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Journal of Health Care for the Poor and Underserved

Hants Williams, R N Susan Silva, David Cline, Caroline Freiermuth, Paula Tanabe
to determine frequency of health care encounters among people with sickle cell disease (SCD) seeking treatment for a vaso-occlusive crisis (VOC). Health care encounters are categorized by visit type (day hospital, ED visit, hospitalization), prevalence of self-reported behavioral and social factors, and any associations between behavioral and social factors and health care encounters. Ninety-five people with SCD were enrolled in a prospective descriptive study in North Carolina. Patients were interviewed concerning behavioral-social factors, and a report of health care encounters was produced, generated by ICD codes associated with VOCs between October 2011 and March 2014...
2018: Journal of Health Care for the Poor and Underserved
Dan Shetler, Donald S Shepard
Medical respite (MR) programs provide medical care, social services, and a safe place to recuperate for people experiencing homelessness after hospital discharge. We examined the financial impact of MR on hospitals and insurers in states with varying Medicaid coverage. Urban case-study hospitals were selected from a state with Medicaid expansion under the Affordable Care Act (Connecticut) and without expansion (Florida). We calculated costs and savings from MR to hospitals and payers from the hospitals' financial data...
2018: Journal of Health Care for the Poor and Underserved
John A Rizzo, Jie Chen, Chad Laurich, Angelo Santos, Brad J Martinsen, Michael P Ryan, Harry Kotlarz, Candace Gunnarsson
INTRODUCTION: This study analyzed the impact of sociodemographic characteristics, patient comorbidities, risk factors for critical limb ischemia and hospital characteristics on racial disparities in amputation rates for Native American patients with peripheral artery disease (PAD). METHODS: The study used the Healthcare Cost and Utilization Program inpatient discharge data from 2006-2013 for patients with a primary diagnosis of PAD. Multivariable models using the Blinder-Oaxaca decomposition method were estimated to isolate the impact of individual covariates to identify determinants of amputation rates for Native Americans compared with non-Hispanic Whites...
2018: Journal of Health Care for the Poor and Underserved
Rebecca J Perry, Sarita Karon
For many years, barriers to access have been a significant concern in the Medicaid program. In November 2015, the Centers for Medicare & Medicaid Services issued a Final Rule that requires states to submit access monitoring plans every three years beginning in October 2016. State access monitoring plans must focus on five categories of service and three domains for measuring and monitoring access to care. This article presents findings from the first national survey that examines what states were doing to measure access to fee-for-service Medicaid care prior to the Final Rule...
2018: Journal of Health Care for the Poor and Underserved
Adana A Llanos, Gregory S Young, Ryan Baltic, Eugene J Lengerich, Betsy B Aumiller, Mark B Dignan, Electra D Paskett
BACKGROUND: Rural residents in the U.S., particularly residents of Appalachia, are underrepresented in biomedical research, limiting the generalizability of research findings. OBJECTIVE: To examine factors associated with Appalachian adults' willingness to participate in biospecimen donation and banking. METHODS: A survey assessing willingness to donate blood, saliva, and buccal specimens and to have these biospecimens stored for future use in genetic studies was conducted among 493 Appalachian adults...
2018: Journal of Health Care for the Poor and Underserved
Leah Frerichs, Jewels Rhode, Ronny Bell, Charlene Hunt, Jan Lowery, Michael Brooks, Cherry Beasley, Dan Reuland
American Indians (AI) have disproportionately high rates of colorectal cancer (CRC), but there is relatively little research focused on developing AI CRC screening interventions. We held six focus groups with AIs in rural Eastern U.S. (n=74) and analyzed the qualitative data from them in order to identify individual and socio-cultural factors that influence AI CRC screening decisions. Screening fear and anxiety was a central theme of the focus groups. For example, participants told stories about how late-stage cancer diagnoses and deaths in the community contributed to their fears and cancer fatalism...
2018: Journal of Health Care for the Poor and Underserved
Imam M Xierali
While differences in practice style and costs between family medicine and internal medicine are relatively well known, the differences in geographic distribution between the two remain underexplored. This study aims to examine differences in distribution of family physicians and general internists by geographic and demographic characteristics. Data sources are the 2016 American Medical Association Physician Master File and 2015 American Community Survey. Results show that internists are more dominant in urban areas, especially in the Northeast; they are also more likely to practice in the West and South...
2018: Journal of Health Care for the Poor and Underserved
Silas P Trumbo, Kelly M Schuering, Justiss A Kallos, Nicolas Baddour, Shayan Rakhit, Li Wang, Michael Fowler, Eduard E Vasilevskis, Robert F Miller
Student-run free clinics (SRFCs) serve uninsured patients and offer unique educational opportunities. However, the impact of these clinics on hospital utilization is unclear. In this pre-post observational study, we used multivariable modeling to test the hypothesis that patients of Shade Tree Clinic, the SRFC affiliated with Vanderbilt University Medical Center (VUMC), would have decreased hospital utilization after joining the clinic. To evaluate the relationship between STC and VUMC, we conducted a sub-analysis of patients referred to Shade Tree from VUMC using univariate Wilcoxon signed-rank tests...
2018: Journal of Health Care for the Poor and Underserved
Emily W Stewart, Leanne R De Souza, Mark H Yudin
We assessed whether eligible refugee claimants faced barriers to accessing prenatal care in the context of changes to Canadian health care policy that generated multiple categories of refugee health care eligibility. METHODS: Prenatal care providers in Toronto were contacted twice using standardized scripts to book appointments for a pregnant non-refugee and refugee claimant, both eligible for prenatal care. PRIMARY OUTCOME: unequivocal offer of appointment. Secondary outcome: reasons for refusal of prenatal care...
2018: Journal of Health Care for the Poor and Underserved
Ivan Marquez, Neil Calman, Casey Crump
OBJECTIVE: To determine whether enhanced primary care services delivered preferentially to high-risk patients with diabetes (HbA1c >9%) can effectively reduce racial/ethnic disparities in glycemic control. METHODS: This retrospective study analyzed electronic health records to examine changes in pre-vs. post-intervention disparities in HbA1c among Hispanics/Latinos relative to non-Hispanic Whites. RESULTS: Mean HbA1c and prevalence of poorly controlled diabetes improved in both racial/ethnic groups, but to a greater extent among Hispanics/Latinos...
2018: Journal of Health Care for the Poor and Underserved
Jessica H Leibler, Kelsey Robb, Eugene Joh, Jessie M Gaeta, Marieke Rosenbaum
Homeless people in the United States may experience poor hygiene and spend extended periods of time outdoors, which increases exposure to animal and insect vectors of disease. Despite these risks, efforts to understand frequency and risk factors for zoonotic and vector-borne infections among homeless people have been limited. We queried homeless people in Boston, Massachusetts (n=194) to evaluate exposure to urban wildlife and ectoparasites associated with infection. Thirty percent of participants reported seeing rodents daily, and 25% reported daily sightings of cats...
2018: Journal of Health Care for the Poor and Underserved
Jelani Kerr, Toya Northington, Tamara Sockdjou, Eleanor Maticka-Tyndale
Socio-environmental factors such as neighborhood quality are increasingly recognized drivers of HIV disparities. Additionally, HIV- related stigma heightens HIV vulnerability among youth in the African Diaspora. However, little research examines the intersection of neighborhood quality and HIV- related stigma. This study uses survey data (N=495) from African, Caribbean, and Black youth in a midsized city in Ontario, Canada to address this research deficit. Analysis of variance and multivariate ordinary least squares regressions were conducted to determine differences in HIV- related stigma by neighborhood quality, experiences of discrimination, HIV- knowledge, and demographic factors...
2018: Journal of Health Care for the Poor and Underserved
Kelly M Doran, Donna G Castelblanco, Tod Mijanovich
Latinos are the largest immigrant group in the United States, representing 17.6% of the total U.S. population, and are therefore critical to include in research. However, Latino immigrants-and particularly those who are undocumented residents-may be increasingly wary of participating in research amidst hostile anti-immigrant rhetoric and high profile cases of deportation. In this commentary we discuss challenges of conducting research with undocumented Latino immigrants in the current sociopolitical climate...
2018: Journal of Health Care for the Poor and Underserved
Shorena Sadzaglishvili
During the 69th UN General Assembly world leaders agreed that ending the AIDS epidemic as a public health threat by 2030 was possible. An AIDS-free generation is not achievable without addressing youth vulnerability globally. Street-connected youths are one of the groups most at risk.
2018: Journal of Health Care for the Poor and Underserved
Alizay Jalisi, Monica Guerrero Vazquez, Linda Bucay-Harari, Flor Giusti, Jessica Contreras, Donna Batkis, Marcelo Batkis, Sarah Polk, Barbara Cook, Kathleen R Page
Latino immigrants face many stressors before, during, and after migration to the U.S., but there are few mental health services available to help them cope with this transition. We established free group sessions moderated by bilingual therapists to address the unmet mental health needs of Latino immigrants.
2018: Journal of Health Care for the Poor and Underserved
Meme Wang-Schweig, Sharon Lipperman-Kreda, Juliet P Lee
We conducted a preliminary study to rapidly assess (1) whether an underground cigarette market exists in the area known as Oakland Chinatown in Oakland, California; and if so, (2) who consumes untaxed cigarettes in this ethnic enclave to provide a basis for further investigation.
2018: Journal of Health Care for the Poor and Underserved
Jennifer K Yee, Aziza Lucas-Wright, Peter Y Liu, Bowen Chung, Rachelle Bross, Silva Malkhassian, Keith C Norris, Christina Wang, Loretta Jones
In South Los Angeles, a community-engaged research project on obesity was initiated between a translational research institute seeking to build community-based or partnered participatory research (CBPR/CPPR) capacity, and a community partner with extensive experience. This manuscript describes the partnership-building process and discusses results from a bi-directional knowledge transfer event.
2018: Journal of Health Care for the Poor and Underserved
Maria C Dolce, Jessica L Parker, Pooja Bhalla, Colleen Anderson
This report describes an innovative cooperative education model for promoting the integration of oral health and primary care in a safety-net setting for homeless populations. The model situates health sciences students as change agents within the health care team to facilitate interprofessional collaboration and medical-dental integration.
2018: Journal of Health Care for the Poor and Underserved
Shreya Kangovi, Tamala Carter, Robyn A Smith, Horace M DeLisser
Medical students often lack training in understanding and addressing the social determinants that shape the health of high-risk populations. We describe a novel clinical elective rotation in which fourth-year medical students served as apprentices to community health workers in order to develop community engagement skills and cultural humility.
2018: Journal of Health Care for the Poor and Underserved
Lisa Simon, Yisi D Ji, Ronny Bell, Meissa Jones, Romesh Nalliah, Carina Fernandez-Golarz, Marya Cohen
Vulnerable populations are more likely to access medical care than visit a dentist. We introduced a dental team into a student-faculty collaborative clinic that serves a low-income Latino population. Documentation of oral exam findings rose from 11.88% to 50.50% in the year following integration of dental students into the clinic.
2018: Journal of Health Care for the Poor and Underserved
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