J Am Board Fam Med
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The declining number of family physicians providing pregnancy care is of concern because they are an important source of pregnancy care in underserved communities. Innovative approaches might reinforce family physician participation in pregnancy care for the underserved. Since group prenatal visits have been shown to improve patient education, support, and satisfaction, we implemented and evaluated a group prenatal visit program for Japanese women in Michigan, an underserved population because of their limited proficiency with English. ⋯ This research demonstrates the feasibility and cultural acceptability of prenatal group visits for Japanese women. Prenatal group visits provided education and social support for Japanese women during the perinatal and postpartum periods that were not otherwise accessible in Japanese. This study confirms the feasibility of family physicians providing prenatal group visits and extends the literature of the applicability of prenatal group visits for patients with limited English skills.
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We investigated the quality of the primary care experienced by health center (HC) patients and investigated whether race/ethnicity and insurance coverage were significantly associated with patients' experiences. ⋯ As safety-net providers for vulnerable populations, HCs provide high-quality primary care and do not exhibit the extent of disparities that exist in other US health care settings. Continued efforts are necessary to address insurance-related disparities, particularly among uninsured patients.
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Ambulatory visits to dermatologists and primary care physicians (PCPs) may improve melanoma outcomes through early detection. We sought to measure the effect of dermatologist and PCP visits on melanoma stage at diagnosis and mortality. ⋯ Improved melanoma outcomes among Medicare beneficiaries may depend on adequate access and use of dermatologist and PCP services.
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Emergency department (ED) use for nonemergent conditions is associated with discontinuity of care at a greater cost. The objective of this study was to determine whether the quality of patient-provider communication and access to one's usual source of care (USC) were associated with greater nonemergent ED use. ⋯ Enhancing primary care by expanding interpreter services and access to care after hours may reduce the demand for nonemergent ED services.
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Economists posit 2 mechanisms increasing financial risk to insurers after health insurance gain: ex ante moral hazard (riskier behavior because of reduced personal costs) and ex post moral hazard (increased use of care because of lower care costs). In contrast, the Health Belief Model (HBM), would anticipate no increase in risk behaviors while also predicting increased health care utilization following insurance gain (because of reduced financial barriers to accessing care). Empirical studies examining the association of insurance change with changes in preventive care and health behaviors have been limited and yielded mixed findings. The objective of this study was to examine the association of health insurance change (gain or loss of coverage) with changes in preventive care and health behaviors in a large, nationally representative sample. ⋯ Consistent with both economic theory and the HBM, preventive care increased (decreased) after gaining (losing) coverage. In contrast, health behaviors changed little after insurance change, consistent with the HBM but not with the potential for decreased personal health care costs (ex ante moral hazard).