Access to Healthcare during COVID-19 Núñez, Alicia; Sreeganga, S D; Ramaprasad, Arkalgud
International journal of environmental research and public health,
03/2021, Volume:
18, Issue:
6
Journal Article
Peer reviewed
Open access
Ensuring access to healthcare is critical to prevent illnesses and deaths from COVID-19 and non-COVID-19 cases in health systems that have deteriorated during the pandemic. This study aims to map the ...existing literature on healthcare access after the appearance of COVID-19 using an ontological framework. This will help us to formalize, standardize, visualize and assess the barriers to and drivers of access to healthcare, and how to continue working towards a more accessible health system. A total of 131 articles are included and considered for mapping in the framework. The results were also compared to the World Health Organization guidelines on maintaining essential health services to determine the overlapping and nonoverlapping areas. We showed the benefits of using ontology to promote a systematic approach to address healthcare problems of access during COVID-19 or other pandemics and set public policies. This systematic approach will provide feedback to study the existing guidelines to make them more effective, learn about the existing gaps in research, and the relationship between the two of them. These results set the foundation for the discussion of future public health policies and research in relevant areas where we might pay attention.
Autistic people are more likely to: be diagnosed with a range of physical health conditions (i.e. cardio-vascular disease); experience premature mortality (for most disease categories); and ...experience barriers to effectively accessing healthcare. This systematic review sought to identify studies that report on barriers and facilitators to physical healthcare access for autistic people. A total of 3111 records were screened and six studies were included: two quantitative, two qualitative, and two mixed-methodology studies. Patient-provider communication, sensory sensitivities, and executive functioning/planning issues emerged as important barriers to healthcare. Recommendations for clinicians and those planning services are discussed.
Full text
Available for:
DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, ODKLJ, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
To describe healthcare experiences and health outcomes among rural LGBTQ + individuals.
2022 cross-sectional survey.
Southern Illinois.
85 individuals.
Demographics, sexual orientation and gender ...identity, healthcare experiences, health outcomes.
Experiences and outcomes were assessed vs orientation and identity. Distribution comparison was by
-test and chi-square, risk prediction by logistic regression, and significance assumed at
< .050.
By orientation, participants were: 35.3% gay, 16.5% lesbian, and 45.8% bisexual plus; and by identity they were: 49.4% cisgender, 25.9% transgender, and 24.8% other identity. Survey item responses ranged from 95%-99%. Compared to gay men, lesbians and bisexual plus individuals more frequently reported medical bill payment difficulty (58.3% and 57.9% vs 25.0%;
= .020) and more past month days of poor mental health (19.4 and 15.8 vs 10.6;
= .018). Compared to heterosexual and other identity, transgender individuals less frequently reported having a routine medical provider (72.7% vs 92.7% and 95.0%;
= .037) and more frequently reported past healthcare denial (45.5% vs 17.5% and 18.8%;
= .042). Current health was associated with medical bill payment ability (OR = .33, 95% CI = .13-.86) and respectful treatment by healthcare administrators (OR = 3.90, 95% CI = 1.34-11.35) and clinicians (OR = 3.82, 95% CI = 1.39-10.47). Significance of some findings likely limited due to sample size.
Our data describes healthcare experience and health outcome disparities among rural lesbian, gay, bisexual, transgender, queer and other sexual and gender minority individuals, and indicate that clinical experiences directly influence health outcomes.
Full text
Available for:
FSPLJ, NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
There is a large treatment gap for common mental disorders (CMD), with wide variation by world region. This review identifies factors associated with formal health service utilisation for CMD in the ...general adult population, and compares evidence from high-income countries (HIC) with that from low-and-middle-income countries (LMIC).
We searched MEDLINE, PsycINFO, EMBASE and Scopus in May 2016. Eligibility criteria were: published in English, in peer-reviewed journals; using population-based samples; employing standardised CMD measures; measuring use of formal health services for mental health reasons by people with CMD; testing the association between this outcome and any other factor(s). Risk of bias was assessed using the adapted Mixed Methods Appraisal Tool. We synthesised the results using "best fit framework synthesis", with reference to the Andersen socio-behavioural model.
Fifty two studies met inclusion criteria. 46 (88%) were from HIC. Predisposing factors: There was evidence linking increased likelihood of service use with female gender; Caucasian ethnicity; higher education levels; and being unmarried; although this was not consistent across all studies. Need factors: There was consistent evidence of an association between service utilisation and self-evaluated health status; duration of symptoms; disability; comorbidity; and panic symptoms. Associations with symptom severity were frequently but less consistently reported. Enabling factors: The evidence did not support an association with income or rural residence. Inconsistent evidence was found for associations between unemployment or having health insurance and use of services. There was a lack of research from LMIC and on contextual level factors.
In HIC, failure to seek treatment for CMD is associated with less disabling symptoms and lack of perceived need for healthcare, consistent with suggestions that "treatment gap" statistics over-estimate unmet need for care as perceived by the target population. Economic factors and urban/rural residence appear to have little effect on treatment-seeking rates. Strategies to address potential healthcare inequities for men, ethnic minorities, the young and the elderly in HIC require further evaluation. The generalisability of these findings beyond HIC is limited. Future research should examine factors associated with health service utilisation for CMD in LMIC, and the effect of health systems and neighbourhood factors.
PROSPERO registration number: 42016046551 .
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Countries are working hard to improve access to healthcare through Universal Healthcare Coverage. To genuinely address the problems of healthcare access, we need to recognize all the dimensions and ...complexities of healthcare access. Levesque's Conceptual Framework of Access to Health introduced in 2013 provides an interesting and comprehensive perspective through the five dimensions of access and the five abilities of the population to access healthcare. The objectives of this paper are to identify and analyze all empirical studies that applied Levesque's conceptual framework for access to healthcare and to explore the experiences and challenges of researchers who used this framework in developing tools for assessing access.
A scoping review was conducted by searching through four databases, for studies citing Levesque et al. 2013 to select all empirical studies focusing on healthcare access that applied the framework. An initial 1838 documents underwent title screening, followed by abstract screening, and finally full text screening by two independent reviewers. Authors of studies identified from the scoping review were also interviewed.
There were 31 studies identified on healthcare access using the Levesque framework either a priori, to develop assessment tool/s (11 studies), or a posteriori, to organize and analyze collected data (20 studies). From the tools used, 147 unique questions on healthcare access were collected, 91 of these explored dimensions of access while 56 were about abilities to access. Those that were designed from the patient's perspective were 73%, while 20% were for health providers, and 7% were addressed to both. Interviews from seven out of the 26 authors, showed that while there were some challenges such as instances of categorization difficulty and unequal representation of dimensions and abilities, the overall experience was positive.
Levesque's framework has been successfully used in research that explored, assessed, and measured access in various healthcare services and settings. The framework allowed researchers to comprehensively assess the complex and dynamic process of access both in the health systems and the population contexts. There is still potential room for improvement of the framework, particularly the incorporation of time-related elements of access.
Full text
Available for:
IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
7.
Traveling Towards Disease Syed, Samina T.; Gerber, Ben S.; Sharp, Lisa K.
Journal of community health,
10/2013, Volume:
38, Issue:
5
Journal Article
Peer reviewed
Open access
Transportation barriers are often cited as barriers to healthcare access. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These ...consequences may lead to poorer management of chronic illness and thus poorer health outcomes. However, the significance of these barriers is uncertain based on existing literature due to wide variability in both study populations and transportation barrier measures. The authors sought to synthesize the literature on the prevalence of transportation barriers to health care access. A systematic literature search of peer-reviewed studies on transportation barriers to healthcare access was performed. Inclusion criteria were as follows: (1) study addressed access barriers for ongoing primary care or chronic disease care; (2) study included assessment of transportation barriers; and (3) study was completed in the United States. In total, 61 studies were reviewed. Overall, the evidence supports that transportation barriers are an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured. Additional research needs to (1) clarify which aspects of transportation limit health care access (2) measure the impact of transportation barriers on clinically meaningful outcomes and (3) measure the impact of transportation barrier interventions and transportation policy changes.
Aim
To describe the experience of stigma among transgender and gender‐diverse (TGD) people accessing care.
Design
A qualitative meta‐synthesis.
Data Sources
CINAHL, Medline, PubMed and PsycINFO were ...used to retrieve English‐language, peer‐reviewed qualitative studies from September 2016 to September 2021.
Review Methods
The methods for this qualitative meta‐synthesis included four steps. Step 1: Form the clinical question and purpose of synthesis to define and refine search terms. Step 2: Evaluate the literature using PRISMA. Step 3: Appraise the literature using Lett’s Critical Review Form. Step 4: Conduct a reciprocal translation to synthesize the results.
Results
Of the 12 articles that met the inclusion criteria, 3 were from nursing journals. The articles included were studies conducted in U.S.A., Brazil, Canada, Colombia, Mozambique, Sweden, Uganda and United Kingdom, and most recruited transfeminine‐identifying participants. Three main themes emerged: stigma experienced within the individual, interpersonal and structural socio‐ecological levels among TGD people accessing care.
Conclusion
Stigma is a significant public health issue as it limits healthcare access among TGD people. Stigma experienced at various socio‐ecological levels contributes to health disparities. Nurses must create and implement interventions informed by the lived experiences of TGD people.
Impact
Extant literature on this topic is limited in the nursing literature. This qualitative meta‐synthesis illuminates TGD identity stigma‐related experiences using a socio‐ecological framework. While stigma is often experienced at the individual and interpersonal levels, oppressive systems that value cisgender cultural norms over other gender identities allow structural‐level stigma to occur. Nurses are morally, ethically and professionally responsible for challenging systems that create and sustain stigma. Understanding how stigma is experienced when accessing care can help deliver critical information needed to improve healthcare access among TGD people and other historically oppressed communities.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Aim
To explore the experiences of recreational‐vehicle‐dwelling American nomads when seeking healthcare in the United States.
Design
This exploratory, qualitative study employed interpretive ...description design to maintain a disciplinary focus in nursing.
Methods
Twenty‐five participants were recruited from campgrounds in eight states. Semi‐structured interviews were conducted face‐to‐face. Thematic analysis was conducted using a phronetic iterative approach.
Results
Three overarching themes described participants' experiences seeking healthcare: overwhelming logistics, don't need healthcare, and orchestrating a web of care.
Conclusion
Recreational‐vehicle‐dwelling nomads in the United States face additional complexity when accessing healthcare related to seeking care in unfamiliar locations and policies that prevent the portability of healthcare across state lines.
Implications
More research is needed to evaluate solutions to improve healthcare access for recreational‐vehicle‐dwelling nomads. Nurses and policymakers should consider healthcare practices through the lens of nomads' lifestyle mobility. The impact of policy decisions on people who are geographically mobile should be considered, and barriers to healthcare portability should be addressed.
Impact
This was the first study focused on the healthcare experiences of recreational‐vehicle‐dwelling nomads in the United States.
Nomads face additional complexity and barriers to healthcare access. Some nomads developed strategies to overcome barriers, while others disengaged from healthcare.
The findings will impact researchers and nurses who study and care for nomads.
Reporting Method
The SRQR reporting guidelines were followed.
Patient or Public Contribution
Recreational‐vehicle‐dwelling nomads reviewed the recruitment flyer and interview guide and provided input on recruitment methods and sites.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK, VSZLJ
•40% of people using drugs avoided healthcare due to anticipated mistreatment.•Those seeking healthcare reported mistreatment and abuse by healthcare providers.•Social mistreatment by clinicians ...included disapproval, embarrassment and shaming.•Medical providers ignored health complaints and provided inappropriate treatment.•Healthcare providers abused patients verbally and physically to convey disapproval.
People who use drugs experience severe health inequities created by structural and social barriers related to healthcare access. This includes stigma.
To characterize the experience of healthcare access among people who use drugs in Maricopa County, Arizona USA.
A 20-item guided survey with quantitative and qualitative items was fielded between October 23-November 5, 2019 among people who use drugs in community locations (public spaces, trap houses, drug copping areas). Surveys were administered face-to-face by community researchers with lived experiences. Survey recruitment included convenience sampling and social referral among respondents. Quantitative items were described and qualitative data were independently coded using an a priori coding scheme including reasons for healthcare seeking and healthcare-related stigma (anticipated, experienced, enacted).
Over one-third (39.5%) of the185 person sample did not seek medical care in the past year. Of this group, 34.2% reported that they did not seek needed healthcare because they were afraid of being treated badly by medical providers for using drugs. The three major experiences reported by those seeking healthcare in the past year included 1) medical mistreatment (not addressing the primary medical complaint, providing wrong or inadequate treatment), 2) social mistreatment (disapproval, embarrassment, shaming) and 3) abusive behavior (verbal and physical) by healthcare providers.
Efforts should create healthcare social and practice environments that assure appropriate and competent medical care and prohibit healthcare provider mistreatment of people who use drugs. Structural incentives such as healthcare finance, hospital accreditation and medical complaint registration should be considered.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
PDF
