Disparities in Access to After-Hours Care in the U.S.: A National Study

After-hours care provides timely access to continuity of care for chronic illnesses and episodic care for acute illness. Lack of timely access to primary care services is one of the main drivers of emergency department overuse. Our aim was to examine disparities in access to after-hours care based on race, income, geographic location, type of insurance, and health care setting. We used data from the 2010 Health Tracking Household Survey. Multivariable logistic regression was used to assess disparities in access to after-hours care. We found disparities by type of insurance, geographic location, and type of health care setting. People with Medicaid were less likely than those with private insurance to have access to after-hours care (aOR 0.67, 95% CI, 0.53-0.88). Those in non-metropolitan areas were less likely to have access to after-hours care (aOR 0.73, 95% CI, 0.61-0.89) as compared to those living in large metropolitan areas. In comparison to the Northeast census region, access to after-hours was less likely in the Midwest (aOR 0.60, 95% CI, 0.49-0.73), South (aOR 0.40, 95% CI, 0.33-0.48), and West region (aOR 0.46, 95% CI, 0.37-0.57). We found no evidence of disparities based on sex, race/ethnicity, or income. With the increasing need of after-hours care, policymakers should plan to provide incentives to providers to offer after-hours care

An Overview of State Criteria for Declaring a Public Health Emergency

https://digitalcommons.unmc.edu/coph_policy_reports/1006/thumbnail.jp

The Economic Impact of Increasing Cigarette Taxes in the State of Nebraska

https://digitalcommons.unmc.edu/coph_policy_reports/1008/thumbnail.jp

Economic Implications of Tobacco Use for the State of Nebraska Government

We examine smoking-related expenditures for the state Medicaid program and for lost productivity among state government employees. The predicted number of new diagnoses of smoking-related illnesses among government employees ranged from 109 cases of kidney disease to 856 cases of arthritis and related diseases. We estimate over 6,000 lost workdays due to sick leave among currently smoking vs. non-smoking employees. Smoking-related illness is estimated to increase state budgetary expenditures on Medicaid by approximately $114.9 million annually.https://digitalcommons.unmc.edu/coph_policy_reports/1025/thumbnail.jp

The Effect of Telehealth Interventions on Quality of Life of Cancer Patients: A Systematic Review and Meta-Analysis

Introduction:In 2016, ∼1.7 million new cases of cancer were diagnosed. Cancer patients can have physical, functional, and psychosocial issues when dealing with cancer treatment. Telehealth has been effectively introduced to help deliver treatment to patients suffering from chronic disease; however, there is little consensus on its effectiveness in administering sociobehavioral cancer treatments. Thus, this study determines the benefits of telehealth-based interventions providing emotional and symptom support in improving quality of life (QOL) among cancer patients. Methods:Two researchers conducted comprehensive searches on PubMed, SCOPUS, Medline, PsycINFO, ERIC, Psychology and Behavioral Collection, and Medline Complete. Key search terms included telehealth or telemedicine and QOL and cancer. Articles were included if they assessed a telehealth-delivered intervention for adult cancer patients and provided a QOL assessment. Data were extracted to calculate mean effect sizes for QOL measures on the effectiveness of telehealth relative to usual care (UC) for cancer treatments. Results:Out of 414 articles identified in our initial search, nine articles fit our inclusion criteria. Both telehealth (Hedges g = 0.211, p = 0.016) and standard of care (Hedges g = 0.217, p \u3c 0.001) cancer treatment delivery methods demonstrated small, but statistically significant improvements in QOL measures. However, there were no statistically significant differences in effectiveness between the telehealth interventions and UC (p = 0.76). Conclusions:The results indicate that telehealth interventions are as effective at improving QOL scores in patients undergoing cancer treatment as in-person UC. Further studies should be undertaken on different modalities of telehealth to determine its appropriate and effective use in interventions to improve the QOL for cancer patients undergoing treatment

Persistent disparities in cholesterol screening among immigrants to the United States

Background: This study compared differences in cholesterol screening among immigrant populations and US born race/ethnic groups and whether improving access to health care reduced differences in screening. Methods: Self-reported cholesterol screening for adults was calculated from multivariate logistic regression analysis of the 1988–2008 National Health and Nutrition Examination Surveys (N = 17,118). Immigrant populations were classified by place of birth and length of residency. Results: After adjusting for individual characteristics and access to health care, the multivariate adjusted probability of cholesterol screening is significantly lower for persons originating from Mexico (70.9%) compared to persons born in the US (80.1%) or compared to US born Hispanic persons (77.8%). Adjustment for access to care did significantly reduce the difference in screening rates between immigrants and natives because the rate for natives remained the same, but the rate for immigrants improved. For example, the difference in screening between US born persons and persons born in Mexico was reduced by nearly 10% after adjustment for access to care. Conclusions: There are persistent disparities in cholesterol screening for immigrants, particularly recent immigrants from Mexico, but improved access to health care may be a viable policy intervention to reduce disparities

Evaluation of a Competency-Based Health Policy Training Program

https://digitalcommons.unmc.edu/coph_policy_reports/1009/thumbnail.jp

Evaluation of a Competency-Based Health Policy Training Program

An academic and practice partnership was formed to create and implement a competency-based training program for local health departments in health policy. We evaluated if the training program improved the policy knowledge and competency of participants. Participants exhibited significant increases for self-assessed policy competency, including substantial improvements in “Critique the feasibility and expected outcomes of potential policy options”, “Identify and assess the strengths and motivations of key stakeholders and potential resistors”, and “Recommend a specific policy change”. The policy competency instrument developed in this report could be used to measure policy knowledge and competency in future training implementations.https://digitalcommons.unmc.edu/coph_policy_reports/1000/thumbnail.jp

La salida de campo, una posibilidad en la formación inicial docente

El artículo presenta una reflexión sobre una experiencia reciente de realización de salidas de campo en el ámbito universitario, en las que se ha creado una figura denominada estudiante de apoyo, para aportar desde otros referentes en su proceso de formación inicial como docente. Así, participa en el proceso logístico y académico de la preparación, desarrollo y finalización del trabajo de campo. De igual manera, realiza una sistematización de la experiencia en su conjunto, asumiendo un rol activo, participativo y de producción de conocimiento al realizar un proceso reflexivo que junto con la docente titular de la actividad, implica repensar no solo la salida de campo sino los saberes escolares que pueden jugar un papel significativo en ella.This article presents a reflection on a recent experience in the development of field trips in a University context, in which has been created a figure named Support Student in order to contribute from different references to the initial process of teaching formation. Thus, it participates in the logistic and academic processes for the preparation development and completion of the fieldwork. Likewise, a systematization of the experience is carried out, assuming an active, participative role which promotes the production of knowledge through a reflective process that, along with the home teacher, implies rethink not only the field trip but also the scholar knowledge that may play a significant role on it