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Journal of Medical Ethics Mar 2022
Topics: Codes of Ethics; Ethics; Ethics, Medical; Humans; Trust
PubMed: 35232769
DOI: 10.1136/medethics-2022-108199 -
Delaware Medical Journal Mar 2016
Topics: Delaware; Humans; Medical Indigency; Medically Uninsured; Safety-net Providers; Uncompensated Care
PubMed: 27215043
DOI: No ID Found -
Community Dentistry and Oral... Oct 2017This systematic review examines the evidence on the effectiveness of programmes that aim to improve the oral health of Indigenous populations worldwide, as well as... (Review)
Review
OBJECTIVES
This systematic review examines the evidence on the effectiveness of programmes that aim to improve the oral health of Indigenous populations worldwide, as well as presents a qualitative analysis to explore the design and implementation of these initiatives.
METHODS
MEDLINE and EMBASE were searched. Studies were included if they described an oral health programme for an Indigenous population in any country worldwide. A thematic synthesis of the qualitative findings was undertaken for each study's results and discussion sections.
RESULTS
Nineteen studies were included. Sixteen studies reported positive results, twelve of which reported statistically significant findings. Three themes regarding design and implementation emerged from the qualitative analysis: (i) elements of successful programmes, (ii) challenges and barriers to successful interventions and (iii) suggestions for improvements.
CONCLUSIONS
Successful programmes considered cultural appropriateness in their design-including extensive community engagement before, during and after implementation to enhance ownership of, and thus participation in the programme. Collaborative approaches were seen as an advantage, not only with Indigenous communities, but also with local health providers and organizations, with particular emphasis on incorporation into existing services. Challenges included low community participation, unstable funding and staffing issues. In addition, future programmes should also incorporate advocacy and community development, focus on changes to public policy, utilize evidence-based interventions that include traditional models of health, attempt to secure a stable funding base, target strategies to ensure staff retention and develop interventions that target the multilevel causes of general and oral health. This review provides an evidence base that can aid in the successful design, implementation and sustainability of oral health programmes for Indigenous people in the future.
Topics: Cultural Competency; Dental Care; Global Health; Health Promotion; Health Services Accessibility; Health Services Needs and Demand; Humans; Medical Indigency; Oral Health; Qualitative Research
PubMed: 28425612
DOI: 10.1111/cdoe.12302 -
Circulation May 2015
Topics: Diagnosis-Related Groups; Fee-for-Service Plans; Hospital Mortality; Humans; Length of Stay; Medical Indigency; Medicare; Motivation; Outcome Assessment, Health Care; Patient Discharge; Patient Protection and Affordable Care Act; Patient Readmission; Quality Improvement; Social Security; United States
PubMed: 25986448
DOI: 10.1161/CIRCULATIONAHA.114.010270 -
Otolaryngology--head and Neck Surgery :... Aug 2016Many young people look forward to volunteering abroad and overlook the ample volunteer opportunities at home. There are several advantages to volunteering at home: you...
Many young people look forward to volunteering abroad and overlook the ample volunteer opportunities at home. There are several advantages to volunteering at home: you help people in your own community; you can make a long-term commitment; and you have continuity of care for your patients. There are >1200 free clinics in the United States whose main goal is to provide care to the indigent population. These free clinics are always looking for volunteers with specialized medical training. This article reviews the medically related and unrelated volunteer opportunities available in the United States. Volunteering at home is a worthwhile experience, and I encourage the otolaryngology community to explore these opportunities.
Topics: Health Services Accessibility; Health Services Needs and Demand; Humans; Medical Indigency; Otolaryngology; United States; Volunteers
PubMed: 27221569
DOI: 10.1177/0194599816649361 -
International Journal of Psychiatry in... May 2017This article describes a novel inter-professional curriculum designed to address the needs of homeless patients in a Midwestern region of the United States which has...
This article describes a novel inter-professional curriculum designed to address the needs of homeless patients in a Midwestern region of the United States which has high rates of poverty. The curriculum is intended for healthcare trainees coming from undergraduate pre-medical programs, nursing, pharmacy, social work, clinical psychology, medical school and post-graduate medical training in family medicine, medicine-pediatrics, and psychiatry. The clinical component is specifically designed to reach destitute patients and the curriculum is structured to reverse commonly held myths about homelessness among the trainees, thereby improving their Homelessness Information Quotient, the ability to more fully understand homelessness. Participants across all disciplines and specialties have shown greater empathy and helper behavior as determined by qualitative measures. Learners have also developed a greater understanding of health-care systems allowing them to more consistently address social determinants of health identified by the authors as their Disparity Information Quotient. This article outlines the process of initiating a homeless service program, a curriculum for addressing common myths about homelessness and the effective use of narrative methods, relational connections, and reflective practice to enable trainees to process their experience and decrease burnout by focusing on the value of altruism and finding meaning in their work.
Topics: Altruism; Curriculum; Delivery of Health Care; Education, Medical, Continuing; Education, Medical, Graduate; Emotional Intelligence; Ill-Housed Persons; Humans; Medical Indigency; United States
PubMed: 29065810
DOI: 10.1177/0091217417730288 -
PloS One 2020In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the...
In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the differences in the level of income and expenditure between chronically-ill people and non-chronic population. Data were gathered from a national level survey conducted namely, the Household Income and Expenditure Survey (HIES) by the Department of Census and Statistics (DCS) of Sri Lanka. These data were statistically analysed with one-way and two-way ANOVA, to identify the factors that cause the differences among different groups. For the first time, this study makes an attempt using survey data, to examine the differences in the level of income and expenditure among chronically-ill people in Sri Lanka. Accordingly, the study discovered that married females who do not engage in any type of economic activity (being unemployed due to the disability associated with the respective chronic illness), in the age category of 40-65, having an educational level of tertiary education or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. If workforce population is compelled to lose jobs, it can lead to income insecurity and impair their quality of lives. Under above findings, it is reasonable to assume that most health care expenses are out of pocket. Furthermore, the study infers that chronic illnesses have a statistically proven significant differences towards the income and expenditure level. This has caused due to the interaction of demographic and socio-economic characteristics associated with chronic illnesses. Considering private-public sector partnerships that enable affordable access to health care services for all as well as implementation of commercial insurance and community-based mutual services that help ease burden to the public, are vital when formulating effective policies and strategies related to the healthcare sector. Sri Lanka is making strong efforts to support its healthcare sector and public, which was affected by the coronavirus (COVID-19) in early 2020. Therefore, findings of this paper will be useful to gain insights on the differences of chronic illnesses towards the income and expenditure of chronically-ill patients in Sri Lanka.
Topics: Adolescent; Adult; Aged; Analysis of Variance; Betacoronavirus; COVID-19; Child; Child, Preschool; Chronic Disease; Comorbidity; Coronavirus Infections; Developing Countries; Disabled Persons; Ethnicity; Family Characteristics; Female; Food; Health Expenditures; Humans; Income; Infant; Infant, Newborn; Male; Medical Indigency; Middle Aged; Pandemics; Pneumonia, Viral; Poverty; SARS-CoV-2; Socioeconomic Factors; Sri Lanka; Surveys and Questionnaires; Young Adult
PubMed: 33113548
DOI: 10.1371/journal.pone.0239576 -
Journal of Medical Ethics May 2023
Topics: Humans; Pandemics; COVID-19; SARS-CoV-2; Policy
PubMed: 35440513
DOI: 10.1136/medethics-2022-108295 -
JAMA Internal Medicine Mar 2015
Topics: Earache; Emigrants and Immigrants; Female; Humans; Medical Indigency; Patient Protection and Affordable Care Act; Philadelphia; United States
PubMed: 25559302
DOI: 10.1001/jamainternmed.2014.7124 -
Digestive Diseases and Sciences Apr 2015Although effective HCV treatment is available, it can be difficult to access for uninsured, urban patients. Our aim was to assess the utility of evaluation and outcomes...
OBJECTIVES
Although effective HCV treatment is available, it can be difficult to access for uninsured, urban patients. Our aim was to assess the utility of evaluation and outcomes in the uninsured with HCV when access to health care and treatment with triple therapy is provided.
METHODS
We performed a retrospective review of consecutive patients referred for HCV from 2011 to June 2013 to an indigent HCV clinic. The primary outcomes were assessment of disease severity by noninvasive means and initiation of therapy.
RESULTS
We identified 350 patients: mean age 50.6, 84 % with no insurance, 62 % men, 58 % black, 91 % HCV treatment naïve. Of these, 148 underwent liver biopsy and 68 % had F0-F1 and 10 % had F3-F4 fibrosis. FIB-4 and APRI were highly correlated (r = 0.9; p < .0001) and correctly classified patients by fibrosis strata (F0-F1, F2, and F3-F4; p = .0004). When combined, a FIB-4 ≤1.5 and APRI ≤0.5 correctly classified the absence of advanced disease in 97 % (p < .0001). Of those evaluated, 39 (11 %) went on to HCV treatment. Of those not in a clinical trial, 51 % completed treatment with SVR in 61 % with genotype 1 and 75 % in genotypenon-1. Of those not treated (n = 309), the most common reasons were mild disease (16 %), lost to follow-up (23 %), ongoing alcohol or substance abuse (24 %), and uncontrolled depression (10 %).
CONCLUSION
Noninvasive assessment can accurately exclude advanced fibrosis. Despite access to care, the utility of evaluating to initiate HCV treatment is low suggesting that eliminating the barrier to health care may not increase HCV treatment.
Topics: Adult; Antiviral Agents; Female; Hepatitis C, Chronic; Humans; Male; Medical Indigency; Medically Uninsured; Medication Adherence; Middle Aged; Retrospective Studies
PubMed: 25371153
DOI: 10.1007/s10620-014-3416-8