scholarly journals A Conceptual Framework for Understanding How and Why People Take Antibiotics Without a Prescription

2020 ◽  
Vol 41 (S1) ◽  
pp. s93-s93
Author(s):  
Larissa Grigoryan ◽  
Osvaldo Alquicira ◽  
Susan Nash ◽  
Melanie Goebel ◽  
Barbara Trautner
Keyword(s):  
United States ◽  
At Risk ◽  
Health Disparities ◽  
Health Literacy ◽  
Conceptual Framework ◽  
Healthcare System ◽  
Antibiotic Use ◽  
The United States ◽  
Clinical Encounter ◽  
Inadequate Health Literacy

Background: The reported prevalence of nonprescription antibiotic use in the United States varies from 5% among socioeconomically and ethnically diverse primary care patients to 66% among Latino migrant workers. Reports indicate that people obtain and take antibiotics from stores or flea markets in the United States, friends or relatives, and leftover antibiotics from previous prescriptions. This unsafe practice may lead to unnecessary and inappropriate antibiotic use and increases the risk of antibiotic resistance. As groundwork to develop an intervention to decrease nonprescription antibiotic use, we mapped reported drivers of nonprescription use to the Kilbourne conceptual framework for advancing health disparities research. Methods: The Kilbourne framework consists of 3 phases: (1) detection of health disparities and identification of vulnerable populations, (2) understanding why disparities exist, and (3) reducing or eliminating disparities through interventions. We focused on the first 2 phases and mapped the identified drivers of nonprescription antibiotic use onto the key domains of the Kilbourne conceptual framework: patient, healthcare system, and clinical encounter factors. We also conducted brief field research to explore anecdotal reports regarding availability of nonprescription antibiotics in our community. Results: We found 8 studies addressing factors related to nonprescription antibiotic use in the United States. These studies were primarily qualitative and included Spanish-speaking Hispanic and Latino immigrants. Figure 1 shows the proposed factors that may directly or indirectly predict nonprescription antibiotic use. Key potential factors are individual factors, psychosocial factors, resources, healthcare system factors, and clinical-encounter factors. For example, patients with inadequate health literacy may have poor access to care because of difficulty finding providers and choosing or navigating insurance plans; thus, they may be at risk for nonprescription use. At the same time, patients with inadequate health literacy may be at risk for using nonprescription antibiotics for a viral infection because of difficulty understanding medication labels or package inserts. The relevance of resources (availability) to nonprescription antibiotic use was supported by our research team’s purchase of amoxicillin, tetracycline, and metronidazole without prescriptions from a flea market in Houston, Texas. Conclusions: The Kilbourne conceptual framework provides a strong, comprehensive basis for research and intervention in the challenging problem of nonprescription antibiotic use. Ongoing research will test the proposed relationships between patient, healthcare system, and clinical-encounter factors and nonprescription antibiotic use outcomes. We are conducting a survey among both indigent and insured patient populations to identify the relative importance of these factors and to validate our proposed conceptual framework of nonprescription antibiotic use.Funding: This project was supported by grant number R01HS026901 from the Agency.Disclosures: None

scholarly journals Health literacy: What we know and don’t know - A literature perspective

2020 ◽  
Vol 9 (6) ◽  
pp. 12
Author(s):  
Kim D. ◽  
O’Connor S.J. ◽  
Williams J.H. ◽  
Opoku-Agyeman W. ◽  
Chu D.I. ◽  
...  
Keyword(s):  
United States ◽  
Health Literacy ◽  
Healthcare System ◽  
General Health ◽  
The United States ◽  
Knowledge And Skills ◽  
The Past ◽  
The Us ◽  
And Performance ◽  
Inadequate Health Literacy

Health literacy has become an important topic to discuss in the US healthcare system. Almost nine out of ten adults in the United States lack the knowledge and skills required to manage their health and prevent disease. While studies have shown the importance of health literacy, not may have explored its’ history and conceptual roots. Hence, the purpose of this study is to address the gap in the literature by reviewing studies related to the past, present, and the effect of health literacy. The results have shown that inadequate health literacy does affect patients’ general health and performance of the US healthcare system.

scholarly journals Addressing Health Disparities in the Undergraduate Curriculum: An Approach to Develop a Knowledgeable Biomedical Workforce

2014 ◽  
Vol 13 (4) ◽  
pp. 636-640 ◽  
Author(s):  
Rocio Benabentos ◽  
Payal Ray ◽  
Deepak Kumar
Keyword(s):  
United States ◽  
Health Disparities ◽  
Health Outcomes ◽  
Healthcare System ◽  
Undergraduate Students ◽  
Life Sciences ◽  
Undergraduate Curriculum ◽  
The United States ◽  
Undergraduate Institutions ◽  
Minority Serving Institutions

Disparities in health and healthcare are a major concern in the United States and worldwide. Approaches to alleviate these disparities must be multifaceted and should include initiatives that touch upon the diverse areas that influence the healthcare system. Developing a strong biomedical workforce with an awareness of the issues concerning health disparities is crucial for addressing this issue. Establishing undergraduate health disparities courses that are accessible to undergraduate students in the life sciences is necessary to increase students’ understanding and awareness of these issues and motivate them to address these disparities during their careers. The majority of universities do not include courses related to health disparities in their curricula, and only a few universities manage them from their life sciences departments. The figures are especially low for minority-serving institutions, which serve students from communities disproportionally affected by health disparities. Universities should consider several possible approaches to infuse their undergraduate curricula with health disparities courses or activities. Eliminating health disparities will require efforts from diverse stakeholders. Undergraduate institutions can play an important role in developing an aware biomedical workforce and helping to close the gap in health outcomes.

From Start-Up to Scale-Up

2018 ◽  
Author(s):  
Gilles Duruflé ◽  
Thomas Hellmann ◽  
Karen Wilson
Keyword(s):  
United States ◽  
Conceptual Framework ◽  
Public Policies ◽  
Scale Up ◽  
The United States ◽  
Smart Money ◽  
Start Up ◽  
The Us ◽  
The Creation

This chapter examines the challenge for entrepreneurial companies of going beyond the start-up phase and growing into large successful companies. We examine the long-term financing of these so-called scale-up companies, focusing on the United States, Europe, and Canada. The chapter first provides a conceptual framework for understanding the challenges of financing scale-ups. It emphasizes the need for investors with deep pockets, for smart money, for investor networks, and for patient money. It then shows some data about the various aspects of financing scale-ups in the United States, Europe, and Canada, showing how Europe and Canada are lagging behind the US relatively more at the scale-up than the start-up stage. Finally, the chapter raises the question of long-term public policies for supporting the creation of a better scale-up environment.

scholarly journals A Confluence of Policy Inequality: Health Disparities in Old Age Among American Indian and Alaska Native Populations

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 37-37
Author(s):  
Sadie Giles
Keyword(s):  
United States ◽  
Health Disparities ◽  
Life Course ◽  
American Indian ◽  
Old Age ◽  
Alaska Native ◽  
Political History ◽  
The United States ◽  
The Political ◽  
The Life Course

Abstract Racial health disparities in old age are well established, and new conceptualizations and methodologies continue to advance our understanding of health inequality across the life course. One group that is overlooked in many of these analyses, however, is the aging American Indian/Native Alaskan (AI/NA) population. While scholars have attended to the unique health inequities faced by the AI/NA population as a whole due to its discordant political history with the US government, little attention has been paid to unique patterns of disparity that might exist in old age. I propose to draw critical gerontology into the conversation in order to establish a framework through which we can uncover barriers to health, both from the political context of the AI/NA people as well as the political history of old age policy in the United States. Health disparities in old age are often described through a cumulative (dis)advantage framework that offers the benefit of appreciating that different groups enter old age with different resources and health statuses as a result of cumulative inequalities across the life course. Adding a framework of age relations, appreciating age as a system of inequality where people also gain or lose access to resources and status upon entering old age offers a path for understanding the intersection of race and old age. This paper will show how policy history for this group in particular as well as old age policy in the United States all create a unique and unequal circumstance for the aging AI/NA population.

scholarly journals Understanding and Promoting Racial Diversity in Healthcare Settings to Address Disparities in Pandemic Crisis Management

2021 ◽  
Vol 12 ◽  
pp. 215013272110183
Author(s):  
Azza Sarfraz ◽  
Zouina Sarfraz ◽  
Alanna Barrios ◽  
Kuchalambal Agadi ◽  
Sindhu Thevuthasan ◽  
...  
Keyword(s):  
United States ◽  
Health Disparities ◽  
Racial Discrimination ◽  
Clinical Training ◽  
Minority Groups ◽  
Mental Health Problems ◽  
Minority Group ◽  
Healthcare Delivery ◽  
The United States ◽  
Majority Group

Background: Health disparities have become apparent since the beginning of the COVID-19 pandemic. When observing racial discrimination in healthcare, self-reported incidences, and perceptions among minority groups in the United States suggest that, the most socioeconomically underrepresented groups will suffer disproportionately in COVID-19 due to synergistic mechanisms. This study reports racially-stratified data regarding the experiences and impacts of different groups availing the healthcare system to identify disparities in outcomes of minority and majority groups in the United States. Methods: Studies were identified utilizing PubMed, Embase, CINAHL Plus, and PsycINFO search engines without date and language restrictions. The following keywords were used: Healthcare, raci*, ethnic*, discriminant, hosti*, harass*, insur*, education, income, psychiat*, COVID-19, incidence, mortality, mechanical ventilation. Statistical analysis was conducted in Review Manager (RevMan V.5.4). Unadjusted Odds Ratios, P-values, and 95% confidence intervals were presented. Results: Discrimination in the United States is evident among racial groups regarding medical care portraying mental risk behaviors as having serious outcomes in the health of minority groups. The perceived health inequity had a low association to the majority group as compared to the minority group (OR = 0.41; 95% CI = 0.22 to 0.78; P = .007), and the association of mental health problems to the Caucasian-American majority group was low (OR = 0.51; 95% CI = 0.45 to 0.58; P < .001). Conclusion: As the pandemic continues into its next stage, efforts should be taken to address the gaps in clinical training and education, and medical practice to avoid the recurring patterns of racial health disparities that become especially prominent in community health emergencies. A standardized tool to assess racial discrimination and inequity will potentially improve pandemic healthcare delivery.

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