Factors Influencing Unmet Medical Need among U.S. Adults: Disparities in Access to Health Services

Inequities in access to health services has negative consequences on individual well-being, and imposes financial and emotional burden on patients, families, health care systems, and the public. Inequities engendered from differences in socioeconomic status, health insurance coverage, race, and other characteristics can engender disparities. This study aimed to identify the potential predictors of unmet medical need among the civilian noninstitutionalized U.S. adults. Inability to receive needed medical care or receiving medical care after a delay, due to the associated costs, constructed unmet medical need. This study used a four-year (2014-2017) National Health Interview Survey (NHIS) data (sample size: 296,301 adults) and implemented a conceptual framework to study disparities in access to health services and estimate the relative importance of predisposing, enabling, and need factors as the predictors of unmet medical need. Findings from machine learning and logistics regression models highlight the importance of health insurance coverage as a key contributing factor of health disparities. About 60% of variation in unmet medical need was predictable, with over 90% accuracy, solely with health insurance coverage status. Self-rated health status, family structure, and family income to poverty ratio were other statistically significant predictors. Even after controlling for a wide variety of sociodemographic and health status variables such as age, gender, perceived health status, education, income, etc., health insurance remains significantly associated with unmet medical need (OR: 5.03 , 95%CI: 4.67-5.42). To ensure precise national estimates, proper survey data analysis methods were incorporated to account for the complex sampling method used by NHIS. Furthermore, the enabling factors (health insurance and income) exert much more weight on unmet medical need than predisposing factors and need factors. The findings raise the concerns about the existence and magnitude of disparities in health care access and provide a comprehensive framework to a target population for understanding the sources of health inequities with data-driven evidence. Results can be utilized to address potential areas for designing public policy and program interventions by identifying the relative vulnerability of different population groups for lacking access to affordable health services. Future studies using longitudinal panel data are necessary to establish a causal relationship between the predictors and unmet medical need

Original Article Customers' Complaints and its Determinants: The Case of a Training Educational Hospital in Iran

Background: Today, despite the efforts of the medical community and healthcare staff along with the advancements in medical technology, patients' dissatisfaction and complaints have been increased. The present study aimed at making a survey on the patients' complaints in a large training hospital affiliated to Mashhad University of Medical Sciences (MUMS). Methods: This descriptive, cross-sectional study was conducted on written and verbal complaints of patients and their relatives in a tertiary (specialty and sub-specialty) training hospital. All the recorded patients' complaints, from March to December 2012, were reviewed. Data were categorized and analyzed using descriptive statistics by Microsoft Excel 2007. Results: A total of 233 complaints were reviewed, of which 46.35%, 31.34% and 22.31%, respectively, were verbal, written and made on the phone. The main reasons for complaints were accessibility to medical staff (21.46%), communication failures (20.17%) and dissatisfaction with the provided care (14.59%). Thirty one (13.31%) cases were solved at first place, 194 (83.26%) referred to the complaints from the committee and 3.43% referred to the legal authorities. The average response time was about six to seven days. Conclusion: The findings of the study suggest that sufficient availability of medical staff, improvement in communication skills and paying attention to the patients' needs and expectations may reduce complaints from public health facilities

Customers’ Complaints and its Determinants: The Case of a Training Educational Hospital in Iran

Background: Today, despite the efforts of the medical community and healthcare staff along with the advancements in medical technology, patients’ dissatisfaction and complaints have been increased. The present study aimed at making a survey on the patients’ complaints in a large training hospital affiliated to Mashhad University of Medical Sciences (MUMS). Methods: This descriptive, cross-sectional study was conducted on written and verbal complaints of patients and their relatives in a tertiary (specialty and sub-specialty) training hospital. All the recorded patients’ complaints, from March to December 2012, were reviewed. Data were categorized and analyzed using descriptive statistics by Microsoft Excel 2007. Results: A total of 233 complaints were reviewed, of which 46.35%, 31.34% and 22.31%, respectively, were verbal, written and made on the phone. The main reasons for complaints were accessibility to medical staff (21.46%), communication failures (20.17%) and dissatisfaction with the provided care (14.59%). Thirty one (13.31%) cases were solved at first place, 194 (83.26%) referred to the complaints from the committee and 3.43% referred to the legal authorities. The average response time was about six to seven days. Conclusion: The findings of the study suggest that sufficient availability of medical staff, improvement in communication skills and paying attention to the patients’ needs and expectations may reduce complaints from public health facilities

Racial, ethnic, and socioeconomic disparities in confirmed COVID-19 cases and deaths in the United States: a county-level analysis as of November 2020

OBJECTIVES: The objective of this study was to investigate potential county-level disparities among racial / ethnic and socioeconomic groups in confirmed COVID-19 cases and deaths in the United States in 100,000 population. DESIGN: Secondary data analysis using county-level data for 3,142 US counties was conducted in 2020. Hierarchical linear regression and concentration curve analyses were performed. The combined association of COVID-19 cases and deaths was examined separately by the county population\u27s socioeconomic characteristics. Data from the American Community Survey (ACS) 5-year estimates (2014-2018), Area Health Resources File (AHRF) 2018-2019, Kaiser Health News 2020, and 2020 COVID-19 data from Johns Hopkins University were used in this study. RESULTS: After adjusting for covariates, U.S. counties with a higher proportion of the Black population and a higher proportion of adults with less than a high school diploma had disproportionately higher COVID-19 cases and deaths (β  \u3e  0, \u3c 0.05 for all relations). A higher proportion of the Hispanic population was associated with higher confirmed cases (β = 0.68, 95% CI = 0.48-0.87). The majority observed disparities in COVID-19 deaths persisted even after controlling for all-cause deaths in 2019 and COVID-19 cases per 100,000 county population. This can potentially aggravate the existing health disparities among these population groups. CONCLUSIONS: Identification of disproportionately impacted population groups can pave the way towards narrowing the disparity gaps and guide policymakers and stakeholders in designing and implementing population group-specific interventions to mitigate the negative consequences of the COVID-19 pandemic

Socioeconomic and Racial Segregation and COVID-19: Concentrated Disadvantage and Black Concentration in Association with COVID-19 Deaths in the USA

Introduction: This study’s objective was to examine the association of the percentage of county population residing in concentrated disadvantage and Black-concentrated census tracts with county-level confirmed COVID-19 deaths in the USA, concentrated disadvantage and Black concentration at census tract-level measure socioeconomic segregation and racial segregation, respectively. Methods: We performed secondary data analysis using tract (N = 73,056) and county (N = 3142) level data from the US Census Bureau and other sources for the USA. Confirmed COVID-19 deaths per 100,000 population was our outcome measure. We performed mixed-effect negative binomial regression to examine the association of county population’s percentage residing in concentrated disadvantage and Black-concentrated tracts with COVID-19 deaths while controlling for several other characteristics. Results: For every 10% increase in the percentage of county population residing in concentrated disadvantage and Black-concentrated tracts, the rate for confirmed COVID-19 deaths per 100,000 population increases by a factor of 1.14 (mortality rate ratio [MMR] = 1.14; 95% confidence interval [CI]:1.11, 1.18) and 1.11 (MMR = 1.11; 95% CI:1.08, 1.14), respectively. These relations stayed significant in all models in further sensitivity analyses. Moreover, a joint increase in the percentage of county population residing in racial and socioeconomic segregation was associated with a much greater increase in COVID-19 deaths. Conclusions: It appears that people living in socioeconomically and racially segregated neighborhoods may be disproportionately impacted by COVID-19 deaths. Future multilevel and longitudinal studies with data at both individual and aggregated tract level can help isolate the potential impacts of the individual-level characteristics and neighborhood-level socioeconomic and racial segregation with more precision and confidence

A Systematic Review of the Role of Telemedicine in Blood Pressure Control: Focus on Patient Engagement

Purpose of Review: To systematically review and synthesize the existing evidence on the effects of different telemedicine interventions on improving patient engagement among patients with hypertension. Patient engagement is defined as patients’ knowledge, skills, ability, and willingness to manage their healthcare within the context of interventions designed to promote positive patient behaviors. Recent Findings: Telemedicine is a rapidly growing method of healthcare services delivery. Telemedicine interventions are mainly used to facilitate communication between the patient and provider, measure, record, and track blood pressure, and educate and train patients about managing their blood pressure. Findings from several studies indicate the evidence of patient engagement, adherence to the care plan, improvement in knowledge about blood pressure, and patient satisfaction with telemedicine interventions for blood pressure. Summary: Telemedicine interventions need to be customized depending on patient demographics and socioeconomic characteristics such as age and education level to ensure optimal patient engagement

Hydroxychloroquine plus standard of care compared with standard of care alone in COVID-19: a meta-analysis of randomized controlled trials

Abstract The efficacy and safety of Hydroxychloroquine (HCQ) in treating coronavirus disease (COVID-19) is disputed. This systematic review and meta-analysis aimed to examine the efficacy and safety of HCQ in addition to standard of care (SOC) in COVID-19. PubMed, the Cochrane Library, Embase, Web of sciences, and medRxiv were searched up to March 15, 2021. Clinical studies registry databases were also searched for identifying potential clinical trials. The references list of the key studies was reviewed to identify additional relevant resources. The quality of the included studies was evaluated using the Cochrane Collaboration tool and Jadad checklist. Meta-analysis was performed using RevMan software (version 5.3). Eleven randomized controlled trials with a total number of 8161 patients were identified as eligible for meta-analysis. No significant differences were observed between the two treatment groups in terms of negative rate of polymerase chain reaction (PCR) (Risk ratio [RR]: 0.99, 95% confidence interval (CI) 0.90, 1.08; P = 0.76), PCR negative conversion time (Mean difference [MD]: − 1.06, 95% CI − 3.10, 0.97; P = 0.30), all-cause mortality (RR: 1.09, 95% CI 1.00, 1.20; P = 0.06), body temperature recovery time (MD: − 0.64, 95% CI − 1.37, 0.10; P = 0.09), length of hospital stay (MD: − 0.17, 95% CI − 0.80, 0.46; P = 0.59), use of mechanical ventilation (RR: 1.12, 95% CI 0.95, 1.32; P = 0.19), and disease progression (RR = 0.82, 95% CI 0.37, 1.85; P = 0.64). However, there was a significant difference between two groups regarding adverse events (RR: 1.81, 95% CI 1.36, 2.42; P < 0.05). The findings suggest that the addition of HCQ to SOC has no benefit in the treatment of hospitalized patients with COVID-19. Additionally, it is associated with more adverse events

Exploring socioeconomic inequalities in the use of medicinal herbs among Iranian households: evidence from a national cross-sectional survey

Background: Association between socioeconomic status and medicinal herbs (MH) are rarely documented in Iran. Our goal was to measure and decompose socioeconomic inequalities in MH use among Iranian households. Methods: The data used in this cross-sectional study were extracted from the 2018 Household Income and Expenditure Survey (HIES) (N = 38,859). Data on MH use, age, gender, and education status of the head of household; a constructed wealth index of household (as a proxy for household’s socioeconomic status); and place of residence (urban or rural) were obtained from the survey. Publicly available province-level data on Human Development Index (HDI) were obtained from the Institute for Management Research at Radbound University. We used the concentration curve and the normalized concentration index (Cn) to measure the magnitude of socioeconomic inequalities in MH among Iranian households. The Cn was decomposed to identify the main determinants of socioeconomic inequalities in MH in Iran. Results: The overall prevalence of MH use among Iranian households was 4.7% (95% confidence interval [CI]: 4.5 to 4.9%) in the last month before data collection. The Cn for MH use for the whole of samples was 0.1519; 95% CI = 0.1254 to 0.1784; suggesting a higher concentration of MH use among the households with high socioeconomic level. The decomposition analysis indicated that the main contributing factors to the concentration of MH use were the economic status of households, development status of the province, and education level of the household head. Conclusions: This study demonstrated that MH use is more concentrated among socioeconomically advantaged households in Iran and its provinces. This finding might contrast with the widespread belief that wealthy and socioeconomically advantaged populations, compared to low SES groups, tend to seek disproportionately more modern medical treatments and medications than MH. Understanding the factors affecting MH use, socioeconomic inequality in use of MH and its determinants provide an opportunity for health policymakers to design effective evidence-based interventions among providers and consumers of MH

Customers’ Complaints and its Determinants: The Case of a Training Educational Hospital in Iran

Background: Today, despite the efforts of the medical community and healthcare staff along with the advancements in medical technology, patients’ dissatisfaction and complaints have been increased. The present study aimed at making a survey on the patients’ complaints in a large training hospital affiliated to Mashhad University of Medical Sciences (MUMS). Methods: This descriptive, cross-sectional study was conducted on written and verbal complaints of patients and their relatives in a tertiary (specialty and sub-specialty) training hospital. All the recorded patients’ complaints, from March to December 2012, were reviewed. Data were categorized and analyzed using descriptive statistics by Microsoft Excel 2007. Results: A total of 233 complaints were reviewed, of which 46.35%, 31.34% and 22.31%, respectively, were verbal, written and made on the phone. The main reasons for complaints were accessibility to medical staff (21.46%), communication failures (20.17%) and dissatisfaction with the provided care (14.59%). Thirty one (13.31%) cases were solved at first place, 194 (83.26%) referred to the complaints from the committee and 3.43% referred to the legal authorities. The average response time was about six to seven days. Conclusion: The findings of the study suggest that sufficient availability of medical staff, improvement in communication skills and paying attention to the patients’ needs and expectations may reduce complaints from public health facilities

Lopinavir/Ritonavir for COVID-19: a Systematic Review and Meta-Analysis

PURPOSE: To provide the latest evidence on the efficacy and safety of lopinavir/ritonavir compared to other treatment options for COVID-19. METHODS: We searched PubMed, Cochran Library, Embase, Scopus, and Web of Science for the relevant records up to April 2021. Moreover, we scanned MedRxiv, Google Scholar, and clinical registry databases to identify additional records. We have used the Newcastle-Ottawa Scale and Cochrane risk of bias tools to assess the quality of studies. This Meta-analysis was conducted using RevMan software (version 5.3). RESULTS: Fourteen studies were included. No significant difference was observed between lopinavir/ritonavir and non-antiviral treatment groups in terms of negative rate of PCR (polymerase chain reaction) on day 7 (risk ratio [RR]: 0.83; 95% CI: 0.63 to 1.09; P=0.17), and day 14 (RR: 0.93; 95% CI: 0.81 to 1.05; P=0.25), PCR negative conversion time (mean difference [MD]: 1.09; 95% CI: -0.10 to 2.29; P=0.07), secondary outcomes, and adverse events (P\u3e0.05). There was no significant difference between lopinavir/ritonavir and chloroquine as well as lopinavir/ritonavir and hydroxychloroquine regarding the efficacy outcomes (P\u3e0.05). However, lopinavir/ritonavir showed better efficacy than arbidol for the same outcomes (P0.05). CONCLUSION: Lopinavir/ritonavir has no more treatment effects than other therapeutic agents used herein in COVID-19 patients