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

The Ethiopian American immigrant (EAI) population is the second-largest African immigrant group in the U.S., yet little health research exists on this community. Ethiopian American immigrants arrive with good health but face declines over time due to acculturation, dietary changes, and health care barriers, increasing their risk of chronic diseases and mental health issues. This study assessed the health needs of EAIs in Cincinnati and Columbus, Ohio-two non-traditional migration cities. Through qualitative interviews with 45 community members, leaders, and health/social providers, we identified six key themes on cultural influences, health care barriers, and social connections. Using thematic analysis and deductive mapping, we classified health concerns into four categories: medical conditions, health behaviors, community conditions, and health system priorities. Findings highlight EAI health needs and priorities in less established migration areas, informing strategies to improve health care access and support for this growing population.

American Indians/Alaska Natives (AI/AN) in Minnesota have experiences with lung cancer that end in mortality at nearly twice the rate of White Minnesotans. Low dose computed tomography (LDCT) chest scans are potentially lifesaving screening tests which, when used annually, are expected to reduce deaths. However, these lung cancer screenings (LCS) are underutilized in the general population. Moreover, many AI/AN are expected to be eligible for LCS but screening uptake is likely even lower in AI/AN than the general population. We and others have reported barriers to LCS, but solutions to improve LCS rates are elusive. Here, we describe a novel approach to overcome patient-level barriers to LCS through community-based LCS events. We worked with a community clinic serving AI/AN and a large health care organization to overcome barriers to LCS through a same-day screening event based in the community and report on the feasibility of this approach.

To increase testing for hepatitis C among people who inject drugs, a syringe service program (SSP) in the northeastern United States trained peer workers to offer testing at van-based clinics. Peer workers approached SSP clients from August 2019 through March 2020 and from June 2021 through March 2022 to discuss hepatitis C and offer rapid onsite hepatitis C antibody testing. Of 573 clients approached, 28 (5%) consented to testing. Reasons for refusal included: 1) already tested, 2) not enough time, and 3) not worried about hepatitis. Of 28 tested, 9 (32%) were positive for hepatitis C antibodies. Adjustments to peer-worker testing strategy may be needed to increase acceptance of testing in this high-risk population.

The COVID-19 pandemic highlighted national health disparities for African American people compared with other races. An urban health district in Georgia developed innovative strategies to improve equity for COVID-19 outcomes among this population.

This study examines the systemic challenges to accessing culturally and linguistically responsive mental health care among farmers and limited English proficient (LEP) agricultural workers in Hawai'i, with a focus on the role of federally qualified health centers (FQHCs) in addressing these access barriers and service gaps. Using geospatial analysis, document reviews, and interviews with FQHC personnel, this study explored potential gaps in services tailored for agricultural communities. Key findings reveal a misalignment between FQHC locations and farming regions, limited culturally responsive programs, and barriers such as stigma and language accessibility. Recommendations include expanding mobile clinics, integrating cultural practices, and enhancing language support to address the special needs of Hawai'i's diverse farming populations. This study underscores the need for systemic innovation to ensure mental health accessibility and support for the well-being of essential agricultural workers.

There has been substantial documentation of racial and ethnic disparities in health outcomes, and a growing body of research on critical care outcomes specifically. In this paper, we seek to quantify the sources of racial disparities in a single urban intensive care unit (ICU), at Johns Hopkins Hospital in Baltimore, Maryland. Between 2014 and 2021, we document significant disparities in in-unit mortality, and length of ICU stay between racial and ethnic minority group patients versus White patients. Using the ZIP-Code and sociodemographic information collected on patients, we quantify the extent to which the disparities can be attributed to the observable socioeconomic and physiological factors. We find that socioeconomic factors and the Sequential Organ Failure Assessment (SOFA) score-a measure of ICU acuity-explain the Black-White, Hispanic-White, and Asian-White gaps in length of stay, and the Hispanic-White and Asian-White gaps in mortality. The SOFA score fully explains the Black-White gap in mortality outcomes, and socioeconomic factors surprisingly offset these gaps.

Federally qualified health centers (FQHCs) are safety-net institutions that are heavily affected by burnout among health care professionals. We examined pharmacist-clinician relationships in FQHCs by assessing clinicians' satisfaction with clinical pharmacy services (CPS), perceptions of the impact of CPS on patient care and clinician well-being, and the potential impact of CPS on clinician retention. We used a survey composed of 21 questions sent to clinicians practicing within Ohio-based FQHCs with access to CPS. Respondents noted that CPS positively affected their well-being, specifically contributing to a more manageable workload, increased professional development, and freedom for clinicians to focus on more professionally fulfilling tasks. Clinicians perceived that CPS positively affects patient outcomes and provider retention. Federally qualified health center leadership can use these results to understand the contributions of CPS to patient care and clinician well-being and retention to enhance health care access and quality.

Adults experiencing homelessness (AEH) have high rates of psychiatric conditions, face barriers to accessing psychiatric care, and are high emergency department (ED) utilizers, a setting often unable to address their complex health needs. This study assesses time trends and high frequency utilization by AEH in one psychiatric emergency services (PES) program. A retrospective review of electronic health records from 2005 to 2020 was conducted at an urban PES program serving uninsured and publicly insured adults. Of the 227,553 PES encounters examined, 75,127 (33%) involved AEH. The percentage of PES encounters involving AEH almost doubled from 23.3% in 2005 to 41.6% in 2020. The proportion of AEH using PES aged 55 and older more than tripled, from 4.2% to 15.4%. Adults experiencing homelessness had over six times the odds of being high frequency PES utilizers (10+ visits/year) as housed adults. These findings support interventions addressing housing access within PES encounters.