Examination of Racial Disparities in Childhood Asthma Management Practices

Objective: To analyze asthma management plan practices for children with asthma in the United States considering race and other demographic and person-level characteristics. Methods: Univariate/Bivariate/Multivariate analysis was performed to examine asthma management plan physician recommendations among children in the United States utilizing secondary data analysis of the 2002 and 2003 National Health Interview Survey. Results: The majority of the study participants reported not having an asthma management plan at (59.00%). In multivariate analysis using SAS callable SUDAAN, Whites were significantly more likely to have an asthma management plan (OR=1.66, p=.0031). Conclusion: Findings from this study indicate that Black and Hispanic children with asthma are less likely to have an asthma management plan. Mandating all insurers to provide an asthma management plan to children with asthma may reduce the race-based inequities and requiring emergency room physicians to provide children with an asthma management plan may target those children that do not have a plan

Disparities in Mental Health Utilization among Persons with Chronic Diseases

This study used Aday and Andersen’s Behavioral Model of Health Services Use to examine the role of chronic disease and the joint impact of race and chronic disease type on mental health utilization. Using data from Community Tracking Survey Household Survey, we tested the assumption that chronic disease, chronic disease type, and race are related to lower rates of mental health visits when adjusted for predisposing, enabling, and need factors. After adjusting for population characteristics, we found that race significantly moderated the impact of chronic disease type on mental health utilization, showing that African Americans with cardiovascular disease were half as likely as whites with cardiovascular disease to have a mental health visit, and Hispanics relative to whites with other chronic diseases were two thirds a likely to have a mental health visit. Overall, chronic disease status was positively associated with mental health utilization. However, adjusted for chronic disease, mental health status, predisposing, enabling and need factors, African Americans and Hispanics were significantly less likely than whites to have a mental health visit. Clinicians and providers must be alert to the full spectrum of needs in underserved populations

Disparities in Mental Health Utilization among Persons with Chronic Diseases

This study used Aday and Andersen\u27s Behavioral Model of Health Services Use to examine to role of chronic disease and the joint impact of race and chronic disease type on mental health utilization. Using data from Community Tracking Survey Household Survey, we tested the assumption that chronic disease, chronic disease type, and race are related to lower rates of mental health visits when adjusted for predisposing, enabling, and need factors. After adjusting for population characteristics, we found that race significantly moderated the impact of chronic disease type on mental health utilization, showing that African Americans with cardiovascular disease were half as likely as whites with cardiovascular disease to have a mental health visit, and Hispanics relative to whites with other chronic diseases were two thirds as likely to have a mental health visit. Overall, chronic disease status was positively associated with mental health utilization. However, adjusted for chronic disease, mental health status, predisposing, enabling and need factors, African Americans and Hispanics were significantly less likely than whites to have a mental health visit. Clinicians and providers must be alert to the full spectrum of needs in underserved populations

Dental Service Utilization Among Children in the Child Welfare System

OBJECTIVE:To examine predisposing, enabling, and need-related factors associated with dental utilization by children involved with the child welfare system (CWS). METHODS:Data were analyzed from the National Survey of Child and Adolescent Well-Being (NSCAW; Wave II), a national probability sample of children (2-17 years) following a welfare assessment during 2008-2009 (n = 2806). Caregiver-reported child receipt of dental services in the past year was the outcome in weighted logistic regression models. RESULTS:Two-thirds of children had a recent dental visit. Older children (OR 2.95, 95% CI 2.06,4.21 for ages 6-11; OR 2.47, CI 1.82, 3.37 for ages 12-17, compared to ages 2-5) were more likely to have visited the dentist, as were children of more educated caregivers (OR 1.68; CI 1.20, 2.36 for high school, OR 2.45; CI 1.71, 3.52 for more than high school). Children without a usual source of care (OR 0.50; CI 0.27, 0.94) and those living with non-biological parents had lower odds of a recent visit (OR 0.64; CI 0.43, 0.97). Children with dental problems were twice as likely to have a recent visit (OR 2.02; CI 1.21, 3.38), while children with unmet needs who could not afford care had lower odds of utilizing services (OR 0.28; CI 0.16, 0.46). CONCLUSIONS FOR PRACTICE:Many children in the CWS, especially younger children (ages 2-5), did not have a reported dental visit in the past year. Cost was a barrier, and caregiver status was associated with the likelihood of obtaining dental care. Health and social service providers should refer these children for dental care

Physician-Targeted Financial Incentives and Primary Care Physicians’ Self-Reported Ability to Provide High-Quality Primary Care

Objective: High-quality primary care is envisaged as the centerpiece of the emerging health care delivery system under the Affordable Care Act. Reengineering the US health care system into a primary care–driven model will require widespread, rapid changes in the management and organization of primary care physicians (PCPs). Financial incentives to influence physician behavior have been attempted with various approaches, without empirical evidence of their effectiveness in improving care quality. This study examines the above research question adjusting for the patient-centeredness of the practice climate, a major contextual factor affecting PCPs’ ability to provide high-quality care. Methods: Secondary data on a sample of salaried PCPs (n = 1733) from the nation-wide Community Tracking Study Physician Survey 2004-2005 were subject to generalized multinomial logit modeling to examine associations between financial incentives and PCPs’ self-reported ability to provide quality care. Results: After adjusting for patient-centered medical home (PCMH)–consistent practice environment, financial incentive aligned with care quality/care content is positively associated with PCPs’ ability to provide high-quality care. An encouraging finding was that financial incentives aligned with clinic productivity/profitability do not to impede high-quality care in a PCMH practice environment. Conclusion: Financial incentives targeted to care quality or content indicators may facilitate rapid transformation of the health system to a primary care–driven system. The study provides empirical evidence of the utility of practically deployable financial incentives to facilitate high-quality primary care

Differential identification of Mycoplasma pulmonis and M. arthritidis using PCR-based RFLP

Mycoplasma pulmonis and Mycoplasma arthritidis were differentially identified using PCR-restriction fragment length polymorphism (RFLP). A genus-specific sequence of mycoplasma was amplified by PCR and the PCR products were digested with the restriction enzyme Smal. Each PCR product from the four isolates of M. pulmonis was digested with Smal into two fragments; however, there was no digestion in the PCR product from M. arthritidis. This method might be useful to differentiate infection of M. pulmonis from that of M. arthritidis.Y