The Development of a Peer-Based Approach for Promoting Prisoner Health in an English Male Young Offender Institution

This chapter considers the development of peer-based approaches in promoting prison health in England and Wales and presents insights into how young adult prisoners perceive and experience these roles in the prison environment. Alongside the benefits of taking on a peer role, the chapter explores prisoners’ views of the implementation and the potential utility of peer-based approaches for health within the wider prison community. The findings are discussed in relation to the potential impact of peer initiatives in seeking to develop and implement the more integrated and innovative approaches that have been called for in this domain in seeking to reduce health inequalities

Perceived Access Problems Among Patients with Diabetes in Two Public Systems of Care

OBJECTIVE: We examined the prevalence of access problems among public clinic patients after participating in trials of automated telephone disease management with nurse follow-up. DESIGN: Randomized trial. SETTING: General medicine clinics of a county health care system and a Veterans Affairs (VA) health care system. PARTICIPANTS: Five hundred seventy adults with diabetes using hypoglycemic medication were enrolled and randomized; 520 (91%) provided outcome data at 12 months. INTERVENTION: Biweekly automated telephone assessments with telephone follow-up by diabetes nurse educators. MEASUREMENTS AND MAIN RESULTS: At follow-up, patients reported whether in the prior 6 months they had failed to obtain each of six types of health services because of a financial or nonfinancial access problem. Patients receiving the intervention were significantly less likely than patients receiving usual care to report access problems (adjusted odds ratio [AOR], 0.61; 95% confidence interval [CI], 0.43 to 0.97). The risk of reporting access problems was greater among county clinic patients than VA patients even when adjusting for their experimental condition, and socioeconomic and clinical risk factors (AOR, 1.61; 95% CI, 1.02 to 2.53). County patients were especially more likely to avoid seeking care because of a worry about the cost (AOR, 2.82; 95% CI, 1.48 to 5.37). CONCLUSIONS: Many of these public sector patients with diabetes reported that they failed to obtain health services because they perceived financial and nonfinancial access problems. Automated telephone disease management calls with telephone nurse follow-up improved patients' access to care. Despite the impact of the intervention, county clinic patients were more likely than VA patients to report access problems in several areas

Healthcare-Related Financial Burden Among Families in the U.S.: The Role of Childhood Activity Limitations and Income

Activity limitations, Child health, Expenditures, Financial burden, MEPS,