Journal of health care for the poor and underserved
-
J Health Care Poor Underserved · Feb 2014
Workforce development in Maryland to promote clinical-community connections that advance payment and delivery reform.
Promoting clinical-community linkages is at the heart of Maryland's efforts systematically to transform health care delivery, with community health workers (CHW) playing a central role. This article describes how Maryland is using the evidence-base on CHW effectiveness and training to develop a workforce capable of most effectively connecting communities with care.
-
J Health Care Poor Underserved · Feb 2014
ReviewA systematic review of factors affecting migrant attitudes towards seeking psychological help.
Research indicates that service utilization rates in migrant groups are low, although levels of distress appear high when compared with host populations. This paper systematically reviews quantitative and qualitative literature on factors associated with attitudes toward seeking psychological help among working age migrants. Data were extracted from MEDLINE, EMBASE, PsycINFO, Science Direct and SAGE databases. ⋯ The majority of studies were conducted in North America (67%). Although results of quantitative studies were heterogeneous, stronger identification with host than heritage culture, fluency in host country language, psychological attributions of distress, higher educational levels, higher socioeconomic status, female gender, and older age were associated with more favourable attitudes toward help-seeking in some migrant groups. Three major themes emerged from the qualitative literature: logistical barriers, cultural mismatch between service providers and participants, and preferences for other sources of assistance.
-
J Health Care Poor Underserved · Feb 2014
Emergency department charges for asthma-related outpatient visits by insurance status.
Though Americans make 1.8 million asthma-related outpatient visits to the emergency department (ED) annually, little is known about the episodic charges for asthma care in the ED. We therefore sought to assess the bills patients could face for acute asthma incidents by examining hospital charges for asthma-related outpatient ED visits. ⋯ The charges did not vary significantly by insurance group but did increase significantly with age. Our results indicate that the financial burden of ED care for asthma may take a severe toll on low-income populations who have limited ability to pay, especially patients who must pay undiscounted charges, including the uninsured and those on high-deductible health plans.
-
J Health Care Poor Underserved · Feb 2014
The projected effect of the Affordable Care Act on dental care for adult Medicaid enrollees.
Fewer than half of all U. S. states provide dental care for non-elderly adult Medicaid enrollees. Although the Affordable Care Act (ACA) expands Medicaid eligibility for adults, states are not required to offer dental care to adults. ⋯ Adult Medicaid recipients with no annual visit reported individual (51%), provider (27%), and system-level (22%) barriers. Hmong, Somali, and American Indian adults were more likely than others to report barriers to receiving dental care. We project that the ACA will not reduce barriers to dental care for adult Medicaid enrollees.
-
J Health Care Poor Underserved · May 2013
Should I call an interpreter?-How do physicians with second language skills decide?
Very little is known about how and when clinicians use their second language skills in patient care and when they rely on interpreters. The purpose of this study was to identify the factors most relevant to physicians' decision-making process when confronting the question of whether their language skills suffice to communicate effectively with patients in particular encounters. ⋯ Physicians consider a variety of factors in deciding whether to use their own language skills in clinical care, including their own and their patient's language proficiency, costs, convenience, and the clinical risk or complexity of the encounter. This study suggests the need for practical guidance and training for clinicians on the appropriate use of second language skills and interpreters in clinical care.