Transportation barriers to care among frequent health care users during the COVID pandemic

Objective: To investigate transportation barriers to accessing health care services during the COVID-19 pandemic among high-frequency health care users.Data Sources: Between June 21 and July 23, 2021, primary survey data were collected for a sample of patients in North Carolina.Study Design: The study analyzed the prevalence of arriving late to, delaying, or missing medical care and examined how transportation barriers contributed to negative health care outcomes. Data Collection Methods: A web-based survey was administered to North Carolina residents aged 18 and older in the UNC Health system who were enrolled in Medicaid or Medicare and had at least six outpatient medical appointments in the past year. 323 complete responses were analyzed to investigate the prevalence of reporting transportation barriers that resulted in having arrived late to, delayed, or missed care, as well as relationships between demographic and other independent variables and transportation barriers. Qualitative analyses were performed on text response data to explain transportation barriers.Principal Findings: Approximately 1 in 3 respondents experienced transportation barriers to health care between June 2020 and June 2021. Multivariate logistic regressions indicate individuals aged 18–64 were significantly more likely to encounter transportation barriers. Costs of traveling for medical appointments and a lack of driver or car availability emerged as major transportation barriers; however, respondents explained that barriers were often complex, involving circumstantial problems related to one’s ability to access and pay for transportation as well as to personal health.Conclusions: To address transportation barriers, we recommend more coordination between transportation and health professionals and the implementation of programs that expand access to and improve patient awareness of health care mobility services. We also recommend transportation and health entities direct resources to address transportation barriers equitably, as barriers disproportionately burden younger adults under age 65 enrolled in public insurance programs.

Health Care Utilization in Diverse Older Adults in the Deep South and the Rest of the United States

We examined racial/ethnic (R/E) differences in health care utilization among older adults with Alzheimer’s disease and related dementia (ADRD) from US Deep South [DS] and non-DS, and individual or context-level factors that affect this utilization. Data were 2013-2015 claims for Medicare beneficiaries with ADRD; county-level data were used to define context-level covariates; adjusted analyses were conducted separately for DS and non-DS. Across R/E groups, 33%-43% in DS, 43%-50% in non-DS used ADRD specialists; 47%-55% in DS, 41%-48% in non-DS used ADRD drugs; 42.9%-53.4% in DS, 42%-51.8% in non-DS had hospitalizations in a one-year follow-up. R/E differences were not significant, with few exceptions. Comorbidities, poverty, and medical resources availability were associated with specialist use and hospitalizations; comorbidities and specialist use were associated with drug use. In non-DS only, other individual, context-level covariates were associated with health care outcomes. Research should further examine determinants of health care utilization in these populations.

The Role of Electronic Medical Records in Reducing Unwarranted Clinical Variation in Acute Health Care: Systematic Review

Background The use of electronic medical records (EMRs)/electronic health records (EHRs) provides potential to reduce unwarranted clinical variation and thereby improve patient health care outcomes. Minimization of unwarranted clinical variation may raise and refine the standard of patient care provided and satisfy the quadruple aim of health care. Objective A systematic review of the impact of EMRs and specific subcomponents (PowerPlans/SmartSets) on variation in clinical care processes in hospital settings was undertaken to summarize the existing literature on the effects of EMRs on clinical variation and patient outcomes. Methods Articles from January 2000 to November 2020 were identified through a comprehensive search that examined EMRs/EHRs and clinical variation or PowerPlans/SmartSets. Thirty-six articles met the inclusion criteria. Articles were examined for evidence for EMR-induced changes in variation and effects on health care outcomes and mapped to the quadruple aim of health care. Results Most of the studies reported positive effects of EMR-related interventions (30/36, 83%). All of the 36 included studies discussed clinical variation, but only half measured it (18/36, 50%). Those studies that measured variation generally examined how changes to variation affected individual patient care (11/36, 31%) or costs (9/36, 25%), while other outcomes (population health and clinician experience) were seldom studied. High-quality study designs were rare. Conclusions The literature provides some evidence that EMRs can help reduce unwarranted clinical variation and thereby improve health care outcomes. However, the evidence is surprisingly thin because of insufficient attention to the measurement of clinical variation, and to the chain of evidence from EMRs to variation in clinical practices to health care outcomes.

Perception towards Male Enrolment in Nursing among High School Students at Selected Schools of Bharatpur, Chitwan

Nursing profession has been a gender lopsided profession which has limited the opportunity for male students to prefer nursing as career choices. However, the perception of male enrolment in nursing among the students is extremely important to maintain the diversity in nursing workforce. This study aimed to assess the perception towards male enrolment in nursing among the students at selected schools of Bharatpur, Chitwan. A cross-sectional survey design consisted of 222 students studying in private and government schools of Chitwan districts. Samples were selected purposively and self-administered structured questionnaire containing of 28 items for perception of male enrolment in nursing were used to collect data. Collected data were analysed using descriptive and inferential statistics. Majority of participants (54.5%) showed positive perception towards male enrolment in nursing whereas less than half (45.5%) showed negative perception towards male enrolment in nursing. The result indicated that perception towards male enrolment was not significantly associated with socio demographic variables. Despite having a positive notion about male in nursing, considerable number of participants were negative about male in nursing. The hiring and maintaining of male nurses in the nursing field is a very apparent issue nowadays. Therefore, this indicates the urgent need by concerning authorities in identifying the predictors in improving the professional nursing image and misconceptions regarding the gender based profession for better health care outcomes. Key words: Perception, Male enrolment, Nursing.

Dignity in the Work Lives of Clinical Nurses

<p>This descriptive study examines how clinical nurses understand, experience, and sustain dignity in their work lives. Nursing has embedded dignity, particularly the dignity of others, as a core professional value. However, while the practice of nursing is deeply concerned with the achievement of patient dignity, dignity as a self-regarding professional right is not well articulated. Hodson's (2001) model for dignity at work provided a lens through which to examine the relevant nursing literature. It was revealed that the dignity of nurses as an intrinsic human and worker right has received little explicit attention, and that the significance of this is possibly not sufficiently well understood. A qualitative descriptive approach was used to further investigate the area of nurse dignity. Seven nurses were recruited to participate in facilitated workshops to explore the research question, 'How do clinical nurses understand, experience, and sustain dignity in their work lives'? The data were analysed using directed content analysis and presented as a descriptive summary. Dignity, for the participants, was strongly associated with the worth, value, and meaning that nurses attach to their profession, to the work that they do, and to themselves personally. This was shown to be central to their understanding, experience, and achievement of dignity in their work lives. Each encounter, each moment, was seen to be invested with the potential to maintain, affirm, erode or infringe personal dignity. The nurses perceived nursing to be a meaningful, worthwhile endeavour, but frequently struggled to extract a sense of dignity when working in environments that they perceived as not supporting their agenda of care. Being seen as a respected professional, enjoying daily positive interactions with colleagues and being successful in the act of nursing, had the strongest association with the ability to extract worth, value, and meaning from the work experience. The absence of a perception of the participants' need to regard managerial colleagues was an unexpected finding. It was concluded that dignity should be pursued as a right in any context including the work context of nurses, both as a moral and pragmatic imperative. It is suggested that the current dominant approach that interests itself in the needs of nurses primarily as a means to achieving health care outcomes for patients may be neglecting an important dimension. Future inquiry into the area of nurse dignity should begin from the premise that to understand the meaning that nurses attach to dignity, one first has to understand the meaning that nurses attach to nursing, and in particular the nature of the social compact that nursing holds with society.</p>

Dignity in the Work Lives of Clinical Nurses

<p>This descriptive study examines how clinical nurses understand, experience, and sustain dignity in their work lives. Nursing has embedded dignity, particularly the dignity of others, as a core professional value. However, while the practice of nursing is deeply concerned with the achievement of patient dignity, dignity as a self-regarding professional right is not well articulated. Hodson's (2001) model for dignity at work provided a lens through which to examine the relevant nursing literature. It was revealed that the dignity of nurses as an intrinsic human and worker right has received little explicit attention, and that the significance of this is possibly not sufficiently well understood. A qualitative descriptive approach was used to further investigate the area of nurse dignity. Seven nurses were recruited to participate in facilitated workshops to explore the research question, 'How do clinical nurses understand, experience, and sustain dignity in their work lives'? The data were analysed using directed content analysis and presented as a descriptive summary. Dignity, for the participants, was strongly associated with the worth, value, and meaning that nurses attach to their profession, to the work that they do, and to themselves personally. This was shown to be central to their understanding, experience, and achievement of dignity in their work lives. Each encounter, each moment, was seen to be invested with the potential to maintain, affirm, erode or infringe personal dignity. The nurses perceived nursing to be a meaningful, worthwhile endeavour, but frequently struggled to extract a sense of dignity when working in environments that they perceived as not supporting their agenda of care. Being seen as a respected professional, enjoying daily positive interactions with colleagues and being successful in the act of nursing, had the strongest association with the ability to extract worth, value, and meaning from the work experience. The absence of a perception of the participants' need to regard managerial colleagues was an unexpected finding. It was concluded that dignity should be pursued as a right in any context including the work context of nurses, both as a moral and pragmatic imperative. It is suggested that the current dominant approach that interests itself in the needs of nurses primarily as a means to achieving health care outcomes for patients may be neglecting an important dimension. Future inquiry into the area of nurse dignity should begin from the premise that to understand the meaning that nurses attach to dignity, one first has to understand the meaning that nurses attach to nursing, and in particular the nature of the social compact that nursing holds with society.</p>

Differences in Dementia Care Between Swedish-Born and Foreign-Born from Countries with Different Country Level Socioeconomic Position: A Nationwide Register-Based Study

Background: With a growing elderly population worldwide, the prevalence of dementia is rapidly increasing. Studies from high income countries have shown that belonging to a minority ethnic group increases the risk of health disadvantages. Objective: The aim of the present registry-based study was to identify potential differences in diagnostics, treatment, and care of individuals with dementia focusing on foreign-born in Sweden and the impact of country level socioeconomic position (SEP). Methods: The study was based on a large dataset from the Swedish Dementia Registry (SveDem) and the Swedish Tax Agency’s population registry. Data on demographic variables, cognitive tests, clinical assessments, medication, diagnosis, and interventions initiated at diagnosis were collected. Country level SEP was determined by country of birth as classified by World Bank Country and Lending groups. Results: Of 57,982 patients with dementia registered in SveDem, 7,171 (12.4%) were foreign-born. The foreign-born were significantly younger at diagnosis (p < 0.001), had a lower MMSE score (p < 0.001), lower odds of receiving a specific dementia diagnosis (p < 0.001), lower use of acetylcholinesterase inhibitors (p < 0.001), and overall a higher use of neuroleptics compared with the Swedish-born group. The lower SEP, the greater differences to Swedish-born were seen in many of the examined variables. Conclusion: There were significant differences in dementia diagnostics, treatment, and care between foreign-born and Swedish-born, a lower SEP indicating greater differences. Further research should focus on various socioeconomic aspects and health care outcomes for a more profound analysis of equity in dementia care.

MANAGEMENT OF DEPRESSION IN CHILDREN WITH LUPUS ERYTHEMATOSUS SYSTEM

CASE REPORTMANAGEMENT OF DEPRESSION IN CHILDREN WITH LUPUS ERYTHEMATOSUS SYSTEMRisza Subiantoro*, Nining Febriyana**, Lestari Basoeki**, Endang Wasiki** *Participant in Specialist I Psychiatric / Psychiatric Education Program, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Surabaya, Indonesia Bumi Panua Hospital, Pohuwato, Gorontalo, Indonesia** Psychiatrist (Consultant), Teaching Staff at Department / SMF Psychiatry, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Surabaya, Indonesia ABSTRACT Depression is a comorbid in patients with Systemic Lupus Erythematus (SLE). Depression can affect up to 60% of adolescents who are comorbid. Depression in adolescents is likely many factors, etiology, psychological burden, chronic disease, effects of long term steroid treatment, social, cultural and genetic factors. Depression is frequently associated with poorer treatment outcomes and poor treatment and health care outcomes in individuals with SLE. In this case, we will discuss the available treatment options. Keyword: Child Depression, Erythematous Systemic Lupus, Management.