How Sociodemographic Factors Impact the Utilization of Recommended Clinical Preventive Screening Services in Poland: A Nationwide Cross-Sectional Study.
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SUBMITTER: Agrawal S
PROVIDER: S-EPMC8701877 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PURPOSE:Integrating oral health care into primary care has been promoted as a strategy to increase delivery of preventive oral health services (POHS) to young children, particularly in rural areas where few dentists practice. Using a multistate sample of Medicaid claims, we examined a child's odds of receiving POHS in a medical office by county rurality. METHODS:We used 2012-2014 Medicaid Analytic extract claims data for 6,275,456 children younger than 6 years in 39 states that allowed Medicaid payment for POHS in medical offices. We used county-level characteristics from the Area Health Resources Files, including a 3-level measure of county rurality. We used logistic regression to estimate a child's odds of receiving POHS in a medical office by county rurality, while controlling for other patient and county characteristics. FINDINGS:POHS in medical offices were received by 7.8% of children. Rates of POHS in medical offices were higher in metropolitan (metro) counties (8.4%) than nonmetro adjacent to metro (5.8%) and nonmetro not adjacent to metro (4.3%). In adjusted analysis, children living in nonmetro not adjacent to metro (OR = 0.79, 95% CI: 0.64-0.99) and adjacent to metro counties (OR = 0.70, 95% CI: 0.59-0.82) were significantly less likely to receive POHS in medical offices than children living in metro counties. CONCLUSIONS:In this study of POHS in medical offices among young Medicaid-enrolled children, we found POHS rates were lowest in nonmetro counties. Given barriers to dental care in rural areas, states should take additional steps beyond allowing Medicaid reimbursement to increase delivery of POHS in medical offices.
| S-EPMC6298795 | biostudies-literature
Project description:The Healthy Aging Partnerships in Prevention Initiative (HAPPI) is a multisectoral collaboration that aims to increase use of recommended cancer screening and other clinical preventive services (CPS) among underserved African American and Latino adults aged 50 and older in South Los Angeles. HAPPI uses the principles of the evidence-based model Sickness Prevention Achieved through Regional Collaboration to increase capacity for the delivery of breast, cervical, and colorectal cancer screening, as well as influenza and pneumococcal immunizations, and cholesterol screening. This article describes HAPPI's collaborative efforts to enhance local capacity by training personnel from community health centers (CHCs) and community-based organizations (CBOs), implementing a small grants program, and forming a community advisory council. HAPPI demonstrates that existing resources in the region can be successfully linked and leveraged to increase awareness and receipt of CPS. Five CHCs expanded quality improvement efforts and eight CBOs reached 2,730 older African Americans and Latinos through locally tailored educational programs that encouraged community-clinic linkages. A community council assumed leadership roles to ensure HAPPI sustainability. The lessons learned from these collective efforts hold promise for increasing awareness and fostering the use of CPS by older adults in underserved communities.
| S-EPMC6775760 | biostudies-literature
Project description:BACKGROUND:Guatemala is currently undergoing an epidemiologic transition. Preventive services are key to reducing the burden of non-communicable diseases, and smoking counseling and cessation are among the most cost-effective and wide-reaching strategies. Internal medicine physicians are fundamental to providing such services, and their knowledge is a cornerstone of non-communicable disease control. METHODS:A national cross-sectional survey was conducted in 2011 to evaluate knowledge of clinical preventive services for non-communicable diseases. Interns, residents, and attending physicians of the internal medicine departments of all teaching hospitals in Guatemala completed a self-administered questionnaire. Participants' responses were contrasted with the Guatemalan Ministry of Health (MoH) prevention guidelines and the US Preventive Services Task Force (USPSTF) recommendations. Analysis compared knowledge of recommendations within and between hospitals. RESULTS:In response to simulated patient scenarios, all services were recommended by more than half of physicians regardless of MoH or USPSTF recommendations. Prioritization was adequate according to the MoH guidelines but not including other potentially effective services (e.g. colorectal cancer and lipid disorder screenings). With the exception of colorectal and prostate cancer screening, less frequently recommended by interns, there was no difference in recommendation rates by level. CONCLUSION:Guatemalan internal medicine physicians' knowledge on preventive services recommendations for non-communicable diseases is limited, and prioritization did not reflect cost-effectiveness. Based on these data we recommend that preventive medicine training be strengthened and development of evidence-based guidelines for low-middle income countries be a priority.
| S-EPMC3485332 | biostudies-literature
Project description:PurposeThe aim of the study was to evaluate general physical activity (PA) level on the basis of leisure time and transportation physical activity (LTPA and TPA), assess the percentage of persons not meeting PA recommendations by the World Health Organisation (WHO), and evaluate the relationship between selected sociodemographic factors and physical inactivity.MethodsThe paper is based on data (n = 7,347) retrieved from five large-scale surveys (2014-2018) used to collect information on the PA of Polish society. In order to meet the aim of the paper, we selected a sample of 2,023 Poles aged ≥ 60 years old. In each wave, the Polish long version of the International Physical Activity Questionnaire was used. Mann-Whitney U and Kruskal-Wallis tests were used to investigate the differences between the types and volume of PA and sociodemographic variables. Relationships between physical inactivity and analysed variables were evaluated using log-linear analysis. To capture relationships between physical inactivity and a set of explanatory variables, a predictive model was built.ResultsThe total average energy expenditure amounted to 1879.5 ± 2352.5 MET-min/week, including LTPA (938.5 ± 1491.9 MET-min/week) and TPA (944.8 ± 1322.4 MET-min/week). Over the course of the last two years of the study, the average value of MET-min/week increased significantly (p < 0.05); however, prohealth WHO norms are not met by nearly 40% of Poles. Sex determines the volume of LTPA and TPA (p < 0.05) but does not determine the inactivity of seniors. Place of residence and education differentiate participation in LTPA and TPA. The lower the education level and the smaller the place of residence, the greater the inactivity.ConclusionsThe target for future interventions should be people aged 60+ living in villages and small towns (especially those with primary education). It is necessary to undertake educational and motivational programmes promoting PA. It is essential to develop detailed recommendations and to create a friendly and supportive environment.
| S-EPMC7787744 | biostudies-literature
Project description:BackgroundWelfare technologies are often described as a solution to the increasing pressure on primary health care services. However, despite initiating welfare technology projects in the health care sector and different government incentives, research indicates that it is difficult to integrate welfare technology innovations in a complex and varying setting, such as long-term care.ObjectiveWe aim to describe the types of welfare technology and the extent to which welfare technology is provided in long-term care (ie, nursing homes and home care services); examine whether the extent of welfare technology provision differs on the basis of municipal characteristics (ie, population size, centrality, the proportion of older inhabitants, and income); and identify how local governments (ie, municipalities) describe their efforts toward integrating welfare technologies in long-term care.MethodsQuantitative and qualitative data about welfare technology from a larger cross-sectional survey about the provision of long-term care services in Norwegian municipalities were combined with registry data. Representatives of 422 Norwegian municipalities were invited to participate in the survey. Frequencies were used to describe the distribution of the types and extent of welfare technologies, whereas the Fisher exact test and Kruskal-Wallis one-way analysis of variance were used to determine the association between the extent of welfare technology and municipal characteristics. Free-form text data were analyzed using thematic analysis.ResultsA total of 277 municipalities were surveyed. Technology for safety was the most widespread type of welfare technology, whereas technology for social contact was the least prevalent. Two-thirds of the sample (183/277, 66.1%) in nursing home and (197/277, 71.1%) in home care services reported providing one or two different types of welfare technology. There was a statistically significant association between the extent of welfare technology and population size (in both nursing homes and home care services: P=.01), centrality (nursing homes: P=.01; home care services: P<.001), and municipal income (nursing homes: P=.02; home care services: P<.001). The extent of welfare technology was not associated with the proportion of older adults. The municipalities described being in a piloting phase and committing to future investment in welfare technology. Monetary resources were allocated, competency development among staff was initiated, and the municipalities were concerned about establishing collaborations within and between municipalities. Home care services seem to have a more person-centered approach in their efforts toward integrating welfare technologies, whereas nursing homes seem to have a more technology-centered approach.ConclusionsMany municipalities provide welfare technologies; however, their extent is limited and varies according to municipal characteristics. Municipal practices still seem dominated by piloting, and welfare technologies are not fully integrated into long-term care services. Innovation with welfare technology appears top-down and is influenced by national policy but also reflects creating a window of opportunity through the organization of municipal efforts toward integrating welfare technology through, for example, collaborations and committing personnel and financial resources.
| S-EPMC8406104 | biostudies-literature
Project description:BackgroundHuntington's disease (HD) is a hereditary disease which could have a large impact on patients' quality of life. As the neurodegenerative disorders progress, HD patients are expected to regularly take follow-up medical visits for proper treatment. This study aimed to analyze the general situation of health services utilization of Chinese HD patients and factors associated with their adherence to follow-up medical visits.MethodsWe collected data from a questionnaire-based investigation conducted by the Chinese Huntington's Disease Association. Data from 232 respondents were included to investigate whether they adhered to regular follow-up medical visits and the influencing factors. Based on Andersen's behavioral model, the independent variables were categorized into predisposing, enabling and need factors. The variables were analyzed by chi-square test and stepwise logistic regression analysis.ResultsThirty-one point nine percent of the respondents had regular follow-up medical visits over the past year. Univariate analysis showed that there were significant differences with 6 factors (P < 0.05), among which, according to logistic regression, 2 enabling factors (reimbursement of health insurance, need for accompanying family members to follow-up visits) and 3 need factors (perceived stage of disease, perceived effectiveness of drugs, self-care ability) were independent influencing factors of follow-up medical behaviors of Chinese HD patients. The predisposing factors investigated here did not play a part in determining patients' adherence to follow-up visits.ConclusionsPoor adherence to medical visits among Chinese HD patients is derived from multiple factors, including reimbursement of health insurance, perceived stage of disease and effectiveness of drugs, need for accompanying family members and self-care ability. To promote HD patients' health services utilization, the improvement of the health insurance system, the enhancement of social support and the development of therapeutic approaches still have a long way to go.
| S-EPMC8362235 | biostudies-literature
Project description:Organizational and educational activities in primary care in Poland have been introduced to improve the chronic heart failure (CHF) management.To assess the use of diagnostic procedures, pharmacotherapy and referrals of CHF in primary care in Poland.The cross-sectional survey was conducted in 2013, involving 390 primary care centres randomly selected from a national database. Trained nurses contacted primary care physicians who retrospectively filled out the study questionnaires on the previous year's CHF management in the last five patients who had recently visited their office. The data on diagnostic and treatment procedures were collected.The mean age?±?SD of the 2006 patients was 72?±?11 years, 45% were female, and 56% had left ventricular ejection fraction <50%. The percentage of the CHF patients diagnosed based on echocardiography was 67% and significantly increased during the last decade. Echocardiography was still less frequently performed in older patients (?80 years) than in the younger ones (respectively 50% versus 72%, ??<0.001) and in women than in men (62% versus 71%, P?<0.001). The percentage of the patients treated with ?-blocker alone was 88%, but those with a combination of angiotensin inhibition 71%. The decade before, these percentages were 68% and 57%, respectively. Moreover, an age-related gap observed in the use of the above-mentioned therapy has disappeared.The use of echocardiography in CHF diagnostics has significantly improved in primary care in Poland but a noticeable inequality in the geriatric patients and women remains. Most CHF patients received drug classes in accordance with guidelines.
| S-EPMC5774260 | biostudies-literature
Project description:ObjectiveTo study the association between macroeconomic conditions and preventive medical service utilization.Data sources/study settingSecondary data collection of a survey of the civilian, non-institutionalized population of adults (age 18 and older) in the United States between 1987 and 2010.Study designRegression analyses that adjust for individual-level demographic and socioeconomic determinants, state and time-fixed effects, and state-specific time trends.Data collection/extraction methodsState health departments, with technological and methodological assistance from the Centers for Disease Control and Prevention, conducted a cross-sectional yearly telephone survey using a standardized questionnaire.Principal findingsThe use of preventive medical services is procyclical: a 1 percentage point increase in the state-level unemployment rate is associated with a 1.58 percent decrease in the quantity of distinct preventive care services utilized. Women and economically disadvantaged populations are shown to be especially sensitive to macroeconomic fluctuations.ConclusionsPolicy makers should be aware of cyclical changes in preventive care use, particularly among disadvantaged populations, when making challenging budgetary decisions during economic downturns. As physician recommendations can have a strong impact on patients' use, health care providers could increase efforts to persuade patients to seek screening exams and necessary vaccinations during periods of high unemployment.
| S-EPMC3922473 | biostudies-literature
Project description:ObjectiveTo quantify the impact of Medicaid enrollment on access to care and adherence to recommended preventive services.Data source2005-2015 Medical Expenditure Panel Survey Household Component.Study designWe examined several access measures and utilization of several preventive services within the past year and within the time frame recommended by the United States Preventive Services Task Force, if more than a year. We estimated local average treatment effects of Medicaid enrollment using a new, two-stage regression model developed by Nguimkeu, Denteh, and Tchernis. This model accounts for both endogenous and underreported Medicaid enrollment by using a partial observability bivariate probit regression as the first stage. We identify the model with an exogenous measure of Medicaid eligibility, the simulated Medicaid eligibility rate by state, year, and parents vs childless adults. A wide range of changes in Medicaid eligibility occurred during the time period studied.Data collection/extraction methodsSample of low-income, nonelderly adults not receiving disability benefits.Principal findingsMedicaid enrollment decreased the probability of having unmet needs for medical care by 7.5 percentage points and the probability of experiencing delays getting prescription drugs by 7.7 percentage points. Medicaid enrollment increased the probability of having a usual source of care by 16.5 percentage points, the probability of having a routine checkup by 17.1 percentage points, and the probability of having a flu shot in past year by 12.6 percentage points.ConclusionMedicaid enrollment increased access to care and use of some preventive services. Additional research is needed on impacts for subgroups, such as parents, childless adults, and the smaller and generally older populations for whom screening tests are recommended.
| S-EPMC7839643 | biostudies-literature
Project description:BACKGROUND:Electronic health (eHealth) literacy has become an important topic in health fields. Studies have found that individuals with higher eHealth literacy are more likely to use preventive care services and to have effective interactions with their physicians. In addition, previous studies have revealed a gender difference in the utilization of physician access and outpatient services. Nevertheless, few studies have explored the effect of the three levels of eHealth literacy (functional, interactive, and critical levels) on the four aspects of health services utilization (type, site, purpose, and time interval). It is unclear whether the associations between these three levels of eHealth literacy and the four aspects of health services utilization among college students are positive or negative. OBJECTIVE:The objective of this study was to investigate the associations among gender, eHealth literacy, and health services utilization. METHODS:We used the eHealth Literacy Scale, a 12-item instrument designed to measure college students' functional, interactive, and critical eHealth literacy, and the Health Services Utilization Scale, which is a 10-item instrument developed to measure the four aspects of health services utilization by college students. A nationally representative sample of 489 college students in Taiwan was surveyed. We conducted multiple regression analysis to examine the associations among gender, eHealth literacy, and health services utilization. RESULTS:The study found that being female was negatively related to the purpose aspect of health services utilization (t487=-2.85, P<.01). However, the R2 value of gender on the purpose aspect was low enough to be ignored. Critical (t484=2.98-4.23, P<.01) and interactive eHealth literacy (t484=2.43-2.89, P<.05) were related to three aspects of the health services utilization, and functional eHealth literacy was related to the purpose aspect (t484=-4.99, P<.001). CONCLUSIONS:This study showed that Taiwanese college students with interactive eHealth literacy were more likely to have a higher rate of outpatient care use. Moreover, Taiwanese college students with critical eHealth literacy were more likely to make full use of health services than those with functional eHealth literacy. Finally, the educated and age-restricted sample may attenuate gender disparities in health services utilization among Taiwanese college students.
| S-EPMC6231732 | biostudies-other