A patient navigation program to enhance access to care for undeserved patients with a suspicion or diagnosis of cancer in Mexico City.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6544-6544
Author(s):  
Alexandra Bukowski ◽  
Enrique Soto Perez De Celis ◽  
Wendy A Ramos-López ◽  
Patricia Rojo-Castillo ◽  
Jesus Armando Sanchez- Gonzalez ◽  
...  
Keyword(s):  
Access To Care ◽  
Mexico City ◽  
Patient Navigation ◽  
Healthcare Access ◽  
Cancer Center ◽  
Running Water ◽  
Diagnosis Of Cancer ◽  
Barriers To Healthcare ◽  
Barriers To Healthcare Access ◽  
Mean Time

6544 Background: High cancer mortality rates in developing nations are partially driven by advanced stages at diagnosis and limited access to care. In Mexico, the interval from problem identification to start of treatment can be up to 7 months, mostly due to healthcare system delays. We implemented a patient navigation (PN) program aimed at reducing time to referral to cancer centers for patients (pts) with a suspicion or a diagnosis of cancer seen at a public general hospital in Mexico City. Methods: Pts age > 18 seen at Hospital General Ajusco Medio in Mexico City who required referral to a cancer center were enrolled. Baseline demographic, economic and psychosocial data were collected. A Patient Navigator assisted pts with scheduling; paperwork; obtaining results in a timely manner; transportation; and with other cultural barriers. The goal of the PN program was for at least 70% of enrolled patients to obtain a specialized appointment at a cancer center within the first 3 months from enrollment. Results: 53 pts (median age 54, range 19-80; 51% female) were included between 01/16 and 12/16. 19% (n = 10) had breast/GYN, 19% (n = 10) GU, 19% (n = 10) endocrine, 19% GI (n = 10) and 14% (n = 13) other tumors. All the pts were uninsured, 59% (n = 30) had less than middle school education, 80% (n = 41) were unemployed and 96% (n = 49) had a monthly household income of < $360 USD. 54% (n = 28) reported deprivation in at least one basic living need (education, running water, toilet, electricity or flooring). The most commonly identified barriers to healthcare access were financial (73%, N = 37), lack of transportation (47%, N = 24), fear (37%, N = 19) and poor communication with healthcare workers (35%, N = 18). Mean time to referral was 11 days (range 0–46, SD 11.2) and mean time to cancer specialist appointment 26 days (range 1–94, SD 21.18). 92% of pts successfully obtained appointments at a cancer center in < 3 months. Conclusions: Compared with previously reported data, this PN program shortened time to referral to a cancer center for pts with a suspicion or diagnosis of cancer in Mexico City. PN represents a potential solution to overcome barriers to healthcare access for underserved pts with cancer in developing countries.

scholarly journals Poor Outcomes of Older Adults with Acute Promyelocytic Leukemia (APL) Regardless of Insurance Types

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3065-3065
Author(s):  
Prajwal Dhakal ◽  
Elizabeth R. Lyden ◽  
Utsav Joshi ◽  
Avantika Pyakuryal ◽  
Krishna Gundabolu ◽  
...  
Keyword(s):  
Older Adults ◽  
Research Funding ◽  
Private Insurance ◽  
Healthcare Access ◽  
Cancer Center ◽  
Database Analysis ◽  
Income Status ◽  
Insurance Type ◽  
Barriers To Healthcare ◽  
Barriers To Healthcare Access

Abstract Introduction Prior studies report multiple factors, including insurance status, as significant barriers to healthcare access in the United States. Barriers to healthcare access may lead to worse outcomes in APL, which requires timely diagnosis and prompt treatment. We performed a large database analysis to examine the effects of insurance type and other factors on one-month mortality and overall survival (OS) in patients ≥65 years of age with APL. Methods We aimed to compare one-month mortality and OS of patients on private insurance with patients on non-private insurance, which included Medicare, Medicaid, and other government insurance. Patients ≥65 years of age who were diagnosed with APL between 2004-2015 were identified from the National Cancer Database (NCDB). Multiple regression analysis was used to evaluate the effects of insurance type on the probability of one-month mortality. The Kaplan-Meier method estimated overall survival (OS), which was defined as the time from APL diagnosis to last contact or death from any cause. We used Cox regression model to determine the effects of insurance type on mortality risk adjusting for the other covariates of interest. Results We analyzed a total of 1520 patients- either private (12%) or non-private (88%), which included Medicare (85%), Medicaid (2%), and other government insurance (1%). Among total patients, 60% were 65-74 years of age, 46% were female, 87% were white, 84% had Charlson-Deyo comorbidity index (CCI) of 0 or 1, and 52% were treated at academic centers. One-month mortality was 18% for patients with private insurance and 23% for patients with non-private insurance. In a multivariate regression analysis, insurance type did not affect one-month mortality (Table 1). One-month mortality was higher for older patients; patients ≥75 years of age were more likely to die at one month compared to patients 65-74 years (Odds ratio [OR] 1.98, 95% confidence interval [CI] 1.53-2.57, p&lt;0.0001). Compared to patients with CCI of 0, patients with CCI of 1 (OR 1.91, 95% CI 1.43-2.55, p&lt;0.0001), CCI 2 (OR 1.68, 95% CI 1.10-2.56, p=0.01), and CCI ≥3 (OR 2.88, 95% CI 1.75-4.73, p&lt;0.0001) had worse one-month mortality. One-month mortality was higher for patients treated at comprehensive community cancer center compared to those treated at academic cancer center. Median follow-up for surviving patients was 4.5 years (0.03-13.72). Three-year OS was 56% for private insurance and 50% for non-private insurance (Table 2, Figure 1). In Cox proportional hazard model, there was no statistically significant difference in OS based on insurance type. (Table 3). OS did decrease with increasing age. Compared to patients 65-74 years of age, the likelihood of death was higher for patients ≥75 years (Hazard ratio [HR] 1.80, 95% CI 1.57-2.07, p&gt;&lt;0.001). OS decreased with increasing comorbidities: HR 1.31 (95% CI 1.12-1.54, p=0.0007) for CCI 1, HR 1.60 (95% CI 1.28-1.99, p&lt;0.0001) for CCI 2, and HR 1.80 (95% CI 1.37-2.37, p&lt;0.0001) for CCI ≥3 compared to patients with CCI of 0. OS was lower for patients treated at comprehensive community cancer center compared to those treated at academic cancer center. Higher income status and diagnosis after 2009 were associated with improved OS. Conclusion In our large database analysis, while insurance types were not associated with mortality in patients ≥65 years of age with APL, one-month mortality (about 20%) still remains high and only half of older adults are alive at 3 years. Our study highlights a significant effect of increasing age on mortality even among older adults, with approximately 2-fold higher risk of mortality among patients ≥75 years versus those 65-74 years. Other factors associated with higher mortality included treatment outside of academic centers and lower income status. Unlike younger adults, APL in older adults still has significant unmet need. Figure 1 Figure 1. Disclosures Gundabolu: Bristol-Myers Squibb Company: Consultancy; Blueprint Medicines: Consultancy; Pfizer: Research Funding; Samus Therapeutics: Research Funding; BioMarin Pharmaceuticals: Consultancy. Bhatt: Servier Pharmaceuticals LLC: Consultancy; Partnership for health analytic research, LLC: Consultancy; Abbvie: Consultancy, Research Funding; Jazz: Research Funding; Incyte: Consultancy, Research Funding; Pfizer: Research Funding; Tolero Pharmaceuticals, Inc: Research Funding; National Marrow Donor Program: Research Funding; Abbvie: Consultancy, Research Funding; Genentech: Consultancy; Rigel: Consultancy.

scholarly journals A mixed methods study to evaluate the impact of a student-run clinic on undergraduate medical education

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nathan G. Rockey ◽  
Taylor M. Weiskittel ◽  
Katharine E. Linder ◽  
Jennifer L. Ridgeway ◽  
Mark L. Wieland
Keyword(s):  
Mixed Methods ◽  
Patient Care ◽  
Social Factors ◽  
Healthcare Access ◽  
Community Services ◽  
Student Understanding ◽  
Learning Objectives ◽  
Barriers To Healthcare ◽  
The Impact ◽  
Barriers To Healthcare Access

Abstract Background The purpose of this study was to evaluate the extent to which a longitudinal student-run clinic (SRC) is meeting its stated learning objectives, including providing critical community services and developing physicians who more fully appreciate the social factors affecting their patients’ health. Methods This was a mixed methods program evaluation of an SRC at Mayo Clinic Alix School of Medicine (MCASOM). A survey was conducted of medical students who had participated in the clinic and seven interviews and three focus groups were conducted with SRC patients, students, faculty, staff, and board members. Transcripts were coded for systematic themes and sub-themes. Major themes were reported. Survey and interview data were integrated by comparing findings and discussing areas of convergence or divergence in order to more fully understand program success and potential areas for improvement. Results Greater than 85% of student survey respondents (N = 90) agreed or strongly agreed that the SRC met each of its objectives: to provide a vital community service, to explore social determinants of health (SDH), to understand barriers to healthcare access and to practice patience-centered examination. Qualitative data revealed that the SRC contextualized authentic patient care experiences early in students’ medical school careers, but the depth of learning was variable between students. Furthermore, exposure to SDH through the program did not necessarily translate to student understanding of the impact of these social factors on patient’s health nor did it clearly influence students’ future practice goals. Conclusions The MCASOM SRC experience met core learning objectives, but opportunities to improve long-term impact on students were identified. Participation in the SRC enabled students to engage in patient care early in training that is representative of future practices. SRCs are an avenue by which students can gain exposure to real-world applications of SDH and barriers to healthcare access, but additional focus on faculty development and intentional reflection may be needed to translate this exposure to actionable student understanding of social factors that impact patient care.

scholarly journals A Review of Models Used for Investigating Barriers to Healthcare Access in Australia

2020 ◽  
Vol 17 (11) ◽  
pp. 4087
Author(s):  
Nagesh Shukla ◽  
Biswajeet Pradhan ◽  
Abhirup Dikshit ◽  
Subrata Chakraborty ◽  
Abdullah M. Alamri
Keyword(s):  
Computational Models ◽  
Healthcare Access ◽  
Geographical Area ◽  
Patient Characteristics ◽  
Population Based ◽  
Rural And Urban ◽  
Key Points ◽  
Barriers To Healthcare ◽  
Future Work ◽  
Barriers To Healthcare Access

Understanding barriers to healthcare access is a multifaceted challenge, which is often highly diverse depending on location and the prevalent surroundings. The barriers can range from transport accessibility to socio-economic conditions, ethnicity and various patient characteristics. Australia has one of the best healthcare systems in the world; however, there are several concerns surrounding its accessibility, primarily due to the vast geographical area it encompasses. This review study is an attempt to understand the various modeling approaches used by researchers to analyze diverse barriers related to specific disease types and the various areal distributions in the country. In terms of barriers, the most affected people are those living in rural and remote parts, and the situation is even worse for indigenous people. These models have mostly focused on the use of statistical models and spatial modeling. The review reveals that most of the focus has been on cancer-related studies and understanding accessibility among the rural and urban population. Future work should focus on further categorizing the population based on indigeneity, migration status and the use of advanced computational models. This article should not be considered an exhaustive review of every aspect as each section deserves a separate review of its own. However, it highlights all the key points, covered under several facets which can be used by researchers and policymakers to understand the current limitations and the steps that need to be taken to improve health accessibility.

Barriers to healthcare access in a non-elderly urban poor American population

2001 ◽  
Vol 9 (6) ◽  
pp. 445-453 ◽  
Author(s):  
Syed M. Ahmed ◽  
Jeanne P. Lemkau ◽  
Nichol Nealeigh ◽  
Barbara Mann
Keyword(s):  
Urban Poor ◽  
Healthcare Access ◽  
American Population ◽  
Barriers To Healthcare ◽  
Barriers To Healthcare Access

scholarly journals Understanding Barriers to Healthcare Access for Heart Failure Patients during the COVID-19 Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1027-1028
Author(s):  
Hanzhang Xu ◽  
Julie Miller ◽  
Roy Thompson ◽  
Bradi Granger ◽  
Matthew Dupre
Keyword(s):  
Heart Failure ◽  
Access To Care ◽  
Healthcare Access ◽  
Transitions Of Care ◽  
Structured Interviews ◽  
Patient Centered ◽  
Patients With Heart Failure ◽  
Heart Center ◽  
Barriers To Healthcare Access

Abstract Early outpatient follow-up within two weeks after hospital discharge is an effective strategy for improving transitions of care in older patients with heart failure (HF). However, implementing timely follow-up care for HF patients has been challenging, especially during the COVID-19 pandemic. This convergent mixed-methods study identified patients’ barriers to accessing care and ascertained their recommendations for addressing these barriers. We enrolled 264 HF patients admitted to the Duke Heart Center between May 2020 and August 2021. A standardized survey and electronic health records (EHR) were used to collect patients’ sociodemographic, psychosocial, behavioral, and clinical data. For patients who reported some difficulty accessing their healthcare (n=30), semi-structured interviews were conducted to understand these barriers. Data were analyzed using rapid analysis techniques. Barriers to accessing care varied across participants, with scheduling an appointment being the most common barrier (12 of the 30 responses). Participants indicated that job-related conflicts, providers’ availability, or COVID-19 contributed most to the difficulty in scheduling an appointment. Some participants experienced more difficulties during the pandemic due to fewer appointments available for non-acute and non-COVID-19 related needs. Transportation was another critical barrier, which was often associated with the participants’ physical functional status. Participants identified the benefits of using telemedicine to address access to care barriers; however, they shared their concerns that telemedicine visits may not be sufficient to assess their HF conditions. Study findings highlight the need for more continual, tailored, and patient-centered interventions to improve access to care in older HF patients.

scholarly journals Barriers to healthcare access for Arabic-speaking population in an English-speaking country

2020 ◽  
Vol 18 (2) ◽  
pp. 1809
Author(s):  
Ali A. Al Jumaili ◽  
Kawther K. Ahmed ◽  
Dave Koch
Keyword(s):  
Health Insurance ◽  
Health Literacy ◽  
Focus Group ◽  
Healthcare Access ◽  
Healthcare Services ◽  
Preventive Healthcare ◽  
Physician Visits ◽  
Barriers To Healthcare ◽  
Arabic Speaking ◽  
Barriers To Healthcare Access

Objective: To identify barriers to healthcare access, to assess the health literacy levels of the foreign-born Arabic speaking population in Iowa, USA and to measure their prevalence of seeking preventive healthcare services. Methods: A cross-sectional study of native Arabic speaking adults involved a focus group and an anonymous paper-based survey. The focus group and the Andersen Model were used to develop the survey questionnaire. The survey participants were customers at Arabic grocery stores, worshippers at the city mosque and patients at free University Clinic. Chi-square test was used to measure the relationship between the characteristics of survey participants and preventive healthcare services. Thematic analysis was used to analyze the focus group transcript. Results: We received 196 completed surveys. Only half of the participants were considered to have good health literacy. More than one-third of the participants had no health insurance and less than half of them visit clinics regularly for preventive measures. Two participant enabling factors (health insurance and residency years) and one need factor (having chronic disease(s)) were found to significantly influence preventive physician visits. Conclusions: This theory-based study provides a tool that can be used in different Western countries where Arabic minority lives. Both the survey and the focus group agreed that lacking health insurance is the main barrier facing their access to healthcare services. The availability of an interpreter in the hospital is essential to help those with inadequate health literacy, particularly new arriving individuals. More free healthcare settings are needed in the county to take care of the increasing number of uninsured Arabic speaking patients.

Overcoming Barriers to Healthcare Access and HIV Prevention among Migrants in Spain

2018 ◽  
Author(s):  
Miriam Navarro ◽  
B�rbara Navaza ◽  
Anne Guionnet ◽  
Rogelio L�pez-V�lez
Keyword(s):  
Hiv Prevention ◽  
Healthcare Access ◽  
Barriers To Healthcare ◽  
Barriers To Healthcare Access
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