scholarly journals A Multilevel Analysis of Stigma and Health

2014 ◽  
Vol 1 (1) ◽  
pp. 213-221 ◽  
Author(s):  
Laura Smart Richman ◽  
Mark L. Hatzenbuehler
Keyword(s):  
Health Care ◽  
Stress Responses ◽  
Social Inequalities ◽  
Physiological Stress ◽  
Care Delivery ◽  
Population Level ◽  
Well Being ◽  
Disadvantaged Groups ◽  
Stigma And Discrimination ◽  
And Bisexual

This article reviews research on stigma and discrimination—at both the interpersonal and societal levels—faced by disadvantaged groups. Research on interpersonal discrimination primarily concerns discrimination that is perceived and directly experienced (e.g., discrimination in employment and health care), whereas research on societal discrimination focuses on broad societal factors (e.g., institutional policies, social attitudes). We review evidence across numerous fields of study that rely on several types of research designs, which indicate that both forms of stigma and discrimination demonstrably contribute to health inequalities for disadvantaged groups such as racial and ethnic minorities and lesbian, gay, and bisexual populations. These adverse health outcomes range from maladaptive physiological stress responses in a laboratory setting to premature mortality at a population level. The science on stigma and discrimination applies to policy issues in education, same-sex marriage, and health care delivery. Some current policies increase the experience of stigma. We argue that more holistic social policies can recognize the psychosocial factors that contribute to well-being, thereby reducing social inequalities in health.

Direct Primary Care: A Successful Financial Model for the Clinical Practice of Lifestyle Medicine

2021 ◽  
pp. 155982762110066
Author(s):  
Amy R. Mechley
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Care Delivery ◽  
Health Care Systems ◽  
Well Being ◽  
The United States ◽  
Fee For Service ◽  
Financial Model ◽  
Lifestyle Medicine ◽  
Direct Primary

Primary care has been shown to significantly decrease the overall cost of a population’s health care while improving the quality of each person’s well-being. Lifestyle medicine (LM) is ideally positioned to be delivered via primary care and has been shown to improve short- and long-term health outcomes of patients and populations. Direct primary care (DPC) represents a viable alternative to the fee-for-service reimbursement model. It has been shown to be economically and financially sustainable. Furthermore, it has the potential to fulfill the Quadruple Aim of health care in the United States. LM practiced in a DPC model has the potential to transform health care delivery. This article will discuss the need for health care systems change, provide an overview of the DPC model, demonstrate a basic understanding of the benefits, and review the steps needed to de-risk the investment of time, money, and resources for our future DPC providers.

scholarly journals Socio-demographic profile of child and adolescent users of oral health services in Victoria, Australia

2014 ◽  
Vol 30 (9) ◽  
pp. 1903-1911 ◽  
Author(s):  
J Rodrigo ◽  
Hanny Calache ◽  
Martin Whelan
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Health Services ◽  
Health Care Services ◽  
Social Inequalities ◽  
Secondary Analysis ◽  
Well Being ◽  
Oral Health Care ◽  
Sample Mean ◽  
Oral Health Services

The aim of this study was to investigate the socio-demographic characteristics of the eligible population of users of public oral health care services in the Australian state of Victoria, aged 17 years or younger. The study was conducted as a secondary analysis of data collected from July 2008 to June 2009 for 45,728 young clients of public oral health care. The sample mean age was 8.9 (SD: 3.5) years. The majority (82.7%) was between 6 and 17 years of age, and 50.3% were males. The majority (76.6%) was Australian-born and spoke English at home (89.1%). The overall mean DMFT was 1.0 (SD: 2.1) teeth, with a mean dmft of 3.16 (SD: 5.79) teeth. Data indicate that, among six year olds in the Significant Caries Index (SiC) category, the mean dmft was 6.82 teeth. Findings corroborate social inequalities in oral health outcome and provide suggestions for oral health services to develop strategies and priorities to reduce inequalities in health and well-being, and better coordinate and target services to local needs.

Adult Care in Cystic Fibrosis

2019 ◽  
Vol 40 (06) ◽  
pp. 857-868 ◽  
Author(s):  
J. Stuart Elborn
Keyword(s):  
Health Care ◽  
Cystic Fibrosis ◽  
Care Delivery ◽  
Health Care Systems ◽  
Well Being ◽  
Models Of Care ◽  
Adult Care ◽  
Care Systems ◽  
Expanding Population ◽  
Almost All

AbstractCystic fibrosis (CF) is now more common in adults than children in countries with well-developed health care systems. The number of adults continues to increase and will further increase if the new cystic fibrosis transmembrane conductance regulator (CFTR) modulators are disease modifying. Most of the complex morbidity and almost all the mortality of CF occur in adults and will increasingly follow this pattern even with new effective modulator therapies. Maintaining good quality of life including social functioning and maximizing survival for adults are the key priorities. This requires a highly knowledgeable and adaptable multidisciplinary team, which, though focused on maintaining lung health, requires an increasing range of other disciplines and specialties to maximize well-being. Changes in health care systems will require current models of care to adapt to provide care for the large number of adult patients. With increasing survival and age, many are likely to have both CF morbidities and additional diseases of aging. New models are needed for health care delivery for this expanding population with complex medical conditions.

scholarly journals Do no harm

2020 ◽  
Author(s):  
Hasan Hawilo ◽  
Elise Quint
Keyword(s):  
Health Care ◽  
Medical Education ◽  
Care Delivery ◽  
Organizational Factors ◽  
Well Being ◽  
Professional Challenges ◽  
Do No Harm ◽  
Canadian Health ◽  
Canadian Health Care

Physician wellness and burnout have long been important topics in Canadian health care. Though burnout presents in various occupations, physicians experience unique professional challenges that predispose them to experience burnout. Elements inciting this chronic condition are introduced early in medical education, reinforced during residency training, and poorly addressed during clinical practice. Substantial evidence demonstrates that burnout has significant and undesirable impacts on patient outcomes and care delivery. Physician quality of life and well-being as well as health care spending are also negatively impacted by burnout. However, there is an ongoing need to apply these research results in the clinical setting. Currently, research suggests that individual, cultural, and organizational factors play a role in the development and maintenance of burnout. Best practices to prevent burnout and manage its effects, including interventions during medical education and greater work autonomy, are required to address barriers to wellness at each of these levels.

Population Health: The Diabetes Educator’s Evolving Role

2019 ◽  
Vol 45 (4) ◽  
pp. 333-348 ◽  
Author(s):  
Teresa L. Pearson ◽  
Joan Bardsley ◽  
Susan Weiner ◽  
Leslie Kolb
Keyword(s):  
Health Care ◽  
Population Health ◽  
Diabetes Management ◽  
Management Education ◽  
Care Delivery ◽  
Population Level ◽  
Cost Effective ◽  
Self Management ◽  
Quality Initiatives ◽  
Diabetes Educators

Purpose The US health care system’s focus on high-quality, efficient, and cost-effective care has led payers and provider groups to identify new models with a shift toward value-based care. This perspective on clinical practice describes the population health movement and the opportunities for diabetes educators beyond diabetes self-management education, as well as steps to engage in and drive new care models to demonstrate individual, organizational, and payer value. Conclusion Diabetes educators have an opportunity to position themselves as diabetes specialists for diabetes management, education, and population health care delivery. With expertise that extends beyond diabetes self-management education and with a wide variety of skills, diabetes educators recognize that there is a range of personal, social, economic, and environmental factors that influence diabetes health outcomes. Diabetes educators should align with organizational strategic plans and support the population-level performance measures and quality initiatives, thus enhancing the value that diabetes educators bring to health care organizations.

Inequalities in healthcare utilisation: a decomposition analysis based on financial protection against health risks in Senegal

2020 ◽  
Author(s):  
Mouhamed Samba ◽  
Ibrahima Thiam ◽  
Fabienne Fecher ◽  
Elisabeth Paul
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Social Inequalities ◽  
Decomposition Analysis ◽  
Healthcare Utilisation ◽  
Well Being ◽  
Horizontal Equity ◽  
Financial Protection ◽  
Oaxaca Decomposition ◽  
Economic Well Being

Abstract Background: Developing countries are characterised by lack of financial protection against health hazards that can lead to health inequity. Improving horizontal equity in the utilisation of health care requires a better understanding of the factors that influence it. This study used Senegal as a case to examine healthcare utilisation disparities and their determinants. Methods: The study used the most recent Demographic and Health Survey (2017) from Senegal. Frequencies, a logit model and an extension of Blinder-Oaxaca decomposition (proposed by Fairlie) were employed to examine healthcare utilisation gap between covered and uncovered people as well as factors explaining this gap.Results: The results of the logistic regression show that healthcare utilisation increases with quintiles of economic well-being; people covered by an insurance or fee exemption scheme use more health care services than those not covered. Women, urban people, children aged under five years and elderly (60 and +). Results from Blinder-Oaxaca decomposition suggests a difference in healthcare utilisation between covered and uncovered people. 39% of these disparities are explained by the distribution of observed characteristics (age, area of residence, economic well-being, education) while 61% of these disparities are explained by differences in coefficients. This component may be related to discriminatory practices in favour of the persons covered.Conclusion: The results also raise the issue of the fragmentation of coverage schemes that can lead to differences in the care packages offered. Public authorities need to make efforts to reduce social inequalities and have an important stewardship role across all branches of society to ensure that policies and actions in other sectors improve health equity.

Medical Geography

2004 ◽  
Author(s):  
Wil Gesler
Keyword(s):  
Health Care ◽  
Spatial Analysis ◽  
Disease Ecology ◽  
Cultural Theory ◽  
Care Delivery ◽  
Well Being ◽  
Medical Geography ◽  
Health Issues ◽  
Place Meaning ◽  
Political Economic

Medical geographers employ geographical concepts and techniques to study issues related to disease and health. In its early stages of development as a distinct geographic subdiscipline, from the 1950s and into the 1980s, medical geography focused on disease ecology and health-care delivery as topics and spatial analysis as technique. These three areas have maintained their importance and research productivity within them has increased over the last decade. At the same time, since the 1980s, medical geography has evolved into new areas of concern. Both those who continue to call themselves medical geographers and those who do not identify closely with the subdiscipline have moved toward a geography of health that is less concerned with disease and the medical world and more with well-being and social models of health and health care (Rosenberg 1998). Health geography is characterized by an emphasis on place and place meaning, grounding in socio-cultural theory, and a critical perspective on health issues (Kearns and Moon 2000). The evolution of medical geography led to lively debates in the mid-1990s (Kearns 1993; Mayer and Meade 1994; Litva and Eyles 1995; Philo 1996) that have been put into historical perspective by Del Casino and Dorn (1998). By the end of the 1990s, the dichotomy between old and new medical geographers constructed during the debate was giving way to complementarity and synthesis. As examples, disease ecology was opened out to include political economic concerns (Mayer 1996) and multi-level modeling combined aspects of spatial analysis with a focus on place (Duncan et al. 1996; Verheij 1999). The structure of this chapter results from a decision made by the Medical Geography Specialty Group (MGSG) to base its contribution to this volume on papers presented at two special sessions on “Retrospect and Prospect” during the 1998 Association of American Geographers meetings in Boston. The six presenters were Michael Greenberg on disease ecology, Ellen Cromley on health services, Gerard Rushton on spatial analysis, Susan Elliott on women’s health, Jennifer Wolch on mental health, and Joseph Scarpaci on the developing world.

Physicians’ Perceptions Toward Use of Telemedicine During COVID-19 Pandemic in Riyadh, Saudi Arabia (Preprint)

2021 ◽  
Author(s):  
sarah idriss ◽  
walaa alasaadi ◽  
abdullah Aldhuhayyan ◽  
Ahmed alenzi ◽  
Reem alharbi ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Well Being ◽  
Future Research ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Face To Face

BACKGROUND The use of communication technologies to deliver health care remotely is known as telemedicine. The coronavirus disease 2019 (COVID-19) pandemic had a variety of consequences for health-care delivery in 2020. As a result, it was necessary to adapt and deliver high-quality care to patients while limiting possible viral exposure for both patients and health-care workers. During the pandemic, physicians employed video visits, phone visits, and electronic written visits (e-consultations), all of which have the ability to provide a comparable quality of care while removing social barriers. OBJECTIVE The study’s aim is to assess physicians’ perspectives and attitudes concerning the usage of telemedicine in Riyadh hospitals during the COVID-19 pandemic. The main domains of the assessment are physicians’ overall experience with telemedicine use before and during COVID-19, future adaptability to using telemedicine, perceptions about patients’ experience, and the influence of telemedicine on burnout. METHODS Methods: An anonymous 28-question cross-sectional survey was developed using SurveyMonkey and distributed to all physicians from all specialty disciplines across Riyadh city hospitals. RESULTS A total of 362 doctors were included in the study. Among them, 28.7% were consultants, 30.4% were specialists, and 40.9% were residents. Male doctors formed the majority (56.1%). When asked about the frequency of using telemedicine, 41.4% answered “frequently,” 26% responded “occasionally,” and 32.6% said “never.” Thirty one percent of doctors agreed and somewhat agreed that the “quality of care during telemedicine is comparable with face-to-face visits.” About 55% doctors believed that telemedicine consultation is a cost-effective way, compared to face-to-face visits. Most of the doctors were skilled (70%) at telemedicine, and they were also able to solve technology issues during telemedicine visits (54%). Overall, the physicians felt that their patients liked telemedicine: 68% said they felt comfortable using telemedicine and 76% said theyfound that it saved time. As per the burnout question, 4.1% of doctors felt burnout every day, 7.5% felt burnout a few times a week, and 27.3% felt burnout a few times per month. CONCLUSIONS Physicians had a generally favorable attitude toward telemedicine, believing that the quality of health-care delivery using it was comparable to that of in-person care. Future research is needed to investigate how physicians’ attitudes toward telemedicine have changed since the pandemic, as well as how this virtual technology might be used to improve their professional and personal well-being.

Health Care Needs of Children in the Foster Care System

PEDIATRICS ◽  
2000 ◽  
Vol 106 (Supplement_3) ◽  
pp. 909-918 ◽  
Author(s):  
Mark D. Simms ◽  
Howard Dubowitz ◽  
Moira A. Szilagyi
Keyword(s):  
Health Care ◽  
Foster Care ◽  
Parent Education ◽  
Continuity Of Care ◽  
Care Delivery ◽  
Well Being ◽  
The United States ◽  
Developmental Problems ◽  
Children In Foster Care ◽  
The Impact

Nearly 750 000 children are currently in foster care in the United States. Recent trends in foster care include reliance on extended family members to care for children in kinship care placements, increased efforts to reduce the length of placement, acceleration of termination of parental rights proceedings, and emphasis on adoption. It is not clear what impact welfare reform may have on the number of children who may require foster care placement. Although most children enter foster care with medical, mental health, or developmental problems, many do not receive adequate or appropriate care while in placement. Psychological and emotional problems, in particular, may worsen rather than improve. Multiple barriers to adequate health care for this population exist. Health care practitioners can help to improve the health and well-being of children in foster care by performing timely and thorough admission evaluations, providing continuity of care, and playing an active advocacy role. Potential areas for health services research include study of the impact of different models of health care delivery, the role of a medical home in providing continuity of care, the perception of the foster care experience by the child, children's adjustment to foster care, and foster parent education on health outcomes.

scholarly journals INTEREST GROUP SESSION—FAMILY CAREGIVING: SUPPORTING FAMILY CAREGIVERS WITHIN SYSTEMS OF CARE DELIVERY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S206-S206
Author(s):  
Jennifer L Wolff ◽  
Lynn F Feinberg
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Health Care ◽  
Family Caregivers ◽  
Family Caregiver ◽  
Systems Of Care ◽  
Population Aging ◽  
Care Delivery ◽  
Well Being ◽  
Home Health

Abstract Family and other unpaid caregivers have a foundational role in supporting the health and well-being of older adults with complex health needs and disabilities and the demands imposed on them can be significant. The availability and adequacy of support provided by family and other unpaid caregivers has profound consequences for quality and outcomes of care delivery, but they are not well-supported in treatment decisions and care planning. Given population aging, the shift of long-term services and supports from nursing homes toward community settings, and technological advances that allow patients to be served in the community with higher acuity of care, there is a pressing need to develop systems-level processes to identify, engage, and support family caregivers in systems of care. This symposium will feature 5 presentations that provide novel insight regarding family caregivers’ experience within systems of care. We focus on family caregivers to older adults living in the community and receiving home and community-based services, primary care, or Medicare skilled home health services. Individual presentations will describe 1) differences in access to services and experiences of family caregivers by under-represented minority status; 2) a framework for health systems to include family caregivers as part of health care teams; 3) family caregivers’ capacity to help during the course of Medicare-funded skilled home health care; 4) perceived communication with health professionals, using a validated measure of family caregiver capacity; and 5) the feasibility of implementing a family caregiver screening instrument in primary care.

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