Microfinance investments in quality at private clinics in Uganda: a case-control study

Background: Small private-sector health care providers can play an important role in meeting the developing country health care needs, but a lack of credit can prove major constraint to small-provider expansion. This study examines the potential of small, microfinance loans to strengthen the private health sector and improve access to quality preventive and curative health services in Uganda. Methods: This study estimates logistic regressions using 2,387 client exit interviews to assess the impact of microfinance loans on perceived quality and the viability and sustainability of small, private clinics. Results: The study finds perceived quality improved with loan recipients' clients being more likely to choose clinics on the basis of drug availability, fair charges, cleanliness, and confidentiality. In addition, the assessment found evidence of increased client flows, but the changes produced mixed results for sustainability with respondents being only half as likely to "always" visit a particular clinic. Conclusion: The results indicate that the microfinance program improved perceived quality at loan recipient clinics, especially as reliable drug outlets

The Ohio COVID-19 Survey: Preliminary Findings and Their Use During the Pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic has created exceptional health and economic uncertainty for Ohioans in 2020. In the spring of 2020, the state commissioned the Ohio COVID-19 Survey (OCS) to ask residential Ohio adults about how the pandemic was affecting them. The purpose of this research is to provide state leadership with real-time information about the effects of the pandemic and concurrent recession on Ohio households.Methods: The OCS is a special supplement to the Ohio Medicaid Assessment Survey (OMAS), a stratified random digit dial, cell phone and landline telephone survey. This study includes data collected weekly between April 20, 2020, and August 24, 2020. We conducted descriptive time-series analysis of the survey data and provided updates to the state's COVID-19 Response Team throughout the survey period.Results: Preliminary findings from the OCS reflect 3 themes among respondents: 1) elevated levels of concern over health and household economics; 2) disproportionate effects that exacerbate existing inequities; and 3) majority adjustment to "new normal" and acceptance of public health guidelines .Conclusion: Preliminary findings indicate that groups that were struggling before the pandemic have faced the biggest challenges with regard to health and household economics since it began. Data from the OCS enabled us to provide real-time analysis to state leadership regarding Ohioans' experience during the first 6 months of the COVID-19 pandemic. Further analysis and integration of additional data will allow us to provide deeper insights as Ohio seeks to move into recovery

Trends in Ambulatory Prescribing of Antiplatelet Therapy among US Ischemic Stroke Patients: 2000–2007

Objective. Study objectives were to assess temporal trends and identify patient- and practice-level predictors of the prescription of antiplatelet medications in a national sample of ischemic stroke (IS) patients seeking ambulatory care. Methods. IS-related outpatient visits by adults were identified using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey for the years 2000–2007. We assessed prescribing of antiplatelet medications using the generic drug code and drug entry codes in these data. Temporal trends in antiplatelet prescribing were assessed using the Cochran-Mantel-Haenszel test for trend. Results. We identified 9.5 million IS-related ambulatory visits. Antiplatelet medications were prescribed at 35.5% of visits. Physician office prescribing of the clopidogrel-aspirin combination increased significantly from 0.5% in 2000 to 22.0% in 2007 (P=0.05), whereas prescribing of aspirin decreased from 17.9% to 7.0% (P=0.50) during the same period. Conclusion. We observed a continued increase in prescription of the aspirin-clopidogrel combination from 2000 to 2007. Clinical trial evidence suggests that the aspirin-clopidogrel combination does not provide any additional benefit compared with clopidogrel alone; however, our study findings indicate that even with lack of adequate clinical evidence physician prescribing of this combination has increased in real-world community settings

The Design and Methodology of the Ohio COVID-19 Survey

Background: Governments worldwide are balancing contrasting needs to curtail the toll that coronavirus disease 2019 (COVID-19) takes on lives and health care systems and to preserve their economies. To support decisions, data that simultaneously measure the health status of the population and the economic impact of COVID-19 mitigation strategies are needed. In the United States, prior to the onset of COVID-19, surveys or tracking systems usually focused on public health or economic indicators, but not both. However, tracking public health and economic measures together allow policy makers and epidemiologists to understand how policy and program decisions are associated. The Ohio COVID-19 Survey (OCS) attempts to track both measures in Ohio as one of the first statewide population surveys on COVID-19. To achieve this there are several methodological challenges which need to be overcome. Methods: The OCS utilizes a representative panel offering both cross-sectional and longitudinal analyses. It targets 700 to 1000 respondents per week for a total of 12 600 to 18 000 respondents over an 18-week period. Leveraging a sample of 24 000 adult Ohioans developed from a statewide population health survey conducted in fall 2019, the OCS produces weekly economic and health measures that can be compared to baseline measures obtained before the COVID-19 pandemic began. Results: The OCS was able to quickly launch and achieve high participation (45.2%) and retention across waves. Conclusion: The OCS demonstrates how it is possible to leverage an existing health-based survey in Ohio to generate a panel which can be used to quickly track fast-breaking health issues like COVID-19

A Comparison of Benefit Limits in Mental Health

This study provides insight to policy makers and stakeholders on how three types of benefits limits on Medicaid-covered mental health services might affect access for consumers diagnosed with severe mental illness. The study used a retrospective cohort design with data for Medicaid-covered, community-based mental health services provided in Ohio during fiscal year 2010. Log-binomial regression was used for the analysis. Results indicate that limits compared have significant, varying consequences based on Medicaid coverage and diagnoses. When constraining Medicaid costs, policy makers should consider how limits will disrupt care and include clinicians in discussions prior to implementatio

Maternal and child health and family planning service utilization in Guatemala: implications for service integration

Does the utilization of modern maternal and child health (MCH) services influence subsequent contraceptive use? The answer to this question holds important implications for proposals which advocate MCH and family planning service integration. This study uses data from the 1995/6 Guatemalan Demographic Health Survey and its 1997 Providers Census to test the influence of MCH service utilization on individual contraceptive use decisions. We use a full-information maximum likelihood regression model to control for unobserved heterogeneity. This model produces estimates of the MCH effect, independent of individual women's underlying receptiveness to MCH and contraceptive messages. The results of the analysis indicate that the intensity of MCH service use is indeed positively associated with subsequent contraceptive use among Guatemalan women, even after controlling for observed and unobserved individual- , household- , and community-level factors. Importantly, this finding holds even after controlling for the unobserved factors that 'predispose' some women to use both types of services. Simulations reveal that, for these Guatemalan women, key determinants such as age and primary schooling work indirectly through MCH service use to increase contraceptive utilization.Contraceptives MCH Guatemala Family planning

Racism Measurement Framework: A Tool for Public Health Action and Accountability

Racism is a principal determinant of health inequity, but recent events have galvanized local and state leaders across Ohio to declare racism a public health emergency. In addition to the renewed call to racial justice, sustained progress will require ongoing measurement to determine which anti-racist efforts are working, and why. In this review, we present existing measures categorized by 3 dimensions of racism that interact and build off of one another: (1) systemic racism, considering the health effects of policies in housing, voting, criminal legal system, economic opportunity, and health care; (2) interpersonal racism, and measures of provider bias and cultural competency; (3) internalized racism, measured as allostatic stress and heightened vigilance in distinct contexts. After identifying knowledge gaps, we developed a racism measurement framework that more comprehensively depicts the disparities caused by racism within Ohio and can be used to monitor and evaluate the effectiveness of anti-racist efforts implemented across the state. As such, this framework provides not only a call for action against racism in Ohio, but an opportunity for organizations to measure the extent to which efforts have intervened on supposedly entrenched pathways to health inequities and disparities caused by racism