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

Developing political engagement among nurses who care for rural and underserved communities can help mitigate health inequities. An experiential learning opportunity informed by Lobby Day was developed to prepare primary care advanced practice nursing students with the policy skills needed to actively serve as advocates for their patients and communities.

The Food is Medicine (FIM) movement posits that food access and knowledge are key parts of disease prevention and treatment, but little research has explored how FIM programs fit into the organizational context of federally qualified health centers (FQHC). The purpose of this study was to explore the organizational climate and clinic staff perspectives on a FIM program being implemented in an FQHC. We conducted a cross-sectional survey study with clinic staff during the early implementation of a clinicbased FIM program. Clinic staff (n=40) perceived that patient nutrition was a high priority for the clinic, but that support for providing nutrition resources was more limited. We found high willingness and likelihood of using the FIM program services among staff, but some expressed concern regarding staffing and cultural appropriateness of programming. Optimal adoption and use of FIM investments in FQHCs may be supported by integration with existing clinical workflows.

Background: It is reported that racial differences exist among patients with multimorbidity. However, there are no studies that have investigated racial disparities within multimorbidity-related hospitalization encounters among patients with multimorbidity in rural states such as Arkansas.

Methods: Binomial logistic regression identified associations between race and hospitalization utilization. Insurance type was assessed as a potential effect modifier of the association.

Results: Non-Hispanic Black, non-Hispanic Other and Hispanic patients collectively represented more than 50% of 18-34-year-old patients with multimorbidity. Compared with patients who were non-Hispanic White, Other patients were more likely to have a high length of stay. In the insurance-type stratified analysis, uninsured Hispanic patients demonstrated greater hospital length of stay during the study period.

Conclusion: Results of the current study suggest that multimorbidity-related conditions differentially affect racially and ethnically minoritized, young patients. These findings highlight the need for future studies to understand the contributory factors involved in this disparity.

Central Appalachia's coal fields are the site of health disparities influenced by social determinants of health including poverty and isolation, compounded by transportation barriers to health care. In this study, we conducted two surveys among patients at a rural federally qualified health center (FQHC) to evaluate the health and financial ramifications of transportation barriers to primary care. Our findings indicate that patients facing transportation barriers rely disproportionately on emergency department services or hospitalization. Most notably, we found that Medicaid beneficiaries, theoretically eligible for no- cost, non- emergency medical transportation (NEMT), often resort to paying for transportation to office visits. Patients, especially Medicaid beneficiaries, who are financially burdened by transportation costs exhibit higher likelihood of requiring emergency department services or hospitalization. Our study underscores the potential benefits of investing in NEMT services, with the potential to reduce health care spending by mitigating reliance on emergency care and hospitalization while increasing equitable access to care.

Navigating health care and insurance systems presents significant challenges for American Indian (AI) Elders. Access to culturally congruent assistance with decision-making, scheduling, transportation, and communication can bridge the gap between AI Elders and health systems. This study uses qualitative interviews with professionals providing navigation services to American Indian Elders in a Southwestern state to understand the skills, experiences, and challenges involved in delivering this support. We conducted semi-structured interviews with 16 professionals providing navigation support to AI Elders between November 2018 and August 2020 and used a constant comparative approach to identify themes. Participants' descriptions of their work centered on the themes of (1) respect for Elders; (2) wide-ranging responsibilities; (3) acting as a trusted communicator; (4) developing trust; and (5) challenges to providing navigation support for AI Elders. Efforts to achieve health equity for AI Elders must include supporting individuals such as these within communities and advocating for a just health care system for American Indian people.

This report highlights the efforts of six community-based organizations (CBOs) implementing community-clinical linkages (CCLs) to identify individuals with hypertension in underserved populations and connect them to community health centers (CHCs) participating in the National Hypertension Control Initiative. This report emphasizes the importance of understanding the CBOs' capacity to implement CCLs.

Objective: There are significant inequities in colorectal cancer (CRC) screening and outcomes. Via literature review, we assessed CRC screening rates for the vulnerable populations served by free clinics.

Methods: A systematic review was conducted for publications on CRC screening in free clinics. Outcomes included CRC screening characteristics, population demographics, and limitations. A methodological quality assessment was completed.

Results: Out of 63 references, six studies were included, representing 8,844 participants. Black or Hispanic participants were the plurality in all but one study. All participants were uninsured. Median CRC screening rate was 48.4% (range 6.6-78.9%). Screening methods included colonoscopy, fecal occult blood test, flexible sigmoidoscopy, and fecal immunochemical test. Clinics offering only one screening method had a mean screening rate of 7.2% while those with multiple methods had a screening rate of 65.4%.

Conclusion: Access to multiple CRC screening modalities correlates with higher screening rates in free clinics. More work is needed to increase CRC screening in free clinics.

Introduction: Obesity disproportionately affects some non-White and low-socioeconomic-status Americans. Medical obesity treatment includes aggressive lifestyle interventions with medications when applicable. We evaluated a physician-led, resource-limited obesity medicine program.

Methods: This retrospective review included 98 adults with BMI >30 completing three or more obesity medicine physician visits, without bariatric surgery before or during Oct 2019-Feb 2022 at an academic medical center in Newark, N.J. Outcomes included changes in weight, HbA1c, blood pressure, and lipids.

Results: Sixty-eight percent (68%) of patients lost weight, with one-third losing 5% or more of total weight. Almost 30% (29.3%) gained and 2.4% maintained weight. Number of visits (p<.01) and GLP-1 receptor agonist use predicted weight loss (p<.05). Hemoglobin A1c decreased (p<.01); blood pressure and lipids did not.

Conclusion: Our study shows that medical weight management programs can achieve meaningful weight loss, despite resource limitations. Patients using GLP-1 receptor agonists lost more weight compared with other agents, even on suboptimal doses.

Sickle cell disease is a prime example of the devastating impact of healthcare inequities. The End Sepsis Initiative developed after a tragic death due to sepsis, provides a powerful model for the sickle cell community. This model recognizes the importance of evidence-based protocols and policy recommendations/mandates to drive transformative systems change. We propose that the sickle cell community mirror this approach. We propose that hospital systems, healthcare organizations, and insurers implement evidence-based protocols, including personalized pain plans, stigma reduction through staff training, vaccinations, preventative screening, disease-modifying therapies, pediatric to adult transition, and connecting unaffiliated SCD patients to a medical home. We recommend state-level interventions, such as using SCD navigator in electronic health records for quality reporting, supporting community health workers' use, and ensuring rural hospitals have access to SCD specialists.