The American journal of managed care
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This letter discusses COVID-19 vaccine hesitancy and health literacy.
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Complex Medicare Advantage (MA) health plan choices may overwhelm immigrants, especially for those facing decision-making constraints due to limited English proficiency (LEP). We examined the trends and patterns of MA enrollment by immigration and English proficiency status. ⋯ Our findings suggest higher MA enrollment among immigrants, especially for LEP immigrants. Future research should study the care experience of immigrants in MA.
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Heart failure (HF) imposes a large and growing burden on the population, with a prevalence that is projected to increase to more than 8 million adults by 2030. The high risk of morbidity and mortality associated with HF is further exacerbated by the frequent presence of comorbidities. The coexistence of HF and comorbid conditions can result in emergency department visits and hospitalizations that not only affect patients and their families but also pose a growing economic burden on health care systems. ⋯ Optimal treatment can be hindered by such patient factors as the presence of comorbidities and socioeconomic barriers that include the cost of multiple treatments. Furthermore, poor treatment adherence is common among patients with HF. Measures aimed at tailoring therapies to individual patients and reducing medical costs are important to increase the uptake of and adherence to therapy and therefore improve clinical outcomes.
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Research about mistrust in health care often relies on the narrative that lacking trust causes underuse of health care services. This narrative seemed to hold up in the COVID-19 pandemic era, when mistrust in systems and providers led to widely recognized vaccine hesitancy and reluctance to seek care. In this review, we suggest that the "mistrust leads to underuse" narrative is important but incomplete, as mistrust in health care may also cause patients to overuse health care services. ⋯ Physicians also report being more likely to utilize extraneous tests and medications when patients do not trust them. Hence, problems of trust may lead to both underuse and overuse of health care services. We postulate several factors that may influence whether a mistrustful patient underuses or overuses health care resources, including personal characteristics, environmental characteristics, and levels of analysis, and we encourage more investigation about mistrust and health care overutilization.