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Journal of Health Care for the Poor and Underserved

Jinjing Wu, Kelsey S Dean, Zohn Rosen, Peter A Muennig
We evaluated whether Nurse-Family Partnership might serve as a cost-effective social policy for improving health. Using data from studies of randomized controlled trials as well as real-world data, we conducted a Monte Carlo simulation to estimate cost-effectiveness of Nurse-Family Partnership in a hypothetical cohort of first-born children in the United States. Analyses were conducted in 2015. Were all new mothers eligible for Nurse-Family Partnership, the program would produce 0.11 QALYs (95% confidence interval [CI]=0...
2017: Journal of Health Care for the Poor and Underserved
Donald Warne, Kristen Dulacki, Margaret Spurlock, Thomas Meath, Melinda M Davis, Bill Wright, K John McConnell
OBJECTIVES: To assess the prevalence of Adverse Childhood Experiences (ACEs) and their association with behavioral health in American Indian (AI) and non-AI populations in South Dakota. METHODS: We included the validated ACE questionnaire in a statewide health survey of 16,001 households. We examined the prevalence of ACEs and behavioral health conditions in AI and non-AI populations and associations between ACEs and behavioral health. RESULTS: Compared with non-AIs, AIs displayed higher prevalence of ACEs including abuse, neglect, and household dysfunction and had a higher total number of ACEs...
2017: Journal of Health Care for the Poor and Underserved
Xai Saenphansiri, David K Wyant, Linda G Wofford
We examined barriers to health care among Laotian Americans in a Middle Tennessee community that included a Laotian-speaking practitioner. A Laotian American primary care clinic nurse practitioner surveyed 312 adult Laotian Americans. The dependent variable was whether respondents visited (n = 214, 77.8%) or did not visit (n = 61,22.2%) primary care providers (PCP) in the last year. Chi-square analysis found visiting less likely if respondents were age 18-34 (p < .001), born in U.S. (p < .001), spent less time in U...
2017: Journal of Health Care for the Poor and Underserved
Kathleen Mathieson, Joan S Leafman, Mark B Horton
INTRODUCTION: Health care access for medically underserved patients managing chronic conditions is challenging. While telemedicine can support patient education and engagement, the "digital divide" may be particularly problematic among the medically underserved. This study evaluated physical access to digital devices, use of e-mail and social media tools, and perceptions of telemedicine among American Indian (AI) patients with diabetes mellitus (DM). METHODS: Survey data were collected from AI patients with DM during teleophthalmology exams...
2017: Journal of Health Care for the Poor and Underserved
Erin Fanning Madden, Fares Qeadan
Medicare provides access to chronic outpatient dialysis for most U.S. patients diagnosed with end-stage renal disease. However, many new and/or undocumented immigrants do not qualify due to lawful presence and work credit requirements. Medicare-ineligible dialysis patients often wait until their health is poor enough for admission to emergency room dialysis. We use University of New Mexico Hospital chart data from 2013-2016 for a case-control study measuring the likelihood of being admitted to an emergency room for dialysis among patients who use interpreters, which is employed as a proxy for new and undocumented immigrants, compared with other patients...
2017: Journal of Health Care for the Poor and Underserved
Lisa M Lines, Allison B Rosen, Arlene S Ash
Much of emergency department use is avoidable, and high-quality primary care can reduce it, but performance measures related to ED use may be inadequately risk-adjusted. To explore associations between emergency department (ED) use and neighborhood poverty, we conducted a secondary analysis of Massachusetts managed care network data, 2009-2011. For enrollees with commercial insurance (n = 64,623), we predicted any, total, and total primary-care-sensitive (PCS) ED visits using claims/enrollment (age, sex, race, morbidity, prior ED use), network (payor, primary care provider [PCP] type and quality), and census-tract-level characteristics...
2017: Journal of Health Care for the Poor and Underserved
Elizabeth Kvach, Jane Lose, Hayley Marcus, Lucy Loomis
OBJECTIVE: The goal of this project was to increase rates of screening for pregnancy intention in primary care. METHODS: Two urban federally qualified health centers with diverse patient populations undertook a quality improvement project to increase rates of routine screening for pregnancy intention among pre-menopausal non-pregnant women ages 12-45 without history of sterilization. Responses were recorded in the electronic medical record (EMR). RESULTS: Screening rates of eligible women increased from 0% to 68...
2017: Journal of Health Care for the Poor and Underserved
Erika Heredia-Ponce, A Esther Irigoyen-Camacho, Sergio Sánchez-García
OBJECTIVE: To determine the association between oral health and socioeconomic position in institutionalized older women in Mexico City. METHODS: A cross-sectional study was performed in two groups: high socioeconomic position (HSEP), living in a private retirement home, and low socioeconomic position (LSEP), living in a public assistance center. Oral health was determined by edentulism, oral hygiene, healthy teeth, experience of dental caries, missing and filled teeth, gingival bleeding, dental calculus, and periodontal disease...
2017: Journal of Health Care for the Poor and Underserved
Kristine R Hearld, Henna Budhwani
This study compares maternal health care utilization of women living with HIV with that of their HIV-negative peers in Haiti. Data from the 2012-2013 Haiti Demographic and Health Survey were analyzed. Three percent of mothers were HIV-positive. These mothers had over two times greater odds than HIV-negative mothers of accessing prenatal care in the first trimester and to deliver in a medical institution, and 1.9 greater odds of having a medical personnel at delivery. Haiti has made progress in increasing maternal health care utilization, specifically in an effort to reduce mother-to-child-transmission of HIV...
2017: Journal of Health Care for the Poor and Underserved
Alex Harocopos, Bennett Allen, Sarah Glowa-Kollisch, Homer Venters, Denise Paone, Ross Macdonald
A cohort of frequently incarcerated individuals in the New York City jail system was identified through "hot spotting" analysis. This group demonstrated higher levels of substance use, mental illness, and homelessness than the general jail population, and was typically incarcerated on minor criminal charges. To understand this population better, in-depth interviews (n = 20) were conducted at three Rikers Island correctional facilities with people who had entered the jail system at least 18 times in a six-year period...
2017: Journal of Health Care for the Poor and Underserved
Cindy Jean Hadenfeldt, Marie Darabaris, Marilee Aufdenkamp
PURPOSE: Frailty is most commonly associated with older adults; however, it has also been identified in vulnerable populations, including homeless adults. Patients who seek health care services in a free clinic often report physical exhaustion, difficulty coping with stressors, chronic disease states, environmental limitations, and a lack of social support, which may contribute to a state of frailty. This pilot study (N = 38) was conducted in adults ages 40-64 years who utilized a free clinic to determine if factors suggestive of frailty were present...
2017: Journal of Health Care for the Poor and Underserved
Vivian Irizarry Gatell, Thu Nguyen, Emily E Anderson, Michael P McCarthy, John J Hardt
We explored medical students' desire to practice medicine in a medically under-served area (MUS). We surveyed M1-M4 students at Loyola University Stritch School of Medicine (66% overall response rate). Primary outcome was intent to locate future practice in a MUS. Predictor variables included gender, race/ethnicity, and measures of religiosity, spirituality, sense of calling, burnout, and interest in primary care. In bivariate analysis, we found statistically significant associations between our primary outcome variable and gender, spirituality, growing up in MUS, sense of calling, primary care interest, and burnout...
2017: Journal of Health Care for the Poor and Underserved
Paul C Erwin, Laurie L Meschke, Samantha F Ehrlich, Lisa C Lindley
OBJECTIVE: To describe the epidemiology of neonatal abstinence syndrome (NAS) in a 16-county Appalachian area of eastern Tennessee. METHODS: The Tennessee Surveillance System for NAS provided data on maternal sources of opioids. Data linking hospital discharge diagnosis for NAS to birth certificate data allowed us to compare maternal, delivery, and infant characteristics for NAS births with those for non-NAS births. RESULTS: There were 339 cases of NAS in 2013 and 367 in 2014, for NAS rates of 25...
2017: Journal of Health Care for the Poor and Underserved
Avik Chatterjee, Marvin So, Spencer Dunleavy, Emily Oken
BACKGROUND: We assessed whether and how health care organizations serving homeless pediatric patients meet recommendations issued by the American Academy of Pediatrics (AAP). METHODS: We conducted a web-based survey of Health Care for the Homeless (HCH) Program grantees serving children. RESULTS: Of 169 grantees, 77 (46%) responded. All organizations reported connecting patients to specialty services. Nearly all reported screening for homelessness (90%), facilitating Medicaid enrollment (90%), connecting patients to benefits (94%), addressing underlying causes of homelessness (83%), assisting with transportation (83%), and knowing about the causes of homelessness (76%)...
2017: Journal of Health Care for the Poor and Underserved
Renuka Bhaskar, Brett J O'Hara
Compared with other racial/ethnic groups, American Indians and Alaska Natives (AIANs) have higher uninsured rates and worse health outcomes. Using data from the 2010-2014 American Community Survey, we employ logistic regression techniques to assess the characteristics associated with Indian Health Service (IHS) coverage among working-age AIANs who have health insurance or are uninsured. Across all insurance categories, geographic residence is a factor in IHS coverage. Among the uninsured, those with and without IHS coverage are more dissimilar than similar across socioeconomic characteristics...
2017: Journal of Health Care for the Poor and Underserved
Jong-Deuk Baek, Robert L Seidman, Tracy L Finlayson
The Affordable Care Act expanded health insurance for low-income, uninsured individuals. Few longitudinal analyses have investigated how insurance expansion influences cost and utilization among adults with chronic conditions. This study conducted longitudinal analysis investigating time trends in utilization and cost among newly insured, chronically ill, low-income individuals using Generalized Estimating Equations models. For hospitalization, hospital outpatient services, emergency department (ED) visits, and primary care visits, two indicators were measured: the proportion of enrollees with services and the average number of visits among users...
2017: Journal of Health Care for the Poor and Underserved
Sabrina A Assoumou, Wei Huang, Kraig Young, C Robert Horsburgh, Benjamin P Linas
BACKGROUND: Little is known about real-world outcomes for new interferon-free treatment for hepatitis C virus (HCV) among underserved and diverse communities. OBJECTIVE: To identify predictors of treatment prescription and evaluate outcomes as measured by sustained virologic response (SVR) with HCV RNA testing three months after therapy completion. DESIGN: Retrospective cohort at a safety-net health care system. PARTICIPANTS: Patients with (1) at least one clinical visit between December 6, 2013, and December 31st 2014; and (2) at least three months follow-up...
2017: Journal of Health Care for the Poor and Underserved
Ashley Sturgeon, David Allen Pate, Ravi Patel, Katherine Snodgrass, Michelle Tarbox, Fiona Prabhu, Phillip Watkins
Non-melanoma skin cancer (NMSC) is a common reason for outpatient primary care visits. Uninsured patients may be at a higher risk for NMSC due to lack of access to health care and a possible increased risk of sun exposure due to insecure housing. The true incidence of NMSC in this population is unknown. In order to determine the population's incidence of NMSC we performed a retrospective chart review on all patients (n = 656) seen at the Lubbock Impact Free Clinic from July 1, 2014 through July 30, 2015. This highlighted an increased incidence of NMSC in our uninsured population (1...
2017: Journal of Health Care for the Poor and Underserved
Ana P Martinez-Donate, Ifna Ejebe, Xiao Zhang, Sylvia Guendelman, Félice Lê-Scherban, Gudelia Rangel, Eduardo Gonzalez-Fagoaga, Melbourne F Hovell, Catalina Amuedo-Dorantes
OBJECTIVES: We examined differences in, and factors associated with, access to health services among Mexican im/migrants to the U.S. across migration phases, including pre-departure, destination, interception, and return. METHODS: Using data from a cross-sectional survey conducted in Tijuana, Mexico (N = 1,541), we computed descriptive statistics and staged logistic regressions to estimate health care access indicators and factors associated with access to services...
2017: Journal of Health Care for the Poor and Underserved
Grant Benham, Suad F Ghaddar, Liza Talavera-Garza
The present study examined the relationship between obesity and sleep duration among Hispanic manufacturing workers. Two hundred and twenty eight Hispanic workers from eight manufacturing plants completed an in-person interview that included measures of demographics, health literacy, and sleep duration. Height and weight were directly assessed. A logistic regression, controlling for gender, education, age, income, physical activity levels, self-reported health status, and health literacy, indicated that workers who slept six hours or less were significantly more likely to be obese than those sleeping seven to nine hours (OR: 1...
2017: Journal of Health Care for the Poor and Underserved
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