Health Care Opinion Leaders' Views on Vulnerable Populations in the U.S. Health System

Presents survey responses from healthcare experts about the equity of the health system; healthcare reform's potential effects on safety-net institutions, access, and financial protection; and strategies for improving quality of care

AN ANALYSIS OF IODINE DEFICIENCY DISORDER AND ERADICATION STRATEGIES IN THE HIGH ATLAS MOUNTAINS OF MOROCCO

Food Consumption/Nutrition/Food Safety, Health Economics and Policy,

How Strong Is the Primary Care Safety Net? Assessing the Ability of Federally Qualified Health Centers to Serve as Patient-Centered Medical Homes

By expanding access to affordable insurance coverage for millions of Americans, the Affordable Care Act will likely increase demand for the services provided by federally qualified health centers (FQHCs), which provide an important source of care in low-income communities. A pair of Commonwealth Fund surveys asked health center leaders about their ability to function as medical homes. Survey findings show that between 2009 and 2013, the percentage of centers exhibiting medium or high levels of medical home capability almost doubled, from 32 percent to 62 percent. The greatest improvement was reported in patient tracking and care management. Despite this increased capability, health centers reported diminished ability to coordinate care with providers outside of the practice, particularly specialists. Ongoing federal funding and technical support for medical home transformation will be needed to ensure that FQHCs can fulfill their mission of providing high-quality, comprehensive care to low-income and minority populations

The Relationship Between Parental Warmth and Parental Pressure to Achieve with Adolescent Depression and Anxiety in China

Adolescents in mainland China are under strong family pressure to excel academically, and they experience psychological symptoms at higher rates than those found in Western countries, but little attention has been paid to the association between the two. This study investigated the relationship between parental warmth and parental pressure to achieve academically, and two forms of adolescent psychological maladjustment (depression and anxiety). A sample of 997 students were surveyed in four high schools in Beijing, China. Results indicated that perceived parental warmth correlated negatively with adolescents' levels of anxiety and depression symptoms, perceived parental pressure to acheive correlated positively with anxiety and depression symptoms, and parental warmth moderated the relationship between perceived parental pressure and adolescents depression symptoms but not adolescents' anxiety symptoms. Gender differences were explored, with significantly stronger correlations found for boys than for girls between pressure and symptoms of anxiety and depression

DSM-5, Asperger\u27s Syndrome Diagnosis, and Mothers\u27 Experiences with Mental Health Services

Mothers who have children with a previous Asperger\u27s syndrome diagnosis had to go through a process to maintain or obtain services for their child when the fifth edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) removed the diagnosis. Prior to and since the release of the DSM-5 in 2013, there has been an expression of concern in the literature about how this diagnostic change would affect services for children with a previous Asperger\u27s syndrome diagnosis. Current research has not sufficiently explored the experiences mothers have had with this process. The purpose of this hermeneutical phenomenological study was to explore the experiences of mothers since this diagnostic change. Data were collected and saturation was reached at 6 participants using semistructured interviews. Interpretive phenomenological analysis was used to interpret the experiences of these mothers which produced 3 main themes related to the process of obtaining a new diagnosis, insurance-funded services, and educationally-funded services. The results included both subthemes and superordinate themes that highlighted the need for more stakeholder education, difficulty navigating systems, the need for advocacy, concerns about new diagnoses and loss of services, and the public\u27s perception and the stigma associated with the Asperger\u27s syndrome diagnosis both before and after this diagnostic change. Study results may assist with improving counselors and other stakeholder\u27s knowledge about the importance of the mothers\u27 experiences when there is a diagnostic change of this nature. Also, counselor educators can instill the importance of diagnostic accuracy and supporting all stakeholders when teaching new counselors

Written reflection in assessment and appraisal:GP and GP trainee views

BACKGROUND: In the UK, evidence of written reflection is part of licensing and revalidation for general practitioners (GPs). However, there is little evidence of specific benefits compared to other forms of reflective practice.AIM: To seek GPs' and general practice (GP) trainees' views on the role of written reflection in learning and assessment.DESIGN AND SETTING: An online survey of 1005 GPs and GP trainees (GPTs) in the UK.METHOD: An anonymous questionnaire containing 38 attitudinal items was administered. Descriptive statistics were used to analyse Likert scale responses, thematic analysis for free-text responses.RESULTS: In total 544 GPs and 461 GPTs completed the survey, with 842 (83.8%) agreeing they find verbal reflection with a colleague more useful than written reflection. Three quarters disagreed that written reflection is a way of identifying poorly performing GPs. Over 70% of respondents stated that summative, written reflection is a time-consuming, box-ticking exercise which distracts from other learning. They question its validity as part of assessment and state that its use may contribute to current difficulties with recruitment and retention to GP.CONCLUSIONS: For many GPs, written reflection is an onerous process rather than beneficial to their learning, indicating its continued use in assessment needs to be critically examined.</p

Closing the Gap: Past Performance of Health Insurance in Reducing Racial and Ethnic Disparities in Access to Care Could Be an Indication of Future Results

This historical analysis shows that in the years just prior to the Affordable Care Act's expansion of health insurance coverage, black and Hispanic working-age adults were far more likely than whites to be uninsured, to lack a usual care provider, and to go without needed care because of cost. Among insured adults across all racial and ethnic groups, however, rates of access to a usual provider were much higher, and the proportion of adults going without needed care because of cost was much lower. Disparities between groups were narrower among the insured than the uninsured, even after adjusting for income, age, sex, and health status. With surveys pointing to a decline in uninsured rates among black and Hispanic adults in the past year, particularly in states extending Medicaid eligibility, the ACA's coverage expansions have the potential to reduce, though not eliminate, racial and ethnic disparities in access to care

Reducing Racial and Ethnic Disparities in Access to Care: Has the Affordable Care Act Made a Difference?

Issue: Prior to the Affordable Care Act (ACA), blacks and Hispanics were more likely than whites to face barriers in access to health care.Goal: Assess the effect of the ACA's major coverage expansions on disparities in access to care among adults.Methods: Analysis of nationally representative data from the American Community Survey and the Behavioral Risk Factor Surveillance System.Findings and Conclusions: Between 2013 and 2015, disparities with whites narrowed for blacks and Hispanics on three key access indicators: the percentage of uninsured working-age adults, the percentage who skipped care because of costs, and the percentage who lacked a usual care provider. Disparities were narrower, and the average rate on each of the three indicators for whites, blacks, and Hispanics was lower in both 2013 and 2015 in states that expanded Medicaid under the ACA than in states that did not expand. Among Hispanics, disparities tended to narrow more between 2013 and 2015 in expansion states than nonexpansion states. The ACA's coverage expansions were associated with increased access to care and reduced racial and ethnic disparities in access to care, with generally greater improvements in Medicaid expansion states

The Adoption and Use of Health Information Technology by Community Health Centers, 2009-2013

With help from targeted federal investments, U.S. physician offices and hospitals have accelerated their adoption and use of patient electronic health records (EHRs) and other health information technology (HIT) in recent years. Comparison of results from. The Commonwealth Fund's two national surveys of federally qualified health centers (FQHCs) in 2009 and 2013 show that HIT adoption has also grown substantially for these important providers of care in poor and underserved communities. Nearly all surveyed FQHCs (93%) now have an EHR system, a 133 percent increase from 2009, the year federal "meaningful use" incentives for HIT were first authorized. Three-quarters of health centers (76%) reported meeting the criteria to qualify for incentive payments. Remaining challenges for health centers include achieving greater interoperability of EHR systems and ensuring patient access to their records. Mobile technology, such as text messaging, may help FQHCs further expand patient outreach and access to care

Ready or Not? How Community Health Centers View Their Preparedness to Care for Newly Insured Patients

By expanding access to affordable insurance coverage for millions of Americans, the Affordable Care Act will likely increase demand for the services provided by federally qualified health centers (FQHCs), an important source of care in low-income communities. A Commonwealth Fund survey asked health center leaders in 2013 about current and anticipated workforce challenges, as well as efforts under way to prepare for the increase in patients. The majority of FQHCs reported shortages of primary care doctors (56%), especially bilingual physicians (60%). Health centers are engaged in activities to meet the needs of new patients, with 53 percent pursuing integration of behavioral health and 31 percent hiring additional clinical staff. To help them provide quality care to more patients, FQHCs will require assistance to recruit additional personnel, particularly bilingual staff and mental health professionals, and to expand access to care through telehealth and other strategies