scholarly journals The Impact of Financial Barriers on Access to Care, Quality of Care and Vascular Morbidity Among Patients with Diabetes and Coronary Heart Disease

2013 ◽  
Vol 29 (1) ◽  
pp. 76-81 ◽  
Author(s):  
Puja B. Parikh ◽  
Jie Yang ◽  
Steven Leigh ◽  
Kunchok Dorjee ◽  
Roopali Parikh ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Quality Of Care ◽  
Access To Care ◽  
Care Quality ◽  
Financial Barriers ◽  
Patients With Diabetes ◽  
The Impact

scholarly journals Protocol: Improving Access to Specialist Nephrology Care Among Rural/Remote Dwellers of Alberta: The Role of Electronic Consultation in Improving Care for Patients With Chronic Kidney Disease

2019 ◽  
Vol 6 ◽  
pp. 205435811987871
Author(s):  
Aminu Bello ◽  
Deenaz Zaidi ◽  
Branko Braam ◽  
Mark Courtney ◽  
Jodi Glassford ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Access To Care ◽  
Care Delivery ◽  
Care Quality ◽  
Care Providers ◽  
Practice Facilitation ◽  
Specialist Care ◽  
Nephrology Care ◽  
The Impact

Background: As the burden of chronic kidney disease (CKD) continues to increase, many geographically dispersed Canadians have limited access to specialist nephrology care, which tends to be centralized in major urban areas. As a result, many rural/remote-dwellers in Canada experience poor quality of care and related adverse outcomes. It is imperative to develop alternative care delivery mechanisms to ensure optimal health outcomes for all Canadians. Objective: To investigate the feasibility and effectiveness of electronic consultation (eConsult) as a new model for interactions between specialists and primary care providers (PCPs) to improve access to care for patients with CKD. Design: This is a sequential, mixed methods study that will be conducted in 3 phases. Setting: The study will be conducted across the entire province of Alberta, supported by Alberta Kidney Care (formerly, Northern and Southern Alberta Renal Programs [NARP/SARP]). Patients: Patients suffering from CKD will be included in the study. Measurements: We will assess the barriers and enablers of implementation and adoption of an e-consultation protocol to facilitate access to care for patients with CKD in Alberta with a focus on rural/remote-dwellers with CKD. We will also evaluate the impact of the eConsult system (eg, improved access to specialist care, reduction in care gaps), assess the feasibility of province-wide implementation, and compare eConsult with practice facilitation versus eConsult alone in terms of access to specialist care, quality of care, and related outcomes. Methods: The study will be conducted in 3 phases. In phase 1, we will assess the perceptions of stakeholders (ie, PCPs, nephrologists, patients, policymakers, and other care providers) to improve CKD care delivery, quality, and outcomes in Alberta with focus groups and semistructured interviews. Phase 2 will engage specific family physicians for their input on key factors and logistical issues affecting the feasibility of implementing eConsult for the care of patients with CKD. Phase 3 will provide academic detailing including practice facilitation to clinics in Alberta to assess how eConsult with practice facilitation compares with eConsult alone in terms of access to specialist care, quality of care, and related outcomes. Results: We will assess stakeholder perceptions about potential barriers to and enablers of a new eConsult and decision support system strategy, focusing on elements that are most important for the design of a feasible and implementable intervention. We will develop, pilot test, and assess the impact of the eConsult model in improving access to specialist nephrology care and the feasibility of province-wide implementation. The final phase of the project will address key challenges for optimal care for patients with CKD living in rural, remote, and underserved areas of Alberta, particularly timely referral and disease management as well as the cost-effective benefits of eConsult. Limitations: Lack of high-speed Internet in many rural and remote areas of Alberta may lead to more time spent in completing the eConsult request online versus faxing a referral the traditional way. Allied health care staff (referral coordinators, administrative staff) require training to the eConsult system, and physicians at many remote sites do not have adequate staff to handle eConsult as an added task. Conclusions: Implementation of eConsult can favorably influence referral patterns, access to care, care quality, patient outcomes, and health care costs for people with CKD. Results of this study will inform the optimization of care for rural/remote-dwellers with CKD and will facilitate future partnerships with policymakers and provincial renal programs in Alberta to ensure optimal kidney health for all residents. Trial registration: Not required.

Abstract 139: Comparison of Access to Care and Quality of Care in Veterans versus Non-veterans With Cardiovascular Disease

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Pallavi Srivastava ◽  
Matthew Lacey ◽  
Javed Butler ◽  
A. Laurie Shroyer ◽  
Puja B Parikh
Keyword(s):  
Cardiovascular Disease ◽  
Health Care ◽  
Heart Disease ◽  
Quality Of Care ◽  
Access To Care ◽  
Medical Care ◽  
Blood Cholesterol ◽  
Financial Barriers ◽  
Flu Shot

Background: Improved access to care and quality of care can mitigate population level risk of heart disease and improve health outcomes. We sought to compare access to care in veterans versus non-veterans with cardiovascular disease (CVD) in the U.S. Methods: The 2013 Centers for Disease Control’s Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of 57,171 adults with CVD. Presence of CVD was noted with a single affirmative response to the following questions: “Has a health care professional ever told you that you had any of the following:” (1) a heart attack or myocardial infarction, (2) angina or coronary heart disease, (3) a stroke? Demographic data, clinical history and medication use were recorded in these patients. Access to care variables included report of financial barriers to medical care and/or prescription drug costs and report of delay in receiving medical care. Quality of care variables included annual blood cholesterol check, blood sugar testing, flu shot administration, antihypertensive use, and aspirin use. Results: Among 57,171 adults with CVD studied, 13,205 (23.1%) were veterans while 43,966 (76.9%) were non-veterans. Veterans with CVD tended to be older (p<0.0001), male (95.6% vs 33.0%, p<0.0001), white (84.8% vs 76.6%, p<0.0001), married (57.3% vs 40.8%, p<0.0001), college-educated (60.9% vs 47.7%, p<0.0001), homeowners (81.1% vs 70.1%, p<0.0001), and with higher annual income. Veterans with CVD were more likely to be taking antihypertensive medications (93.3% vs 91.7%, p<0.0001) and have lower rates of current smoking (15.1% vs 18.9%, p<0.0001), chronic obstructive pulmonary disease (21.5% vs 23.1%, p=0.0003), asthma (12.7% vs 21.4%, p<0.0001), obesity (32.0% vs 36.9%, p<0.0001), physical inactivity (37.1% vs 44.3%, p<0.0001), and depressive disorders (22.0% vs 31.0%, p<0.0001). Veterans with CVD were less likely to report financial barriers to medical care (7.5% vs 15.6%, p<0.0001) and to medication costs (6.1% vs 14.7%, p<0.0001) and had higher rates of blood sugar testing (77.2% vs 72.2%, p<0.0001), blood cholesterol testing (98.2% vs 96.5%, p<0.0001), flu shot administration (64.2% vs 56.6%, p<0.0001), and annual check-up by a health care provider (88.7% vs 84.9%, p<0.0001). Veterans with CVD were more likely to be taking aspirin (77.1% vs 70.0%, p<0.0001). In multivariate analysis, being a veteran was associated with decreased odds of financial barriers to care (OR,0.82; 95% CI 0.73-0.92) and financial barriers to medication cost (OR,0.56; 95% CI 0.48-0.64). Compared to non-veterans, veterans had increased odds of medical checkup in past year (OR,1.25; 95% CI 1.13-1.38), cholesterol check in past year (OR, 1.21; 95% CI 1.07-1.37), and flu shot (OR,1.22; 95% CI 1.14-1.30). Conclusion: Veterans with CVD receive improved access to care and quality of care compared to their non-veteran counterparts.

Does Investor-Ownership of Nursing Homes Compromise the Quality of Care?

2002 ◽  
Vol 32 (2) ◽  
pp. 315-325 ◽  
Author(s):  
Charlene Harrington ◽  
Steffie Woolhandler ◽  
Joseph Mullan ◽  
Helen Carrillo ◽  
David U. Himmelstein
Keyword(s):  
Quality Of Care ◽  
Nursing Homes ◽  
Skilled Nursing Facility ◽  
Nurse Staffing ◽  
Care Quality ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Staffing Ratios ◽  
The Impact

Quality problems have long plagued the nursing home industry. While two-thirds of U.S. nursing homes are investor-owned, few studies have examined the impact of investor-ownership on the quality of care. The authors analyzed 1998 data from inspections of 13,693 nursing facilities representing virtually all U.S. nursing homes. They grouped deficiency citations issued by inspectors into three categories (“quality of care,” “quality of life,” and “other”) and compared deficiency rates in investor-owned, nonprofit, and public nursing homes. A multivariate model was used to control for case mix, percentage of residents covered by Medicaid, whether the facility was hospital-based, whether it was a skilled nursing facility for Medicare only, chain ownership, and location by state. The study also assessed nurse staffing. The authors found that investor-owned nursing homes provide worse care and less nursing care than nonprofit or public homes. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5 percent higher than nonprofit and 43.0 percent higher than public facilities, and also had more of each category of deficiency. In the multivariate analysis, investor-ownership predicted 0.679 additional deficiencies per home; chain-ownership predicted an additional 0.633 deficiencies per home. Nurse staffing ratios were markedly lower at investor-owned homes.

The Impact of Primary Care Dual-Management on Quality of Care

2011 ◽  
Vol 3 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Peter J. Kaboli ◽  
Daniel M. Shivapour ◽  
Michael S. Henderson ◽  
Areef Ishani ◽  
Mary E. Charlton
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Hemoglobin A1c ◽  
Ldl Cholesterol ◽  
Primary Care Providers ◽  
Care Quality ◽  
Care Providers ◽  
Dual Management ◽  
The Impact

Background: Discontinuity is common in US healthcare. Patients access multiple systems of care and in the nation’s largest integrated healthcare system, Veteran’s Administration (VA) patients frequently use non-VA primary care providers. The impact of this “dual-management” on quality is unknown. The authors’ objective was to identify dual-management and associations with markers of care quality for hypertension and associated conditions. Methods: Data was collected via surveys and chart reviews of primary care patients with hypertension from six VA clinics in Iowa and Minnesota. Clinical measures abstracted included the following: goal blood pressure (BP) and use of guideline-concordant therapy, low-density lipoprotein (LDL) cholesterol, hemoglobin A1C, and body mass index (BMI). Dual-management data was obtained through self-report. Results: Of 189 subjects (mean age = 66), 36% were dual-managed by non-VA providers. There was no difference in hypertension quality of care measures by dual-management status. A total of 51% were at BP goal and 58% were on guideline-concordant therapy. Dual-managed patients were more likely to use thiazide diuretics (43% vs 29%; P = .03) and angiotensin receptor blockers (13% vs 3%; P < .01), but less likely to use angiotensin-converting enzyme inhibitors (43% vs 61%; P = .02). There was no difference in LDL cholesterol (97.1 mg/dl vs 100.1 mg/dl; P = .55), hemoglobin A1C (7% vs 6%; P = .74), or BMI (29.8 vs 30.9; P = .40) for dual-managed versus VA managed patients, respectively. Conclusions: Although dual-management may decrease continuity, VA/private sector dual-management did not impact quality of care, though some medication differences were observed. With the high prevalence of dual-management, future work should further address quality and evaluate redundancy of services.

Quality Of Care For Coronary Heart Disease In Two Countries

2001 ◽  
Vol 20 (3) ◽  
pp. 55-67 ◽  
Author(s):  
John Z. Ayanian ◽  
Thomas J. Quinn
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Quality Of Care

The Impact of High-Calorie-Expenditure Exercise on Quality of Life in Older Adults With Coronary Heart Disease

2011 ◽  
Vol 19 (2) ◽  
pp. 99-116 ◽  
Author(s):  
Lizzy Pope ◽  
Jean Harvey-Berino ◽  
Patrick Savage ◽  
Janice Bunn ◽  
Maryann Ludlow ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Exercise Program ◽  
Control Program ◽  
Calorie Expenditure ◽  
The Impact ◽  
High Calorie

The acceptability of a high-calorie-expenditure (HCE) exercise program in older coronary heart disease patients participating in a behavioral weight-control program was evaluated. Seventy-four overweight patients (median age 63 yr) were randomly assigned to a 5-mo intervention of HCE exercise (3,000–3,500 kcal/wk daily walking) or standard cardiac-rehabilitation (CR) exercise (700–800 kcal/wk). Both groups received counseling to achieve a dietary caloric deficit of 3,500 kcal/ wk. Assessments at baseline and 5 mo included self-reported measures of quality of life and psychosocial variables. The HCE group experienced significantly greater weight loss (8.2 ± 4 vs. 3.7 ± 5 kg,p< .001). Changes from baseline to 5 mo on scores of physical, emotional, and social functioning were greater for the HCE than CR group (p< .05). HCE exercise also resulted in greater positive change in exercise enjoyment (p= .05), which was mediated by weight change. Even high-risk older adults can be successful in an HCE exercise program and experience no adverse physical or emotional changes.

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