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1.
Front Public Health ; 10: 1001639, 2022.
Article in English | MEDLINE | ID: covidwho-2080301

ABSTRACT

Our study assesses whether factors related to healthcare access in the first year of the pandemic affect mortality and length of stay (LOS). Our cohort study examined hospitalized patients at Nebraska Medicine between April and October 2020 who were tested for SARS-CoV-2 and had a charted sepsis related diagnostic code. Multivariate logistic was used to analyze the odds of mortality and linear regression was used to calculate the parameter estimates of LOS associated with COVID-19 status, age, gender, race/ethnicity, median household income, admission month, and residential distance from definitive care. Among 475 admissions, the odds of mortality is greater among those with older age (OR: 1.04, 95% CI: 1.02-1.07) and residence in an area with low median household income (OR: 2.11, 95% CI: 0.52-8.57), however, the relationship between mortality and wealth was not statistically significant. Those with non-COVID-19 sepsis had longer LOS (Parameter Estimate: -5.11, adjusted 95% CI: -7.92 to -2.30). Distance from definitive care had trends toward worse outcomes (Parameter Estimate: 0.164, adjusted 95% CI: -1.39 to 1.97). Physical and social aspects of access to care are linked to poorer COVID-19 outcomes. Non-COVID-19 healthcare outcomes may be negatively impacted in the pandemic. Strategies to advance patient-centered outcomes in vulnerable populations should account for varied aspects (socioeconomic, residential setting, rural populations, racial, and ethnic factors). Indirect impacts of the pandemic on non-COVID-19 health outcomes require further study.


Subject(s)
COVID-19 , Sepsis , Humans , COVID-19/epidemiology , SARS-CoV-2 , Cohort Studies , Nebraska/epidemiology , Income , Health Services Accessibility
2.
J Patient Rep Outcomes ; 6(1): 113, 2022 Oct 17.
Article in English | MEDLINE | ID: covidwho-2079564

ABSTRACT

BACKGROUND: The impact of the coronavirus disease 2019 (COVID) is worse among those with fewer financial resources, in jobs not amenable to remote work, and in denser living conditions. People of color are more likely to be among these vulnerable groups. Although race itself is a social construction and not based on underlying genetic/biological differences, this study investigated race/ethnicity differences in the negative repercussions of COVID and in the benefits of psychological and social resources. METHODS: This cross-sectional, web-based study (n = 4817) was administered to a heterogeneous United States sample in Spring/Summer 2020. Information was gathered on the following COVID-specific variables: Infection Status, Coping with Lockdown, Social Support, Post-traumatic Growth, Interpersonal Conflict, Worry about Self, Financial Impact on Family, Lack of Money, Inadequate Access to Healthcare, and Housing Instability. Resilience was operationalized as the ability to maintain a sense of wellness in the face of the pandemic, using the DeltaQuest Wellness measure. Multivariate linear regression (adjusting for demographics) and propensity-matched cohort analysis (matched on demographics) evaluated the impact of COVID-specific variables on Wellness in separate models for Whites and Non-Whites. FINDINGS: Both sets of models retained the same COVID-specific variables and explained about half of the variance in wellness. Coping with Lockdown, Social Support, and Post-traumatic Growth were associated with higher levels of Wellness in both Whites and Non-Whites, while Interpersonal Conflict and Worry about Self were associated with lower levels of Wellness. While these associations are similar, Non-Whites reported worse levels of some positive resources (e.g., social support) and more challenging levels of negative stressors (e.g., interpersonal, worry, financial). Non-Whites also reported much higher levels of post-traumatic growth. CONCLUSION: COVID was a source of worry and even conflict, but also unlocked people's resources in use of health-enhancing behavioral strategies, social support, and renewed gratitude for sources of personal meaning and value. The similar relationships between Whites and Non-Whites on wellness and COVID-specific stressors across racial groups underscore that race is a social construction, not a biological fact. Focusing on a renewed appreciation for sources of personal meaning, and particularly faith, seemed to buffer much of the COVID-related stress for Non-Whites.

3.
Emerg Infect Dis ; 28(11): 2171-2180, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2054897

ABSTRACT

We examined racial/ethnic disparities for COVID-19 seroconversion and hospitalization within a prospective cohort (n = 6,740) in the United States enrolled in March 2020 and followed-up through October 2021. Potential SARS-CoV-2 exposure, susceptibility to COVID-19 complications, and access to healthcare varied by race/ethnicity. Hispanic and Black non-Hispanic participants had more exposure risk and difficulty with healthcare access than white participants. Participants with more exposure had greater odds of seroconversion. Participants with more susceptibility and more barriers to healthcare had greater odds of hospitalization. Race/ethnicity positively modified the association between susceptibility and hospitalization. Findings might help to explain the disproportionate burden of SARS-CoV-2 infections and complications among Hispanic/Latino/a and Black non-Hispanic persons. Primary and secondary prevention efforts should address disparities in exposure, vaccination, and treatment for COVID-19.


Subject(s)
COVID-19 , Adult , United States/epidemiology , Humans , COVID-19/epidemiology , Ethnicity , SARS-CoV-2 , Pandemics , Disease Susceptibility , Prospective Studies , Whites
4.
BMC Musculoskelet Disord ; 22(1): 465, 2021 May 21.
Article in English | MEDLINE | ID: covidwho-2053892

ABSTRACT

BACKGROUND: Care continuum models (also known as care cascade models) are used by researchers and health system planners to identify potential gaps or disparities in healthcare, but these models have limited applications to complex or chronic clinical conditions. Cyclical continuum models that integrate more complex clinical information and that are displayed using circular data visualization tools may help to overcome these limitations. We performed proof-of-concept cyclical continuum modeling for one such group of conditions-musculoskeletal infections-and assessed for racial and ethnic disparities across the complex care process related to these infections. METHODS: Cyclical continuum modeling was performed in a diverse, retrospective cohort of 1648 patients with musculoskeletal infections, including osteomyelitis, septic arthritis, and/or infectious myositis, in the University of New Mexico Health System. Logistic regression was used to estimate the relative odds of each element or outcome of care in the continuum. Results were visualized using circularized, map-like images depicting the continuum of care. RESULTS: Racial and ethnic disparities differed at various phases in the care process. Hispanic/Latinx patients had evidence of healthcare disparities across the continuum, including diabetes mellitus [odds ratio (OR) 2.04, 95% confidence interval (CI): 1.61, 2.60 compared to a white non-Hispanic reference category]; osteomyelitis (OR 1.28, 95% CI: 1.01, 1.63); and amputation (OR 1.48; 95% CI: 1.10, 2.00). Native American patients had evidence of disparities early in the continuum (diabetes mellitus OR 3.59, 95% CI: 2.63, 4.89; peripheral vascular disease OR 2.50; 95% CI: 1.45, 4.30; osteomyelitis OR 1.43; 95% CI: 1.05, 1.95) yet lower odds of later-stage complications (amputation OR 1.02; 95% CI: 0.69, 1.52). African American/Black non-Hispanic patients had higher odds of primary risk factors (diabetes mellitus OR 2.70; 95% CI: 1.41, 5.19; peripheral vascular disease OR 4.96; 95% CI: 2.06, 11.94) and later-stage outcomes (amputation OR 2.74; 95% CI: 1.38, 5.45) but not intervening, secondary risk factors (osteomyelitis OR 0.79; 95% CI: 0.42, 1.48). CONCLUSIONS: By identifying different structural and clinical barriers to care that may be experienced by groups of patients interacting with the healthcare system, cyclical continuum modeling may be useful for the study of healthcare disparities.


Subject(s)
Healthcare Disparities , Continuity of Patient Care , Humans , Mexico , Retrospective Studies , United States
5.
Health Sci Rep ; 5(5): e839, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2041219

ABSTRACT

Background and Aims: Elderly people are potentially vulnerable with a higher need for health services, and utilization of Essential Public Health Services (EPHS) among this group is of high importance. This study aimed to examine the utilization of health services among the elderly in Iran during the coronavirus disease 2019 outbreak. Methods: This was a cross-sectional study conducted in 21 public health centers in Sirjan, Southern Iran, from May to December 2020. A total of 420 elderly patients were selected through a systematic random sampling method. Data were collected using a questionnaire and were analyzed using SPSS v22.0. The binary logistic regression was used to examine the effect of demographic, socioeconomic and morbidity status on inpatient and outpatient healthcare utilization. Results: Our results showed that 56% of the elderly had a history of hospitalization during the last year. Although 60% of the elderly reported they had a perceived need for outpatient services, only 49% of them reported that they utilized outpatient services. 51% and 35.5% of the elderly reported that their inpatient and outpatient costs were covered by health insurance, respectively. Others reported their health spending was financed through out-of-pocket payments. Male gender aged 80 and above, urban residents, higher socioeconomic and supplemental insurance coverage were associated with an increase in health services utilization. The elderly with Cancer, mental disorders, kidney disease, and cardiovascular diseases (CVDs) were more likely to be hospitalized. Conclusion: There were demographic and socioeconomic inequalities in health services utilization among the elderly. Therefore, appropriate interventions and strategies are needed to reduce these inequalities in health services utilization among the elderly. In addition, given that the hospitalization rate was significantly higher among the elderly with chronic diseases than those without, it is crucial and necessary to take interventions to reduce the burden of chronic diseases in the future.

6.
Int J Equity Health ; 21(1): 137, 2022 09 22.
Article in English | MEDLINE | ID: covidwho-2038765

ABSTRACT

BACKGROUND: The COVID-19 pandemic has had a disproportionate effect on the Black/African American population. In addition to the higher infection rates and the worse outcomes, there were other unintended consequences of the pandemic. The study objective was to determine the impact of COVID-19 on the Black/African American community. METHODS: A needs assessment was conducted using a mixed-methods approach. To address this specific study objective, an item included in the survey questionnaire asked respondents (n = 183) about their greatest worry related to CODID-19. Interviews and focus group discussions were conducted to further explore individual and community perceptions. RESULTS: The areas of greatest concern were Health (41.0%), Family (25.1%), Finances (8.2%), and Education (4.9%). The needs assessment revealed that the COVID-19 pandemic had a profound impact on the mental health and wellness, healthcare access and utilization, and social aspects of life the Black community. Emerging themes revealed that there was worsening mental health for many, limited healthcare access and under-utilization, and profound disruption of the social cohesive identity of the Black/African American community. CONCLUSION: Pre-existing structural inequities are implicated in the mental health impact, as well as the under-utilization of and limited access to healthcare services in the Black/African American population. The impact on social well-being emphasizes the important role of culture in the population health of communities of color, further supporting the need for culturally-responsive public health interventions when targeting these communities.


Subject(s)
COVID-19 , Health Services Accessibility , Humans , Mental Health , Needs Assessment , Pandemics
7.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-343260

ABSTRACT

India being a developing country and recording a population of 1.4 billion, the pandemic exposed the vulnerabilities in its healthcare system, especially in terms of healthcare access as well as health inequality. The COVID-19 pandemic exacerbated the limitations of the healthcare system by creating an acute shortage of resources, infrastructure, and manpower. The study empirically develops the comprehensive Healthcare Access Index (HAI) for 19 Indian states and Healthcare Inequality Index (HII) for 9 states for the years 2015 and 2020 signifying pre COVID and post COVID scenarios respectively. In addition to this, the study strives to understand the association between healthcare access and healthcare inequality and estimate the effects of the pandemic on this relationship. Findings of the study shows that HAI across two time points has fallen for states like Tamil Nadu, Karnataka, and Maharashtra, and has increased for states like Rajasthan, Himachal Pradesh, Haryana, Madhya Pradesh, and Jharkhand. In case of HII, Kerala and Karnataka reported high value while states like Andhra Pradesh, Maharashtra, Gujrat, Himachal Pradesh, J & K, Assam, and Bihar occupied the lower range. Further, the association between the indices support the hypothesis that pandemic has widened the disparity between healthcare access and inequality across the Indian states. Henceforth, to mitigate future health challenges, states with low HAI and HII should focus on prioritizing healthcare with adequate financing, strong capacity building measures and leveraging more public – private partnerships.

8.
Int J Environ Res Public Health ; 19(17)2022 Sep 01.
Article in English | MEDLINE | ID: covidwho-2023714

ABSTRACT

Cancer screening programs are public health interventions beneficial to early diagnoses and timely treatments. Despite the investment of health policies in this area, many people in the recommended age groups do not participate. While the literature is mainly focused on obstacles and factors enabling access to health services, a gap from the point of view of the target population concerns healthcare providers. Within the "Miriade" research-action project, this study aims to explore the dimensions that mediate the relationship between healthcare providers and preventive practices through the narrations of 52 referents and healthcare providers involved in breast, cervical and colorectal cancer screening. We conducted ad hoc narrative interviews and used theory-driven analysis based on Penchansky and Thomas' conceptualization and Saurman's integration of six dimensions of healthcare access: affordability, availability, accessibility, accommodation, acceptability and awareness. The results show that 21 thematic categories were representative of the access dimensions, and 5 thematic categories were not; thus, we have classified the latter as the dimension of affection. The results suggest trajectories through which psychological clinical intervention might be constructed concerning health, shared health decisions and access to cancer screening.


Subject(s)
Early Detection of Cancer , Neoplasms , Health Personnel , Health Services Accessibility , Humans , Narration , Qualitative Research
9.
Support Care Cancer ; 30(11): 9101-9108, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-1999946

ABSTRACT

PURPOSE: We aimed to determine whether there was a difference in access to cancer-related healthcare between people living in Sweden and the United Kingdom (UK) during the COVID-19 pandemic. We also describe how the pandemic affected social contact of patients undergoing treatment. METHODS: This cross-sectional study used survey data collected through the War on Cancer mobile phone application between September 5, 2020, and January 6, 2021. We included individuals with cancer diagnoses living in Sweden or the UK. The association between difficulty accessing cancer-related healthcare and country was examined using logistic regression. Frequencies were used to describe the effect of the pandemic on social contact. RESULTS: Of 491 individuals included in the study, 183 were living in the UK and 308 in Sweden. Living in the UK was associated with greater difficulty accessing cancer-related healthcare (n = 99/183, 54.1%) than living in Sweden (n = 100/308, 32.5%) (odds ratio 2.12, 95% CI 1.39-3.23, p < 0.001). The pandemic affected social contact for almost all patients (n = 218/238, 91.6%) undergoing treatment. CONCLUSION: This study highlights the differential impact that the pandemic may have had on patients' access to cancer-related care in the UK and Sweden. In both countries, the pandemic overwhelmingly affected social contact of individuals undergoing cancer treatment. New ways must be found to improve access to cancer-related care and reduce social isolation for patients with cancer during a pandemic.


Subject(s)
COVID-19 , Neoplasms , Humans , COVID-19/epidemiology , Pandemics , Cross-Sectional Studies , Sweden/epidemiology , United Kingdom/epidemiology , Neoplasms/epidemiology , Neoplasms/therapy
10.
J Immigr Minor Health ; 2022 Aug 17.
Article in English | MEDLINE | ID: covidwho-1990714

ABSTRACT

The coronavirus 2019 pandemic led to rapid expansion of outpatient telemedicine. We sought to characterize patient factors influencing outpatient teleneurology utilization at an urban safety-net hospital. We reviewed all neurology televisits scheduled between June 15, 2020 to April 15, 2021. We used the chi-squared test and multivariate logistic regression to characterize patient demographic factors associated with televisit completion and video use. Of 8875 scheduled televisit encounters, 7530 were completed successfully, 44% via video. Non-English speaking patients, Black patients, Latinx patients, and those with a zip code-linked annual income less than $50,000 were less likely to successfully complete a scheduled televisit. The same demographic groups other than Latinx ethnicity were also less likely to use the video option. Our study found unequal telehealth utilization based on patients' demographic factors. Currently declining telemedicine reimbursement rates asymmetrically affect audio-only visits, which may limit telehealth access for vulnerable patient populations.

11.
Per Med ; 19(5): 411-422, 2022 09.
Article in English | MEDLINE | ID: covidwho-1974551

ABSTRACT

Aim: The COVID-19 pandemic forced medical practices to augment healthcare delivery to remote and virtual services. We describe the results of a nationwide survey of cardiovascular professionals regarding telehealth perspectives. Materials & methods: A 31-question survey was sent early in the pandemic to assess the impact of COVID-19 on telehealth adoption & reimbursement. Results: A total of 342 clinicians across 42 states participated. 77% were using telehealth, with the majority initiating usage 2 months after the COVID-19 shutdown. A variety of video-based systems were used. Telehealth integration requirements differed, with electronic medical record integration being mandated in more urban than rural practices (70 vs 59%; p < 0.005). Many implementation barriers surfaced, with over 75% of respondents emphasizing reimbursement uncertainty and concerns for telehealth generalizability given the complexity of cardiovascular diseases. Conclusion: Substantial variation exists in telehealth practices. Further studies and legislation are needed to improve access, reimbursement and the quality of telehealth-based cardiovascular care.


As the COVID-19 pandemic was just beginning, the American College of Cardiology administered a survey to cardiology professionals across the USA regarding their preparedness for telehealth and video-visits. The results demonstrated rapid adoption of video based telehealth services, however revealed uncertainty for how to best use these services in different practice settings. Many providers expressed concerns about how these visits will be compensated, but fortunately federal agencies have dramatically changed the way telehealth is reimbursed as the pandemic has progressed. Further studies are needed to explore the impact of telehealth on healthcare inequality, however we hope that rather it serves to increase healthcare access to all.


Subject(s)
COVID-19 , Cardiology , Telemedicine , COVID-19/epidemiology , Cross-Sectional Studies , Humans , Pandemics , Telemedicine/methods , United States/epidemiology
12.
Healthcare (Basel) ; 10(8)2022 Jul 22.
Article in English | MEDLINE | ID: covidwho-1957266

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, college students faced health disparities in addition to a negative burden on academic performance; however, little is reported in the literature regarding healthcare utilization. METHODS: A cross-sectional survey was conducted among consenting college student participants aged 18 or older from a Hispanic-serving institution. Descriptive and bivariate statistics were used to analyze demographic characteristics and the types of healthcare services needed by such characteristics. Logistic regression was used to adjust for noted sex differences in associations between reporting limited healthcare services and types of healthcare services. RESULTS: The study population of 223 participants was mostly Hispanic/Latino (65%) and female (73%). Of the population, 11% reported they could not obtain needed healthcare services, with time being reported as the most common reason. Significant associations were found between seeking general healthcare services/routine screening, seeking mental health services, and seeking sexual health services with reporting limited healthcare services, with sex-adjusted odds ratios and 95% confidence intervals of 1.90 (95% CI: 1.08, 3.36), 3.21 (95% CI: 1.44, 4.15), and 2.58 (95% CI: 1.05, 6.35), respectively. CONCLUSIONS: Availability and inability to obtain health services may exacerbate college student health disparities. Targeted interventions are needed in the population to mitigate the potential burdens of unmet healthcare needs, particularly among minority college students.

13.
Linacre Q ; 89(2): 178-183, 2022 May.
Article in English | MEDLINE | ID: covidwho-1950618

ABSTRACT

Understanding the resource limitations in developing countries, a community health worker (CHW) project was developed to help educate, provide materials, and prevent the spread of COVID-19 in Haiti. CHWs have shown to be an evidence-driven alternative in resource-limited settings. Pwojé Bon Vwazen (The Good Neighbor Project) took place from May 2020 to September 2020 in Port-au-Prince, Haiti. Through the project, 9 CHWs were trained. The project had two coordinators in Haiti. The CHWs, over the period of 4 months, were able to reach 1350 individuals and provide them with education regarding spread and prevention of COVID-19 and distribute materials including soap, hand sanitizers, and masks which were sewn in Haiti. Access to affordable health care presents a unique challenge in resource-limited countries. Training of CHWs and implementation of a CHW program can be an alternative in certain situations.

14.
Am J Otolaryngol ; 43(5): 103525, 2022.
Article in English | MEDLINE | ID: covidwho-1944084

ABSTRACT

OBJECTIVE: To investigate perspectives of patients, family members, caregivers (PFC), and healthcare professionals (HCP) on tracheostomy care during the COVID-19 pandemic. METHODS: The cross-sectional survey investigating barriers and facilitators to tracheostomy care was collaboratively developed by patients, family members, nurses, speech-language pathologists, respiratory care practitioners, physicians, and surgeons. The survey was distributed to the Global Tracheostomy Collaborative's learning community, and responses were analyzed. RESULTS: Survey respondents (n = 191) from 17 countries included individuals with a tracheostomy (85 [45 %]), families/caregivers (43 [22 %]), and diverse HCP (63 [33.0 %]). Overall, 94 % of respondents reported concern that patients with tracheostomy were at increased risk of critical illness from SARS-CoV-2 infection and COVID-19; 93 % reported fear or anxiety. With respect to prioritization of care, 38 % of PFC versus 16 % of HCP reported concern that patients with tracheostomies might not be valued or prioritized (p = 0.002). Respondents also differed in fear of contracting COVID-19 (69 % PFC vs. 49 % HCP group, p = 0.009); concern for hospitalization (55.5 % PFC vs. 27 % HCP, p < 0.001); access to medical personnel (34 % PFC vs. 14 % HCP, p = 0.005); and concern about canceled appointments (62 % PFC vs. 41 % HCP, p = 0.01). Respondents from both groups reported severe stress and fatigue, sleep deprivation, lack of breaks, and lack of support (70 % PFC vs. 65 % HCP, p = 0.54). Virtual telecare seldom met perceived needs. CONCLUSION: PFC with a tracheostomy perceived most risks more acutely than HCP in this global sample. Broad stakeholder engagement is necessary to achieve creative, patient-driven solutions to maintain connection, communication, and access for patients with a tracheostomy.


Subject(s)
Caregivers , Communication , Family , Patients , Postoperative Care/methods , Tracheostomy , COVID-19/complications , COVID-19/epidemiology , Caregivers/psychology , Cross-Sectional Studies , Family/psychology , Fatigue , Humans , Nurses/psychology , Pandemics , Patients/psychology , Physicians/psychology , Postoperative Care/standards , SARS-CoV-2 , Sleep Deprivation , Speech Therapy/psychology , Stress, Psychological , Surgeons/psychology
15.
Health Technol (Berl) ; 12(3): 633-635, 2022.
Article in English | MEDLINE | ID: covidwho-1943268

ABSTRACT

Not available. The manuscript is an editorial communication.

16.
Lancet Reg Health Eur ; 20: 100455, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1914784

ABSTRACT

Background: How international migrants access and use primary care in England is poorly understood. We aimed to compare primary care consultation rates between international migrants and non-migrants in England before and during the COVID-19 pandemic (2015-2020). Methods: Using data from the Clinical Practice Research Datalink (CPRD) GOLD, we identified migrants using country-of-birth, visa-status or other codes indicating international migration. We linked CPRD to Office for National Statistics deprivation data and ran a controlled interrupted time series (ITS) using negative binomial regression to compare rates before and during the pandemic. Findings: In 262,644 individuals, pre-pandemic consultation rates per person-year were 4.35 (4.34-4.36) for migrants and 4.60 (4.59-4.60) for non-migrants (RR:0.94 [0.92-0.96]). Between 29 March and 26 December 2020, rates reduced to 3.54 (3.52-3.57) for migrants and 4.2 (4.17-4.23) for non-migrants (RR:0.84 [0.8-0.88]). The first year of the pandemic was associated with a widening of the gap in consultation rates between migrants and non-migrants to 0.89 (95% CI 0.84-0.94) times the ratio before the pandemic. This widening in ratios was greater for children, individuals whose first language was not English, and individuals of White British, White non-British and Black/African/Caribbean/Black British ethnicities. It was also greater in the case of telephone consultations, particularly in London. Interpretation: Migrants were less likely to use primary care than non-migrants before the pandemic and the first year of the pandemic exacerbated this difference. As GP practices retain remote and hybrid models of service delivery, they must improve services and ensure primary care is accessible and responsive to migrants' healthcare needs. Funding: This study was funded by the Medical Research Council (MC_PC 19070 and MR/V028375/1) and a Wellcome Clinical Research Career Development Fellowship (206602).

17.
BMC Health Serv Res ; 21(1): 1355, 2021 Dec 19.
Article in English | MEDLINE | ID: covidwho-1910318

ABSTRACT

BACKGROUND: Chronic conditions are common and require ongoing continuous management and preventive measures. The COVID-19 pandemic may have affected the management of chronic conditions by delaying care. We sought to understand the impact of personal characteristics (i.e., age) and healthcare factors (i.e., access to a provider) on healthcare access in a sample of Americans 50 years of age or older during COVID-19. METHOD: Participants completed an online survey at the start of the COVID-19 pandemic - the Aging in the Time of COVID Survey. Questions focused on health status, health care access, COVID-19 fear, and social connectedness. Participants were recruited through social media advertisements, list serves, and snowball sampling. Data collection started in early April 2020 and concluded in late May 2020. Logistic regression models examined the results of two key access points: healthcare provider/doctor (n = 481) and medication (n = 765), with 56 and 93% of participants reporting access to a provider and medications, respectively. RESULTS: Individuals with an established primary care provider were much more likely to obtain access to a healthcare provider, OR = 3.81 (95% CI: 1.69, 8.77), and to receive medication, OR = 4.48 (95% CI: 1.61, 11.48), during the time of COVID-19. In addition, access to medication was (a) higher for those who were older, OR = 1.05 (95% CI: 1.01, 1.09), had a higher income (greater than 100 k compared to less than 50 k, OR = 3.04 (95% CI: 1.11, 8.98), and (b) lower for those having caregiving responsibilities, OR = 0.41 (95% CI: 0.21, 0.78), or greater social isolation, OR = 0.93 (95% CI: 0.87, 0.98). CONCLUSIONS: Although most participants had access to medication, just over half had access to a healthcare provider when needed. Notably, health-seeking behaviors for individuals who do not have an established primary care providers as well as those who provide unpaid care, are socially isolated, and younger may require more proactive approaches to care monitoring, management, and maintenance.


Subject(s)
COVID-19 , Aging , Health Services Accessibility , Humans , Pandemics , SARS-CoV-2 , Self Report
18.
Cambridge Journal of Regions, Economy and Society ; 2022.
Article in English | Web of Science | ID: covidwho-1908787

ABSTRACT

This study establishes a novel empirical framework using machine learning techniques to measure the urban-regional disparity of the public's mental health signals in Australia during the pandemic, and to examine the interrelationships amongst mental health, demographic and socioeconomic profiles of neighbourhoods, health risks and healthcare access. Our results show that the public's mental health signals in capital cities were better than those in regional areas. The negative mental health signals in capital cities are associated with a lower level of income, more crowded living space, a lower level of healthcare availability and more difficulties in healthcare access.

19.
Int J Environ Res Public Health ; 19(12)2022 06 17.
Article in English | MEDLINE | ID: covidwho-1896871

ABSTRACT

Transgender and gender-independent individuals (TGI) encounter myriad barriers to accessing affirming healthcare. Healthcare discrimination and erasure exposure among TGI individuals is vital to understanding healthcare accessibility, utilization behaviors, and health disparities in this population. Exposure to gender identity-related healthcare discrimination and erasure in childhood may contribute to TGI adults' healthcare utilization behaviors. The commonality of childhood exposure to gender identity-related healthcare discrimination and its relationship to healthcare avoidance during the early months of the COVID-19 pandemic among TGI adults were explored. TGI adults aged 18 to 59 (N = 342) in the United States were recruited online during the summer of 2020. Among individuals who reported childhood exposure to gender identity-related healthcare discrimination, 51% reported experiencing two or more distinct forms of discrimination. Hierarchical logistic regression indicated that exposure to healthcare discrimination in childhood significantly increased the odds of healthcare avoidance during the early months of the COVID-19 pandemic, after accounting for demographic factors and self-reported COVID-19 symptoms (odds ratio = 1.30, 95% confidence interval = 1.10, 1.54). These findings suggest that childhood exposure to gender identity-related healthcare discrimination is a prominent barrier to the utilization of healthcare for TGI adults, even during a global pandemic.


Subject(s)
COVID-19 , Transgender Persons , Adult , COVID-19/epidemiology , Female , Gender Identity , Health Services Accessibility , Humans , Male , Pandemics , United States/epidemiology
20.
Am J Surg ; 224(5): 1267-1273, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-1881645

ABSTRACT

BACKGROUND: The COVID-19 pandemic yielded rapid telehealth deployment to improve healthcare access, including for surgical patients. METHODS: We conducted a secret shopper study to assess telehealth availability for new patient and follow-up colorectal cancer care visits in a random national sample of Commission on Cancer accredited hospitals and investigated predictive facility-level factors. RESULTS: Of 397 hospitals, 302 (76%) offered telehealth for colorectal cancer patients (75% for follow-up, 42% for new patients). For new patients, NCI-designated Cancer Programs offered telehealth more frequently than Integrated Network (OR: 0.20, p = 0.01), Academic Comprehensive (OR: 0.18, p = 0.001), Comprehensive Community (OR: 0.10, p < 0.001), and Community (OR: 0.11, p < 0.001) Cancer Programs. For follow-up, above average timeliness of care hospitals offered telehealth more frequently than average hospitals (OR: 2.87, p = 0.04). CONCLUSIONS: We identified access disparities and predictive factors for telehealth availability for colorectal cancer care during the COVID-19 pandemic. These factors should be considered when constructing telehealth policies.


Subject(s)
COVID-19 , Colorectal Neoplasms , Telemedicine , Humans , United States/epidemiology , COVID-19/epidemiology , Pandemics , Health Services Accessibility , Colorectal Neoplasms/therapy
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