Exploring Transportation Accessibility to Health Care among Vermont's Rural Seniors

2015 ◽  
Vol 2531 (1) ◽  
pp. 137-145 ◽  
Author(s):  
Geoffrey A. Battista ◽  
Brian H. Y. Lee ◽  
Jane Kolodinsky ◽  
Sarah N. Heiss
Keyword(s):  
Health Care ◽  
Rural Areas ◽  
Health Care Services ◽  
Social Connectedness ◽  
The United States ◽  
Transportation Systems ◽  
Local Health ◽  
Baby Boomer Generation ◽  
Care Services ◽  
Health Care Accessibility

The aging baby boomer generation will have a profound impact on the demand for health care services in the United States. This impact will be felt strongly in rural areas, where the population in general is older and the supplies of health care services and alternative transportation are limited. This study employed a mixed-method approach to assess health care accessibility among seniors in the state of Vermont. A geographic information system was used to project health care accessibility according to the spatial characteristics of the health care and transportation systems. Subsequently, the mechanisms that shaped accessibility were assessed through semistructured interviews with 20 seniors and caregivers. The study found that health care accessibility varied among seniors, given the local health care supply, transportation, and individual resources at their disposal. Health care accessibility also was shaped by less tangible factors, which included social connectedness and personal preferences for care and transportation. The results suggested that mixed methods provided a more nuanced and valid perspective on health care accessibility. This perspective can better inform policy makers as they strive to accommodate rural senior preferences to age in place in a healthy manner.

scholarly journals Using Prospective Methods to Identify Fieldwork Locations Favourable to Understanding Divergences in Health Care Accessibility

2021 ◽  
Vol 10 (8) ◽  
pp. 506
Author(s):  
Jan Ketil Rød ◽  
Arne H. Eide ◽  
Thomas Halvorsen ◽  
Alister Munthali
Keyword(s):  
Health Care ◽  
Low Income ◽  
Access To Health Care ◽  
Health Care Services ◽  
Good Health ◽  
Low Income Countries ◽  
Care Services ◽  
Health Care Accessibility ◽  
Barriers To Health ◽  
Walking Time

Central to this article is the issue of choosing sites for where a fieldwork could provide a better understanding of divergences in health care accessibility. Access to health care is critical to good health, but inhabitants may experience barriers to health care limiting their ability to obtain the care they need. Most inhabitants of low-income countries need to walk long distances along meandering paths to get to health care services. Individuals in Malawi responded to a survey with a battery of questions on perceived difficulties in accessing health care services. Using both vertical and horizontal impedance, we modelled walking time between household locations for the individuals in our sample and the health care centres they were using. The digital elevation model and Tobler’s hiking function were used to represent vertical impedance, while OpenStreetMap integrated with land cover map were used to represent horizontal impedance. Combining measures of walking time and perceived accessibility in Malawi, we used spatial statistics and found spatial clusters with substantial discrepancies in health care accessibility, which represented fieldwork locations favourable for providing a better understanding of barriers to health access.

scholarly journals Timing of Home Health Care Initiation and 30-Day Rehospitalizations among Medicare Beneficiaries with Diabetes by Race and Ethnicity

2021 ◽  
Vol 18 (11) ◽  
pp. 5623
Author(s):  
Jamie M. Smith ◽  
Haiqun Lin ◽  
Charlotte Thomas-Hawkins ◽  
Jennifer Tsui ◽  
Olga F. Jarrín
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Race And Ethnicity ◽  
Health Care Services ◽  
Propensity Scores ◽  
The United States ◽  
Home Health ◽  
Medicare Beneficiaries ◽  
Timely Initiation ◽  
Care Services

Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization admission during 2015. Of these patients, 26.6% were discharged to home health care. To evaluate the association between timing of home health care initiation and 30-day rehospitalizations, multivariate logistic regression models including patient demographics, clinical and geographic variables, and neighborhood socioeconomic variables were used. Inverse probability-weighted propensity scores were incorporated into the analysis to account for potential confounding between the timing of home health care initiation and the outcome in the cohort. Compared to the patients who received home health care within the recommended first two days, the patients who received delayed services (3–7 days after discharge) had higher odds of rehospitalization (OR, 1.28; 95% CI, 1.25–1.32). Among the patients who received late services (8–14 days after discharge), the odds of rehospitalization were four times greater than among the patients receiving services within two days (OR, 4.12; 95% CI, 3.97–4.28). Timely initiation of home health care following diabetes-related hospitalizations is one strategy to improve outcomes.

Revising the ERDs for the 21st Century

2021 ◽  
Vol 46 (8) ◽  
pp. 1-2
Author(s):  
John F. Brehany ◽  
Keyword(s):  
United States ◽  
Health Care ◽  
21St Century ◽  
Health Care Services ◽  
Care Delivery ◽  
The United States ◽  
Care Services ◽  
Moral Tradition ◽  
Modern Health Care ◽  
Catholic Health Care

Since their inception in 1948, The Ethical and Religious Directives for Catholic Health Care Services (ERDs) have guided Catholic health care ministries in the United States, aiding in the application of Catholic moral tradition to modern health care delivery. The ERDs have undergone two major revisions in that time, with about twenty years separating each revision. The first came in 1971 and the second came twenty-six years ago, in 1995. As such, a third major revision is due and will likely be undertaken soon.

scholarly journals A Socio-ecological Framing of the Philippine Mental Health Act of 2017

Spectrum ◽  
2018 ◽  
Author(s):  
Josiah Michael Villareal De Los Santos ◽  
Sonya Jakubec
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Rural Areas ◽  
Health Care Services ◽  
Population Level ◽  
Case Review ◽  
Care Services ◽  
Barriers To Implementation ◽  
Sphere Of Influence

Filipinos experience numerous barriers to mental health care in their country, such as stigmatization ofillness and behaviours, lack of mental health care services, and resource deficits. The Philippine MentalHealth Act of 2017 was formed to resolve these issues and is in its early stages of implementation.Legislation and policy interventions of this nature are but one level of many interventions that can addresshealth care at a population level. The influence of this legislation for different levels of society is analyzed inorder to understand the different barriers and alternatives to its implementation. Solutions suggested in thelegislation, such as addressing lack of accessibility in rural areas, creating liaisons between different levelsof mental health care, and educating the population regarding mental health, are explored for their effects ondifferent spheres, or levels, of influence. The comprehensiveness of the legislation to address the needs ofmental health service users are highlighted, as are barriers to implementation that inhibit the realization ofpractical strategies. This policy case review and analysis informs program development by highlighting thestrengths and weaknesses aligned to the legislative articles’ target sphere of influence and the population.

scholarly journals Rural Michigan Farmers’ Health Concerns and Experiences: A Focus Group Study

2021 ◽  
Vol 12 ◽  
pp. 215013272110535
Author(s):  
Nathan Wright ◽  
Marylee Scherdt ◽  
Michelle L. Aebersold ◽  
Marjorie C. McCullagh ◽  
Barbara R. Medvec ◽  
...  
Keyword(s):  
Health Care ◽  
Focus Groups ◽  
Health Care System ◽  
Health Care Services ◽  
Well Being ◽  
The United States ◽  
Full Time ◽  
Rural Residents ◽  
Care Services ◽  
Care System

Objectives: Rural residents comprise approximately 15% of the United States population. They face challenges in accessing and using a health care system that is not structured to meet their unique needs. It is important to understand rural residents’ perceptions of health and experiences interacting with the health care system to identify gaps in care. Methods: Our team conducted focus groups with members of the Michigan Farm Bureau during their 2019 Annual Meeting. Topics explored included resources to manage health, barriers to virtual health care services, and desired changes to localized healthcare delivery. Surveys were used to capture demographic and internet access information. Conclusion: Analysis included data from 2 focus groups (n = 14). Participants represented a wide age range and a variety of Michigan counties. The majority were full-time farm owners with most—93% (n = 13)—reporting they had access to the internet in their homes and 86% (n = 12) reporting that their cellphones had internet capabilities. Participants identified challenges and opportunities in 4 categories: formal health care; health and well-being supports; health insurance experiences; and virtual health care. Conclusion: The findings from this study provide a useful framework for developing interventions to address the specific needs of rural farming residents. Despite the expressed challenges in access and use of health care services and resources, participants remained hopeful that innovative approaches, such as virtual health platforms, can address existing gaps in care. The study findings should inform the design and evaluation of interventions to address rural health disparities.

Too Much Medicine: Behavioral Science Insights on Overutilization, Overdiagnosis, and Overtreatment in Health Care

2018 ◽  
Vol 5 (2) ◽  
pp. 155-162 ◽  
Author(s):  
Victoria A. Shaffer ◽  
Laura D. Scherer
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Behavioral Science ◽  
The United States ◽  
Science Literature ◽  
Psychological Mechanisms ◽  
Care Services ◽  
Medical Tests ◽  
Diagnostic Labels ◽  
Cost Of Health Care

Overutilization—defined as the use of health care services for which the benefits do not outweigh the harms—has been identified as one of the leading contributors to the rising cost of health care in the United States. Although informational interventions designed to address overutilization have had a significant, but modest, impact on the rate of overutilization, they have not been sufficient to solve the problem. Also, various psychological mechanisms contribute to the desire for more medical tests and treatments. To effectively address overutilization, we need to better understand the psychological underpinnings of overuse in medicine. The article reviews recent findings from the behavioral science literature—including reliance on anecdotal evidence, test-related affect, the use of diagnostic labels, and medical maximizing tendencies—that lend insight into why patients sometimes seek, demand, or expect medical tests and treatments that are considered by experts to be low value.

Innovation in ICT-Based Health Care Provision

2011 ◽  
Vol 6 (2) ◽  
pp. 14-27 ◽  
Author(s):  
Synnøve Thomassen Andersen ◽  
Arild Jansen
Keyword(s):  
Health Care ◽  
Rural Areas ◽  
Health Care Services ◽  
Innovation Process ◽  
Care Provision ◽  
Power Structures ◽  
Mobile Phone Technology ◽  
Existing Structures ◽  
Care Services ◽  
Decentralized Model

This paper describes a project redesigning psychiatric services for children and adolescents, introducing a new decentralized model into the ordinary structures of health care services in rural areas in Norway by using mobile phone technology. The authors apply a multilayer and dialectic perspective in the analysis of the innovation process that created the ICT solution that supports this treatment model. The salient challenges of the project were related to the contradictions between the existing, dominant power structures and the emergent structures in the different layers of the design structures. As a result of the development process, a new model emerged with a larger potential for creating a new innovation path than if it had been linked to existing structures. This paper contributes to the understanding of how user-driven innovation can break with existing power structures through focusing on different layers in the change processes.

… And Health Care for All: Immigrants in the Shadow of the Promise of Universal Health Care

2009 ◽  
Vol 35 (1) ◽  
pp. 185-204 ◽  
Author(s):  
Adrianne Ortega
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Services ◽  
Insurance Coverage ◽  
The United States ◽  
Care Plan ◽  
Universal Health Care ◽  
Care Services ◽  
Eligibility Requirements ◽  
Universal Health

President Obama’s ambitious universal health care plan aims to provide affordable and accessible health care for all. The plan to cover the estimated 46.5 million uninsured, however, ignores the over thirty million non-citizens living in the United States. If the United States passes universal health care coverage, Congress should repeal the prohibitions of the Welfare Reform Act, extend Medicaid coverage to non-citizens, and allow non-citizens to purchase employer-based insurance coverage.President Obama’s plan follows the lead of state universal health care legislation by retaining private, employer-sponsored insurance coverage and expanding the eligibility requirements of the Medicaid program. This strategy will not aid uninsured immigrants or overburdened states and hospitals, though, because current law excludes most non-citizens from nonemergency health care services.

Promoting Health in Rural India: Enhancing Job Performance of Lay Health Care Activists

2019 ◽  
Vol 9 (2) ◽  
pp. 226-242 ◽  
Author(s):  
Jatin Pandey ◽  
Manjari Singh ◽  
Biju Varkkey ◽  
Dileep Mavalankar
Keyword(s):  
Health Care ◽  
Job Performance ◽  
Community Health ◽  
Health Care Workers ◽  
Rural Areas ◽  
Health Care Services ◽  
Rural India ◽  
Community Health Care ◽  
Care Services ◽  
Care Workers

The health of people in a nation is a potential indicator of its development. Over and above that, the job performance of people involved in the delivery and facilitation of health care services within a nation reflects the actual health conditions in it. In developing countries, where a large chunk of the population lives in rural areas, the job performance of grass-roots health care workers gains significant importance in order to ensure effective and efficient delivery of health care services to the masses and marginalized communities. The present study takes the case of Accredited Social Health Activists (ASHAs) in difficult rural areas of India to identify factors that affect their job performance and suggests interventions through which it could be enhanced. Fifty-five ASHAs were interviewed and five focused group discussions (FGDs) were conducted. Additionally, triangulation was done by interviewing other stakeholders, while studying relevant documents. Through content analysis of these interviews and documents, this study identifies the demands, resources and stressors that affect the job performance of these important intermediaries in the health care supply chain (in the Indian context). The study also suggests policy-level decisions that could help in enhancing job performance of ASHAs by managing demands, increasing resources and reducing stressors. Key Messages We have developed a model that delineates the demands, resources and stressors that affect job performance of women workers in rural India. We have studied Accredited Social Health Activists (ASHAs) who are part of community health care sector. However, our findings are applicable to a wider set of similar job roles. We have studied the nuances of factors affecting job performance for a category of community health care workers who are not full-time employees, have received minimal training and work in close proximity of their residence in a closely knit society. We have looked at job performance of ASHAs who are women community health workers, with low educational qualifications, based in rural setting of a developing country. We have recommended policy implications that would aid in enhancing the performance of ASHAs and thus improve the health care situation in rural India.

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