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The Journal of Nutrition Jun 2024The purpose of this scoping review was to determine the extent to which accessibility and acceptability of federal food assistance programs in the United States have... (Review)
Review
The purpose of this scoping review was to determine the extent to which accessibility and acceptability of federal food assistance programs in the United States have been evaluated among indigenous peoples and to summarize what is currently known. Twelve publications were found that examine aspects of accessibility or acceptability by indigenous peoples of 1 or more federal food assistance programs, including the supplemental nutrition assistance program (SNAP) and/or the Food Distribution Program on Indian Reservations (n = 8), the Special Supplemental Nutrition Program for Women, infants, and children (WIC) (n = 3), and the national school lunch program (n = 1). No publications were found to include the commodity supplemental food program or the child and adult care food program. Publications ranged in time from 1990-2023, and all reported on findings from rural populations, whereas 3 also included urban settings. Program accessibility varied by program type and geographic location. Road conditions, transportation access, telephone and internet connectivity, and an overall number of food stores were identified as key access barriers to SNAP and WIC benefit redemption in rural areas. Program acceptability was attributed to factors such as being tribally administered, providing culturally sensitive services, and offering foods of cultural significance. For these reasons, Food Distribution Program on Indian Reservations and WIC were more frequently described as acceptable compared to SNAP and national school lunch programs. However, SNAP was occasionally described as more acceptable than other assistance programs because it allows participants autonomy to decide which foods to purchase and when. Overall, little attention has been paid to the accessibility and acceptability of federal food assistance programs among indigenous peoples in the United States. More research is needed to understand and improve the participation experiences and health trajectories of these priority populations.
Topics: Food Assistance; Humans; United States; Indigenous Peoples; Food Supply; Indians, North American
PubMed: 38614239
DOI: 10.1016/j.tjnut.2024.04.017 -
Pediatrics Dec 2023Children and Youth with Special Health Care Needs have high healthcare utilization, fragmented care, and unmet health needs. Accountable Care Organizations (ACOs)...
BACKGROUND AND OBJECTIVES
Children and Youth with Special Health Care Needs have high healthcare utilization, fragmented care, and unmet health needs. Accountable Care Organizations (ACOs) increasingly use pediatric care management to improve quality and reduce unnecessary utilization. We evaluated effects of pediatric care management on total medical expense (TME) and utilization; perceived quality of care coordination, unmet needs, and patient and family experience; and differential impact by payor, risk score, care manager discipline, and behavioral health diagnosis.
METHODS
Mixed-methods analysis including claims using quasi-stepped-wedge design pre and postenrollment to estimate difference-in-differences, participant survey, and semistructured interviews. Participants included 1321 patients with medical, behavioral, or social needs, high utilization, in Medicaid or commercial ACOs, and enrolled in multidisciplinary, primary care-embedded care management.
RESULTS
TME significantly declined 1 to 6 months postenrollment and continued through 19 to 24 months (-$645.48 per member per month, P < .001). Emergency department and inpatient utilization significantly decreased 7 to 12 months post-enrollment and persisted through 19 to 24 months (-29% emergency department, P = .012; -82% inpatient, P < .001). Of respondents, 87.2% of survey respondents were somewhat or very satisfied with care coordination, 56.1% received education coordination when needed, and 81.5% had no unmet health needs. Emergency department or inpatient utilization decreases were consistent across payors and care manager disciplines, occurred sooner with behavioral health diagnoses, and were significant among children with above-median risk scores. Satisfaction and experience were equivalent across groups, with more unmet needs and frustration with above-median risk scores.
CONCLUSIONS
Pediatric care management in multipayor ACOs may effectively reduce TME and utilization and clinically provide high-quality care coordination, including education and family stress, with high participant satisfaction.
Topics: Adolescent; United States; Humans; Child; Medicaid; Quality of Health Care; Accountable Care Organizations; Patient Acceptance of Health Care
PubMed: 38013488
DOI: 10.1542/peds.2022-058268 -
Annual Review of Public Health May 2024Food insecurity affects an estimated 691-783 million people globally and is disproportionately high in Africa and Asia. It arises from poverty, armed conflict, and... (Review)
Review
Food insecurity affects an estimated 691-783 million people globally and is disproportionately high in Africa and Asia. It arises from poverty, armed conflict, and climate change, among other demographic and globalization forces. This review summarizes evidence for policies and practices across five elements of the agrifood system framework and identifies gaps that inform an agenda for future research. Under availability imbalanced agriculture policies protect primarily staple food producers, and there is limited evidence on food security impacts for smallholder and women food producers. Evidence supports the use of cash transfers and food aid for affordability and school feeding for multiple benefits. Food-based dietary guidelines can improve the nutritional quality of dietary patterns, yet they may not reflect the latest evidence or food supplies. Evidence from the newer food environment elements, promotion and sustainability, while relatively minimal, provides insight into achieving long-term impacts. To eliminate hunger, our global community should embrace integrated approaches and bring evidence-based policies and practices to scale.
Topics: Humans; Food Insecurity; Global Health; Food Supply; Nutrition Policy; Agriculture; Food Assistance
PubMed: 38166503
DOI: 10.1146/annurev-publhealth-060922-041451 -
Journal of the American Society of... Aug 2023
Topics: United States; Nephrology; Consensus; Health Care Reform; Medicare
PubMed: 37526982
DOI: 10.1681/ASN.0000000000000179 -
The Proceedings of the Nutrition Society Sep 2023The present paper reviews the growing body of literature on food insecurity and food bank use in the UK. It provides an overview of food insecurity in this context,... (Review)
Review
The present paper reviews the growing body of literature on food insecurity and food bank use in the UK. It provides an overview of food insecurity in this context, followed by a description of the emergence of food banks, highlighting how any role that food banks play in the food insecure population is limited. Data on food insecurity and food bank use suggest many people experiencing food insecurity do not receive help from food banks. To better understand the factors influencing the relationship between food insecurity and food bank use, a conceptual framework is outlined, suggesting the relationship is far from straightforward and contingent on many factors. The nature and availability of food banks and other local support services and individual-level factors influence the likelihood of food banks being used in the context of food insecurity. Then, the extent to which food banks can impact food insecurity is also dependent on the quantity and quality of food distributed, as well as other support services offered from food banks. Closing reflections highlight rising living costs and food banks reporting that they do not have capacity to cope with increasing demand, underscoring the need for policy interventions. Reliance on food banks to respond to food insecurity may ultimately impede formulation of effective policy interventions to reduce food insecurity, giving the illusion of widespread available support, whilst food insecurity persists among those receiving help from food banks and those who experience food insecurity but do not use food banks.
Topics: Humans; Food Supply; Food Assistance; Food Insecurity; Food; United Kingdom
PubMed: 36999354
DOI: 10.1017/S0029665123002720 -
JAMA Aug 2023
Topics: Medicaid; Medicare Part C; Psychiatry; United States; Insurance Benefits
PubMed: 37467005
DOI: 10.1001/jama.2023.12551 -
JAMA Network Open Nov 2023
Topics: Medicaid; United States; Hospital Costs
PubMed: 38015509
DOI: 10.1001/jamanetworkopen.2023.44841 -
International Journal of Environmental... Aug 2023With the COVID-19 pandemic, the notion of health system (HS) performance has been discussed, and the notion of resilience has become increasingly important. Lacking a... (Review)
Review
With the COVID-19 pandemic, the notion of health system (HS) performance has been discussed, and the notion of resilience has become increasingly important. Lacking a recognised framework that measures the performance of HSs throughout a crisis, i.e., one that explicitly includes time as a key aspect, we examined the literature about conceptual frameworks for measuring the performance and the resilience of HSs. This review highlighted a significant diversity among 18 distinct HS performance frameworks and 13 distinct HS resilience frameworks. On this basis, we developed a model that integrates the WHO's widely recognised six building block framework in a novel approach derived from the European Observatory on HSs and Policies. The resulting framework adapts the building blocks to the different stages of a crisis, thereby allowing for a comprehensive assessment of an entire health system's performance throughout the crisis's duration, while also considering the key aspect of resilience. For a more pragmatic use of this framework in the future, indicators will be developed as a next step.
Topics: Humans; COVID-19; Pandemics; Government Programs; Medical Assistance; Policy
PubMed: 37681806
DOI: 10.3390/ijerph20176666 -
Recenti Progressi in Medicina Nov 2023The health systems of developed countries are now made by specialists and specialties and the resulting fragmentation of competences makes it increasingly difficult to...
The health systems of developed countries are now made by specialists and specialties and the resulting fragmentation of competences makes it increasingly difficult to consider the patient/person as a whole. An orchestra director is needed, a generalist, however generalists are a few and are generally confined to primary care. Perhaps hospital generalists should be introduced and a new training model for the generalist should be devised.
Topics: Humans; Hospitals; Medical Assistance; Medicine
PubMed: 37902538
DOI: 10.1701/4133.41267 -
American Journal of Public Health Dec 2023
Topics: United States; Humans; Food Assistance; United States Department of Agriculture; Food Supply; Policy
PubMed: 38118091
DOI: 10.2105/AJPH.2023.307480