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

Geographic barriers and long travel distances contribute significantly to urban/rural health disparities, making online technology use a vital tool for improving individual and community health in rural areas. However, factors related to technology use, particularly in the Deep South (a historically under-resourced U.S. region characterized by high poverty, limited access to healthcare and education, and a predominantly African American population), remain understudied. Guided by the notion of a digital divide, we explore social determinants of online technology use for seeking health information among rural residents through a cross-sectional survey (N=157). Multiple linear regression analysis (R2=.52) revealed that lower social isolation was associated with reduced online technology use. In contrast, greater social media use, higher education, and improved health literacy were linked to increased use. These findings underscore the need for coordinated efforts among researchers, practitioners, and policymakers to expand access to (and engagement with) health-related online technologies in rural communities.

This study examines health care service utilization of adults impacted by the justice system (n=3380) and general patient population (n=226,970) receiving care at one federally qualified health center (FQHC; n=62 service sites) in California between 2020-2022. A hybrid manual review of the electronic medical record was conducted. The top five departments used by adults impacted by the justice system, based on total number of encounters, were general medicine, case management, mental health services, specialty services, and substance use disorder services. Patients demonstrated vulnerabilities in education, employment, and housing and extensive use of clinical services. Adults impacted by the justice system can benefit from targeted and coordinated case management to support health care utilization. Findings may inform funding initiatives, staffing, and service delivery models to optimize care and support services for individuals who have experienced contact with the justice system.

There is increasing recognition within the U.S. health care system that structural determinants are major drivers of health inequities. Many of the current strategies to advance health equity, however, do not directly address the power differentials at the roots of structural determinants. Community organizing offers a framework to address this gap, by offering time-tested tools that shift power to community members who are systemically harmed and create social change most important to them. Three important principles of community organizing-shifting power, centering lived expertise, and solidarity-may be particularly relevant to health systems in their work to advance health equity. Through two contemporary case studies and historical examples, the meanings and applications of these principles are explored. We believe that the integration of community organizing into health systems is a necessary component towards achieving community-led structural change and ultimately: health equity for all.

Little is known about patients treated by prescribing psychologists. We conducted a descriptive cross-sectional study using electronic health record data of patients (N = 4,540) from a large prescribing psychology clinic in Las Cruces, New Mexico (2017-2023). Data on patient demographics (e.g., age at first visit, county of residence), clinical characteristics (e.g., psychiatric diagnoses, comorbidities), and county-level geographic factors (e.g., rurality) were collected. Less than half (48.9%) were privately insured, and patients had myriad psychiatric and comorbid conditions. Patients were from 75.8% of the counties in the state, nearly all rural counties (95.4%) with high social deprivation index scores (M = 92.1; SD = 10.8). Combination treatment with both medication and psychotherapy was most common (62.2%) and visits exclusively for medication management were rare (4.7%). Prescribing psychologists appear to treat rural, underserved patients with a diversity of psychiatric conditions using both medication and therapy.

This study evaluated the race and ethnicity-specific association between having a personal doctor or nurse and/or a usual site for care and preventive care utilization among 15,989 insured male adolescents. The 2021-2022 National Survey of Children's Health was used to conduct bivariate and multivariable binomial regression analyses and obtain crude and adjusted prevalence differences, overall and by race and ethnicity. Seventy-nine percent of male adolescents with a personal doctor or nurse had a preventive care visit, compared with 63.0% with a usual site but no personal doctor or nurse, and 31.9% with neither. Having a personal doctor a nurse was associated with greater preventive care utilization overall and for each racial and ethnic group [aPD:43.49 (95% CI:35.24, 51.73)]. Established relationships with a personal health care provider may facilitate preventive care utilization, which could be particularly important for racial and ethnic minority adolescents given existing disparities in health care utilization and outcomes.

Introduction: Sexual and/or gender minority young adults (SGM YAs) display high tobacco use rates but less is known regarding disparities among those residing in rural vs. urban areas.

Methods: Among 609 U.S. SGM YAs (ages 18-25) who completed 2023/2024 surveys, multivariable regressions examined associations of: 1) rurality (vs. urbanicity) with minority stressors (negative behaviors from parents, discrimination, less peer support and SGM community connectedness); and 2) rurality and minority stressors with tobacco use for those assigned female (AFAB) or male (AMAB) at birth, separately.

Results: Among SGM YAs AFAB, rurality predicted greater minority stress (negative parenting, discrimination, less SGM community connectedness). Rurality and minority stressors predicted past-month e-cigarette use, polytobacco use, and nicotine dependence. Among those AMAB, rurality predicted greater nicotine dependence.

Conclusions: Findings provide insights into intervention targets for tobacco use among SGM YAs AFAB residing in rural areas with less SGM community connectedness (i.e., acceptance and resources).

Collaborative Opportunities to Advance Community Health (COACH) is a cross-health system partnership organized to collectively meet federal Community Health Needs Assessment implementation planning requirements while addressing community food insecurity. Partners developed a food insecurity screening and resource referral model, screening 7,126 patients during an 18-month pilot period.

We investigated the perception and attitudes of health care providers who manage patients with diabetes mellitus on the routine employment of an oral health assessment tool (OHAT) in diabetes management. A survey was conducted among health care providers practicing in underserved areas (N=54). Most providers acknowledged that oral health has an impact on diabetes, with participants identifying poor periodontal health as a contributing factor, and that untreated periodontitis influences patients' response to diabetes therapy. Conversely, health care professionals responded in the affirmative that blood glucose levels affect oral health, and the status of periodontal health and maintenance differs between patients with diabetes and other patients. Most providers also acknowledged that their institution currently has no OHAT for patients with diabetes. Despite this, most health care professionals are willing to incorporate an OHAT in their current diabetes self-management education curricula.

Gastrointestinal diseases (GI), such as gastritis and peptic ulcer disease, are common, especially among Hispanics, among whom over 60% are infected with Helicobacter pylori (H. pylori), a leading cause of ulcers and a known carcinogen. Traditionally, esophagogastroduodenoscopy (EGD) has been the standard diagnostic method for chronic gastrointestinal symptoms. This study evaluates the feasibility and acceptability of magnetically controlled capsule endoscopy (MCCE) as a diagnostic tool for upper GI symptomatology in Hispanic immigrants residing in the U.S. Of 31 studies performed, 41.9% identified no findings. Pathological findings included acute gastritis (32.3%) and ulceration (16.1%). Patients tolerated MCCE well, with no side effects reported. Satisfaction rates were high, with 100% of respondents willing to recommend the procedure. Findings indicate that MCCE is a culturally adaptable, well acceptable, non-invasive alternative, addressing significant health care barriers.