Prevalence and Determinants of Difficulty in Accessing Medical Care in U.S. Adults

Rifai, Mahmoud Al; Mahtta, Dhruv; Kherallah, Riyad; Kianoush, Sina; Liu, Jing; Rodríguez, Fátima; Nasir, Khurram; Valero, J. Martín-Calama; Khan, Safi U.; Ballantyne, Christie M.; Petersen, Laura A.; Virani, Salim S.

doi:10.1016/j.amepre.2021.03.026

Cited by 5 publications

(3 citation statements)

References 13 publications

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“…The global health burden of vascular diseases, such as atherosclerosis, cerebrovascular disease, hypertension, and complications of diabetes, is rapidly increasing ( Al Rifai et al, 2021 ; Ji et al, 2021 ; Riccardi et al, 2021 ). Epidemiological surveys have shown that the increasing cost of vascular diseases worldwide compromises quality of life for individuals ( Liss et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Berberine: A Review of its Pharmacokinetics Properties and Therapeutic Potentials in Diverse Vascular Diseases

Peng

et al. 2021

Front. Pharmacol.

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Traditional Chinese medicine plays a significant role in the treatment of various diseases and has attracted increasing attention for clinical applications. Vascular diseases affecting vasculature in the heart, cerebrovascular disease, atherosclerosis, and diabetic complications have compromised quality of life for affected individuals and increase the burden on health care services. Berberine, a naturally occurring isoquinoline alkaloid form Rhizoma coptidis, is widely used in China as a folk medicine for its antibacterial and anti-inflammatory properties. Promisingly, an increasing number of studies have identified several cellular and molecular targets for berberine, indicating its potential as an alternative therapeutic strategy for vascular diseases, as well as providing novel evidence that supports the therapeutic potential of berberine to combat vascular diseases. The purpose of this review is to comprehensively and systematically describe the evidence for berberine as a therapeutic agent in vascular diseases, including its pharmacological effects, molecular mechanisms, and pharmacokinetics. According to data published so far, berberine shows remarkable anti-inflammatory, antioxidant, antiapoptotic, and antiautophagic activity via the regulation of multiple signaling pathways, including AMP-activated protein kinase (AMPK), nuclear factor κB (NF-κB), mitogen-activated protein kinase silent information regulator 1 (SIRT-1), hypoxia-inducible factor 1α (HIF-1α), vascular endothelial growth factor phosphoinositide 3-kinase (PI3K), protein kinase B (Akt), janus kinase 2 (JAK-2), Ca2+ channels, and endoplasmic reticulum stress. Moreover, we discuss the existing limitations of berberine in the treatment of vascular diseases, and give corresponding measures. In addition, we propose some research perspectives and challenges, and provide a solid evidence base from which further studies can excavate novel effective drugs from Chinese medicine monomers.

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Section: Introductionmentioning

confidence: 99%

Berberine: A Review of its Pharmacokinetics Properties and Therapeutic Potentials in Diverse Vascular Diseases

Peng

et al. 2021

Front. Pharmacol.

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“…There are approximately 5.4 million uninsured people in Texas, which has not expanded Medicaid; 771,000 of these uninsured adults fall into the Medicaid coverage gap [ 8 ]. Patients in non-expansion states such as Texas are more likely to report variations in ability to access medical care compared to their counterparts in expansion states [ 9 ]. The Kaiser Family Foundation reports that 13.5% of Texas adults report not seeing a doctor in the past 12 months due to the cost of care [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

A qualitative investigation of uninsured patient and primary care provider perspectives on specialty care eConsults

Bifulco,

Grzejszczak,

Velez

et al. 2023

BMC Health Serv Res

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Background Uninsured and underinsured patients face specialty care access disparities that prevent them from obtaining the care they need and negatively impact their health and well-being. We aimed to understand how making specialty care electronic consultations (eConsults) available at a multi-site Federally Qualified Health Center (FQHC) in central Texas affected uninsured patients’ care-seeking experiences and impacted their ability to receive the needed care. Methods We used concepts from Ecological Systems Theory to examine individual, interpersonal, organization-level, social, and health policy environment factors that impacted patients’ access to specialty care and the use of eConsults. We conducted thematic analysis of semi-structured, qualitative interviews with patients about seeking specialty care while uninsured and with uninsured patients and FQHC PCPs about their experience using eConsults to obtain specialists’ recommendations. Results Patients and PCPs identified out-of-pocket cost, stigma, a paucity of local specialists willing to see uninsured patients, time and difficulty associated with travel and transportation to specialty visits, and health policy limitations as barriers to obtaining specialty care. Benefits of using eConsults for uninsured patients included minimizing/avoiding financial stress, expanding access to care, expanding scope of primary care, and expediting access to specialists. Concerns about the model included patients’ limited understanding of eConsults, concern about cost, and worry whether eConsults could appropriately meet their specialty needs. Conclusions Findings suggest that eConsults delivered in a primary care FQHC addressed uninsured patients’ specialty care access concerns. They helped to address financial and geographic barriers, provided time and cost savings to patients, expanded FQHC PCPs’ knowledge and care provision options, and allowed patients to receive more care in primary care.

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“…7 As these individuals require longitudinal access to healthcare, 8 it is important to identify barriers to receiving timely medical attention. 9 While prior studies have examined measures related to healthcare access in the overall U.S. population 10,11 and those with cardiovascular risk factors, 12 few have focused specifically on individuals of Asian descent. 13,14 To address these knowledge gaps, the barriers to accessing healthcare among Asians living in the U.S. were examined, specifically among those with hypertension, diabetes mellitus, or ASCVD.…”

Section: Introductionmentioning

confidence: 99%

Healthcare Access Among Individuals of Asian Descent in the U.S.

Rifai

Kianoush²,

Jain³

et al. 2022

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Introduction. Some groups of Asian Americans, especially Asian Indians, experience higher rates of atherosclerotic cardiovascular disease (ASCVD) compared with other groups in the U.S. Barriers in accessing medical care partly may explain this higher risk as a result of delayed screening for cardiovascular risk factors and timely initiation of preventive treatment. Methods. Cross-sectional data were utilized from the 2006 to 2015 National Health Interview Survey (NHIS). Barriers to accessing medical care included no place to seek medical care when needed, no healthcare coverage, no care due to cost, delayed care due to cost, inability to afford medication, or not seeing a doctor in the past 12 months. Results. The study sample consisted of 18,150 Asian individuals, of whom 20.5% were Asian Indian, 20.5% were Chinese, 23.4% were Filipino, and 35.6% were classified as “Other Asians”. The mean (standard error) age was 43.8 (0.21) years and 53% were women. Among participants with history of hypertension, diabetes mellitus, or ASCVD (prevalence = 25%), Asian Indians were more likely to report delayed care due to cost (2.58 (1.14,5.85)), while Other Asians were more likely to report no care due to cost (2.43 (1.09,5.44)) or delayed care due to cost (2.35 (1.14,4.86)), compared with Chinese. Results among Filipinos were not statistically significant. Conclusions. Among Asians living in the U.S. with cardiovascular risk factors or ASCVD, Asian Indians and Other Asians are more likely to report delayed care or no care due to cost compared with Chinese.

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Prevalence and Determinants of Difficulty in Accessing Medical Care in U.S. Adults

Cited by 5 publications

References 13 publications

Berberine: A Review of its Pharmacokinetics Properties and Therapeutic Potentials in Diverse Vascular Diseases

Berberine: A Review of its Pharmacokinetics Properties and Therapeutic Potentials in Diverse Vascular Diseases

A qualitative investigation of uninsured patient and primary care provider perspectives on specialty care eConsults

Healthcare Access Among Individuals of Asian Descent in the U.S.

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