Alabama Veterans Rural Health Initiative: A Preliminary Evaluation of Unmet Health Care Needs

The Alabama Veterans Rural Health Initiative aims to better understand the health care needs, health status, and barriers to care for rural veterans. Following extensive community outreach, Veteran Community Outreach Health Workers assessed 203 veterans residing in rural counties of Alabama who either: 1) had never enrolled in VA health services, or 2) had not used those services in at least two years. While 71.4 percent of participants reported having utilized non-VHA primary care within the past year, 33.5 percent reported an inability or delay in obtaining needed health care for one or more services: primary care, specialty care, mental health care, addictions treatment, dental care, or prescription medication. The most commonly cited barrier was cost. Among all participants, 56 percent screened positive for at least one Axis I mental disorder. Rurally residing, non-VHA utilizing veterans appear to have fairly good access to primary care, but need dental care, prescription medication, and mental health care

Immediate and lagged effects of daily stress and affect on caregivers’ daily pain experience

We examined the effect of daily stress, affect, and adult day service (ADS) use on the daily pain experience among caregivers of individuals with dementia (IWD). Participants were interviewed for 8 consecutive days. Caregivers utilized an ADS program on some days and provided care at home on other days. We hypothesized ADS use, care-related and noncare-related subjective stress, and affect would significantly influence and interact in ways to exacerbate or buffer the experience of daily pain

Determinants of mental health utilization in a palliative care outpatient setting

This study examines the determinants of psychology service utilization among a chronically ill population. Data were combined from an outpatient palliative care clinic using two patient outcome studies for a secondary data analysis. Overall, 149 patients were examined with the majority being middle-aged (M = 55, SD = 14.73), female (n=112; 75.2%) and White (n=123; 82.6%) with a primary diagnosis of cancer (n=117; 78.5%) over a 37 month time period. Using the Behavioral Model of Health Service Use (Andersen, 1995), separate logistic regression analyses were conducted to assess for significant predisposing, enabling and need factor determinants of psychology service utilization in outpatient palliative care. The significant determinants from each of these factors were then modeled together. The total number of visits to see a palliative care physician was found to be the strongest determinant of psychology service utilization (p < .001). Seeing multiple providers was also a statistically significant determinant of psychology service utilization (p = .002) as well as not taking a non-opioid analgesic (p = .024). These findings suggest enabling factors from Andersen's model are most strongly associated with psychology service utilization in outpatient palliative care populations. Of note, many factors associated with need for psychology services, such as emotional distress, psychological symptom burden or having a psychological comorbidity, did not reach significance in determining psychology service use. These findings reinforce previous research that indicates chronically ill individuals are not likely to receive mental health care even though it is documented that they have increased distress related to their mental health. Also, these findings indicate the need for further investigation as to who is receiving referrals for psychology services, as it is noted in the scientific literature that many chronically ill individuals are under-recognized as needing mental health care referrals by their physicians. (Published By University of Alabama Libraries

Race, immigration status and job satisfaction among certified nursing assistants

Certified Nursing Assistants (CNAs) provide up to 90% of direct care to long-term care residents. Unfortunately, CNAs have an extraordinarily high turnover rate that is accompanied by low levels of work satisfaction. A largely qualitative body of literature has indicated that perceived lack of respect and perceived discrimination drive job satisfaction differently in CNAs of different race/ethnicity. This quantitative study examined CNA job satisfaction with an emphasis on race, immigration status, dementia training, respect, and perceived discrimination. Secondary data analysis of the National Nursing Assistant Survey used information from 3,017 nursing assistants in 1,500 nursing facilities, including data on training, supervision, client relationships, and workplace environment. This study looked at a sample of 2,352 participants; 61.3% were Non-Hispanic Whites (NHWs) and 31.4% were African Americans (AAs); 89% were US born citizens, 4.2% immigrants, and 6.8% citizens through naturalization. Path analyses indicated that race predicts job satisfaction, and that both respect and discrimination partially mediate that association. This pattern of findings was consistent across both racial groups. These effects varied with age. Immigration status and dementia training were hypothesized to moderate these effects by improving understanding of problem behavior, yet neither hypothesis was supported. These results highlight the complex nature of CNA job satisfaction in long-term care. (Published By University of Alabama Libraries