Background: Innovative, patient-centred mHealth interventions have the potential to help with the
Effective chronic condition management is dependent upon prescription medication access and compliance. Impacted access results in increased pain, worsening of the condition and association of additional health-related problems. Prescription medication costs constitute a significant burden for patients who are uninsured and managing chronic conditions. This burden links to the likelihood of medication non-compliance. The purpose of this research was to test the ability of the Andersen Behavioral Model of Health Services Use to examine health behaviors among adult uninsured patients managing physician-diagnosed chronic conditions. To enhance its chronic disease management model for uninsured patients diagnosed with chronic conditions requiring prescription regimens, a local community health center added a pharmaceutical access component to its health care delivery model. The Andersen Behavioral Model of Health Services Use was employed to gain insight on how the predictors of predisposing, enabling and need factors impact the change in clinical outcomes and the number of non-urgent triage telephone encounters, physician visits, and emergency department visits of each uninsured patient diagnosed with a chronic condition requiring prescription medication treatment and receiving care at this facility. Individual health behavior patterns are based on predisposition to care, factors that impede or enable the use of care and overall need for care. In this study, there was a statistically significant relationship between population characteristics and health behavior; between health behavior and outcomes; and between population characteristics and outcomes.
Objectives: Despite great efforts to improve paediatric dental care access in the last two decades, the use of emergency departments (ED) for dental conditions among children that are more appropriately addressed in dental offices remains a public health concern in the United States. We examined factors associated with ED visits for nontraumatic dental conditions or NTDCs and ED visits for any other reason among children and adolescents.Methods: A retrospective secondary data analysis of ED visits was conducted using the 2014-2015 Nationwide Emergency Department Sample (NEDS) data. NTDCs were further categorized as diseases of hard tissue (eg dental caries), pulp/periapical (eg root canal infections), gingival/periodontal (eg conditions that affect the supporting tissues) and other. We included patient/socioeconomic characteristics, disposition, time of visit, and the Grouped Charlson Comorbidity Index (GRPCI) in our analysis. Bivariate associations were tested using chi-squared test (α = 0.05).Results: There were 70 616 194 ED visits in 2014-15, with 465 353 (0.7%) visits for NTDCs. Statistically significant differences were observed for all patient characteristics tested, except for gender when comparing children visiting the ED for NTDCs and children visiting for any other reason. Medicaid was the expected payer for nearly 60% of all ED visits, and the uninsured shared a larger proportion of NTDC visits (19.4%) than other visits (8.8%). Late adolescents (aged 18-21) accounted for over 50% of NTDC visits but only one-fifth of all other types of ED visits. Late adolescents (18-21 years old) who were uninsured had a significantly higher proportion of NTDC visits. Of all NTDC visits, 19.1% were related to hard tissue disease, 25.3% pulp/periapical, 7.9% periodontal disease, and the remaining were grouped as other dental diseases. Conclusions:The ED use for NTDCs is more common among late adolescents, Medicaid and uninsured groups. Examining and implementing new approaches that improve access to routine dental care for these groups may help in reducing inefficient ED use related to NTDCs.
Introduction: Prior evidence indicates that predictors of older adult falls vary by indoor-outdoor location of the falls. While a subset of United States’ studies reports this finding using primary data from a single geographic area, other secondary analyses of falls across the country do not distinguish between the two fall locations. Consequently, evidence at the national level on risk factors specific to indoor vs outdoor falls is lacking. Methods: Using the 2017 Nationwide Emergency Department Sample (NEDS) data, we conducted a multivariable analysis of fall-related emergency department (ED) visits disaggregated by indoor vs outdoor fall locations of adults 65 years and older (N = 6,720,937) in the US. Results: Results are compatible with findings from previous primary studies. While women (relative risk [RR] = 1.43, 95% confidence interval [CI], 1.42-1.44) were more likely to report indoor falls, men were more likely to present with an outdoor fall. Visits for indoor falls were highest among those 85 years and older (RR = 2.35, 95% CI, 2.33-2.37) with outdoor fall visits highest among those 84 years and younger. Additionally, the probabilities associated with an indoor fall in the presence of chronic conditions were consistently much higher when compared to an outdoor fall. We also found that residence in metropolitan areas increased the likelihood of an indoor elderly fall compared to higher outdoor fall visits from seniors in non-core rural areas, but both indoor and outdoor fall visits were higher among older adults in higher income ZIP codes. Conclusion: Our findings highlight the contrasting risk profile for elderly ED patients who report indoor vs outdoor falls when compared to the elderly reporting no falls. In conjunction, we highlight implications from three perspectives: a population health standpoint for EDs working with their primary care and community care colleagues; an ED administrative vantage point; and from an individual emergency clinician’s point of view.
Due to lack of mental healthcare facilities in rural areas, the population often resorts to private practice practitioners to address their need for mental health services. Dr. Taryn S. Van Gilder-Pierce and her husband, Dr. William D. Pierce founded their private practice in Yankton, SD in 2001. She has more than 25 years of training and experience treating individuals, married couples, families, and groups in rural South Dakota. The interview delves into the challenges faced by early career professionals in building a practice in remote areas and extends into the room for expansion within the field of rural mental health provision of services.
Background Frequent or repeat ED visits make up over 20% of the total ED visits, while frequent users constitute up to 8% of all ED users. While some studies have analyzed ED encounters over a single healthcare system, a single year or a condition, this study examines frequent and recurrent ED utilization for the state of Maryland over three years. Methods Using 2017–2019 State Emergency Department Databases (SEDD), we conducted bivariate and multivariate analyses and identified patient/community level characteristics associated with frequent (> 4 visits/year) and recurrent frequent ED users (two and three consecutive years) in Maryland. Results Of the total 5,331,843 ED visits, frequent visits were 24.4% (1,301,301) while frequent users made up 7.16% (234,973) of all ED users. Females [OR = 1.30, 95% CI 1.24, 1.36] and patients aged 21–44 [OR = 2.41, 95% CI 2.24,2.60] were more likely to visit the ED recurrently than males, children and adolescents respectively. Compared to those with private insurance and no chronic conditions, Medicaid beneficiaries were 2.41 (95% CI 2.24,2.60) and those with multiple chronic conditions was 2.34 [95% CI 2.14,2.54] times more likely to be recurrent frequent ED users respectively. The NH Blacks were 26% [95% CI 1.25,1.28] more likely to be frequent users than NH White patients while those from the lowest income quartile were 69% [95% CI 1.66,1.71] and 33% [95% CI 1.21,1.46] more likely to be frequent and recurrent frequent ED users compared to the highest income quartile. Compared to residents of large metropolitan areas, patients from micropolitan areas were 43% [95% CI 1.38,1.48] while those living further from an ED were 9% [95% CI 1.09, 1.10] were more likely to be frequent ED users. Conclusions Frequent and recurrent frequent ED users in the state of Maryland were associated with being female, 21–44 years old, NH Black, Medicaid beneficiaries, with multiple chronic conditions and reside in a lower income zip code. Frequent ED users were also more likely to reside micropolitan areas, and further from an ED facility. We propose recommendations to stakeholders to invest in care coordination and IT infrastructure, and expand community access to outpatient care.
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