scholarly journals Disruption of medical care among individuals in the southeastern United States during the COVID-19 pandemic

2021 ◽  
Author(s):  
Bin Ni ◽  
Erin Gettler ◽  
Rebecca Stern ◽  
Heather M. Munro ◽  
Mark Steinwandel ◽  
...  
Keyword(s):  
Medical Care ◽  
Low Income ◽  
Perceived Risk ◽  
Healthcare Access ◽  
Individual Perceptions ◽  
The Common ◽  
Barriers To Healthcare ◽  
Race Ethnicity ◽  
Barriers To Healthcare Access

Background: Widespread disruptions of medical care to mitigate COVID-19 spread and reduce burden on healthcare systems may have deleterious public health consequences.Design and Methods: To examine factors contributing to healthcare interruptions during the pandemic, we conducted a COVID-19 impact survey between 10/7-12/14/2020 among participants of the Southern Community Cohort Study, which primarily enrolled low-income individuals in 12 southeastern states from 2002-2009. COVID survey data were combined with baseline and follow-up data.Results: Among 4,463 respondents, 40% reported having missed/delayed a health appointment during the pandemic; the common reason was provider-initiated cancellation or delay (63%). In a multivariable model, female sex was the strongest independent predictor of interrupted care, with odds ratio (OR) 1.63 (95% confidence interval [CI] 1.40-1.89). Those with higher education (OR 1.27; 95% CI 1.05-1.54 for college graduate vs ≤high school) and household income (OR 1.47; 95% CI 1.16-1.86 for >$50,000 vs <$15,000) were at significantly increased odds of missing healthcare.  Having greater perceived risk for acquiring (OR 1.42; 95% CI 1.17-1.72) or dying from COVID-19 (OR 1.25; 95% CI 1.04-1.51) also significantly increased odds of missed/delayed healthcare. Age was inversely associated with missed healthcare among men (OR for 5-year increase in age 0.88; 95% CI 0.80-0.96) but not women (OR 0.97; 95% CI 0.91-1.04; p-interaction=0.04). Neither race/ethnicity nor comorbidities were associated with interrupted healthcare.Conclusions: Disruptions to healthcare disproportionately affected women and were primarily driven by health system-initiated deferrals and individual perceptions of COVID-19 risk, rather than medical co-morbidities or other traditional barriers to healthcare access.

scholarly journals A Multilevel Modelling of Barriers to Healthcare Access and Healthcare Seeking for Childhood Illnesses Among Childbearing Women in Burundi

2020 ◽  
Author(s):  
Bright Opoku Ahinkorah ◽  
Abdul-Aziz Seidu ◽  
John Elvis Elvis Hagan ◽  
Eugene Budu ◽  
Aliu Mohammed ◽  
...  
Keyword(s):  
Maternal Health ◽  
Medical Care ◽  
Healthcare Access ◽  
Multilevel Modelling ◽  
Health Seeking ◽  
Lower Odds ◽  
Childhood Illnesses ◽  
Barriers To Healthcare ◽  
Barriers To Healthcare Access ◽  
Childbearing Women

Abstract BackgroundPoor health seeking behaviour continue to be major challenge in accessing healthcare in sub-Saharan Africa despite the availability of effective treatment for most childhood illnesses. The current study investigated the barriers to healthcare access and health seeking for childhood illnesses in Burundi.Methods The study utilized data from the 2016-17 Burundi Demographic and Health Survey (BDHS). A total of 11,828 childbearing women who had complete information on all the variables of interest were included in our study. The outcome variable for the study was healthcare seeking for childhood illnesses. The data were analyzed using STATA version 14.2 for windows. Chi-square test of independence and a multilevel modelling were carried out to generate the results. Statistical significance was pegged at 95% confidence intervals (CIs).Results Overall, 80.55% of women in Burundi sought care for their children’s illness. We found that women who perceived getting money for medical care for self as a big problem [AOR=0.82; CI=0.73-0.91] and considered going for medical care alone as a big problem [AOR=0.84; CI=0.73-0.96], had lower odds of seeking healthcare for their children, compared to those who considered these indicators as not a big problem. The results also showed that cohabiting mothers [AOR=0.86; CI=0.76-0.96], those taking healthcare decisions alone [AOR=0.83; CI=0.71-0.97], women in female headed households [AOR=0.85;CI=0.74-0.98], women with children larger [AOR=0.86;CI=0.77-0.96] and smaller than average [AOR=0.76;CI=0.67-0.87], single birth children [AOR=0.65; 0.47-0.89], and women in rural areas [AOR=0.79; CI=0.63-0.99] had lower odds of seeking care for their children’s illness.ConclusionFindings suggest that Burundi should strengthen maternal health care regarding women’s healthcare accessibility and health seeking behaviours, especially with residential consideration and among women from the poorest wealth quintile, those cohabiting and those with lower parity. The Burundian government through multi-sectoral partnership should strengthen health systems (e.g. pay-for-performance [P4P]) for maternal health and address structural determinants of women’s health by creating favourable conditions to improve the status of women and foster their overall socioeconomic well-being.

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.

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.

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.

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