% of adults with depression were diagnosed, and 38% of those with depression or anxiety were in treatment; individuals with a diagnosis of depression were more likely to receive treatment than those without a diagnosis (61% versus 7%; p<.001). Immigrants with depression were 60% less likely to be diagnosed than their U.S.-born counterparts; immigrants arriving in this country ten or more years ago had slightly more anxiety than immigrants arriving less than ten years ago (3% versus 2%, not significant). Among respondents with anxiety, 23% reported disability compared with 15% of those with depression. Compared with adults with neither diagnosis, adults with depression or anxiety were twice as likely to smoke tobacco (p<.05), adults with depression were twice as likely to have diabetes (p<.01), and those with anxiety were twice as likely to have asthma (p<.01). Mental disorders are often disabling and inadequately diagnosed and treated. Foreign-born adults experience barriers to diagnosis and treatment despite having less depression; anxiety may increase with time since immigration. Increased awareness of and linkage to mental health services are needed, especially in larger, more diverse urban communities.

Homeless Women: Who is Really at Risk for Unintended Pregnancy?

To identify correlates of failure to use contraception among homeless women at risk for unintended pregnancy. A representative sample of 974 homeless women surveyed in Los Angeles County in 1997 included 457 who were at risk for unintended pregnancy. Logistic regression modeling was used to identify important predictors of contraceptive nonuse or rare use in the past year. One third of the sample used contraception rarely or never in the past year. Having a partner, being monogamous, and not engaging in sex trade predicted contraceptive nonuse or rare use (odds ratios 2.43-4.73, P < .05). Partner dislike and uncertainty about which contraceptive to use were also associated with failure to use contraception (odds ratios 2.64-2.96, P < .05). Having a regular source of care and having been encouraged to use contraception protected against failure to use contraception. Homeless women, including those at apparently low risk for unintended pregnancy, need to be targeted with integrated services that include education, a regular source of medical care, and encouragement to use contraception.

Prevalence of Active Epilepsy and Health‐Related Quality of Life among Adults with Self‐Reported Epilepsy in California: California Health Interview Survey, 2003

To examine the prevalence of self-reported epilepsy and active epilepsy, associated burden of impaired health-related quality of life, risk factors, and access to care in adults with self-reported epilepsy, and those classified as having active epilepsy with and without recent seizures. We analyzed data from adults aged >or=18 years (n = 41,494) who participated in the 2003 California Health Interview Survey (CHIS). In California, 1.2% of adults reported ever being told they had epilepsy or seizure disorder, and 0.7% were classified as having active epilepsy. About three-fourths of adults with active epilepsy with recent seizures reported fair or poor health status. Adults with active epilepsy with recent seizures reported almost two weeks of poor physical or mental health and activity limitation days compared with two to 4 days per month in those without epilepsy. Among adults with active epilepsy and recent seizures, about one-quarter reported not taking any medicine to control their seizure disorder or epilepsy. About one-third reported physical disability/unable to work compared to a small proportion of the general population. The majority of adults with active epilepsy reported having a regular source of medical care. Our findings highlight the burden of epilepsy among adults in California. CHIS serves as a model demonstrating the value of including questions about epilepsy on public health surveillance systems to ascertain the burden of the disorder and to guide intervention research and public policy to improve HRQOL in people with epilepsy.

Health Care Access and Sociodemographic Factors Associated with Hepatitis B Testing in Vietnamese American Men

Chronic hepatitis B viral (HBV) infection greatly increases the risk for cirrhosis and hepatocellular carcinoma. HBV serologic testing is important for the identification of chronically infected individuals, who may benefit from antiviral treatment and regular monitoring for disease sequelae. Elevated rates of cirrhosis and hepatocellular carcinoma among Vietnamese American men can largely be attributed to high rates of chronic HBV infection. We surveyed 509 Vietnamese men aged 18-64 years in Seattle, Washington and examined sociodemographic and health care access factors associated with HBV serology testing. Nearly two-thirds (65%) reported past testing. The following were among those factors associated with HBV testing in bivariate comparisons: older age; short proportion of life in the US; low English fluency; private health insurance; identifying a regular source of medical care; reporting no long waits for medical appointments; and having access to interpreter services. The following were independently associated with HBV testing in multiple logistic regression analysis: older age; college education; low English fluency; private health insurance; having a regular medical provider; and reporting no long waits for medical appointments. Younger and less educated men, and those with difficulty accessing medical care may be at particular risk for never having had HBV testing. Programs to reduce HBV transmission and sequelae should make special effort to target these vulnerable Vietnamese Americans.

Association between screening family medical history in general medical care and lower burden of cancer worry among women with a close family history of breast cancer

Purpose:Soliciting family medical history (FMH) is the initial step in the process of screening for heritable cancer risk in medical care. We investigate whether recent solicitation of FMH in general medical care is associated with cancer worry among a sample of women having a first-degree relative with a breast cancer diagnosis. MethodsSurveys were mailed to women registered with the Cancer Genetics Network having a first-degree relative with a breast cancer diagnosis and a regular source of medical care. The independent measure consisted of two items for solicitation of FMH based on validated measures of clinical interactions with one's physician; the dependent measure was a novel measure of cancer worry based on validated patient-centered measure of distress; and the secondary measures were 6-point scales for perceived likelihood of developing breast cancer and perceived severity of breast cancer as a health outcome. ResultsA total of 353 women responded and met eligibility criteria (76.4% minimum response rate). One fifth reported no cancer worry during the past 4 weeks. After adjustment for age, education, pedigree features, and clustering within families, recent FMH solicitation was associated with lower odds of cancer worry (odds ratio = 0.58; 95% confidence interval = 0.51–0.70). FMH solicitation was associated with lower perceptions of the severity of developing breast cancer but not with the perception of cancer likelihood. ConclusionsOur data do not support the hypothesis that FMH solicitation in general medical practice causes cancer worry. In fact, we observed a protective association possibly explained by influences on perceptions of breast cancer severity. Prospective research among less select populations is necessary.

Eliminating Health Care Disparities Requires Proper Treatment Tools

Eliminating Health Care Disparities Requires Proper Treatment Tools

Patterns and correlates of HIV testing among sheltered and low-income housed women in Los Angeles County.

This study investigated the prevalence, location, and correlates of HIV testing in a random sample of women drawn from shelters (n = 460) and low-income housing units (n = 438) in Los Angeles County. Most women (83%) had been tested for HIV, with the most common location being a clinic or physician's office (82%). Sheltered women were more likely to have ever been tested and, among those tested, to have been tested in a treatment program, mobile van, hospital or emergency department, or jail. Multivariate analyses indicated that testing was more likely among women who were sampled from shelters, younger, living with a child, had a regular source of medical care, were drug or alcohol dependent in the past year, experienced sexual violence, and were at low risk for mental health problems. Few women reported lack of money, transportation, or access to testing facilities as primary barriers to being tested. Although our results suggest that most impoverished women in our study area did not experience significant impediments to HIV testing, programs to encourage testing among older women, stably housed women who lack a regular source of care, and women at high risk for mental health problems may be warranted.

Effect of medical, drug abuse, and mental health care on receipt of dental care by drug users

We examined the association of patterns of health care in 1996 with subsequent dental care in 1997 or 1998 for 47,260 drug users enrolled in New York State Medicaid. From Medicaid files, we identified psychiatric care, prescribed antidepressants, a regular source of medical care, regular drug treatment (6+ contiguous months), and clinical conditions. Of this cohort, 58% received dental care. The adjusted odds ratios (AOR) of dental care were increased for drug users receiving psychiatric care and antidepressants (1.66 [1.55, 1.77]), psychiatric care alone (1.48 [1.41, 1.56]), or only antidepressants (1.18 [1.10, 1.27]), vs. neither. AORs of dental care were also higher for those with a regular source of medical care alone (1.27 [1.23, 1.35]) or with regular drug treatment (1.33 [CI 1.25, 1.41]) vs. neither. Mental health care and, to a lesser extent, a regular source of medical care and regular drug treatment may promote dental care in this vulnerable population.