Journal of Health Care for the Poor and Underserved最新文献

Introduction: Access to mechanical thrombectomy (MT) for ischemic stroke with large vessel occlusion is limited in upper middle-income countries.

Objective: To describe the experience of a public-private partnership (PPP) aimed at enhancing MT access in Bogotá, Colombia's public health care network.

Methods: Cross-sectional study describes access to MT under two drip-and-ship referral models (model A and B). Bivariate analysis was conducted using SPSS V25.

Results: Between 2021 and 2023, there were 116 MT code activations. Over sixty percent (61.6%) successfully accessed MT, while administrative barriers prevented access in the remaining cases. There was no significant difference in MT access between PPP models A (60%) and B (66.7%). Model B faced prominent administrative issues related to insurance.

Conclusions: Public-private partnerships significantly improved MT access in Bogotá, benefiting nearly two-thirds of the studied population. However, administrative challenges persist. Effective referral systems and robust national policies are crucial for further enhancing MT access.

Reproductive health needs of incarcerated individuals are complex due to multiple forms of structural oppression, but little is known about the present state of obstetrics and gynecology (Ob/Gyn) resident training on providing reproductive health care to this rapidly growing population. Through this cross-sectional study, program leaders at all United States Ob/Gyn residency programs were emailed a survey in 2022. Among respondent programs (response rate of 38%), 81% have opportunities for residents to see incarcerated patients in a clinical setting, but only 23% have mandatory didactic content on caring for this population. There is a glaring gap in Ob/Gyn resident education on caring for incarcerated patients, even though residents are actively treating these patients. Furthermore, although most program leaders believe that training residents to care for this population is important, programs are not equipped to do so because of various barriers, including limited faculty expertise and competing educational requirements.

Introduction: Length of stay (LOS) is an important quality metric often affected by social determinants of health including health-harming legal needs (HHLNs). We sought to determine the feasibility of medical-legal partnerships (MLPs) in the inpatient setting to improve LOS.

Methods: Adult patients admitted to a safety-net public hospital beyond medically predicted LOS (n=110) were assessed for HHLNs via chart review and standardized surveys then referred for legal intervention if indicated. Staff were surveyed regarding HHLNs and MLPs. Retrospective cost-analysis was performed one year later.

Results: Average excess LOS days were 41±51, and HHLNs were identified among 69% of patients. The need for guardianship was specifically associated with increased excess LOS (p=.03). Staff reported interest in MLPs, and referrals increased after initial exposure. Cost-analysis at one year showed savings in excess of $200,000.

Conclusions: Medical-legal partnerships have potential to reduce excess LOS, improving inpatient clinical outcomes and health care cost-effectiveness.

Background: Tooth decay is common, but low-income families have low rates of preventive oral health care. The American Dental Association community dental health coordinator (CDHC) model has successfully increased referrals to co-located dentists.

Objective: To implement a CDHC to link families between the medical home and community dentists.

Methods: The CDHC universally screened patients between 2-17 years of age during medical check-ups at two sites. Iterative plan-do-study-act (PDSA) cycles aim to increase screening, increase participants, and increase phone follow-up with families. When participation was low, family and provider focus groups were held.

Results: The CDHC completed 2,933 intakes with 745 appointments made and 250 dental appointments attended. Focus group participants of patients and providers endorsed support for the program, but iterative PDSA cycles did not increase participation.

Discussion: The generalizability of the CDHC model from referrals to internal, co-located dentists to external, community providers was not as successful as expected.

This study explores medical training programs within community health centers (CHCs) and investigates the organizational and environmental factors associated with these programs. Using cluster analysis, we identified four distinct clusters based on the prevalence of physician, nurse, advanced practitioner, and medical assistant trainees in CHCs. These clusters reveal variations in the composition of trainees within CHCs, indicating diverse training and recruitment priorities. Our analysis of organizational and environmental correlates found significant associations between factors such as urban location, CHC size, and the percentage of other clinical trainee types with the distribution of clinical trainees. The insights gained from this study are crucial for advancing the ongoing development of CHC medical training programs, emphasizing the delivery of high-quality primary care, comprehensive training, and education while addressing workforce challenges in resource-limited settings.

Amyotrophic lateral sclerosis (ALS) poses challenges for timely diagnosis due to its protean early manifestations and lack of definitive tests. This article explores how patient navigation interventions can expedite diagnosis, particularly for underserved patients who face disproportionately longer delays. Patient navigation has proven effective in reducing disparities in various diseases by providing guidance and support to patients and caregivers. It enhances awareness, facilitates communication with health care providers, and streamlines diagnosis. Drawing from literature on patient navigation in other diseases, this article proposes tailored adaptations for ALS diagnosis and addresses potential implementation barriers and strategies to overcome them. Integrating patient navigation into the ALS diagnostic pathway holds promise for improving efficiency, optimizing outcomes, and reducing health care disparities among underserved populations.

Reason. Guatemala's Infant Mortality Rate (IMR) of 18 deaths per 100,000 live births was 17th highest in the world in 2020. One contributor is lay midwives, who attend most births at home and often lack education about helping babies breathe (HBB). An educational activity that incorporated cultural humility was provided orally in the native language of participants about HBB. The educational activity was provided in the most remote department with some of the worst health outcomes in the country. Demographic and quality improvement data were collected. A pretest posttest was used to evaluate if the educational activity changed participants' knowledge. Findings. A t test showed a statistically significant change in knowledge from pretest (n=195, M=2.64, SD=1.27) to posttest (n=195, M=4.22, SD=1.37), 95% Confidence Interval, p=.0001. Conclusion. Educational activities for vulnerable populations with low literacy should be provided orally in the native language of participants and should be designed with cultural humility to maximize knowledge improvement.

The lack of culturally and linguistically appropriate health services accessibility has disproportionately affected communities with limited English proficiency. Comprehensive community efforts, including outreach and education, medical interpreter training, and advocacy to inform practices and policies, may lead to sustainable improvements in access to quality health care for diverse communities.

The All One Community (A1C) program addresses chronic disease among immigrant populations, specifically South Asian, Arab, and Rohingya groups in Greater Chicago. The program offers culturally and linguistically tailored type 2 diabetes education, incorporating social support from family or friends. Participants (n=247) provided biometric data at baseline and during community screenings at 3, 6, and 9 months. Of the 199 participants completing at least 10 sessions, 91 had diabetes (HbA1C ≥ 6.5). Significant improvements in blood pressure (p=0.025) and body mass index (BMI, p=0.015) were observed. Diabetic participants with a social support partner experienced greater BMI reductions (p<0.05). Uninsured participants showed more significant improvements in systolic blood pressure (p=0.02) and cholesterol (p=0.04) than those with insurance. The findings suggest that social support and targeted interventions can improve diabetes management in uninsured immigrants at higher health risk.

Health literacy plays a critical role in the prevention and management of chronic diseases. Health Equity and Advancing Health Literacy-DC (HEAL-DC) engaged with faith-based and community organizations to provide health literacy events in trusted settings by integrating the community sector as a key partner.