Overcoming barriers to health-care access: A qualitative study among African migrants in Guangzhou,China

Guangzhou is China's third most populous city, and the region's burgeoning manufacturing economy has attracted many young African businessmen and entrepreneurs to the city. The aims of this study were to examine strategies that African migrants in Guangzhou have adopted in response to health-care barriers, and explore their perceptions of how to address their needs. Twenty-five semi-structured interviews and two focus groups were conducted among African migrants residing in Guangzhou, China. Facing multiple barriers to care, African migrants have adopted a number of suboptimal and unsustainable approaches to access health care. These included: using their Chinese friends or partners as interpreters, self-medicating, using personal connections to medical doctors, and travelling to home countries or countries that offer English-speaking doctors for health care. Health-care providers and health organisations in Guangzhou have not yet acquired sufficient cultural competence to address the needs of African migrants residing in the city. Introducing linguistically and culturally competent health-care services in communities concentrated with African migrants may better serve the population. With the growing international migration to China, it is essential to develop sustainable approaches to improving health-care access for international migrants, particularly those who are marginalised.     

流动人口基本公共卫生服务可及性及影响因素分析

目的:了解流动人口基本公共卫生服务可及性及其影响因素。方法:以安德森卫生服务利用模型为理论基础,使用"流动人口卫生计生服务流出地监测调查(2014)"数据,采用多水平Logistic回归模型从宏观和微观两个层面,对流动人口基本公共卫生服务可及性及影响因素进行分析。结果:流动人口基本公共卫生服务利用率偏低,其在流出地和流入地均有卫生服务需求;对于全人群适用的健康档案、健康教育和健康体检服务项目的利用,流动人口群体内部存在差异;在同一调查点,流动人口卫生服务利用存在组内聚集性,多水平logistic回归分析发现经济社会发展水平、流出地卫生资源配置水平这两个宏观因素和流动人口的性别、年龄、受教育程度、医疗保险参保情况、流动范围及就业单位性质等个体微观因素,是影响流动人口基本公共卫生服务可及性的主要因素;不同服务项目的影响因素既有共性又有差异。结论:流动人口基本公共卫生服务可及性较差,应强化健康教育和引导干预;不同服务项目利用水平存在差异,应重点关注全人群适用项目和慢性非传染病管理;宏观环境因素和微观个体因素对服务可及性均存在影响,因此在增加服务供给的同时还应从流动人口特征着手,提高其主动性和参与意愿;不同性质就业单位中的流动人口卫生服务利用情况不同,应考虑单位及职业特征对服务利用的影响。     

浙江省学生人群2014和2018年肺结核知识及获取途径变化

目的了解浙江省学生人群对肺结核病认知及信息获取途径的变化,为更加有效开展针对学生群体的健康促进工作,制定结核病健康促进策略提供有关依据。方法于2014年4—9月、2018年9—11月采用多阶段分层抽样方法,抽取浙江省554名≤30岁学生人群进行结核病知晓率调查,计数资料比较采用χ²检验,应用单因素和多因素Logistic回归分析影响学生对肺结核认知的相关因素。结果知道肺结核者440人(79.4%),其中2014年215人(85.7%)、2018年225人(74.3%)。多因素Logistic回归分析显示,性别(AOR=1.60,95%CI=1.04～2.47)、文化程度[初中AOR(95%CI)=1.99(1.03～3.85)、高中AOR(95%CI)=3.27(1.57～6.81)、大专及以上AOR(95%CI)=6.73(2.55～17.76)]、调查时间(AOR=0.50,95%CI=0.31～0.80)是知道肺结核的相关因素。两次调查知道肺结核的学生人群对5条肺结核核心信息认知得分及格比例差异无统计学意义(P>0.05)。2018年知道肺结核病的学生...     

河南省中老年居民门诊治疗费用及就医选择调查

目的 对河南省3个市县中老年人口在门诊治疗时医疗保险的使用情况以及对于医疗费用的影响进行分析,并探讨影响目标人群选择三级医院就诊的因素。方法 于2013年8月对河南省3个市县45岁以上的人群进行问卷调查。结果 共有1 464名被调查者参与了此次调查,在调查前1年的时间里,有1 134名（77.5%）被调查者接受过门诊治疗,其中609名（53.7%）居民门诊治疗次数超过3次。门诊治疗总费用和净费用中位数分别为800元和600元。教育程度、就诊医院类型、是否有慢性病和门诊治疗次数与门诊治疗总费用和净费用的支出都有关联,而医疗保险的使用对医疗总费用和净费用均不产生影响。婚姻状况、在企业工作、平均个人收入、是否有慢性病、离家最近的医院类型在一定程度上会影响人们的就医行为。结论 需要进一步对我国的医疗保险制度进行改革,尽快建立有效的双向转诊机制。     

The association between primary source of ambulatory care and access to and outcomes of treatment among AIDS patients.

OBJECTIVES: To examine the relationship between having a primary source of ambulatory care (PSAC), access to AIDS treatment and prophylaxis for opportunistic infection, and hospital and mortality outcomes among heterosexual men and women with AIDS. METHODS: Using a linked AIDS Registry-Medicaid database, 366 adults were identified (1989-1991) with at least 1 year of continuous Medicaid enrollment before AIDS diagnosis, who survived 2 weeks after diagnosis, and with no antiretroviral use or Pneumocystis carinii pneumonia (PCP) prophylaxis during the pre-diagnosis year. Outcomes included times to zidovudine treatment, PCP prophylaxis, hospitalization and death following diagnosis. Multivariate proportional hazards models were used to estimate the effects of patients' PSAC status in the 12-month post-diagnosis period on outcomes, controlling for demographic and case-mix variables. RESULTS: Study criteria preferentially included females, non-whites and enrollees eligible on the basis of aid to families with dependent children. A total of 49% of the patients had no PSAC. Patients with a PSAC were more likely to have received zidovudine [relative risk (RR) = 1.75, 95% confidence interval (CI) = 1.2, 2.2] or PCP prophylaxis (RR = 2.22, 95% CI = 1.5, 3.3). Regression models simultaneously examining association of the propensity to use zidovudine and PCP prophylaxis agents with death indicated that zidovudine-treated and PCP-prophylaxed patients were 64% and 51% less likely to die, respectively (RRdeath,zidovudine = (.36, 95% CI = 0.2, 0.4; RRdeath, PCP prophylaxis = 0.49, 95% CI = 0.3, 0.8). CONCLUSIONS: Patients' underuse of zidovudine and PCP prophylaxis was systematically associated with not having a PSAC. Lack of PSAC, in turn, predicted shorter survival but not increased hospitalization. Female gender, injecting drug use, non-white race and earlier diagnosis year also predicted poorer outcomes.     

云南省3县TB/HIV患者结核病知识知晓率及影响因素分析

目的分析云南省TB/HIV患者的流行特征和结核病知识知晓率及其影响因素,为进一步加强云南省结核病健康促进和健康教育工作提供理论依据。方法对2010年1月—2012年6月期间218名TB/HIV患者进行结核病知识知晓率的问卷调查。统计分析采用单因素分析和Logistic回归分析。结果调查对象结核病知识综合得分为（8.23±2.01）分。职业（χ2=22.515）、婚姻状况（χ2=50.110）、患者来源（χ2=6.378）、住院治疗（χ2=3.915）、管理方式（χ2=4.579）及抗病毒治疗（χ2=11.342）各组间差异均有统计学意义（P均〈0.05）。Logistic回归分析显示,影响结核病知识综合得分的因素有患者来源（Waldχ2=6.277,P=0.02）和抗病毒治疗（Waldχ2=10.678,P〈0.001）。结论云南省TB/HIV患者结核病核心信息总知晓率为82.29%,高于全国结核病防治知识80%的目标。应根据不同地区、不同人群的特点,针对性的制作各种不同的宣传材料,积极宣传结核病的防治知识。     

上海市闵行区外来人口结核病发现与治疗

[目的 ]　对上海市闵行区外来人口结核病防治工作进行基线调查 ,了解外来人口结核病防治工作中存在的问题及其原因 ,提出相应对策。　 [方法 ]　对闵行区疾病预防控制中心的日常结核病报表资料进行分析 ,同时采访结核病防治工作人员和外来人口结核病患者 ,收集定性资料进行分析。　 [结果 ]　外来人口结核病新登记率高于本地人口 ,而其实际的流行情况更加严重。但是外来人口对结核病的卫生服务需要不能得到满足。　 [结论 ]　缺乏有效管理方式、经济困难以及缺乏卫生知识是外来人口结核病防治工作中面临的主要困难。应加强管理 ,提供免费诊治 ,加强宣传教育。     

Poverty,vulnerability, and provision of healthcare in Afghanistan

This paper presents findings on conditions of healthcare delivery in Afghanistan. There is an ongoing debate about barriers to healthcare in low-income as well as fragile states. In 2002, the Government of Afghanistan established a Basic Package of Health Services (BPHS), contracting primary healthcare delivery to non-state providers. The priority was to give access to the most vulnerable groups: women, children, disabled persons, and the poorest households. In 2005, we conducted a nationwide survey, and using a logistic regression model, investigated provider choice. We also measured associations between perceived availability and usefulness of healthcare providers. Our results indicate that the implementation of the package has partially reached its goal: to target the most vulnerable. The pattern of use of healthcare provider suggests that disabled people, female-headed households, and poorest households visited health centres more often (during the year preceding the survey interview). But these vulnerable groups faced more difficulties while using health centres, hospitals as well as private providers and their out-of-pocket expenditure was higher than other groups. In the model of provider choice, time to travel reduces the likelihood for all Afghans of choosing health centres and hospitals. We situate these findings in the larger context of current debates regarding healthcare delivery for vulnerable populations in fragile state environments. The ‘scaling-up process’ is faced with several issues that jeopardize the objective of equitable access: cost of care, coverage of remote areas, and competition from profit-orientated providers. To overcome these structural barriers, we suggest reinforcing processes of transparency, accountability and participation.     

Factors associated with mortality and default among patients with tuberculosis attending a teaching hospital clinic in Accra, Ghana

Tuberculosis (TB) remains a major cause of mortality despite availability of effective chemotherapy. This study was performed to identify contributing factors for poor outcome during anti-tuberculosis treatment at a teaching hospital chest clinic. Medical records of registered patients treated for TB between 1 January and 31 December, 2009 were reviewed and abstracted for demographic, clinical and outcome data. Risk factors for mortality during therapy were assessed using bivariate and multivariate logistics approaches. Of 599 patients, 355 (58.9%) completed therapy and/or were cured, 192 (32.1%) died, and 39 (6.5%) defaulted. In multivariate analysis, independent risk factors for mortality included pulmonary cases for which sputum smear status was unknown (odds ratio [OR] 13.7; 95% confidence interval [CI] 6.0, 31.4), HIV coinfection (OR, 3.6; 95% CI 2.4, 5.4), disseminated TB (OR, 2.2; 95% CI 1.0, 4.9), TB meningitis (OR, 2.8; 95% CI 1.5, 5.3), not having a treatment supporter (OR, 2.0; 95% CI 1.3, 3.1), and low body weight (OR, 11.0; 95% CI 3.1, 38.6). Not having a treatment supporter (OR, 3.2; 95% CI 1.6, 6.6) and HIV coinfection (OR, 2.4; 95% CI 1.2, 5.2) were also independently associated with treatment default. Our findings suggest that enhanced measures to reduce mortality and default in TB patients with HIV coinfection, disseminated or meningeal disease and those who have no treatment supporters may help improve treatment outcomes in Ghana.     

"I spent nine years looking for a doctor": exploring access to health care among immigrants in Mississauga, Ontario, Canada

There is a growing body of research in Canada and from other countries acknowledging that immigrants face barriers in accessing health care services. As immigrants make up an increasing percentage of the population in many developed nations, a better understanding and eliminating these barriers is a major priority. This research contributes to current understandings of access among immigrant populations in Canada by exploring perceptions of access to care through focus groups with a diverse group of immigrants living in a Mississauga, Ontario neighbourhood. The results of eight focus groups reveal that immigrants face geographic, socio-cultural and economic barriers when attempting to access health care services in their community. This paper provides policy recommendations relevant to the federal, provincial and local levels for eliminating these barriers.     

Undocumented immigrants and their use of medical services in Orange County, California

Does an undocumented immigration status predict the use of medical services? To explore this question, this paper examines medical care utilization of undocumented Latino immigrants compared to Latino legal immigrants and citizens, and non-Latino whites in Orange County, California. Data were collected through a random sample telephone survey of 805 Latinos and 396 non-Hispanic whites between January 4 and January 30, 2006. Findings show that undocumented immigrants had relatively low incomes and were less likely to have medical insurance; experience a number of stresses in their lives; and underutilize medical services when compared to legal immigrants and citizens. Predictors of use of medical services are found to include undocumented immigration status, medical insurance, education, and gender. Undocumented Latinos were found to use medical services less than legal immigrants and citizens, and to rely more on clinic-based care when they do seek medical services.     

天津市劳教人员结核病防治知识知晓情况调查

目的了解天津市劳教人员结核病防治知识知晓情况、信息获取途径及其对媒体的喜好情况,为有针对性的开展劳教人员结核病健康教育提供依据。方法采用统一设计的问卷对在津羁押的1223名劳教人员进行面对面调查,应用x。检验。结果调查对象结核病防治核心信息总知晓率为50．5％,全部知晓率为7．7％。其中男性（49．0％）,15—19岁组（38．6％）与20～29岁组（46．7％）,小学及以下文化程度（38．5％）的核心信息总知晓率均低于相应其他组别人群,差异均有统计学意义（P〈O．01）。获取信息的主要来源为电视（38．1％）、与别人聊天（21．2％）和报刊（13．4％）。调查对象对知识获取途径的喜好以电视（44．4％）、其他宣传品（20．0％）和网络（15．4％）的选择率居高。结论天津市劳教人员结核病防治知识知晓率较低,今后要根据劳教场所的实际情况充分利用电视、同伴教育和报刊等方式进行宣传,以提高在押人员的结核病知识水平。     

Ethnic Disparities in Self-Reported Oral Health Status and Access to Care among Older Adults in NYC

There is a growing burden of oral disease among older adults that is most significantly borne by minorities, the poor, and immigrants. Yet, national attention to oral heath disparities has focused almost exclusively on children, resulting in large gaps in our knowledge about the oral health risks of older adults and their access to care. The projected growth of the minority and immigrant elderly population as a proportion of older adults heightens the urgency of exploring and addressing factors associated with oral health-related disparities. In 2008, the New York City Health Indicators Project (HIP) conducted a survey of a representative sample of 1,870 adults over the age of 60 who attended a random selection of 56 senior centers in New York City. The survey included questions related to oral health status. This study used the HIP database to examine differences in self-reported dental status, dental care utilization, and dental insurance, by race/ethnicity, among community-dwelling older adults. Non-Hispanic White respondents reported better dental health, higher dental care utilization, and higher satisfaction with dental care compared to all other racial/ethnic groups. Among minority older adults, Chinese immigrants were more likely to report poor dental health, were less likely to report dental care utilization and dental insurance, and were less satisfied with their dental care compared to all other racial/ethnic groups. Language fluency was significantly related to access to dental care among Chinese immigrants. Among a diverse community-dwelling population of older adults in New York City, we found significant differences by race/ethnicity in factors related to oral health. Greater attention is needed in enhancing the cultural competency of providers, addressing gaps in oral health literacy, and reducing language barriers that impede access to care.     

Socioeconomic status and access to care and the incidence of a heart failure diagnosis in the inpatient and outpatient settings

Purpose

Despite well-documented associations of socioeconomic status with incident heart failure (HF) hospitalization, little information exists on the relationship of socioeconomic status with HF diagnosed in the outpatient (OP) setting.

Barriers to accessing adequate maternal care in Latvia: A mixed-method study among women,providers and decision-makers

Introduction

Latvia has a high maternal mortality ratio compared to other European countries, as well as major inequities in accessing adequate maternal care. Adequacy refers to the extent to which services are safe, effective, timely, efficient, equitable and people-centred. This study aims to explore stakeholder views on access to adequate maternal care in Latvia and the extent to which there was consensus.

Trends in the incidence of treated end-stage kidney disease among Indigenous Australians and access to treatment

OBJECTIVE: To determine temporal trends of incidence of treated end-stage kidney disease in Indigenous Australians and the extent to which these patients had to move from their home community to access renal replacement therapy. METHODS: Data for 1993-2001, regarding place of residence before starting renal replacement therapy, were analysed to give accurate incidence for 1,194 Indigenous treated end-stage kidney disease patients. We calculated indirectly standardised incidence ratios of treated end-stage kidney disease by State and Territory. We surveyed treating renal units about which Indigenous patients relocated to access therapy from 1999 to 2001. RESULTS: The incidence of treated end-stage kidney disease among Indigenous Australians is high and rising; however, the rate of increase is lower than has been previously reported. The Northern Territory (NT) and Queensland have the most new Indigenous treated end-stage kidney disease cases. The highest standardised incidence ratio was in the NT (17.0), followed by Western Australia (WA) (11.9). From 1999 to 2001, half of the 476 Indigenous patients starting therapy had to relocate to access treatment. CONCLUSIONS: The incidence of end-stage kidney disease among Indigenous Australians continues to rise. However, significant gaps in knowledge remain about the burden of early chronic kidney disease and whether many Indigenous patients with end-stage kidney disease still choose not to receive renal replacement therapy. The need to relocate to access treatment has a strong negative impact on individuals, families and entire communities.     

宁波市居民结核病防治知识知晓率调查分析

目的了解宁波市社会群体对结核病防治知识的掌握现况。方法采用分层随机抽样方法,在全市11个县区,按不同职业人群各抽取10~25名居民,用封闭问卷对有关结核病的症状、就诊、治疗、传播和预防知识、结核病信息来源的获得等10个问题进行调查。结果11个县(市)区共收回问卷1366份,其中有效问卷1329份(97.3%)。结核病防治知识得分平均为7.2±2.0分,且男女之间没有显著性差异,而在年龄、文化程度、职业及获得知识来源方面差异显著。结核病特定知识知晓率51.7%,传播方式知晓率79.8%,预防知识知晓率11.3%。结论结核病防治知识知晓率偏低,特别是预防知识更低。加强并重视结核病防治知识的宣传教育是目前结核病控制的当务之急。     

Racial and ethnic residential segregation and access to health care in rural areas

This study examined the relationship between racial/ethnic residential segregation and access to health care in rural areas. Data from the Medical Expenditure Panel Survey were merged with the American Community Survey and the Area Health Resources Files. Segregation was operationalized using the isolation index separately for African Americans and Hispanics. Multi-level logistic regression with random intercepts estimated four outcomes. In rural areas, segregation contributed to worse access to a usual source of health care but higher reports of health care needs being met among African Americans (Adjusted Odds Ratio [AOR]: 1.42, CI: 0.96-2.10) and Hispanics (AOR: 1.25, CI: 1.05-1.49). By broadening the spatial scale of segregation beyond urban areas, findings showed the complex interaction between social and spatial factors in rural areas.