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Tropical Medicine & International... Jul 2003
Topics: Developing Countries; Health Status; Humans; Insurance, Health; Medical Indigency; Poverty
PubMed: 12828538
DOI: 10.1046/j.1365-3156.2003.01081.x -
Ochsner Journal 2014Pain can significantly influence an individual's health status and can have serious negative consequences: poor nutrition, decreased appetite, abnormal sleep patterns,... (Review)
Review
BACKGROUND
Pain can significantly influence an individual's health status and can have serious negative consequences: poor nutrition, decreased appetite, abnormal sleep patterns, fatigue, and impairment of daily living activities. Pain can cause psychological impairment and decrease healing and recovery from injuries and illness. A hallmark of many chronic conditions, pain affects more patients' lives than diabetes mellitus, heart disease, and cancer combined. However, many chronic sufferers do not have access to effective pain management for a variety of reasons, including limited access, restrictions, and personal and cultural biases.
METHODS
This review summarizes issues of access, distribution, and cultural bias with regard to opioid agents and seeks to clarify the challenges related to opioid delivery. The considerable negative physical and mental consequences of chronic pain are discussed for the general and palliative care population.
RESULTS
Opioids are an effective treatment for various intractable painful conditions, but problems in global opioid access for safe and rational use in pain management contribute to unnecessary suffering. These problems persist despite increased understanding in recent years of the pathophysiology of pain.
CONCLUSIONS
Comprehensive guidelines for goal-directed and patient-friendly chronic opiate therapy will potentially enhance the outlook for future chronic pain management. The improvement of pain education in undergraduate and postgraduate training will benefit patients and clinicians. The promise of new medications, along with the utilization of multimodal approaches, has the potential to provide effective pain relief to future generations of sufferers.
PubMed: 24940131
DOI: No ID Found -
Indian Journal of Medical Ethics 2007
Topics: Developing Countries; Drug Costs; Health Services Needs and Demand; Humans; Infant; Measles; Measles Vaccine; Medical Indigency
PubMed: 18630363
DOI: 10.20529/IJME.2007.018 -
International Journal For Equity in... Nov 2013Lack of access to health care is a persistent condition for most African indigents, to which the common technical approach of targeting initiatives is an insufficient... (Review)
Review
BACKGROUND
Lack of access to health care is a persistent condition for most African indigents, to which the common technical approach of targeting initiatives is an insufficient antidote. To overcome the standstill, an integrated technical and political approach is needed. Such policy shift is dependent on political support, and on alignment of international and national actors. We explore if the analytical framework of social exclusion can contribute to the latter.
METHODS
We produce a critical and evaluative account of the literature on three themes: social exclusion, development policy, and indigence in Africa-and their interface. First, we trace the concept of social exclusion as it evolved over time and space in policy circles. We then discuss the relevance of a social exclusion perspective in developing countries. Finally, we apply this perspective to Africa, its indigents, and their lack of access to health care.
RESULTS
The concept of social exclusion as an underlying process of structural inequalities has needed two decades to find acceptance in international policy circles. Initial scepticism about the relevance of the concept in developing countries is now giving way to recognition of its universality. For a variety of reasons however, the uptake of a social exclusion perspective in Africa has been limited. Nevertheless, social exclusion as a driver of poverty and inequity in Africa is evident, and manifestly so in the case of the African indigents.
CONCLUSION
The concept of social exclusion provides a useful framework for improved understanding of origins and persistence of the access problem that African indigents face, and for generating political space for an integrated approach.
Topics: Africa; Health Policy; Health Services Accessibility; Humans; Medical Indigency; Social Isolation
PubMed: 24238000
DOI: 10.1186/1475-9276-12-91 -
British Medical Journal Nov 1972
Topics: Adolescent; Africa, Southern; Eyeglasses; Female; Humans; Medical Indigency; Medical Missions; Medicine; Mitral Valve Stenosis; Physical Therapy Modalities; South Africa; Specialization; Surgery, Plastic; Surgical Procedures, Operative
PubMed: 5083893
DOI: 10.1136/bmj.4.5835.288 -
PLoS Medicine Oct 2007The defining physical and legal characteristics of slums profoundly affect the health of these communities and may also serve as potential targets for immediate... (Review)
Review
The defining physical and legal characteristics of slums profoundly affect the health of these communities and may also serve as potential targets for immediate intervention.
Topics: Adult; Child; Female; Global Health; Goals; Health Priorities; Health Promotion; Health Services Needs and Demand; Health Status; Healthcare Disparities; Humans; Male; Medical Indigency; Population Density; Poverty; Poverty Areas; Social Problems; United Nations; Urban Health
PubMed: 17958462
DOI: 10.1371/journal.pmed.0040295 -
Journal of General Internal Medicine Jun 2008New policies regulating physician/pharmaceutical company relationships propose to eliminate access to free prescription drug samples. Little is known about the...
BACKGROUND
New policies regulating physician/pharmaceutical company relationships propose to eliminate access to free prescription drug samples. Little is known about the prevalence of patient activity in requesting or receiving free prescription drug samples, or the characteristics of patients who access drug samples.
OBJECTIVE
To determine the prevalence of free sample access and to examine demographic, clinical, and insurance characteristics of Medicare beneficiaries who access free samples.
DESIGN
Cross-sectional study.
PARTICIPANTS
A national sample of 13,847 Medicare beneficiaries participating in the fall 2004 Medicare Current Beneficiary Survey.
MEASUREMENTS AND MAIN RESULTS
Prevalence of free prescription drug sample access (self-reported request for or receipt of free drug samples) and the demographic, clinical, and insurance characteristics of Medicare beneficiaries who accessed drug samples. Overall, 48.3% (95% confidence of interval [CI]: 46.6%, 49.9%) of Medicare beneficiaries reported accessing free drug samples. Access was higher among beneficiaries reporting cost-related medication nonadherence compared to those without (77.7% (95% CI: 74.5%, 80.6%) vs 43.0% (95% CI: 41.4%, 44.7%)). Multivariable analysis revealed cost-related medication nonadherence (CRN) to have the strongest relationship with accessing drug samples (adjusted odds ratio [AOR] 4.43 [95% CI: 3.64, 5.39]). Compared to beneficiaries with generous drug benefits from Medicaid, beneficiaries who lacked prescription drug benefits were more likely to access drug samples (AOR 2.42 [95% CI: 2.06, 2.85]). Beneficiaries with drug coverage from employer-sponsored plans or partial coverage (Medicare HMO, self-purchased Medicare supplement, or state-sponsored low-income plans) were also more likely to access drug samples (AOR 2.02, 1.74, respectively). Having 2-3 or > or = 4 comorbidities (vs 0-1 comorbidities) also increased the likelihood of accessing drug samples (AOR 1.60 (95% CI: 1.44, 1.79) and 2.00 (95% CI: 1.74, 2.29).
CONCLUSIONS
Accessing free prescription drug samples is prevalent among many categories of beneficiaries, especially among individuals with cost-related medication nonadherence and poor health status. Policies restricting or prohibiting drug sample distribution may adversely impact access to medications among patients in high-risk groups.
Topics: Aged; Aged, 80 and over; Cross-Sectional Studies; Data Collection; Drug Costs; Drug Prescriptions; Female; Health Expenditures; Humans; Male; Marketing; Medical Indigency; Medicare; Middle Aged; Physician-Patient Relations; Practice Patterns, Physicians'; Treatment Refusal; United States
PubMed: 18365289
DOI: 10.1007/s11606-008-0568-2 -
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 -
BMJ (Clinical Research Ed.) May 1991
Topics: Health Policy; Health Services Accessibility; Humans; Medical Indigency; United Kingdom; United States
PubMed: 2043806
DOI: 10.1136/bmj.302.6786.1163 -
Journal of Cancer Survivorship :... Dec 2011This study was conducted to compare cost-related medication nonadherence among elderly Medicare enrollees with and without cancer and to describe the strategies cancer...
OBJECTIVES
This study was conducted to compare cost-related medication nonadherence among elderly Medicare enrollees with and without cancer and to describe the strategies cancer survivors used to offset the costs of medications.
METHODS
Using the 2005 Medicare Current Beneficiary Survey and Medicare claims, we compared self-reported cost-related medication nonadherence (CRN), spending less on basic needs to afford medicines, and cost reduction strategies among elderly beneficiaries with and without cancer. Descriptive statistics and logistic regression models were used to characterize and compare these populations.
RESULTS
In a nationally representative sample of 9,818 non-institutionalized elderly Medicare enrollees, 1,392 (14%) were classified as cancer survivors based on Medicare claims. Cancer survivors were older, more highly educated, more likely to be male and non-Hispanic, and more likely to have multiple comorbidities, poorer health status, and employer-paid medication coverage. While 10% of cancer survivors and 11% without cancer reported CRN, about 6% and 9% (p = 0.004) of those with and without cancer, respectively, reported spending less on basic needs to offset the costs of medications. Cancer survivors who reported CRN (n = 143) had lower income (62.2% versus 48.6%, p = 0.11) and were more likely to be African-American (13.0% versus 6.4%, p = 0.033) and have non-employer-based medication insurance (p = 0.002) compared to those who did not report CRN. In adjusted analyses, CRN among the two groups was similar, but with some subgroup differences noted by gender and cancer type. Use of cost reduction strategies was mostly similar among cancer survivors and those without cancer.
CONCLUSION
Cost-related medication nonadherence medication is common among elderly Medicare beneficiaries, but appears to be similar among those with and without cancer.
Topics: Black or African American; Aged; Aged, 80 and over; Drug Costs; Female; Humans; Longitudinal Studies; Male; Medical Indigency; Medicare; Medication Adherence; Neoplasms; Prognosis; Survival Rate; Survivors; United States
PubMed: 21800053
DOI: 10.1007/s11764-011-0188-4