We evaluated access to primary health care for older women and men in Barbados, a developing country, using a widely accepted access indicator, hospitalization for ambulatory care sensitive conditions. Using 2003-2008 data, we calculated gender-specific total annual population-based rates of these hospitalizations per 1,000 older women and men and individual rates for the six most prevalent conditions. Across the 6 years, these hospitalizations increased 33.6% for women, 30.6% for men (both P < .0001). However, the average rate for diabetes fell 32% for women, 36% for men. Findings suggest an opportunity to improve access to primary health care, particularly for older women.
Reaction of primary aromatic amines with peroxidic tetrahydrofuran (THF) in the presence of hydrogen and 10% palladium on carbon catalyst results in THF ring opening to give 4-N-arylamino-1-butanols in good yield. The reaction mechanism is believed to involve a free-radical sequence resulting in an imino alcohol subsequently reduced to product.
Objectives
Lack of access to high‐speed internet may explain disparities in the use of technologies that support electronic patient engagement (EPE). This study describes trends in how people with and without fixed broadband connectivity in urban and rural communities used EPE tools to interact with health care providers between 2014 and 2018.
Methods
We linked Federal Communications Commission fixed broadband data with the Association of American Medical Colleges Consumer Survey of Health Care Access data for years 2014‐2018 (n = 23,131). ZIP Codes with a 25Mbps download speed and 3Mbps upload speed were determined to have broadband connectivity access. We evaluated 6 activities involving the use of 4 EPE tools (email, text, website, chat, video, and mobile app) and the intensity of use (0 = none, 1‐3 = low, 4‐6 = high). Multivariate logistic and multinomial regression models were used to determine factors associated with EPE.
Results
More than half (57.1%) of those without broadband access lived in rural areas. Overall, the intensity in the use of EPE tools increased from 2014 to 2016, then declined steadily with higher increases in use observed in urban and suburban than in rural areas. Lack of broadband access was associated with increased odds of zero intensity versus low‐intensity use of EPE tools in rural areas (OR = 1.72, 95% CI: 1.42‐2.09).
Conclusions
Inequality in broadband connectivity access may explain why rural communities lag in using various electronic tools for interacting with health care providers. Continued efforts to increase broadband connectivity in rural communities could improve their engagement with care providers.
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