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

In 2022, Penn State College of Medicine launched the LION Mobile Clinic, a teaching mobile health clinic offering preventive health services in rural Snow Shoe, Pennsylvania. We outline four challenges the clinic team faced in implementation, along with adaptations made to tailor the model to Snow Shoe's needs and opportunities.

Background Black individuals with chronic musculoskeletal (MSK) pain tend to experience worse pain and opioid use-related outcomes, including other substance co-use, compared with non-Hispanic White individuals. Co-using cannabis with opioids could instigate a cascade of pain-related vulnerabilities and poor outcomes. Here, we test associations between cannabis/opioid co-use and pain-related outcomes among Black individuals with chronic MSK pain. Methods Black adults with chronic MSK pain who use opioids (N=401; 51.62% female, Mage=35.90, SD=11.03) completed online measures of pain intensity/interference, emotional distress, opioid dependence, and risky use of other substances. Results Compared with opioid use alone, opioid and cannabis co-use was associated with elevated anxiety and depression symptoms, opioid dependence, and risky substance use, but not pain. Conclusions Black individuals with chronic MSK pain who co-use opioids and cannabis warrant targeted interventions that address their needs. Tailored interventions could help address disparities in pain-related outcomes and opioid morbidity and mortality rates.

We evaluated outcomes from a telephone-based transitional patient navigation (TPN) service for people living with hepatitis C virus (HCV) upon returning to the community after incarceration in New York City (NYC) jails. NYC Health + Hospitals/Correctional Health Services offered referrals for TPN services provided by the NYC local health department patient navigation staff. We compared rates of connection to care among people referred for TPN services with those who were not referred. People living with HIV had a higher connection to care rate at three months (65.0% vs 39.8%, p≤.05) and people with opioid use disorder had a higher connection rate at six months (55.1% vs 36.1%, p≤.05) compared with people without these conditions. However, there was not an improved connection to HCV care associated with referral to TPN services for the overall cohort. Further research, including qualitative studies, may inform improved strategies for connection to HCV care after incarceration.

Objective: To determine the impact of adverse social and behavioral determinants of health (SBDH) on health care use in a safety-net community hospital (SNCH) heart failure (HF) population.

Methods: We performed a retrospective analysis of HF patients at a single SNCH between 2018-2019 (N= 4594).

Results: At least one adverse SBDH was present in 21% of the study population. Patients with at least one adverse SBDH were younger (57 vs. 68 years), more likely to identify as Black (50% vs. 36%), be male (68% vs. 53%), and have Medicaid insurance (48% vs. 22%), p<.001. Presence of at least one adverse SBDH (homelessness, substance use, or incarceration) correlated with increased hospitalizations (2.3 vs 1.4/patient) and ED visits (5.1 vs 2.1/patient), p<.0001. Adverse SBDH were independent predictors of HF readmissions. Prescribing of guideline-directed medical therapy was similar among all patients.

Conclusions: In a SNCH HF cohort, adverse SBDH predominantly afflict younger Black men on Medicaid and are associated with increased utilization.

The American Diabetes Association (ADA) guidelines prioritize Sodicum-glucose transporter-2-inhibitors (SGLT2i) given cardio-renal and glycemic benefits. This study was conducted to observe clinical factors associated with initial SGLT2i prescription in type 2 diabetes patients eligible for SGLT2i by the ADA.

Methods: A retrospective case-control study was performed in a safety-net clinic and consisted of the initial SGLT2i prescriptions group and the group without. The data from the electronic medical records between July 2021 and December 2022 were analyzed in the regressional models.

Results: There was a significant association between A1c ≥8% (OR 3.7, p=.01), heart failure (OR 19.3, p<.0001), a history of hypotension (OR 11.9, p=.01), and sulfonylureas (OR 6.5, p=.003) with the SGLT2i prescription.

Conclusion: Patients with high A1c levels, heart failure, a history of hypotension, and sulfonylureas were more likely than their counterparts to receive SGLT2i prescriptions. Future research should investigate adherence and provider prescribing behaviors related to SGLT2i to further assess optimal drug use.

This quality improvement initiative aimed to increase first dose of COVID-19 vaccinations during pediatric/adolescent clinic visits. Four plan-do-study-act cycles were performed with creation of eligibility lists and increasing health educator (HE) engagement. Statistical process control analysis assessed vaccine receipt over time. Logistic regression modeling evaluated odds of receipt. Among 6,740 visits, 52.2% of patients were eligible for first COVID-19 vaccine; 17.9% of eligible patients accepted it. First-vaccine improvements from 13.1% to 21.7% were not sustained. Odds of receipt increased in each cycle compared with baseline (1: Odds Ratio=1.99 [95% Confidence Interval 1.49-2.67], 2: OR=2.22 [1.58-3.14]), 3: OR=2.15 [1.51-3.05]), 4: OR=1.48 [1.11-1.96]), and with HE discussion versus no HE discussion (OR=1.64 [1.16-1.90]). First COVID-19 vaccine receipt increased with vaccine-eligible patient lists and HE-initiated discussions, although improvements diminished over time. Health educator versus no HE discussion led to improved vaccinations, supporting further quality improvement research on HE role to improve vaccine uptake.

Food insecurity is a mechanism through which the mental health impacts of systemic social inequities multiply across the lifespan. Federally administered food assistance programs improve food security, but their impact on mental health is less clear. We conducted a systematic review of all studies that reported an association between food assistance participation and mental health (N = 34), and a multilevel meta-analysis among studies that met inclusion criteria and reported sufficient statistical results (n = 21; k = 44). The overall effect of food assistance on mental health was not significant (d = -0.025, p = .724). However, follow-up moderator analyses indicated that receipt of food assistance mitigated developmental risk among children (F = 7.73, p = .008). Our results highlight the importance of addressing systemic problems, such as insufficient funds and outdated nutrition guidelines, that limit the potential of food assistance programs to positively affect public health.

Introduction: The aims of this study were to estimate state-level racial inequities in dental care use among children in the U.S., overall and by insurance type, and to examine relationships between inequities and state-level structural racism.

Methods: Pooled 2017-2019 data from the National Survey of Children's Health were used to estimate racial inequities in dental care use. Independent variables included state-level structural racism indicators and other factors.

Results: There was substantial variation in the degree and direction of inequities across states and by insurance type. Inequities were not associated with overall structural racism indices. However, one dimension of structural racism-the Black-White incarceration index-was significantly associated with the Black-White disparity (p=.040).

Conclusion: Racial inequities in dental utilization among children varied across states and by insurance status. More research is needed to explore more granular geographic levels of structural racism and relationships with additional dental care access indicators.

The United States grapples with over 30,000 new HIV infections annually, a challenge exacerbated by delayed diagnosis and treatment. HIV stigma hinders data collection and contributes to health disparities. High-quality data and a community-driven approach are critical to reducing these disparities. The collaborative effort of the Satcher Health Leadership Institute at Morehouse School of Medicine, and the Center for Minority Health and Health Disparities Research and Education at Xavier University of Louisiana, addresses systemic barriers perpetuating the HIV epidemic in Georgia and Louisiana. We influence policy, implement an HIV education curriculum, map resources, and display data via the Health Equity Tracker. Stigma surrounding HIV/AIDS impedes disclosure, creates data gaps, and affects care quality and access. Addressing these data gaps, influencing policy, and implementing education are crucial steps to improving outcomes for Black people living with HIV/AIDS. This framework aligns with the federal Ending the HIV Epidemic program's goals, advancing health equity for vulnerable populations.

The Georgetown University's Cancer Legal Assistance and Well-being Project launched in 2020 as a medical-legal partnership that works with health care providers at a Washington, D.C. safety-net hospital to treat the health-harming legal needs of historically and intentionally marginalized patients with cancer.