Disparities in the Treatment of Substance Use Disorders: Does Where You Live Matter?

This study focused on (1) whether disparities in timely receipt of substance use services can be explained in part by the characteristics of the community in which the clients reside and (2) whether the effect of community characteristics on timely receipt of services was similar across racial/ethnic groups. The sample was composed of adults receiving publicly funded outpatient treatment in Washington State. Treatment data were linked to data from the US census. The outcome studied was “Initiation and Engagement” in treatment (IET), a measure noting timely receipt of services at the beginning of treatment. Community characteristics studied included community level economic disadvantage and concentration of American Indian, Latino, and Black residents in the community. Black and American Indian clients were less likely to initiate or engage in treatment compared to non-Latino white clients, and American Indian clients living in economically disadvantaged communities were at even greater risk of not initiating treatment. Community economic disadvantage and racial/ethnic makeup of the community were associated with treatment initiation, but not engagement, although they did not entirely explain the disparities found in IET.     

Determinants of Low Birth Weight in Ghana: Does Quality of Antenatal Care Matter?

Maternal and Child Health Journal - Low birth weight is a public health issue that contributes to perinatal and infant mortality, especially in limited-resource settings, but there is limited...     

Correction to: Disparities in the Treatment of Substance Use Disorders: Does Where You Live Matter?

The Journal of Behavioral Health Services & Research - The professional degree of co-author Kevin Campbell is incorrect. It should be “DrPH” and not “PhD”.     

Determinants of the Uptake of the Full Dose of Diphtheria–Pertussis–Tetanus Vaccines (DPT3) in Northern Nigeria: A Multilevel Analysis

Objectives Health behaviors are influenced by an array of factors at the individual, household, community and societal levels. This paper examines the relative contribution of child’s characteristics, mother’s attributes, household profiles and community factors on the probability that a child will receive the full series of diphtheria–pertussis–tetanus vaccines (DPT3) as a proxy for full immunization. Methods We used data from a 2004 household survey conducted in three northern Nigeria states: Borno, Kano and Yobe. We estimated multilevel models with fixed effects specified at the individual, household and community levels, and random effects at the community level. Results Overall, only 16.0% of the children aged 12–35 months had received DPT3. The data show that a significant amount of the variation in DPT3 uptake occurs at the community level. The most significant predictors of the uptake of DPT3 are found at multiple levels and include child’s place of birth, presence of an immunization card, mother’s ideation, mother’s decision-making power and perceived social approval of immunization. The data further show that significant community-level variations in immunization uptake remain even after individual and household factors have been considered. Conclusions The data reveal that childhood immunization is influenced by norms and unmeasured factors at the community level in addition to factors operating at the level of the individual child and the household. Strategies for improving the uptake of immunization should include culturally appropriate interventions that target multiple levels of influences. Improving parental attitudes towards immunization without addressing the issue of community norms is not likely to yield significant results.     

Does the Quality of Prenatal Care Matter in Promoting Skilled Institutional Delivery? A Study in Rural Mexico

Objectives: To determine if the quality of prenatal care predicts skilled institutional delivery, a primary means of reducing maternal mortality. Methods: The probability of skilled institutional delivery is predicted among 4173 rural low-income women of reproductive age in seven Mexican states, as a function of maternal retrospective reports about prenatal care services received in 1997–2003. Results: Women who received most prenatal care procedures were more likely to have a skilled institutional delivery (OR 2.29, 95% CI 1.18, 4.44). Women who received less than the 75th percentile of prenatal care procedures were not significantly different from those who received no prenatal care. Conclusions: Policies promoting increased access to prenatal services should be linked to the promotion of practice standards to impact health and behavioral outcomes.National Institute of Public Health, Avenue Universidad No. 655     

Does Continuity of Care Matter in a Universally Insured Population?

OBJECTIVE: To examine the relation between continuity of care and preventive health care and emergency department (ED) use in a universal health care system. DATA SOURCES/STUDY SETTING: Administrative data that capture health care use of the entire population of a midwestern Canadian city. STUDY DESIGN: A population-based, retrospective study of all individuals who had a least one physician contact in 1998 or 1999 (total N=536,893). METHODS: Logistic regressions were conducted to examine the relation between continuity of care, defined in terms of the proportion of total visits to family physicians (FPs) made to the same FP, and cervical cancer screening, breast cancer screening, influenza vaccination, pneumococcal vaccination, and ED visits, controlling for demographic variables, socioeconomic status (defined in terms of relative affluence of neighborhood of residence), and health status. PRINCIPAL FINDINGS: Continuity of care was related to better preventive health care and reduced ED use. A consistent socioeconomic gradient also emerged. For instance, the odds of having a mammogram was double for individuals living in the wealthiest neighborhoods, relative to those in the poorest neighborhoods (adjusted odds ratio=2.31, 99 percent CI 2.13-2.50). CONCLUSIONS: Having a long-term relationship with a single physician makes a difference even in a universal health care system. Moreover, socioeconomic disparities remain, suggesting the need to target specifically individuals from lower socioeconomic strata for preventive health care.     

Discontinuity of Women Veterans’ Care in Patient-Centered Medical Homes: Does Workforce Gender Sensitivity Matter?

BackgroundPrior research has found that 25% of women veterans who are new to the Department of Veterans Affairs (VA) health care system discontinue services within 3 years of initial use. Although it has been suggested that providing more gender-sensitive care might improve women veterans' health care experiences, no study has yet documented an empirical relationship between clinic and provider factors associated with the provision of gender-sensitive care and women veterans’ care discontinuity.MethodsSurveys of primary care providers (n = 82) and staff members (n = 108) from 12 VA medical centers were linked to administrative data for women veteran patients with at least one primary care visit in 2014 and 2015 (n = 9,958). Patient care discontinuity was operationalized as having no additional primary care visit within 3 years after the patient's baseline visit. Key indicators of gender-sensitive comprehensive primary care included type of medical home (women's health-focused vs. general primary care), workforce gender sensitivity, team functioning, perceived quality of provider/staff communication, leadership support for medical home implementation, and other structural components of care delivery (e.g., chaperone availability). We used logistic regression to assess the association between these indicators and women's care discontinuity, measuring discontinuity for both new and continuing VA users and controlling for patient characteristics.ResultsEleven percent of women patients discontinued primary care within 3 years. Poor workforce gender sensitivity (lowest quartile vs. top three quartiles) was significantly associated with higher odds of discontinuity (odds ratio, 1.26; 95% confidence interval, 1.01–1.57); other indicators were not associated with discontinuity.ConclusionsThis study is the first to document a relationship between workforce gender sensitivity and women veterans’ care continuity. This finding underscores the need for additional attention to enhancing workforce gender sensitivity in VA.     

Does Time Since Immigration Modify Neighborhood Deprivation Gradients in Preterm Birth? A Multilevel Analysis

Immigrants’ health is jointly influenced by their pre- and post-migration exposures, but how these two influences operate with increasing duration of residence has not been well-researched. We aimed to examine how the influence of maternal country of birth and neighborhood deprivation effects, if any, change over time since migration and how neighborhood effects among immigrants compare with those observed in the Canadian-born population. Birth data from Ontario hospital records (2002–2007) were linked with an official Canadian immigration database (1985–2000). The outcome measure was preterm birth. Neighborhoods were ranked according to a neighborhood deprivation index developed for Canadian urban areas and collapsed into tertiles of approximately equal size. Time since immigration was measured from the date of arrival to Canada to the date of delivery, ranging from 1 to 22 years. We used cross-classified random effect models to simultaneously account for the membership of births (N = 83,233) to urban neighborhoods (N = 1,801) and maternal countries of birth (N = 168). There were no differences in preterm birth between neighborhood deprivation tertiles among immigrants with less than 15 years of residence. Among immigrants with 15 years of stay or more, the adjusted absolute risk difference (ARD%, 95% confidence interval) between high-deprived (tertile 3) and low-deprived (tertile 1) neighborhoods was 1.86 (0.68, 2.98), while the ARD% observed among the Canadian-born (N = 314,237) was 1.34 (1.11, 1.57). Time since migration modifies the neighborhood deprivation gradient in preterm birth among immigrants living in Ontario cities. Immigrants reached the level of inequalities in preterm birth observed at the neighborhood level among the Canadian-born after 14 years of stay, but neighborhoods did not influence preterm birth among more recent immigrants, for whom the maternal country of birth was more predictive of preterm birth.     

Investigating the Heterogeneity in Women’s Preferences for Breast Screening: Does the Communication of Risk Matter?

Background

The relative benefits and risks of screening programs for breast cancer have been extensively debated.

Does Perceived Quality of Care Moderate Postpartum Depression? A Secondary Analysis of a Two-Stage Survey

Maternal and Child Health Journal - The purpose of this study was to examine if women’s perceptions of the quality of hospital care during childbirth moderate their risks for symptoms of...     

Does the state you live in make a difference? Multilevel analysis of self-rated health in the US

This paper investigates the different sources of variation between US states in self-rated health using multilevel statistical procedures. The different sources that are considered are based on individual- and state-level factors. Data for the analysis comes from the 1993-94 Behavioral Risk Factor Surveillance System and the 1986-90 General Social Surveys. Results show that individual-level factors (such as low income, being black, smoking) are strongly associated with self-rated poor health. Significant variation, however, remain between states after allowing for individual characteristics. Crucially, between-state variation in self-rated health is different for different income groups. State-level contextual effects are found for per-capita median-income and 'social capital'. While not strong, there seems to be a differential impact of state income-inequality on high-income groups, such that the affluent report better health from living in high inequality states. The paper substantiates the need to connect individual health to their macro socioeconomic context. Importantly, it is argued that without adopting an explicitly multilevel approach, the debate on linkages between individual health and income-inequality/social capital cannot be adequately addressed.     

Disparities in Adolescent Health and Health Care: Does Socioeconomic Status Matter?

DATA COLLECTION/EXTRACTION METHODS: National household survey. DATA SOURCES/STUDY SETTING: We analyzed data on 12,434 adolescents (10 through 18 years old) included in the 1999 and 2000 editions of the National Health Interview Survey. STUDY DESIGN: We assessed the presence of income gradients using four income groups. Outcome variables included health status, health insurance coverage, access to and satisfaction with care, utilization, and unmet health needs. PRINCIPAL FINDINGS: After adjustment for confounding variables using multivariate analysis, statistically significant disparities were found between poor adolescents and their counterparts in middle- and higher-income families for three of four health status measures, six of eight measures of access to and satisfaction with care, and for six of nine indicators of access to and use of medical care, dental care, and mental health care. CONCLUSION: Our analyses indicate adolescents in low-income families remain at a disadvantage despite expansions of the Medicaid program and the comparatively new State Children's Health Insurance Program (SCHIP). Additional efforts are needed to ensure eligible adolescents are enrolled in these programs. Nonfinancial barriers to care must also be addressed to reduce inequities.     

Does the Timing of Food Stamp Distribution Matter? A Panel‐Data Analysis of Monthly Purchasing Patterns of US Households

In this paper, we examine the relationship between the timing of food stamp receipt and purchasing patterns. We combine data on state distribution dates of food stamps with scanner data on a panel of households purchases tracked between 2004 and 2011. We find that purchases of a variety of goods are meaningfully higher on receipt days, consistent with previous work that suggests that recipients are very impatient. Additionally, and importantly, estimates indicate that when food stamp receipt days fall on weekends, total monthly purchases within the same households are affected. In particular, monthly purchases of beer are higher when food stamps are distributed on a weekend rather than in months where benefits are distributed on weekdays. For these households, total beer purchases are between 4 and 5% higher in those months. Among households ineligible for food stamps, no effect is identified. These results demonstrate that the ‘day‐of‐the‐week’ of SNAP treatment may have important impacts on household purchase habits. Copyright © 2016 John Wiley & Sons, Ltd.     

Economic Evaluation of New Models of Care: Does the Decision Change Between Cost-Utility Analysis and Multi-Criteria Decision Analysis?

ObjectivesTo experiment with new approaches of collaboration in healthcare delivery, local authorities implement new models of care. Regarding the local decision context of these models, multi-criteria decision analysis (MCDA) may be of added value to cost-utility analysis (CUA), because it covers a wider range of outcomes. This study compares the 2 methods using a side-by-side application.MethodsA new Dutch model of care, Primary Care Plus (PC+), was used as a case study to compare the results of CUA and MCDA. Data of patients referred to PC+ or care-as-usual were retrieved by questionnaires and administrative databases with a 3-month follow-up. Propensity score matching together with generalized linear regression models was used to reduce confounding. Univariate and probabilistic sensitivity analyses were performed to explore uncertainty in the results.ResultsAlthough both methods indicated PC+ as the dominant alternative, complementary differences were observed. MCDA provided additional evidence that PC+ improved access to care (standardized performance score of 0.742 vs 0.670) and that improvement in health-related quality of life was driven by the psychological well-being component (standardized performance score of 0.710 vs 0.704). Furthermore, MCDA estimated the budget required for PC+ to be affordable in addition to preferable (€521.42 per patient). Additionally, MCDA was less sensitive to the utility measures used.ConclusionsMCDA may facilitate an auditable and transparent evaluation of new models of care by providing additional information on a wider range of outcomes and incorporating affordability. However, more effort is needed to increase the usability of MCDA among local decision makers.     

Does Argumentation Matter? A Systematic Literature Review on the Role of Argumentation in Doctor–Patient Communication

In view of a growing interest in argumentative discourse in the context of patient-centered consultation and shared decision making, this article explores the role that argumentation has been attributed in the literature on doctor–patient consultation so far. It studies to what extent theories and concepts of argumentation have been applied by scholars from various fields in order to analyze, understand, facilitate, and improve the argumentative nature of medical consultation. It reports on an extensive and systematic literature search—using eight online databases, expert suggestions, and a manual search—and the subsequent evaluation of 1,330 abstracts on the basis of strict inclusion and exclusion criteria. Forty relevant scientific contributions are grouped into four main categories and discussed accordingly: (a) argumentation theory, (b) discourse analysis, (c) medical informatics, and (d) medical ethics. Because of its systematic approach, this study forms a solid starting point for further integration of argumentation theoretical insights into contemporary views of patient-centered medicine and evidence-based medicine. It provides suggestions for further interdisciplinary and theory-driven research with a strong focus on empirical reality. Doing so, a preliminary model is proposed that outlines the potential effects of the quality of doctors’ communication on proximal, intermediate, and long-term consultation outcomes.     

The Costs of Dementia From the Societal Perspective: Is Care Provided in the Community Really Cheaper than Nursing Home Care?

ObjectiveTo compare the costs of care for community-dwelling dementia patients with the costs of care for dementia patients living in nursing homes from the societal perspective.DesignCross-sectional bottom-up cost of illness study nested within the multicenter German AgeCoDe-cohort.SettingCommunity and nursing homes.ParticipantsOne hundred twenty-eight community-dwelling dementia patients and 48 dementia patients living in nursing homes.InterventionNone.MeasurementsUtilization and costs of medical care and long term care, including formal and informal social and nursing care based on proxy interviews. Informal care was valued using the replacement cost method.ResultsUnadjusted mean annual total costs including informal care were €29,930 ($43,997) for community-dwelling patients and €33,482 ($49,218) for patients living in nursing homes. However, multiple regression analysis controlling for age, sex, deficits in basic and instrumental activities of daily living and comorbidity showed that living in the community significantly increased total costs by €11,344 ($16,676; P < .01) compared with living in a nursing home, mainly due to higher costs of informal care (+€20,585; +$30,260; P < .001).ConclusionFrom the societal perspective care for dementia patients living in the community tends to cost more than care in nursing homes when functional impairment is controlled for.