Evolving Primary Care Utilization of Transgender and Gender-Nonconforming People at a Community Sexual Health Clinic

2020 ◽

pp. 134-145

Author(s):

Heather L. Armstrong

Keyword(s):

Sexual Health ◽

Sexual Disorders ◽

Minority Populations ◽

Gender Nonconforming ◽

Complex Disorders ◽

Gender Minority ◽

Research Perspectives ◽

Sexual Orientations ◽

Sexual And Gender Minority ◽

And Gender

Sexual disorders and dysfunction are common among people of all sexual orientations and gender identities. And while definitions and conceptions of sexual health are typically broad, the clinical and research perspectives on sexual function and dysfunction have traditionally relied on the four-phase model of sexual response and disorders are generally classified as “male” or “female.” This chapter reviews the diagnostic criteria for specific sexual dysfunctions and presents a summary of existing research among sexual and gender minority populations. Overall, research on sexual dysfunction among sexual and gender minority people is limited, and this is especially true for transgender and gender nonconforming individuals. Understanding these often complex disorders requires that individuals, clinicians, and researchers consider a range of biopsychosocial factors that can affect and be affected by one’s sexual health and sexuality.

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Predictors of post-release primary care utilization among HIV-positive prison inmates: A pilot study

AIDS Care ◽

10.1080/09540120500161892 ◽

2006 ◽

Vol 18 (4) ◽

pp. 290-301 ◽

Cited By ~ 30

Author(s):

A. J. Harzke ◽

M. W. Ross ◽

D. P. Scott

Keyword(s):

Primary Care ◽

Pilot Study ◽

Care Utilization ◽

Hiv Positive ◽

Prison Inmates ◽

Primary Care Utilization

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Evaluating Child Health Plus in Upstate New York: How Much Does Providing Health Insurance to Uninsured Children Increase Health Care Costs?

PEDIATRICS ◽

10.1542/peds.105.se1.728 ◽

2000 ◽

Vol 105 (Supplement_E1) ◽

pp. 728-732 ◽

Cited By ~ 2

Author(s):

Jack Zwanziger ◽

Dana B. Mukamel ◽

Peter G. Szilagyi ◽

Sarah Trafton ◽

Andrew W. Dick ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

New York ◽

Health Insurance ◽

Care Utilization ◽

Average Change ◽

Uninsured Children ◽

Primary Care Utilization ◽

Care Costs ◽

Child Health Plus

Background. In response to the increase in the number of American children without health insurance, new federal and state programs have been established to expand health insurance coverage for children. However, the presence of insurance reduces the price of care for families participating in these programs and stimulates the use of medical services, which leads to an increase in health care costs. In this article, we identified the additional expenditures associated with the provision of health insurance to previously uninsured children. Methods. We estimated the expenditures on additional services using data from a study of children living in the Rochester, New York, area who were enrolled in the New York State Child Health Plus (CHPlus) program. CHPlus was designed specifically for low-income children without health insurance who were not eligible for Medicaid. The study sample consisted of 1910 children under the age of 6 who were initially enrolled in CHPlus between November 1, 1991 and August 1, 1993 and who had been enrolled for at least 9 continuous months. We used medical chart reviews to determine the level of primary care utilization, parent interviews for demographic information, as well as specialty care utilization, and we used claims data submitted to CHPlus for the year after enrollment to calculate health care expenditures. Using this information, we estimated a multivariate regression model to compute the average change in expenditures associated with a unit of utilization for a cross-section of service types while controlling for other factors that independently influenced total outpatient expenditures. Results. Expenditures for outpatient services were closely related to primary care utilization—more utilization tended to increase expenditures. Age and the presence of a chronic condition both affected expenditures. Children with chronic conditions and infants tended to have more visits, but these visits were, on average, less expensive. Applying the average change in expenditures to the change in utilization that resulted from the presence of insurance, we estimated that the total increase in expenditures associated with CHPlus was $71.85 per child in the year after enrollment, or a 23% increase in expenditures. The cost increase was almost entirely associated with the provision of primary care. Almost three-quarters of the increase in outpatient expenditures was associated with increased acute and well-child care visits. Conclusions. CHPlus was associated with a modest increase in expenditures, mostly from additional outpatient utilization. Because the additional primary care provided to young children often has substantial long-term benefits, the relatively modest expenditure increases associated with the provision of insurance may be viewed as an investment in the future.

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Abstract P685: Primary Care Utilization for Primary Prevention Continues to Be Lacking in Patients With Stroke

Stroke ◽

10.1161/str.52.suppl_1.p685 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Alexander J Senetar ◽

Daniel A Bonnin ◽

Hannah E Branstetter ◽

Alexis N Simpkins ◽

Keyword(s):

Primary Care ◽

Regression Analysis ◽

Primary Prevention ◽

Hemoglobin A1c ◽

Care Utilization ◽

P Value ◽

Stroke Severity ◽

Institutional Review ◽

And Gender ◽

Ischemic Attack

Introduction: Primary care plays an essential role in stroke prevention. Yet still, for many stroke patients, a relationship with a primary care provider (PCP) is not established until after stroke. Our goal was to determine if lack of PCP and the consequential differences in management affects stroke severity. Methods: Data was obtained from our Institutional Review Board approved stroke admission database from 2017 to November 2019 of all stroke subtypes (ischemic stroke, transient ischemic attack, subarachnoid and intracerebral hemorrhages). Non-parametric Mann Whitney t-test and regression analysis was used to identify significant differences in medications, stroke risk factors and stroke severity. Results: A total of 559 patients were included, median age 67 (interquartile range (IQR) 58-76), 49% woman, 32% established care with a PCP, 36% on medications for diabetes mellitus (DM), 42% hyperlipidemia, 66% anti-hypertensives, 39% anti-platelet agents, and 10% anticoagulation. More patients with PCP were taking anti-hypertensive medications (80% versus (vs) 60%, p value < 0.0001), DM medications (56% vs 30%, p value < 0.0001), anti-platelet agents (46% vs 35%, p value = 0.0149), and medications for hyperlipidemia (49% vs 39%, p value = 0.0426). Admission NIHSS was lower in patients with a PCP median 6 (IQR 3-11) vs median 9 (IQR 4 -15), p value= 0.0016, and median hemoglobin A1c was higher in patients with a PCP 8 (IQR 5.7- 9.3) vs patients without a PCP prior to their stroke 6 (IQR 5.4 - 8.5), p value= 0.0002. Admitting systolic blood pressure was similar 155 (137-177) vs 152 (134-171). After correcting for age and gender, regression analysis demonstrated a significant association between whether a patient had PCP and antihypertensive medication use (odds ratio (OR) 2.413, 95% confidence interval 1.511 - 3.914) and hemoglobin A1c (OR 1.122, 95% CI 1.037 - 1.215). Also, patients with a PCP were more likely to have a lower NIHSS on admission (OR 0.9679, 95% CI 0.9423 - 0.9930). Conclusions: These result show that patients not followed by a PCP prior to stroke are less likely to be on medications for primary prevention of stroke, contributing to an increased stroke severity on admission. More research is needed to identify barriers to patients establishing care with PCP.

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