scholarly journals Sex, Socioeconomic Status, Access to Cardiac Catheterization, and Outcomes for Acute Coronary Syndromes in the Context of Universal Healthcare Coverage

2014 ◽  
Vol 7 (4) ◽  
pp. 540-549 ◽  
Author(s):  
G. E. Fabreau ◽  
A. A. Leung ◽  
D. A. Southern ◽  
M. L. Knudtson ◽  
J. M. McWilliams ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Cardiac Catheterization ◽  
Acute Coronary Syndromes ◽  
Universal Healthcare ◽  
Healthcare Coverage ◽  
Coronary Syndromes ◽  
Universal Healthcare Coverage

scholarly journals Universal Healthcare Coverage Does Not Ensure Adherence to Initial Colorectal Cancer Screening Guidelines

2020 ◽  
Author(s):  
Christian S McEvoy ◽  
Nina G Shah ◽  
Sarah E Roberts ◽  
Anna M Carroll ◽  
Timothy A Platz ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Socioeconomic Status ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Active Duty ◽  
Average Risk ◽  
Screening Guidelines ◽  
Universal Healthcare ◽  
Healthcare Coverage ◽  
Universal Healthcare Coverage

Abstract Introduction Colorectal cancer is the second leading cause of cancer deaths in the USA, and screening tests are underutilized. The aim of this study was to determine the proportion of individuals at average risk who utilized a recommended initial screening test in a universal healthcare coverage system. Materials and Methods This is a retrospective cohort study of active duty and retired military members as well as civilian beneficiaries of the Military Health System. Individuals born from 1960 to 1962 and eligible for full benefits on their 50th birthday were evaluated. Military rank or rank of benefits sponsor was used to determine socioeconomic status. Adherence to the U.S. Preventive Services Task Force guidelines for initial colorectal cancer screening was determined using “Current Procedural Terminology” and “Healthcare Common Procedure Coding System” codes for colonoscopy, sigmoidoscopy, fecal occult blood test, and fecal immunohistochemistry test. Average risk individuals who obtained early screening ages 47 to 49 were also identified. Results This study identified 275,665 individuals at average risk. Of these, 105,957 (38.4%) adhered to screening guidelines. An additional 19,806 (7.2%) individuals were screened early. Colonoscopy (82.7%) was the most common screening procedure. Highest odds of screening were associated with being active duty military (odds ratio [OR] 3.63, 95% confidence interval [CI] 3.43 to 3.85), having highest socioeconomic status (OR 2.37, 95% CI 2.31 to 2.44), and having managed care insurance (OR 4.36, 95% CI 4.28 to 4.44). Conclusions Universal healthcare coverage does not ensure initial colorectal cancer screening utilization consistent with guidelines no does it eliminate disparities.

scholarly journals Why does healthcare utilisation differ between socioeconomic groups in OECD countries with universal healthcare coverage? A protocol for a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e054806
Author(s):  
Iris Meulman ◽  
Ellen Uiters ◽  
Johan Polder ◽  
Niek Stadhouders
Keyword(s):  
Systematic Review ◽  
Healthcare Access ◽  
Healthcare Utilisation ◽  
Oecd Countries ◽  
Primary Data ◽  
Scientific Article ◽  
Socioeconomic Groups ◽  
Universal Healthcare ◽  
Healthcare Coverage ◽  
Universal Healthcare Coverage

IntroductionEven in advanced economies with universal healthcare coverage (UHC), a social gradient in healthcare utilisation has been reported. Many individual, community and healthcare system factors have been considered that may be associated with the variation in healthcare utilisation between socioeconomic groups. Nevertheless, relatively little is known about the complex interaction and relative contribution of these factors to socioeconomic differences in healthcare utilisation. In order to improve understanding of why utilisation patterns differ by socioeconomic status (SES), the proposed systematic review will explore the main mechanisms that have been examined in quantitative research.Methods and analysisThe systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and will be conducted in Embase, PubMed, Scopus, Web of Science, Econlit and PsycInfo. Articles examining factors associated with the differences in primary and specialised healthcare utilisation between socioeconomic groups in Organisation for Economic Co-operation and Development (OECD) countries with UHC will be included. Further restrictions concern specifications of outcome measures, factors of interest, study design, population, language and type of publication. Data will be numerically summarised, narratively synthesised and thematically discussed. The factors will be categorised according to existing frameworks for barriers to healthcare access.Ethics and disseminationNo primary data will be collected. No ethics approval is required. We intend to publish a scientific article in an international peer-reviewed journal.

scholarly journals Adherence to Guidelines for Cardiac Catheterization Referrals and Secondary Prevention Strategies in Patients with Non-ST Segment Elevation Acute Coronary Syndromes

1970 ◽  
Vol 9 (3) ◽  
Author(s):  
Michelle J. Haroun MD ◽  
Anjali Shroff MD, ◽  
Joshua J. Manolakos ◽  
Madhu K. Natarajan MD MSc ◽  
John You MD MSc, ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Cardiac Catheterization ◽  
Acute Coronary Syndromes ◽  
Wait Times ◽  
Prevention Strategies ◽  
Invasive Procedures ◽  
St Segment Elevation ◽  
Rehabilitation Programs ◽  
St Segment ◽  
Coronary Syndromes

Background: Previous studies have demonstrated higher referral rates for invasive procedures among patients admitted with acute coronary syndromes (ACS) to hospitals with catheterization facilities compared to those without. Studies have also reported underuse of evidence-based medical therapies and cardiac rehabilitation programs post myocardial infarction. We evaluated referral patterns for cardiac catheterization and use of secondary prevention strategies in current practice.Methods: We conducted a retrospective study of 397 patients with non-ST segment elevation ACS, comparing angiography referrals at a hospital with on-site catheterization facilities (Site A, n = 194) versus a hospital without (Site B, n = 203). We also recorded the use of secondary prevention strategies including discharge medications, referrals to smoking cessation programs and cardiac rehabilitation.Results: There was no significant effect of on-site angiography on the decision to manage patients invasively (adjusted OR for on-site angiography 1.49 95% CI 0.92-2.44, p = .11), or wait times for cardiac catheterization (Site A 1.9 days vs. Site B 2.2 days, difference −0.3 days, 95% CI −0.83 to 0.55, p = .70). However, at the time of hospital discharge, less than 70% of patients were prescribed dual antiplatelet therapy and only 13% of patients were referred for cardiac rehabilitation.Conclusion: These observations suggest that in contemporary practice in a Southern Ontario community, the availability of on-site percutaneous coronary intervention does not influence referral rates or wait times for cardiac catheterization. However we did observe significant underuse of cardiac rehabilitation programs and certain medical therapies. This suggests that despite improvements in access to invasive procedures, there remain important gaps in secondary prevention of coronary artery disease, which represent opportunities to improve quality of care in these patients.

Health inequalities in hospitalisation and mortality in patients diagnosed with heart failure in a universal healthcare coverage system

2018 ◽  
Vol 72 (9) ◽  
pp. 845-851 ◽  
Author(s):  
Raquel Garcia ◽  
Rosa Abellana ◽  
Jordi Real ◽  
José-Luis del Val ◽  
Jose Maria Verdú-Rotellar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Total Mortality ◽  
Community Dwelling ◽  
Socioeconomic Groups ◽  
Universal Healthcare ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Healthcare Coverage ◽  
Cox Proportional Hazard Models ◽  
Universal Healthcare Coverage

BackgroundInformation regarding the effect of social determinants of health on heart failure (HF) community-dwelling patients is scarce. We aimed to analyse the presence of socioeconomic inequalities, and their impact on hospitalisations and mortality, in patients with HF attended in a universal healthcare coverage system.MethodsA retrospective cohort study carried out in patients with HF aged >40 and attended at the 53 primary healthcare centres of the Institut Català de la Salut in Barcelona (Spain). Socioeconomic status (SES) was determined by an aggregated deprivation index (MEDEA). Cox proportional hazard models and competing-risks regression based on Fine and Gray’s proportional subhazards were performed to analyse hospitalisations due to of HF and total mortality that occurred between 1 January 2009 and 31 December 2012.ResultsMean age was 78.1 years (SD 10.2) and 56% were women. Among the 8235 patients included, 19.4% died during the 4 years of follow-up and 27.1% were hospitalised due to HF. A gradient in the risk of hospitalisation was observed according to SES with the highest risk in the lowest socioeconomic group (sHR 1.46, 95% CI 1.27 to 1.68). Nevertheless, overall mortality did not differ among the socioeconomic groups.ConclusionsIn spite of finding a gradient that linked socioeconomic deprivation to an increased risk of hospitalisation, there were no differences in mortality regarding SES in a universal healthcare coverage system.

scholarly journals Evidences supporting the inclusion of immigrants in the universal healthcare coverage

2020 ◽  
Vol 30 (4) ◽  
pp. 785-787
Author(s):  
Albert Prats-Uribe ◽  
Sílvia Brugueras ◽  
Dolors Comet ◽  
Dolores Álamo-Junquera ◽  
LLuïsa Ortega Gutiérrez ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Infectious Diseases ◽  
Chronic Obstructive ◽  
Matched Sample ◽  
Obstructive Pulmonary Disease ◽  
Universal Healthcare ◽  
Primary Health ◽  
Healthcare Coverage ◽  
Universal Healthcare Coverage

Abstract In 2012, the Spanish government enforced a healthcare exclusion policy against undocumented immigrants. The newly elected government has recently derogated this policy. To analyze how this decree could have affected population health, we looked at primary health patients who would have been excluded and compared with a matched sample of non-excluded patients. Potentially excluded patients had decreased odds of: depression, chronic obstructive pulmonary disease, dyslipidaemia, heart failure and hypertension while diabetes mellitus rates were similar to non-excluded. Infectious diseases were more frequent in potentially excluded population (HIV, tuberculosis and syphilis). The exclusion of patients impedes the control of infectious diseases at a community level.

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