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"Access to care"

Jan Boone
In a model where patients face budget constraints that make some treatments unaffordable without health insurance, we ask which treatments should be covered by universal basic insurance and which by private voluntary insurance. We argue that next to cost effectiveness, prevalence is important if the government wants to maximize the welfare gain that it gets from its health budget. Conditions are derived under which basic insurance should cover treatments that are mainly used by high risk agents with low income...
May 31, 2018: Journal of Health Economics
Claire E H Barber, J Carter Thorne, Vandana Ahluwalia, Jennifer Burt, Diane Lacaille, Deborah A Marshall, Glen S Hazlewood, Dianne Mosher, Lisa Denning, Ildiko Szamjo, Ricky Chin, Sean Hamilton, Susanne Benseler, Marinka Twilt, Natalie J Shiff, Vivian Bykerk, Joanne Homik, Cheryl Barnabe
OBJECTIVE: To test the feasibility of reporting on 4 national performance measures for patients with rheumatoid arthritis (RA) in 5 different models of care. METHODS: The following performance measures were evaluated in 5 models of care: waiting time (WT) to rheumatologist consultation, percentage of patients seen in yearly followup (FU), percentage taking disease-modifying antirheumatic drugs (DMARD), and time to starting DMARD. All models aimed to improve early access and care for patients with RA...
June 15, 2018: Journal of Rheumatology
Adrienne M Gilligan, David S Alberts, Denise J Roe, Grant H Skrepnek
PURPOSE: To evaluate the impact of cancer upon a patient's depletion of net worth and incursion of debt in the U.S. METHODS: This longitudinal study used the Health and Retirement Study (HRS) from 1998-2014. Persons ≥50 years with newly-diagnosed malignancies were included, excluding minor skin cancers. Multivariable generalized linear models were employed to assess changes in net worth and debt (consumer, mortgage, home equity) at two-and four-years following diagnosis (Year+2 , Year+4 ) after controlling for demographic and clinically-related variables, cancer-specific attributes, economic factors, and mortality...
June 12, 2018: American Journal of Medicine
Gloria R Sue, Woodrow C Covington, James Chang
BACKGROUND: A paradigm shift is underway in the world of humanitarian global surgery to address the large unmet need for reconstructive surgical services in low- and middle-income countries (LMICs). Here, we discuss the ReSurge Global Training Program (RGTP), a model for surgical training and capacity building in reconstructive surgery in the developing world. The program includes an online reconstructive surgery curriculum, visiting educator trips, expert reconstructive surgeon involvement, trainee competency tracking system, and identification of local outreach partners to provide safe reconstructive surgery to the neediest of patients in the developing world...
June 13, 2018: Annals of Plastic Surgery
Valerie A Luyckx, Marcello Tonelli, John W Stanifer
Kidney disease has been described as the most neglected chronic disease. Reliable estimates of the global burden of kidney disease require more population-based studies, but specific risks occur across the socioeconomic spectrum from poverty to affluence, from malnutrition to obesity, in agrarian to post-industrial settings, and along the life course from newborns to older people. A range of communicable and noncommunicable diseases result in renal complications and many people who have kidney disease lack access to care...
June 1, 2018: Bulletin of the World Health Organization
Brian Wahl, Katherine L O'Brien, Adena Greenbaum, Anwesha Majumder, Li Liu, Yue Chu, Ivana Lukšić, Harish Nair, David A McAllister, Harry Campbell, Igor Rudan, Robert Black, Maria Deloria Knoll
BACKGROUND: Pneumococcal conjugate vaccine (PCV) and Haemophilus influenzae type b (Hib) vaccine are now used in most countries. To monitor global and regional progress towards improving child health and to inform national policies for disease prevention and treatment, we prepared global, regional, and national disease burden estimates for these pathogens in children from 2000 to 2015. METHODS: Using WHO and Maternal and Child Epidemiology Estimation collaboration country-specific estimates of pneumonia and meningitis mortality and pneumonia morbidity from 2000 to 2015, we applied pneumococcal and Hib cause-specific proportions to estimate pathogen-specific deaths and cases...
July 2018: Lancet Global Health
Samia Laokri, Rieza Soelaeman, David R Hotchkiss
BACKGROUND: The goal of universal health coverage is challenging for chronically under-resourced health systems. Although household out-of-pocket payments are the most important source of health financing in low-income countries, relatively little is known about the drivers of primary health care expenditure and the predictability of the burden associated with high fee-for-service payments. This study describes out-of-pocket health expenditure and investigates demand- and supply-side drivers of excessive costs in the Democratic Republic of Congo (DRC), a central African country in the midst of a process of reforming its health financing system towards universal health coverage...
June 15, 2018: BMC Health Services Research
Lori A Spies, Susan Gerding Bader, Jackline G Opollo, Jennifer Gray
BACKGROUND: Hypertension is the leading preventable contributor to cardiovascular morbidity and mortality, affecting 1 billion people globally. Low- and middle-income countries have increasing rates of hypertension, much of it undiagnosed. AIMS: The purpose of the project is to review studies of nurse-led hypertension interventions that have been implemented in East Africa and to inform hypertension interventions in low-resource settings. METHODS: A scoping review was conducted following Arksey and O'Malley's (2005) format...
June 14, 2018: Worldviews on Evidence-based Nursing
Mary Vaughan Sarrazin, Gary E Rosenthal, Carolyn L Turvey
OBJECTIVE: Up to 70 percent of patients who receive care through Veterans Health Administration (VHA) facilities also receive care from non-VA providers. Using applied classification techniques, this study sought to improve understanding of how elderly VA patients use VA services and complementary use of non-VA care. METHODS: The study included 1,721,900 veterans age 65 and older who were enrolled in VA and Medicare during 2013 with at least one VA encounter during 2013...
June 12, 2018: Health Services Research
Olga Husson, Peter C Huijgens, Winette T A van der Graaf
Adolescents and young adults (AYA) occupy a unique place within the hematologic malignancy community due to the challenges they face related to their disease biology, physical, psychosocial and economic circumstances, and issues related to access to care and long-term follow-up. Efforts to define age-specific (supportive) care needs and targets for intervention in these areas are evolving. This review discusses the psychosocial issues AYA with hematologic malignancies are dealing with, how these might affect their health-related quality of life (HRQoL), and the challenges in delivering high quality supportive care to this underserved population...
June 12, 2018: Blood
Nicolas Boissel, André Baruchel
Adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL) are recognized as a unique population with specific characteristics and needs. In adolescents aged 15-20 years old, the use of full pediatric protocols is supported by many comparative studies of pediatric and adult cooperative groups. In young adults, growing evidence suggests that pediatric-inspired or even fully pediatric approaches may also dramatically improve outcomes, leading to long-term survival rates of almost 70%, despite diminishing indications of hematopoietic stem cell transplantation...
June 12, 2018: Blood
Jody L Miniard, Kathleen Ballman
BACKGROUND: Nurse practitioners (NPs) are helping to bridge the gap not only in primary care but also in specialty practice. In an outpatient, neurosurgical spinal clinic in the midwest, patient volume exceeded provider availability, and to rectify this problem, a proposal for an NP triage system and an NP-led spinal clinic was presented. PURPOSE: The aim of this project was to use NPs to facilitate patient triage in an outpatient neurosurgical practice to expedite patients' access to care and ultimately improve patient satisfaction, outcomes, and healthcare expenditure...
June 12, 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Desmond A Brown, Benjamin T Himes, Panagiotis Kerezoudis, Yirengah M Chilinda-Salter, Sanjeet S Grewal, Joshua A Spear, Mohamad Bydon, Terry C Burns, Ian F Parney
Background: The current standard of care for glioblastoma (GBM) constitutes maximal safe surgical resection, followed by fractionated radiation and temozolomide. This treatment regimen is logistically burdensome, and in a healthcare system in which access to care is variable, there may be patients with worsened outcomes due to inadequate access to optimal treatment. Methods: The National Cancer Database was queried for patients diagnosed with GBM in 2006-2014. Patients were grouped according to insurance status: private insurance, Medicare, Medicaid, or uninsured...
June 11, 2018: Neuro-oncology
Eric Pierce, Renato Rapada, Penelope Anne Herder, Anthony J LaPorta, Tuan N Hoang, Mathew Pena, Jeff Blankenship, Jeff Kiser, Sarah Ashley Catlin
BACKGROUND: The US Navy initiated design concepts for a Medical Mission Module Support Container (M3SC), a mobile operating room capable of rapid installation aboard maneuverable ships within proximity of active combat units. The M3SC provides an alternative echelon of care in the current trauma system by decreasing the time between point of injury, arrival, and surgical intervention. The mobile ships used as M3SC platforms, however, are more susceptible to oceanic conditions that can induce detrimental physiologic motion sickness in medical personnel and patients aboard the vessels...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Henry H Fischer, Susan L Moore, Tracy L Johnson, Rachel M Everhart, Holly Batal, Arthur J Davidsoni
Introduction: Short Message Service (SMS) appointment reminders may provide a wide-reaching, low cost approach to reducing operational inefficiencies and improving access to care. Previous studies indicate this modality may improve attendance rates, yet there is a need for large-scale, pragmatic studies that include unintended consequences and operational costs. Methods: This pragmatic investigation was a before-after analysis that compared visit attendance outcomes among patients who opted into SMS appointment reminders with outcomes among those who declined over an 18-month evaluation period from March 25, 2013, to September 30, 2014...
September 4, 2017: EGEMS
Jane Currie, Mary Chiarella, Thomas Buckley
BACKGROUND: To facilitate the expansion of nurse practitioners working in community and primary health settings, legislative changes were enacted in 2010. These led to privately practicing nurse practitioners (PPNPs) being enabled to provide care subsidized through the Australian Government Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme. Little is known about the impact of this legislation on patient access to care in Australia. PURPOSE: To explore how, why and in which contexts PPNP services in Australia impact on patient access to care...
June 2018: Journal of the American Association of Nurse Practitioners
Rachel Mack
BACKGROUND AND PURPOSE: In 2013, the Advisory Committee of the Food and Drug Administration determined hydrocodone combination medications (HCMs) needed tighter regulation due to high abuse potential; they recommended upscheduling HCMs from Schedule III to II. The purpose of this study was to examine the effect of upscheduling of HCMs on pain management practices of advanced practiced registered nurses (APRNs) in Oklahoma. METHODS: In this qualitative study, 25 participants described their primary care experiences after the upscheduling...
June 2018: Journal of the American Association of Nurse Practitioners
Michelle A Mollica, Kathryn E Weaver, Timothy S McNeel, Erin E Kent
BACKGROUND: Rural cancer patients often have challenges in accessing quality care. This study examined associations between the place of residence at cancer diagnosis (urban vs rural) and patient ratings of access to care among older cancer survivors participating in Medicare-managed care. METHODS: Using Surveillance, Epidemiology, and End Results -Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) linked data, which included SEER data and Medicare CAHPS patient experience surveys, this study identified urban (n = 6140) and rural Medicare beneficiaries (n = 686) aged ≥ 65 years with a breast, lung, colorectal, or prostate cancer diagnosis who had completed a Medicare CAHPS survey between 1998 and 2013...
June 7, 2018: Cancer
Farzana Ferdous, Shahnawaz Ahmed, Sumon Kumar Das, Mohammod Jobayer Chisti, Dilruba Nasrin, Karen L Kotloff, Myron M Levine, James P Nataro, Enbo Ma, Khitam Muhsen, Yukiko Wagatsuma, Tahmeed Ahmed, Abu Syed Golam Faruque
Background: The present study aimed to examine the risk factors for death due to pneumonia in young children and healthcare behaviors of the guardians for children in rural Bangladesh. A prospective autopsy study was conducted among guardians of children aged 4 weeks to 59 months in Mirzapur, Bangladesh, from 2008 to 2012. Results: Pneumonia was the primary cause of death, accounting for 26.4% ( n  = 81) of all 307 deaths. Of the pneumonia deaths, 58% ( n  = 47) deaths occurred in younger infants (aged 4 weeks to < 6 months) and 24...
2018: Tropical Medicine and Health
Audrey Buelo, Susannah McLean, Steven Julious, Javier Flores-Kim, Andy Bush, John Henderson, James Y Paton, Aziz Sheikh, Michael Shields, Hilary Pinnock
INTRODUCTION: Asthma attacks are responsible for considerable morbidity and may be fatal. We aimed to identify and weight risk factors for asthma attacks in children (5-12 years) in order to inform and prioritise care. METHODS: We systematically searched six databases (May 2016; updated with forward citations January 2017) with no language/date restrictions. Two reviewers independently selected studies for inclusion, assessed study quality and extracted data. Heterogeneity precluded meta-analysis...
June 5, 2018: Thorax
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