scholarly journals Financial burden and impact of atopic dermatitis out-of-pocket healthcare expenses among black individuals in the United States

Author(s):  
Raj Chovatiya ◽  
Wendy Smith Begolka ◽  
Isabelle J. Thibau ◽  
Jonathan I. Silverberg

AbstractBlack race is associated with increased atopic dermatitis (AD) severity and healthcare resource utilization. However, the burden of out-of-pocket (OOP) expenses among black individuals with AD is not well understood. We sought to characterize the categories and impact of OOP healthcare expenses associated with AD management among black individuals. A 25-question voluntary online survey was administered to National Eczema Association members (N = 113,502). Inclusion criteria (US residents age ≥ 18 years; self-report of AD or primary caregivers of individuals with AD) was met by 77.3% (1118/1447) of respondents. Black individuals with AD were younger, had lower household income, Medicaid, urban residence, poor AD control and frequent skin infections (P ≤ 0.02). Blacks vs. non-blacks reported more OOP costs for prescription medications covered (74.2% vs. 63.6%, P = 0.04) and not covered (65.1% vs. 46.5%, P = 0.0004) by insurance, emergency room visits (22.1% vs. 11.8%, P = 0.005), and outpatient laboratory testing (33.3% vs. 21.8%, P = 0.01). Black race was associated with increased household financial impact from OOP expenses (P = 0.0009), and predictors of financial impact included minimally controlled AD (adjusted OR [95% CI] 13.88 [1.63–117.96], P = 0.02), systemic therapy (4.34 [1.63–11.54], 0.003), > $200 monthly OOP expenses (14.28 [3.42–59.60], P = 0.0003), and Medicaid (4.02 [1.15–14.07], P = 0.03). Blacks with Medicaid had higher odds of harmful financial impact (3.32 [1.77–6.24], P = 0.0002) than those of black race (1.81 [1.04–3.15], P = 0.04) or with Medicaid (1.39 [1.02–1.88], P = 0.04) alone. Black race is associated with increased OOP costs for AD and significant household financial impact. Targeted interventions are needed to address financial disparities in AD.

Author(s):  
Benjamin Oosterhoff ◽  
Cara palmer

Importance: As COVID-19 spreads across the globe, it is critical to understand the psychological factors that influence pandemic-related behaviors (i.e., news monitoring, social distancing, hygiene/disinfecting, hoarding). This may be especially important to study among youth, who are less likely to experience severe symptoms but contribute to the spread of the virus.Objective: To examine psychological correlates of adolescents’ behaviors during the COVID-19 pandemic. Design: Self-report survey conducted between March 20th and March 22nd, 2020. Setting: This is an online survey study of youth from the United States.Participants: A population-based sample of adolescents were recruited via social media to complete an anonymous survey. Youth were eligible if they had internet access, lived in the United States, and were between the ages of 13 and 18. Main Outcomes and Measures: Outcomes included COVID-19 news monitoring, social distancing, disinfecting, and hoarding behaviors over the 7 days after the US declared a national emergency. The correlates measured were attitudes about COVID-19 severity, values related to social responsibility, social trust, and self-interest. The a priori hypotheses were that attitudes about the severity of COVID-19, along with greater social responsibility and social trust, would be associated with greater news monitoring, social distancing, and disinfecting, whereas greater self-interest would be associated with more hoarding.Results: The final analytic sample included 770 adolescents (Mage = 16.34, 72% female). The majority of teens reported not engaging in pure social distancing (70%), but were monitoring the news (75%) and engaging in at least one disinfecting behavior multiple times per day (88%). Some teens reported engaging in hoarding behavior (19%). Greater attitudes about the severity of COVID-19 were associated with more social distancing, disinfecting, and news monitoring, but also more hoarding. Greater social responsibility was associated with more disinfecting and news monitoring, and less hoarding. Participants who reported valuing their own self-interest over others reported less social distancing and more hoarding. Greater social trust was associated with less hoarding.Conclusions and Relevance: Emphasizing the severity of COVID-19 and the social implications of pandemic-related behaviors may be important for teens, particularly for those who are not following recommended preventative health behaviors or who are engaging in hoarding.


Author(s):  
Adam E. M. Eltorai ◽  
Grayson L. Baird ◽  
Joshua Pangborn ◽  
Ashley Szabo Eltorai ◽  
Valentin Antoci ◽  
...  

Despite largely unproven clinical effectiveness, incentive spirometry (IS) is widely used in an effort to reduce postoperative pulmonary complications. The objective of the study is to evaluate the financial impact of implementing IS. The amount of time nurses and RTs spend each day doing IS-related activities was assessed utilizing an online survey distributed to the relevant national nursing and respiratory therapists (RT) societies along with questionnaire that was prospectively collected every day for 4 weeks at a single 10-bed cardiothoracic surgery step-down unit. Cost of RT time to teach IS use to patients and cost of nurse time spent reeducating and reminding patients to use IS were used to calculate IS implementation cost estimates per patient. Per-patient cost of IS implementation ranged from $65.30 to $240.96 for a mean 9-day step-down stay. For the 566 patients who stayed in the 10-bed step-down in 2016, the total estimated cost of implementing IS ranged from $36 959.80 to $136 383.36. Using national survey workload data, per-patient cost of IS implementation costed $107.36 (95% confidence interval [CI], $97.88-$116.98) for a hospital stay of 4.5 days. For the 9.7 million inpatient surgeries performed annually in the United States, the total annual cost of implementing postoperative IS is estimated to be $1.04 billion (95% CI, $949.4 million-$1.13 billion). The cost of implementing IS is substantial. Further efficacy studies are necessary to determine whether the cost is justifiable.


Author(s):  
Erin Hiatt ◽  
Carla Belliard ◽  
Michelle A. Lloyd Call ◽  
Laura K. Jefferies ◽  
Madalyn Kener ◽  
...  

Abstract Objective: To evaluate food and water storage practices in the United States, including the extent that government emergency preparedness guidelines were followed. Methods: Qualtrics panelists (n = 572) completed a 142-item online survey in August 2014. Cognitive interviews (n = 5) and pilot data (n = 14) informed survey development. Descriptive statistics were used to analyze quantitative data. Open-ended responses related to water storage preparation were classified into 5 categories. Results: Many respondents reported being somewhat or well prepared to provide food and water for their households during a large-scale disaster or emergency. Only 53% met Federal Emergency Management Agency (FEMA) guidelines to have water last at least 3 days. Based on respondents’ self-report, it appeared that those who prepared personally-filled containers for water did not carefully follow FEMA instructions. Most respondents had non-perishable foods available, with 96% meeting the FEMA guidelines of at least 3 days of storage. Conclusion: Households were generally prepared to provide food and, to a lesser extent, water in emergency situations, but were not consistently following FEMA guidelines. Additional easy-to-follow, evidence-based information may better help citizens accurately implement food and water storage emergency preparedness guidelines.


2021 ◽  
Vol 25 (3) ◽  
pp. 85-100
Author(s):  
Yulia Yeni ◽  
Vera Pujani ◽  
Laura Syahrul

Purpose: The aim of this study is to predict perceived risk and consumer willingness in recommending takeaway food from restaurant served in buffet style.                           Methodology/Approach: This study used an online survey of 170 consumers who were selected based on purposive sampling method. The research questionnaire was adapted from previous research. The data were analysed using Structural Equation Modelling (SEM), with Smart PLS. Findings: The research findings show that health risk and psychological risk have a positive effect on intention to recommend takeaway food. Meanwhile, quality risk and trust have no effect on intention to recommend takeaway food. In addition, psychological risk and quality risk have no effect on trust. This study also shows that trust does not function as a mediator of the relationship between health risk, psychological risk, quality risk, trust, and intention to recommend. Research Limitation/Implication: This study only uses a self-report questionnaire by customers. For further research, to enrich the discussion, it is recommended to use interviews or FGD. In addition, this study only uses three risk variables. For the future, it is advisable to add other risk variables. Originality/Value of paper: In other countries such as China, Korea and the United States, related research has been carried out, however for the context of RM Padang which is unique with all the menus served (Buffet) on the visiting customers’ table has not been found in literature.


Author(s):  
Stephen Y Wang ◽  
Javier Valero‐Elizondo ◽  
Hyeon‐Ju Ali ◽  
Ambarish Pandey ◽  
Miguel Cainzos‐Achirica ◽  
...  

Abstract Background Heart failure (HF) poses a major public health burden in the United States. We examined the burden of out‐of‐pocket healthcare costs on patients with HF and their families. Methods and Results In the Medical Expenditure Panel Survey (MEPS), we identified all families with ≥1 adult member with HF during 2014 – 2018. Total out‐of‐pocket healthcare expenditures included yearly care‐specific costs and insurance premiums. We evaluated two outcomes of financial toxicity: (1) high financial burden – total out‐of‐pocket healthcare expense to post‐subsistence income of >20%, and (2) catastrophic financial burden with the rate of >40% ‐ a bankrupting expense defined by the WHO. There were 788 families in MEPS with a member with HF representing 0.54% (95% CI, 0.48%–0.60%) of all families nationally. The overall mean annual out‐of‐pocket healthcare expenses were $4423 (95% CI, $3908–$4939), with medications and health insurance premiums representing the largest categories of cost. Overall, 14% (95% CI, 11%‐18%) of families experienced a high burden and 5% (95% CI, 3%‐6%) experienced a catastrophic burden. Among the two‐fifths of families considered low‐income, 24% (95% CI, 18%‐30%) experienced a high financial burden, while 10% (95% CI, 6%‐14%) experienced a catastrophic burden. Low‐income families had 4‐fold greater risk‐adjusted odds of high (OR=3.9, 95% CI, 2.3–6.6), and 14‐fold greater risk‐adjusted odds of catastrophic financial burden (OR=14.2, 95% CI, 5.1–39.5) compared with middle/high income families. Conclusions Patients with HF and their families experience large out‐of‐pocket healthcare expenses. A large proportion encounter financial toxicity, with a disproportionate effect on low‐income families.


Cephalalgia ◽  
2020 ◽  
Vol 40 (11) ◽  
pp. 1240-1249 ◽  
Author(s):  
Timo Klan ◽  
Anne-Kathrin Bräscher ◽  
Annabella Vales ◽  
Eva Liesering-Latta ◽  
Michael Witthöft ◽  
...  

Background Cluster headache (CH) is clinically associated with considerable psychosocial burden. However, instruments to assess and characterize psychosocial factors in cluster headache more specifically are lacking. This study aimed to develop a self-report questionnaire, which assesses the broadest possible spectrum of psychosocial factors in cluster headache, the Cluster Headache Scales (CHS). Method Items of the Cluster Headache Scales were constructed based on a literature review and semi-structured interviews with several experts (including persons with cluster headache). A cross-sectional online survey was conducted to determine the psychometric properties and the factor structure of the Cluster Headache Scales. Data was analyzed using exploratory factor analysis as well as exploratory structural equation modelling (ESEM). Results In total, n = 342 subjects with cluster headache (mean age 47.8, 63% male, 51% with episodic cluster headache) were included. Factor analysis yielded eight clearly interpretable factors: Medical care, medication side effects, fear of attacks, disability, (auto)aggression, coping, physical activity, and financial burden, which are assessed via 36 items. The internal consistencies of the subscales were acceptable to excellent and ranged between Cronbach’s alpha = .76 and .93. The pattern of correlations with related instruments provides first evidence for convergent validity. Conclusion The CHS represents a reliable and valid self-report instrument for the assessment of psychosocial factors in persons with cluster headache, which appears useful for both clinical practice as well as research. Trial registration: The study was registered at the German Clinical Trials Register ( www.drks.de , ID-Number: DRKS00016502).


2017 ◽  
Vol 137 (7) ◽  
pp. 1461-1467 ◽  
Author(s):  
Shanthi Narla ◽  
Derek Y. Hsu ◽  
Jacob P. Thyssen ◽  
Jonathan I. Silverberg

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1534-1534
Author(s):  
Katherine Daunov ◽  
Michael Daunov ◽  
Kara Noskoff ◽  
Hilary Gan ◽  
Simon Davies ◽  
...  

1534 Background: AYA patients with cancer have inferior outcomes compared to their pediatric and adult counterparts. The NCI recommends they be treated by AYA focused healthcare professionals within an AYA oncology program. This survey captures the current landscape of AYA oncology care in the United States. Methods: An online survey was sent to 272 cancer centers in September 2020, in coordination with Teen Cancer America and included all clinically designated NCI-CC. The survey asked about the presence of an AYA program, types of patients, dedicated resources, clinical space, type of providers, associated support services, educational efforts, importance of AYA oncology care, and how well these services are provided. Results: In total, we received 93 responses, a 34% response rate, including 50 NCI centers, a 72% response rate. Only half (49%) of NCI-CC reported having an AYA program, and 70% were started in the past 5 years. One-third (32%) of centers reported plans to start an AYA program. Most programs included patient ages from ≥15 (56%) to ≤39 (63%) with a variety of cancers – most commonly hematologic (49%) and sarcoma (49%) and least commonly lung (36%), breast (38%), and head and neck cancer (38%). AYA programs are generally embedded in both adult and pediatric oncology services (63%). On average, cancer centers reported seeing 25-50 new AYA patients/month and 100-200 follow-up visits/month. Few programs reported a dedicated inpatient space (4%) or outpatient space (9%). Most NCI-CC have supportive services available for all oncology patients, but fewer of these services were dedicated specifically to AYA patients: navigators (92% vs. 71%), social work (98% vs. 57%), psycho-oncology (96% vs. 54%), dietician (98% vs. 24%), physical therapy (98% vs. 18%), chaplaincy (98% vs. 18%), and child life (83% vs. 26%). Other services available to the AYA population included sexual health (62%), academic support (62%), and career resources (36%). A minority of centers (30%) provided AYA training to their staff. A majority of NCI-CC felt AYA programs were important-very important (60%). They reported providing good-excellent overall AYA care (59%), but this dropped to 22% for sexual health and education of staff, which was relatively consistent across centers (Table). Conclusions: This survey is the first ever national survey to assess AYA oncology programs. Despite greater emphasis on the AYA cancer population, only half of NCI-CC report having a dedicated program, and areas of improvement include education of staff and sexual health services for patients. Self-report of providing good to excellent AYA care in specific areas.[Table: see text]


2021 ◽  
Author(s):  
Daniel J. Erchick ◽  
Alexander J. Zapf ◽  
Prativa Baral ◽  
Jeffrey Edwards ◽  
Shruti H. Mehta ◽  
...  

ABSTRACTIntroductionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) related diagnoses, hospitalizations, and deaths have disproportionately affected disadvantaged communities across the United States. Few studies have sought to understand how risk perceptions related to social interaction and essential activities during the COVID-19 pandemic vary by sociodemographic factors, information that could inform targeted interventions to reduce inequities in access to care and information.MethodsWe conducted a nationally representative online survey of 1,592 adults in the United States to understand risk perceptions related to transmission of COVID-19 for various social and essential activities. We assessed relationships for each activity, after weighting to adjust for the survey design, using bivariate comparisons and multivariable logistic regression modeling, between responses of safe and unsafe, and participant characteristics, including age, gender, race, education, income, and political affiliation.ResultsHalf of participants were younger than 45 years (n=844, 53.0%), female (n=800, 50.3%), and White/Caucasian (n=685, 43.0%), Black/African American (n=410, 25.8%), or Hispanic/Latino (n=382, 24.0%). Risk perceptions of unsafe for 13 activities ranged from 29.2% to 73.5%. Large gatherings, indoor dining, and visits with elderly relatives had the highest proportion of unsafe responses (>58%) while activities outdoor, visiting the doctor or dentist, and going to the grocery store had the lowest (<36%). Older respondents were more likely to view social gatherings and indoor activities as unsafe, yet more likely to view activities such as going to the grocery store, participating in outdoor activities, visiting elderly relatives, and visiting the doctor or emergency room as safe. Compared to White/Caucasian respondents, Black/African American and Hispanic/Latino respondents were more likely to view activities such as dining and visiting friends outdoor as unsafe. Generally, men vs. women, Republicans vs. Democrats and independents, and individuals with higher vs. lower income were more likely to view activities as safe.ConclusionsThese findings suggest the importance of sociodemographic differences in risk perception, health behaviors, and access to information and health care when implementing efforts to control the COVID-19 pandemic. Further research should address how evidence-based interventions can be tailored considering these differences with a goal of increased health equity in the pandemic response.


Sign in / Sign up

Export Citation Format

Share Document