Seeking health information online: does limited healthcare access matter?

Consumers facing barriers to healthcare access may use online health information seeking and online communication with physicians, but the empirical relationship has not been sufficiently analyzed. Our study examines the association of barriers to healthcare access with consumers’ health-related information searching on the internet, use of health chat groups, and email communication with physicians, using data from 27 210 adults from the 2009 National Health Interview Survey. Individuals with financial barriers to healthcare access, difficulty getting timely appointments with doctors, and conflicts in scheduling during clinic hours are more likely to search for general health information online than those without these access barriers. Those unable to get timely appointments with physicians are more likely to participate in health chat groups and email physicians. The internet may offer a low-cost source of health information and could help meet the heightened demand for health-related information among those facing access barriers to care.     

Culturally sensitive strategies designed to target the silent epidemic of hepatitis B in a Filipino community

Hepatitis B is frequent in the Philippines. A high rate of immigration to the United States has brought many Filipinos with infections who are asymptomatic yet will go on to develop liver cancer and cirrhosis unless diagnose and evaluated. Interventions are necessary to educate this ethnic community, identify those infected, and offer therapy. In an effort to reach this high risk population in Hawai'i an intervention program was designed to address the silent epidemic of hepatitis. Ethnic barriers were crossed through involvement of trusted, key stakeholders and individuals within the Filipino health care and church communities, along with groups that had joint missions to address viral hepatitis. After extensive planning and meetings with faith-based organizations and health care providers in the Filipino community, it was decided to hold a community health fair in the Filipino community to provide culturally appropriate health information and services. More than 500 individuals attended the health fair; 167 participated in a survey and were tested for hepatitis B. Significant knowledge gaps were found in relation to risk factors, prevention strategies, and transmission. Five individuals tested positive; all were immigrants and did not know of their disease. The objective to educate people and test them for hepatitis was successful through utilizing ethnic community leaders, religious organizations, health care professionals, and a collaborative health fair.     

Timely cancer diagnosis and management as a chronic condition: opportunities for primary care

One in three men and one in four women in Australia will be diagnosed with cancer in the first 75 years of life. The majority will survive the cancer and ultimately die from unrelated causes. Many cancer patients and their families will experience some physical, social, economic and psychological sequelae, regardless of the prognosis. A recurring theme is that patients are disadvantaged by the lack of coordination of care and their needs are not being adequately met. We argue that greater integration of care through a multidisciplinary team of professionals, peer support groups and primary health practitioners functioning within a care hub could offer better practical and psychosocial supportive care for patients and their families.     

Policies of deterrence and the mental health of asylum seekers

In the past, most refugees who permanently resettled in the traditional recipient countries of North America, Europe, and Australasia were screened prior to arrival in a host country. In the last decade, increasing numbers of unauthorized refugees or asylum seekers, those who formally lodge application for refugee status in the country in which they are residing, have applied for protection after crossing the borders of these countries. Concerns about uncontrolled migration have encouraged host countries to adopt policies of deterrence in which increasingly restrictive measures are being imposed on persons seeking asylum. These measures include, variously, confinement in detention centers, enforced dispersal within the community, the implementation of more stringent refugee determination procedures, and temporary forms of asylum. In several countries, asylum seekers living in the community face restricted access to work, education, housing, welfare, and, in some situations, to basic health care services. Allegations of abuse, untreated medical and psychiatric illnesses, suicidal behavior, hunger strikes, and outbreaks of violence among asylum seekers in detention centers have been reported. Although systematic research into the mental health of asylum seekers is in its infancy, and methods are limited by sampling difficulties, there is growing evidence that salient postmigration stress facing asylum seekers adds to the effect of previous trauma in creating risk of ongoing posttraumatic stress disorder and other psychiatric symptoms. The medical profession has a role in educating governments and the public about the potential risks of imposing excessively harsh policies of deterrence on the mental health of asylum seekers. JAMA. 2000;284:604-611     

Changing faces: A review of infectious disease screening of refugees by the Migrant Health Unit, Western Australia in 2003 and 2004

OBJECTIVE: To document demographic characteristics and prevalence of infectious diseases in refugees and humanitarian entrants attending the Migrant Health Unit (MHU) in Perth for health assessment from 1 January 2003 to 31 December 2004. DESIGN: Retrospective case series. PARTICIPANTS: All refugees and humanitarian entrants arriving in Western Australia on subclass 200 and subclass 202 visas who were invited to attend the MHU. MAIN OUTCOME MEASURES: Demographic details, results of Mantoux tests, and blood and faecal tests for infectious diseases and parasites. RESULTS: WA accepted 2781 refugee and humanitarian entrants in 2003 and 2004; 2617 were invited to attend the MHU, and 2111 (81%) actually attended for screening. Over three-quarters arrived from Africa. Overall, 25% had a positive Mantoux test result, 5% were carriers of hepatitis B, and 5% had positive serological test results for syphilis. People arriving from sub-Saharan Africa had the highest prevalence of most diseases, with 8% having malaria, 7% schistosomiasis, 5% hookworm, and 2% strongyloidiasis. CONCLUSION: Disease prevalence varied greatly between refugees from different countries and was particularly high in those arriving from sub-Saharan Africa, the origin of most of Australia's refugee and humanitarian entrants. These data support the need for refugees and humanitarian entrants from countries with high rates of disease to have access to a comprehensive postarrival medical assessment and appropriate follow-up health care. Health services must provide beneficial and cost-effective services that protect the health of both individual refugees and the wider community.     

Getting new evidence into medicine

The rate of transfer of the knowledge gained from health and medical research into evidence-based practice is determined by many factors. Preconditions for the uptake of new evidence are the availability of good evidence, ready access to the evidence, a supportive organisational environment, and effective mechanisms for promoting knowledge uptake. Evidence-based medicine is being promoted in Australia by a body of enthusiastic clinicians, public health practitioners and consumer advocates, supported by initiatives from national, State and local healthcare services and professional bodies. The short to medium term future of evidence-based medicine in Australia is likely to be shaped by three major factors: a reduction in cost and technical barriers which limit access to computerised databases; a trend towards shared decision-making between clinicians and patients; and increased demand for information to fill the gaps in research-based evidence on specific problems.     

A roadmap for cardiovascular care after release from incarceration: uses of a smartphone application

ObjectiveCardiovascular disease (CVD) and its risk factors disproportionately affect people returning from incarceration. These individuals face multiple barriers to obtaining care, which can impact CVD and risk factor management and may be mitigated through use of a smartphone application (app). Therefore, we explored the CVD-related needs of people released from incarceration and which app features would support these needs.Materials and MethodsIn 2019, we collected qualitative data through 7 focus groups with 76 returning citizens and 19 key informants through interviews and small group discussions in Baltimore, Maryland. Verbal data were audio-recorded, transcribed, and analyzed using inductive thematic coding with N-Vivo qualitative software.ResultsReturning citizens face multiple barriers when trying to engage in care and services related to cardiovascular health, including around medications and health insurance. Some major challenges were identifying trusted social services and making cardiovascular health a priority. Findings suggested that CVD risk factors could be more effectively addressed in combination with attending to other pressing needs related to employment, housing, behavioral health, and building trust. Participants suggested that a smartphone app would be most useful if it broadly addressed these issues by linking returning citizens to social services, including recommendations from peers, and facilitating access to healthcare.DiscussionReturning citizens need broad support for societal reintegration. Addressing social issues would allow them to focus on cardiovascular health.ConclusionGiven the challenges experienced after release from incarceration, an app focused on social and health-access issues may help returning citizens meet their CVD needs.     

Local advocacy for the medically indigent. Strategies and accomplishments in one county

Access to health care for the medically indigent has emerged as a major policy issue throughout the United States. Because no national health program ensures entitlement to basic services, practitioners and patients must cope with barriers to access on the local level. We report several separate but integrated strategies that a community-based coalition has used to achieve improvements in indigent care within a single county. Research strategies have involved short-term investigations of barriers to needed services so that local awareness of the problem would increase rapidly. Political strategies have attempted to improve the county government's administrative procedures and financial support of services for the poor, to modify the practices of local health care institutions, and to influence state and national policies that affect local conditions. Legal strategies have involved the participation of attorneys who represent clients unable to receive care and who could initiate litigation as appropriate. Each of these strategies contains weaknesses as well as strengths. Although such advocacy efforts do not achieve a coherent system that guarantees access, they can substantially improve the availability of local services.     

Religious perspectives on withdrawal of treatment from patients with multiple organ failure

Religious or spiritual values often influence health care decision-making by patients and their families, particularly in times of crisis. Though religious values might seem to be irrelevant where continuing treatment is judged to be "futile", such clinical assessments should instead serve to open a dialogue about values and beliefs. The six major religious traditions in Australia have some similar values and principles about death and provision of care for the dying, but differ in their processes of ethical reasoning, cosmologies, and key moral concepts. Engaging with religious traditions on the common ground of basic values (such as human dignity, care, the sacredness of human life, non-violence, compassion, and selflessness) promotes negotiation of the manner in which care is provided, even where conflicts exist.     

Strategic approaches to the development of Australia's future primary care workforce

Shortages in, and maldistribution of, the primary health care workforce will continue to limit access to health care. The current health reform proposals and policies recognise workforce development as a priority, but only partially address the barriers to improvement. In particular, there will need to be more systematic development of interdisciplinary education within primary health care services, and funding to support this.     

Transforming insurance coverage into quality health care: voltage drops from potential to delivered quality

Although the US health care system is often touted as one of the best in the world, disparities exist in quality of care received by different populations, in different regions, and across different institutions and clinicians. Initiatives to provide access to health insurance have been a major policy tool to ensure that Americans receive high-quality health care. However, availability of insurance coverage does not automatically lead to high-quality care. This article explores points of vulnerability in the US health care system at which the potential to achieve high-quality care can be lost: (1) access to insurance coverage; (2) enrollment in available insurance plans; (3) access to covered services, clinicians, and health care institutions; (4) choice of plans, clinicians, and health care institutions; (5) access to a consistent source of primary care; (6) access to referral services; and (7) delivery of high-quality health care services. Ensuring high-quality health care requires that each of these "voltage drops" be recognized and addressed. JAMA. 2000;284:2100-2107.     

Met and unmet needs of children with epilepsy in a paediatric tertiary care setting

OBJECTIVE: To investigate the extent to which the health needs were met or unmet in children with epilepsy attending a tertiary care outpatient setting. PATIENTS AND METHOD: A semi-structured interview was used to collect relevant information from the parents. It focused on ascertaining the quality of health care received by the children, including the extent to which attention was given to epilepsy related physical, behavioural, social and educational impairments that were identified by the parents. RESULTS: There was satisfactory seizure control in the majority. Most children received only one anticonvulsant and side-effects were reported to be minimal. A large majority had behavioural problems, and social and educational difficulties to a lesser extent. Parents were concerned about the implications of these problems, but there was little communication about them in the doctor-patient contact. Even where the problems were communicated, parent satisfaction about the interventions was low. Parents identified the availability of more consultation time and provision of more information on epilepsy as their expectations from doctors. CONCLUSIONS: This study shows that awareness and communication about the multiple health problems of children with epilepsy are necessary to improve the quality of health care given to them.     

Childhood psychiatric disorders. Focus on conduct disorders

The high prevalence of child and adolescent psychiatric disorders in general and of aggressive behaviors in particular presents a serious problem. Recent social, economic and demographic trends suggest that the problem is likely to grow in degree of seriousness. It is recommended that the broad social and economic policies that impact on risk factors be evaluated and that greater emphasis be placed upon prevention efforts. These efforts need to particularly strengthen the social, emotional, and economic supports that provide an important protective factor for children and families. Practices in education, employment, health, and human services need to be examined to insure that they provide support. Perhaps the most encouraging development is the growth of children's services councils. There needs to be support for their continuing growth and for the development of more effective partnerships between state and local government. A particular focus should be upon strengthening neighborhoods and local communities, involving schools and school-based services as a source of support for families, and the increasing involvement of local civic and religious groups.     

The International Covenant on Economic, Social and Cultural Rights and the right to health: is Australia meeting its obligations to Aboriginal peoples?

There is evidence that Australia is not meeting its obligations to Aboriginal and Torres Strait Islander peoples for their right to the "highest attainable standard" of health, required under the International Covenant on Economic, Social and Cultural Rights (ICESCR). Poor access to primary health care for Aboriginal peoples and substantial shortfalls in government spending to address this are in violation of the ICESCR. Aboriginal and Torres Strait Islander peoples' share of the universal health coverage expenditure offered to all Australians is less per person than for other Australians. The failure to monitor the provision of mainstream health services to Aboriginal peoples and inequitable distribution of health facilities and services compound these violations. Equality in health between Indigenous and non-Indigenous Australians is achievable, but not until the shortfall in health services expenditure for Indigenous Australians is addressed.     

医疗服务信息连续性对分级医疗的影响

医疗服务信息不连续影响着我国分级医疗格局的形成,本文通过对影响医疗服务信息连续性的＂信息孤岛＂、机构沟通障碍等问题的探讨,以期解决部分医疗服务信息不连续问题,从而促进分级医疗体系的推进.     

Non-use of Formal Health Services in Malawi: Perceptions from Non-users

Background

The study upon which this paper is based was undertaken to understand users'' and non-users'' perceptions concerning facilitators and barriers to equitable and universal access to health care in resource-poor countries such as Malawi. In this study, non-users of health services were defined as people who were not in need of health services or those who had stopped using them due to significant barriers.

Methods

A total of 80 interviews with non-users of health services were conducted in Rumphi, Ntchisi, Phalombe and Blantyre Districts of Malawi. Interviews focused on why informants were not using formal health services at the time of data collection. In order to identify non-users, snowballing was used health surveillance assistants, village headmen and community members also helped. One focus group discussion was also conducted with non-users of health services who were members of the Zion Church.

Results

Informants described themselves as non-users of health services due to several reasons: cost of health services; long distances to health facilities; poor attitude of health workers; belief in the effectiveness of traditional medicines; old age and their failure to walk. Others were non-users due to their disability; hence they could not walk over long distances or could not communicate effectively with health providers. Some of these non-users were complete non-users, namely members of the Zion Church and those who believed in traditional medicine, and they stated that nothing could be done to transform them into users of health services. Other non-users stated that they could become users if their challenges were addressed e.g. for those who were non-users of health services due to poor attitudes of health workers, they stated that if these health workers were transferred they would be able to access health services.

Conclusions

Public health education targeting both health workers and non-users, ensuring a functional outreach program and addressing other health system challenges such as shortage of drugs and human resources would assist in transforming non-users into users of health services.     

Beyond universal health insurance to effective health care

The history of the U.S. governmental health care reform indicates that efforts toward universal health insurance cannot be expected from a financially strapped federal government. Ambitious governmental programs such as veterans' services and Medicaid have encountered accessibility problems associated with location, arbitrary limitations of reimbursement criteria, and opposition from taxpayers due to the higher taxes and premiums necessitated by program reform. Nonfinancial obstacles to access include physicians migration away from minorities and the poor, the strained conditions of many public hospitals, and immigrants' isolation due to language barriers and paranoia over citizenship status. Ginzberg presents interim targets for the expansion of access to health care: the expansion of Medicaid, subsidized coverage for the near poor, private sector catastrophic insurance policies, expansion of the Federal Community Health Center program, expansion of the National Health Service Corps and State Educational Debt Forgiveness Programs, and state subsidies for uncompensated care.     

The challenges in making electronic health records accessible to patients

It is becoming increasingly apparent that there is a tension between growing consumer demands for access to information and a healthcare system that may not be prepared to meet these demands. Designing an effective solution for this problem will require a thorough understanding of the barriers that now stand in the way of giving patients electronic access to their health data. This paper reviews the following challenges related to the sharing of electronic health records: cost and security concerns, problems in assigning responsibilities and rights among the various players, liability issues and tensions between flexible access to data and flexible access to physicians.     

Social Justice, Health Inequities, and Access to New Age-Related Interventions

New interventions into the aging process have already prolonged the life span of nematodes, fruit flies, mice, and most recently even of primates. What has been successful in laboratory animals may be applied to human aging in the long run as well. At the same time, the almost universal trend of population aging raises concerns that health care costs will rise significantly and that this trend will threaten universal and equal access to health-related services. Therefore, it is crucial to assess the potential impact of new age-related biomedical interventions on health care systems in order to predict who will have access to these interventions and how this will affect existing health inequities in old age. This would at first require data on the cost-effectiveness of new age-related interventions. However, such data are not yet available. Nevertheless, a discussion on the potential impact of this technological development in such an early stage has one big advantage: possible undesirable outcomes may still be prevented by timely regulatory action. Therefore, instead of trying to answer the question of the possible consequences for publicly and privately financed health care based on data concerning cost-effectiveness, we will try to anticipate which groups will presumably have access to these interventions into the aging process. We will also suggest a social justice framework to evaluate unequal access, based on a conception of health-related equality of opportunity. As a starting point for this projection, we will compare different biodemographic scenarios. According to our analysis, access to age-related interventions will be limited to certain population groups and this will further increase already existing health inequities among the elderly, which should be avoided from a social justice perspective. We suggest that the most promising strategy to prevent such a development would be to set priorities in publicly funded age-related research. An analysis of the development of NIA-funding and the current NIA strategy will examine to which extent starting points for such an ethically justified priority setting already exist and how it could basically be conceived.     

General practice--chaos, complexity and innovation

Primary health care (PHC) reforms focus on improving access to and effectiveness of general practice services, with greater emphasis on health promotion, prevention and chronic disease management, and integration with population health approaches. Currently, reforms are often based on scant evidence from the most accessible and easily known PHC domains and activities, yet most PHC is complex and poorly understood. Complexity theory is based on understanding patterns that are not predictable by traditional evidence and social knowledge, within a complex adaptive system. Complexity knowledge provides a way of understanding the general practitioner's role in PHC in self-organising local networks, with a capacity to generate new solutions integrated through historical and social connections. Complex systems provide a framework for an expanded knowledge base, debate and discussion of reforms and development of PHC goals and strategies.