QOLP-23. EVALUATION OF FINANCIAL TOXICITY (FT) IN PEOPLE WITH RARE CENTRAL NERVOUS SYSTEM (CNS) TUMORS USING AN INNOVATIVE WEB-BASED STUDY DESIGN

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi187-vi188
Author(s):  
Michael Timmer ◽  
Elizabeth Vera ◽  
Alvina Acquaye ◽  
Claudia Chambers ◽  
Alexa Christ ◽  
...  
Keyword(s):  
Access To Health Care ◽  
Symptom Burden ◽  
Financial Impact ◽  
Cns Tumors ◽  
Financial Toxicity ◽  
Poverty Level ◽  
Web Based ◽  
Care Services ◽  
Common Diagnosis ◽  
Work Interference

Abstract BACKGROUND Financial toxicity (FT) refers to the negative financial impact of cancer. Research exploring FT in patients with CNS tumors is limited to more common diagnoses or within single institutions. Total income, work interference and symptom burden are all key parameters when investigating FT in patients with rare CNS tumors. METHODS A web-based study of 210 participants’ responses to financial, clinical, symptom burden (MDASI-BT/MDASI-SP), depression and anxiety (PROMIS-Depression/Anxiety), work interference (SF-36) and general health status (EQ-5D-3L) is reported using descriptive statistics and tests of associations. RESULTS Patients were white (93%) employed (48%) females (72%), with median age of 47 (19-75). The most common diagnosis was ependymoma (80%). Original tumor location was the brain in 83 (40%) and spine in 115 (55%). Median time from tissue diagnosis was 48 months (0 – 402). Income was lower than the poverty level in 6% and lower than the median U.S. in 23%. A change in work due to their tumor was reported by 60%, with the majority stopping work (31%). One-third reported lack of access to health-care services and 10% required home care services. Difficulty walking was reported by 42% and difficulty in performing activities due to physical health by over 60%. Anxiety and depression scores aligned with the average for the U.S. population; however, 21% were taking antidepressants and 42% reported not being able to complete work or activities due to depression. Half of all patients reported moderate-severe pain, fatigue, and weakness with higher symptom burden and depression associated with change in work status (p < 0.003). CONCLUSION Patients with rare CNS tumors report an impact of their tumor diagnosis on activities/work patterns, with an associated higher symptom burden. Future studies exploring financial impact in patients with rare CNS tumors and targeted programs to address these outcomes are needed.

scholarly journals Using Prospective Methods to Identify Fieldwork Locations Favourable to Understanding Divergences in Health Care Accessibility

2021 ◽  
Vol 10 (8) ◽  
pp. 506
Author(s):  
Jan Ketil Rød ◽  
Arne H. Eide ◽  
Thomas Halvorsen ◽  
Alister Munthali
Keyword(s):  
Health Care ◽  
Low Income ◽  
Access To Health Care ◽  
Health Care Services ◽  
Good Health ◽  
Low Income Countries ◽  
Care Services ◽  
Health Care Accessibility ◽  
Barriers To Health ◽  
Walking Time

Central to this article is the issue of choosing sites for where a fieldwork could provide a better understanding of divergences in health care accessibility. Access to health care is critical to good health, but inhabitants may experience barriers to health care limiting their ability to obtain the care they need. Most inhabitants of low-income countries need to walk long distances along meandering paths to get to health care services. Individuals in Malawi responded to a survey with a battery of questions on perceived difficulties in accessing health care services. Using both vertical and horizontal impedance, we modelled walking time between household locations for the individuals in our sample and the health care centres they were using. The digital elevation model and Tobler’s hiking function were used to represent vertical impedance, while OpenStreetMap integrated with land cover map were used to represent horizontal impedance. Combining measures of walking time and perceived accessibility in Malawi, we used spatial statistics and found spatial clusters with substantial discrepancies in health care accessibility, which represented fieldwork locations favourable for providing a better understanding of barriers to health access.

Access to health care and Informal Patient Payments for health care in Serbia

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Buch Mejsner ◽  
S Lavasani Kjær ◽  
L Eklund Karlsson
Keyword(s):  
Health Care ◽  
Health System ◽  
Access To Health Care ◽  
Health Care Services ◽  
Local Population ◽  
Civil Servants ◽  
Care Providers ◽  
Care Services ◽  
Access To Health

Abstract Background Evidence often shows that migrants in the European region have poor access to quality health care. Having a large number of migrants seeking towards Europe, crossing through i.e. Serbia, it is crucial to improve migrants' access to health care and ensure equality in service provision Aim To investigate what are the barriers and facilitators of access to health care in Serbia, perceived by migrants, policy makers, health care providers, civil servants and experts working with migrants. Methods six migrants in an asylum center and eight civil servants in the field of migration were conducted. A complementary questionnaire to key civil servants working with migrants (N = 19) is being distributed to complement the data. The qualitative and quantitative data will be analysed through Grounded Theory and Logistic Regression respectively. Results According to preliminary findings, migrants reported that they were able to access the health care services quite easily. Migrants were mostly fully aware of their rights to access these health care services. However, the interviewed civil servants experienced that, despite the majority of migrants in camps were treated fairly, some migrants were treated inappropriately by health care professionals (being addressed inappropriately, poor or lacking treatment). The civil servants believed that local Serbs, from their own experiences, were treated poorer than migrants (I.e. paying Informal Patient Payments, poor quality of and access to health care services). The interviewed migrants were trusting towards the health system, because they felt protected by the official system that guaranteed them services. The final results will be presented at the conference. Conclusions There was a difference in quality of and access to health care services of local Serbs and migrants in the region. Migrants may be protected by the official health care system and thus have access to and do not pay additional fees for health care services. Key messages Despite comprehensive evidence on Informal Patient Payments (IPP) in Serbia, further research is needed to highlight how health system governance and prevailing policies affect IPP in migrants. There may be clear differences in quality of and access to health care services between the local population and migrants in Serbia.

Substantive Equality in South African Health Care: The Limits of Law

2000 ◽  
Vol 4 (2) ◽  
pp. 111-131 ◽  
Author(s):  
Charles Ngwena
Keyword(s):  
Health Care ◽  
South African ◽  
Access To Health Care ◽  
Health Care Services ◽  
Health Care Reforms ◽  
Structural Inequality ◽  
Care Services ◽  
Substantive Equality ◽  
African Health ◽  
Access To Health

The article considers the scope and limits of law as an instrument for facilitating equitable access to health care in South Africa. The focus is on exploring the extent to which the notion of substantive equality in access to health care services that is implicitly guaranteed by the Constitution and supported by current health care reforms, is realisable for patients seeking treatment. The article highlights the gap between the idea of substantive equality in the Constitution and the resources at the disposal of the health care sector and the country as a whole. It is submitted that though formal equality in access to health care services has been realised, substantive equality is currently unattainable, if it is attainable at all, on account of entrenched structural inequality, general poverty and a high burden of disease.

Impact of restricting access to health care services on Syrian refugees in Jordan: evidence from cross-sectional surveys

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ibraheem Khaled Abu Siam ◽  
María Rubio Gómez
Keyword(s):  
Health Care ◽  
Health Care Access ◽  
Access To Health Care ◽  
Health Care Services ◽  
Health Care Cost ◽  
Syrian Refugees ◽  
Cross Sectional ◽  
Content Type ◽  
Care Access ◽  
Care Services

Purpose Access to health-care services for refugees are always impacted by many factors and strongly associated with population profile, nature of crisis and capacities of hosing countries. Throughout refugee’s crisis, the Jordanian Government has adopted several healthcare access policies to meet the health needs of Syrian refugees while maintaining the stability of the health-care system. The adopted health-care provision policies ranged from enabling to restricting and from affordable to unaffordable. The purpose of this paper is to identify the influence of restricted level of access to essential health services among Syrian refugees in Jordan. Design/methodology/approach This paper used findings of a cross-sectional surveys conducted over urban Syrian refugees in Jordan in 2017 and 2018 over two different health-care access policies. The first were inclusive and affordable, whereas the other considered very restricting policy owing to high inflation in health-care cost. Access indicators from four main thematic areas were selected including maternal health, family planning, child health and monthly access of household. A comparison between both years’ access indicators was conducted to understand access barriers and its impact. Findings The comparison between findings of both surveys shows a sudden shift in health-care access and utilization behaviors with increased barriers level thus increased health vulnerabilities. Additionally, the finding during implementation of restricted access policy proves the tendency among some refugees groups to adopt negative adaptation strategies to reduce health-care cost. The participants shifted to use a fragmented health-care, reduced or delayed care seeking and use drugs irrationally weather by self-medication or reduce drug intake. Originality/value Understanding access barriers to health services and its negative short-term and long-term impact on refugees’ health status as well as the extended risks to the host communities will help states that hosting refugees building rational access policy to protect whole community and save public health gains during and post crisis. Additionally, it will support donors to better mobilize resources according to the needs while the humanitarian actors and service providers will better contribute to the public health stability during refugee’s crisis.

Medicaid Policy Statement

PEDIATRICS ◽  
1994 ◽  
Vol 93 (1) ◽  
pp. 135-136
Author(s):  
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Health Care Services ◽  
Policy Statement ◽  
Medicaid Program ◽  
Term Care ◽  
Care Services ◽  
Access To Health ◽  
Children First ◽  
Poor Children

The American Academy of Pediatrics recognizes the achievements of the Medicaid program in improving access to health care services for poor children. Despite recent legislative expansions to extend eligibility to more poor and disabled children and to broaden the scope of preventive and treatment services in all states, several additional program improvements are needed to eliminate the following barriers to access: 1. Federal and state fiscal crises are creating major roadblocks to Medicaid program implementation and expansion. 2. Thousands of poor children will not be eligible for Medicaid until October 1, 2001.1 3. Only a portion of those who are potentially eligible for Medicaid apply for coverage, and many eligible children do not utilize services. 4. Fewer Medicaid funds are available for primary and preventive care because of the increasing need for long-term care services. 5. Early and periodic screening, diagnosis and treatment (EPSDT)/preventive health services are being received by too few children and the implementation of expanded service coverage under EPSDT, granted in 1989, is subject to a great deal of inconsistent state interpretation. 6. Inadequate provider reimbursement reduces children's access to health care services. The Academy has developed the "Children First" proposal which calls for the elimination of Medicaid and replaces it with a one-class, private insurance system of universal access to health care for all children through age 21 and for all pregnant women.2 However, until the "Children First" proposal, or a similar health care reform initiative is implemented, the Academy recommends the following policy actions to improve the current Medicaid program.

scholarly journals Sex-specific differences in prevalence and in the factors associated to the search for health services in a population based epidemiological study

2014 ◽  
Vol 17 (2) ◽  
pp. 323-340 ◽  
Author(s):  
Suzana Alves de Moraes ◽  
Daniele Almeida Lopes ◽  
Isabel Cristina Martins de Freitas
Keyword(s):  
Epidemiological Study ◽  
Associated Factors ◽  
Access To Health Care ◽  
Health Care Services ◽  
Economic Indicator ◽  
Population Based ◽  
Cross Sectional ◽  
Women Health ◽  
Care Services ◽  
Health Related

Objectives: To identify the access to health care services and associated factors in adults living in the city of Ribeirão Preto, São Paulo, Brazil, in 2007. Methods: A cross-sectional population-based epidemiological study with a sample developed in three stages. The variability introduced in the third sampling fraction was corrected by the attribution of weights, resulting in a sample of 2,471 participants. The outcome prevalence was estimated according to socio-demographic, behavioral and health-related variables. In order to identify associated factors, the regression of Poisson was used, obtaining crude and adjusted prevalence ratios. All estimates were calculated taking into account the effect of the sampling design. Results: The outcome prevalence increased according to the age, being higher in female individuals. A different set of variables remained in the final models, considering each gender separately. Among men, the monthly income > R$ 1,400.00; scores > 823.6 to the Economic Indicator of Ribeirão Preto (IERP) and daily average of sitting down time (154.4 - 240 min/day) constituted themselves into protective factors, whereas the increase of age and scholarship, hospitalization, diabetes and hypertension constituted risk factors for the use of the services. Among women, health self-reported as regular, hospitalization, diabetes and hypertension characterized factors positively associated to the outcome at matter. Conclusions: The results indicate the need for planning actions aimed at capturing male individuals, as well as the revaluation of detection and control of diabetes and hypertension programs, aimed at the primary prevention of terminal cardiovascular events.

scholarly journals Relationships Between Financial Toxicity and Symptom Burden in Cancer Survivors: A Systematic Review

2019 ◽  
Vol 57 (3) ◽  
pp. 646-660.e1 ◽  
Author(s):  
Raymond Javan Chan ◽  
Louisa G. Gordon ◽  
Chia Jie Tan ◽  
Alexandre Chan ◽  
Natalie K. Bradford ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cancer Survivors ◽  
Symptom Burden ◽  
Financial Toxicity

scholarly journals Mobile and Web-Based Apps That Support Self-Management and Transition in Young People With Chronic Illness: Systematic Review

10.2196/13579 ◽  
2019 ◽  
Vol 21 (11) ◽  
pp. e13579 ◽  
Author(s):  
Yisselle Ilene Virella Pérez ◽  
Sharon Medlow ◽  
Jane Ho ◽  
Katharine Steinbeck
Keyword(s):  
Systematic Review ◽  
Chronic Illness ◽  
Young People ◽  
Physical Health ◽  
Chronic Illnesses ◽  
Self Management ◽  
Management Skills ◽  
Adult Care ◽  
Web Based ◽  
Care Services

Background More adolescents with chronic physical illness are living into adulthood, and they require the development of proficient self-management skills to maintain optimal physical health as they transition into adult care services. It is often during this vulnerable transition period that deterioration in illness control is seen as a result of inadequate self-management skills and understanding of their chronic illness. Mobile technology has been proposed as an innovative opportunity to assist in improving the management of chronic conditions as young people transition to adult care services. Over the past 5 years, there has been a significant increase in research into the use of health-related apps. Objective This study aimed to evaluate the utility and effectiveness of mobile and Web-based health apps that support self-management and transition in young people with chronic physical health illnesses. Methods We conducted a comprehensive review of the literature in 5 bibliographic databases, using key search terms, considering only articles published from 2013, as we were extending the data from 2 previous systematic reviews. Abstracts were screened for possible inclusion by 2 reviewers. Data extraction and quality assessment tools were used for the evaluation of included studies. Results A total of 1737 records were identified from the combined electronic searches, and 854 records were removed as duplicates. A total of 68 full articles were further assessed for eligibility, and 6 articles met our review criteria: 3 pilot studies, 2 randomized controlled trials, and 1 prospective cohort study. Publication years ranged from 2015 to 2018. The apps reported were targeted at type 1 diabetes mellitus, epilepsy, asthma, beta thalassemia major, and sickle cell disease, with a combined sample size of 336. A total of 4 studies included in this review reported being effective in increasing knowledge of the targeted condition and increasing therapy adherence, including increased medication adherence. A total of 2 manuscripts only mentioned the word transition. Participant’s satisfaction was reported for all studies. Heterogeneity of the studies prevented meta-analysis. Conclusions There remain limited data on the effectiveness and use of mobile and Web-based apps, which might facilitate the transition of adolescents with chronic illnesses from pediatric to adult health care services. This systematic review provides an updated overview of available apps for adolescents with chronic illnesses. This systematic review has been unable to provide evidence for effectiveness of this approach, but it does provide insights into future study design, with reference to the development, evaluation, and efficacy of apps tailored for adolescents with chronic illnesses, including the involvement of adolescents in such designs. Trial Registration PROSPERO CRD42018104611; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=104611

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