Determinants of Diabetes Disease Management, 2011–2019

This study estimated the effects of Medicaid Expansion, demographics, socioeconomic status (SES), and health status on disease management of diabetes over time. The hypothesis was that the introduction of the ACA and particularly Medicaid Expansion would increase the following dependent variables (all proportions): (1) provider checks of HbA1c, (2) provider checks of feet, (3) provider checks of eyes, (4) patient education, (5) annual physician checks for diabetes, (6) patient self-checks of blood sugar. Data were available from the Behavioral Risk Factor Surveillance System for 2011 to 2019. We filtered the data to include only patients with diagnosed non-gestational diabetes of age 45 or older (n = 510,991 cases prior to weighting). Linear splines modeled Medicaid Expansion based on state of residence as well as implementation status. Descriptive time series plots showed no major changes in proportions of the dependent variables over time. Quasibinomial analysis showed that implementation of Medicaid Expansion had a statistically negative effect on patient self-checks of blood sugar (odds ratio = 0.971, p < 0.001), a statistically positive effect on physician checks of HbA1c (odds ratio = 1.048, p < 0.001), a statistically positive effect on feet checks (odds ratio = 1.021, p < 0.001), and no other significant effects. Evidence of demographic, SES, and health status disparities existed for most of the dependent variables. This finding was especially significant for HbA1c checks by providers. Barriers to achieving better diabetic care remain and require innovative policy interventions.

The Impact of Dental Neglect on Oral Health Among 16-30-Year-Olds in Dhulikhel, Kavrepalanchok, Nepal

Introduction: Oral health status is linked to oral health behaviour and dental neglect can be an important parameter for assessment of oral health status. Such evaluation will help in providing and planning appropriate health promotion activities to target population. Objective: To assess socio-demographic variations in Dental Neglect (DN) and to determine the association between DN and oral health. Methods: Analytical cross-sectional study done at dental hospital in Dhulikhel from September-November 2020. A sample of 327 aged 16-30 years were selected by convenience sampling technique. Demographic details along with DN were collected through the DN questionnaire. Both self-reported oral health and oral health status were assessed. Oral health status was determined by using the Oral Hygiene Index-simplified (OHI-S) and the Decayed Missing Filled index (DMFT). Results: Majority 170 (52%) of the sample were from high DN group. A total of 187 (57.2%) of the participants rated their oral health status as all right. Higher number of participants were seen in the fair group of oral hygiene status. Significant correlations were found between education and OHI-S scores. Mean DMFT score was 3.6±1.6 which had higher mean Decayed (D) component as compared to the Missing (M) and Filled (F) components in the index. Conclusion: Dental neglect is present among the study population and is associated with self-reported oral health status. Disparities were observed between the socio-demographic variables and DN. The DN Scale can be used in dental health promotion and also in evaluation of health promotion interventions.

Approaches to incorporating indigenous health into the Canadian medical school curriculum

In Canada, there are significant health status disparities that exist between Indigenous and non-Indigenous populations. Cultural competency among physicians is a probable way to address this large gap. The purpose of this article is to discuss the current challenges that exist in designing and delivering an Indigenous health curriculum in Canadian undergraduate medical school programs. This article will highlight the importance of cultural competency for improving the health outcomes of Indigenous populations. Additionally, it will explore potential approaches for better integration of Indigenous health into medical curricula.

Dunedin's free clinic: an exploration of its model of care using case study methodology

INTRODUCTION: Models of care are important therapeutic modalities for achieving the goals of health care teams, but they are seldom explicitly stated or investigated. AIM: To describe the model of care at Dunedin's free clinic, and assess whether this model catered to the particular needs of enrolled patients. METHODS: A mixed methods study was conducted using case study methodology to construct the clinic's model of care from multiple data sources, and to create a profile of patients' needs. A nested case study of patients with diabetes examined patients' social vulnerability characteristics. The pattern matching analytic technique was used to assess the degree of alignment between the model of care and patients' needs. RESULTS: Patients were not only high users of both primary and secondary health care, but also of justice and social welfare sector services. The care of patients with diabetes was complicated by coexisting social vulnerability and medical comorbidities. Surveyed patients placed high value on interpersonal dimensions of care, the Christian ethos of the clinic, and the wider range of services available. DISCUSSION: This study suggests a degree of 'fit' between the clinic's model of care and the needs of enrolled patients. A model of care that caters to the needs of patients with complex needs is important for securing their engagement in health services. KEYWORDS: Health services research; health status disparities; primary health care; qualitative research; vulnerable populations

Maori experiences and perceptions of gout and its treatment: a kaupapa Maori qualitative study

INTRODUCTION: The prevalence of gout among Maori is one of the highest in the world. This study explores the perceptions, understanding and treatment of gout among Maori. METHODS: A qualitative general inductive approach was used, guided by kaupapa Maori principles. Participants included 12 Maori aged 48–79 years with gout. Semi-structured interviews were undertaken, taped and transcribed. Themes were identified from transcripts. FINDINGS: Participants described overwhelming sufferance due to gout, which was sometimes considered inevitable. All participants believed or had been informed that gout is caused by food and/or drink. This led to feelings of self-blame and blame from partners and employers. Whanau (family) were a resource for information and a support when independence was limited. Rongoa (traditional medicine) played a role in the lives of rural but not urban participants. Many reported stoicism, putting up with pain and putting others before themselves, as the ‘Maori way’. Medicines used for gout management were predominantly non-steroidal anti-inflammatory drugs, colchicine and prednisone, with allopurinol only playing a role late in the disease. Medications were often poorly understood and consequently improperly used. Relationships with health professionals were important, but cultural, financial and time barriers impaired access and understanding. Gout had a huge, negative impact on the lives of participants. CONCLUSION: The quality of lives of many people with gout could be improved by better understanding through educational campaigns for health professionals and the community. Culturally sensitive health care systems and a paradigm shift in gout management and early preventive treatment are needed. KEYWORDS: Drug therapy; ethnic groups; gout; health status disparities; primary health care; qualitative research

New Zealand health disparities – pharmacists’ knowledge gaps and training needs

INTRODUCTION: Reducing health disparities is a priority for the New Zealand (NZ) Government and the health care sector and, although not mandatory until 2012, Competence Standard 1 for NZ pharmacists has been revised to reflect this. AIM: The main aim was to understand the information needs of pharmacists in the context of reducing health inequalities in NZ through undertaking a baseline study of pharmacists’ knowledge of health status disparities, identifying relevant resources most commonly read by pharmacists, soliciting ideas on how the profession can contribute to reducing health disparities and gauging pharmacists’ willingness to undergo further training. METHOD: An anonymous, semi-structured questionnaire was posted out to 500 randomly selected practising pharmacists registered in NZ. RESULTS: A 27% response rate was achieved. In general, responding pharmacists had good health disparity knowledge about asthma and the prevalence of cardiovascular disease, but were less knowledgeable about differences in life expectancies and some mortality rates. Responding pharmacists made a variety of achievable suggestions where pharmacists can contribute to decreasing health disparities. Eighty percent of respondents indicated they were interested in learning more about cultural competence and health disparities in their community. DISCUSSION: Our results indicate a need for pharmacists to up-skill in the area of health disparities and cultural competence and for more effective promotion of the resources available to pharmacists to improve their knowledge in this area. The pharmacists in this study appear willing to undertake such study; however, due to the low response rate generalisations to all pharmacists practising in New Zealand cannot be made. KEYWORDS: Pharmacists; New Zealand; health disparities; cultural competency