Examination of the Association of Receipt of Opioid Therapy and Lung Cancer Patient Survival Rates among South Carolina Medicaid Recipients

Introduction: Lung cancer is a high pain cancer that can require the attention of clinical specialists. Already vulnerable populations, like those that inhabit rural areas, when dealing with chronic diseases, like lung cancer, need and deserve adequate medical attention. However, rural communities often lack clinical specialists and are left without the needed care. It is necessary to investigate the current availability of treatment options (medications) available to cancer patients in rural communities. Gaining this knowledge can result in economic savings and improvement of the quality of life for rural populations. Methods: Medicaid data from 1996-2010 was used to examine geographical disparities (urban and rural) in the state of South Carolina. Medicaid recipients identified as distant stage lung cancer patients were linked with data from the South Carolina Cancer Registry. All patients included in the sample were either prescribed an opioid or analgesic and were continuously enrolled in Medicaid for at least 9 months prior to diagnosis (N=1,334). Using the weighted data, logistic regression and Cox Proportional Hazard analyses were performed to assess the likelihood of disparate health care treatment and the survival rate of patients in the sample. Results: Findings of the conducted logistic regression were not statistically significant. This indicates that none of the variables analyzed in the patient factor or structure and process of care components were directly associated with patient receipt of medications. For the Cox Proportional Hazard model, gender was the only statistically significant variable that emerged from the model. Males (OR=1.31, CI: 1.03-1.65) were more likely than females to experience cancer-related death than females. Considering patient and provider geography, there was a greater presence of cancer specialists in the urban areas of South Carolina. The deficit of clinical resources referred to a lack of cancer specialists to treat and prescribe medications appropriately as well as pharmacies to fill prescriptions. Each having the potential to impact the manner of health care treatment as well as influence the longevity of a patient’s life. Conclusion: The disparities in access to care in the urban and rural regions of South Carolina indicate the need for policy that improves the availability of specialty clinicians in rural areas as well as rural residents’ access to pain medications. With proper regulatory stipulations in place, the concerns of substance diversion and dependence would decrease. The development of local and federal government policy is necessary to increase the degree of pain control among these populations

Prolonged Injustice in Urban America

Environmental inequality is the suggestion that the working class, the poor, persons of color, and ultimately the economically disadvantaged are subjected to living conditions that may prove to be hazardous both personally, professionally, and also to the infrastructure of the urban communities that these people inhabit. These injustices affect not only housing but education, quality healthcare access, and access to employment. This article investigates the distinct relationship of environmental inequalities imposed in urban communities that are promoted by a prominent institution: the government. It has been suggested that the government is primarily controlled by individuals who are incapable of identifying with individuals who are residents of these urban communities susceptible to the threat of environmental inequality. This introduces multiple questions: Are political leaders less concerned with such individuals and is this why the needed attention in these communities is positioned at the bottom of the agenda if it appears at all? This, in addition to the lack of funding distributed among these regions for improvements, demonstrates the neglect of the government and how this maintains environmental injustice in urban areas

Equal Care, Unequal Outcomes: Experiences of a REACH 2010 Community

Diabetes is growing in prevalence and costs. Guidelines for care have been available since 1983, yet diabetes care and outcomes remain less than ideal. CDC’s Racial and Ethnic Approaches to Community Health 2010 (REACH 2010) identified diabetes in African Americans as a priority for action. This article documents the activities, interventions, and current progress of the REACH 2010 diabetes coalition formed in Charleston and Georgetown counties, South Carolina, in reducing health care disparities and describes next steps for improving outcomes. The Chronic Care Model guided many of the implementation activities, and chart audits were used to document outcomes. Ambulatory care visits (N = 1522) between 2000 and 2004 were reviewed. Significant progress has been made in reducing disparities in process measures, but similar reductions for intermediate outcomes have not been observed

Effectiveness of home-based records on maternal, newborn and child health outcomes: A systematic review and metaanalysis

Abstract : Home-based records (HBRs) may improve the health of pregnant women, new mothers and their children, and support health care systems. We assessed the effectiveness of HBRs on maternal, newborn and child health reporting, care seeking and self-care practice, mortality, morbidity and women’s empowerment in low-, middle- and high-income countries. We con- ducted a systematic search in MEDLINE, EMBASE, CENTRAL, Health Systems Evidence, CINAHL, HTA database, NHS EED, and DARE from 1950 to 2017. We also searched the WHO, CDC, ECDC, JICA and UNAIDS. We included randomised controlled trials, prospec- tive controlled trials, and cost-effectiveness studies. We used the Cochrane Risk of Bias tool to appraise studies. We extracted and analyzed data for outcomes including maternal, new- born and child health, and women’s empowerment. We synthesized and presented data using GRADE Evidence Profiles. We included 14 studies out of 16,419 identified articles. HBRs improved antenatal care and reduced likelihood of pregnancy complications; improved patient–provider communication and enhanced women’s feelings of control and empower- ment; and improved rates of vaccination among children (OR: 2�39, 95% CI: 1.45–3�92) and mothers (OR 1�98 95% CI:1�29–3�04). A three-year follow-up shows that HBRs reduced risk of cognitive delay in children (p = 0.007). HBRs used during the life cycle of women and chil- dren in Indonesia showed benefits for continuity of care. There were no significant effects on healthy pregnancy behaviors such as smoking and consumption of alcohol during preg- nancy. There were no statistically significant effects on newborn health outcomes. We did not identify any formal studies on cost or economic evaluation. HBRs show modest but important health effects for women and children. These effects with minimal-to-no harms, multiplied across a population, could play an important role in reducing health inequities in maternal, newborn, and child health. PLO

Understanding women's, caregivers', and providers' experiences with home-based records : A systematic review of qualitative studies

Abstract: Mothers, caregivers, and healthcare providers in 163 countries have used paper and electronic home-based records (HBRs) to facilitate primary care visit. These standardized records have the potential to empower women, improve the quality of care for mothers and children and reduce health inequities. This review examines experiences of women, caregivers and providers with home-based records for maternal and child health and seeks to explore the feasibility, acceptability, affordability and equity of these interventions. We systematically searched MEDLINE, MEDLINE In-Process, MEDLINE Ahead of Print, Embase, CINAHL, ERIC, and PsycINFO for articles that were published between January 1992 and December 2017. We used the CASP checklist to assess study quality, a framework analysis to support synthesis, and GRADE-CERQual to assess the confidence in the key findings. Of 7,904 citations, 19 studies met our inclusion criteria. In these studies, mothers, caregivers and children shared HBR experiences in relation to maternal and child health which facilitated the monitoring of immunisations and child growth and development..

Racial and Ethnic Disparities in Stroke Outcomes: A Scoping Review of Post-Stroke Disability Assessment Tools

Purpose: To identify how post-stroke disability outcomes are assessed in studies that examine racial/ethnic disparities and to map the identified assessment content to the International Classification of Functioning, Disability, and Health (ICF) across the time course of stroke recovery. Methods: We conducted a scoping review of the literature. Articles published between January 2001 and July 2017 were identified through Scopus, PubMed, CINAHL, and PsycINFO according to predefined inclusion and exclusion criteria. Results: We identified 1791 articles through database and hand-searching strategies. Of the articles, 194 met inclusion criteria for full-text review, and 41 met inclusion criteria for study inclusion. The included studies used a variety of outcome measures encompassing domains within the ICF: body functions, activities, participation, and contextual factors across the time course of stroke recovery. We discovered disproportionate representation among racial/ethnic groups in the post-stroke disability disparities literature. Conclusions: A wide variety of assessments are used to examine disparities in post-stroke disability across the time course of stroke recovery. Several studies have identified disparities through a variety of assessments; however, substantial problems abound from the assessments used including inconsistent use of assessments, lacking evidence on the validity of assessments among racial/ethnic groups, and inadequate representation among all racial/ethnic populations comprising the US. Implications for Rehabilitation An enhanced understanding of racial/ethnic disparities in post-stroke disability outcomes is inherently important among rehabilitation practitioners who frequently engage with racial/ethnic minority populations across the time course of stroke recovery. Clinicians should carefully consider the psychometric properties of assessment tools to counter potential racial bias. Clinicians should be aware that many assessments used in stroke rehabilitation lack cultural sensitivity and could result in inaccurate assessment findings

Correction: Effectiveness of home-based records on maternal, newborn and child health outcomes: A systematic review and meta-analysis

[This corrects the article DOI: 10.1371/journal.pone.0209278. Errors in funding section and references]