Browsing by Subject "Access to care"
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Item Open Access Determinants of Treatment Seeking Behavior Following Injury in Maringá, Brazil(2015) Toomey, NicoleBackground: Injury currently accounts for 6% of all disability adjusted life years (DALYS) lost. As the global incidence of injuries increases, so does the need for care. Current research on access to care and injury does not always account for injury severity or focus on the overall effects of injury. Our project focused on a medium-sized city in Brazil to determine what barriers to care after injury arise in Brazil’s universal health care system.
Methods: Households were randomly selected for survey in the 561 populated districts of the city of Maringa between May 2015 and September 2015. Demographic information was collected for the entire household; one individual from the household was then randomly selected to provide injury history. A chi-square analysis was used to determine the association between care seeking and demographics. A preliminary significance level of α = 0.20 was selected for inclusion of variables into the multivariate logistic regression. A full multivariate logistic regression model using injury as the primary exposure and seeking care as the outcome was run. Thirty reduced models were run; mean squared estimate (MSE) and Akaike Information Criterion (AIC) were calculated to find the best predictive model.
Results: 2678 households and individuals participated, 30.3% individuals reported an injury in their lifetime. The bivariate analysis found that gender (p = 0.034), cause of injury (p = 0.000), race (p = 0.051), severity (p = 0.103) and insurance status (p = 0.026) were potential predictors of seeking care. Education (p = 0.62), income (p = 0.343) and age (p = 0.838) were included in the multivariate model due to past significance in the literature. The reduced multivariate model that eliminated education level and race (MSE = 0.0274, AIC = 0.7689) was chosen as the best representative model and showed gender, age, socioeconomic status, and cause of injury as all strong predictors of care seeking.
Conclusions: Cause of injury is a major predictor for seeking care, as are factors related to socioeconomic status such as insurance and income. Injury cause potentially masked the effects of gender on care seeking. More research needs to be done on specific causes of injuries, the role of gender, and why socioeconomic status is still a barrier to care in a universal access system.
Item Open Access Evaluating Access to Prehospital Care for Traumatic Brain Injury Patients in a Resource Limited Setting: Focus on Prehospital Transport(2015) Rotich, Claire CBACKGROUND: This study describes the prehospital transport of traumatic brain injury (TBI) patients and its impact on TBI outcome to inform quality improvement for the existing trauma system. Data was collected over 4 months at a major referral hospital in Moshi,Tanzania.
METHODS: Patient demographics, mechanism of injury, injury severity (Glasgow Coma Score), and vitals were recorded on presentation to the Casualty Department. Prehospital factors recorded include time, distance and cost. Multivariable regression analyses evaluated the effect of prehospital factors on unfavourable patient TBI outcome, in-hospital factors and demographics were controlled for. Unfavorable outcome was defined as Glasgow Outcome Score<5 on discharge or death.
RESULTS: Road traffic injuries were the most common mechanism of injury (67.1%). The majority of patients were referred from other facilities in and around the region (62.3%), with 23% from the local public hospital There was no evidence of prehospital care available in this region. Average prehospital duration was more than 1 hour, a third of this was spent in prehospital transit for a majority of the patients. A minority used Ambulances. Predictors of unfavourable outcome (GOS<5) were: prehospital time greater than 60 minutes, multiple physical transfers during the prehospital course and being referred from another hospital.
CONCLUSION: The lack of prehospital care calls for further research into prehospital interventions for this setting. Further analysis should be conducted with a larger sample size to increase accuracy of the findings.
Item Open Access Telemedicine utilization by North Carolina farmworkers: a content analysis(2023-04-19) Bey, NadiaFarmworkers face a variety of barriers to accessing health care. Telehealth, often proposed as a solution to access issues, has yet to be widely adopted by this population due to a lack of broadband access amidst other barriers. Policies surrounding funding for broadband and telehealth reimbursement exacerbate the issue. An examination of public use data shows that farmworkers have a great need for mental health and chronic disease services, and that telehealth may be a useful intervention for both. Pre-existing programs in North Carolina such as the Internet Connectivity Project and TeleFuturo contribute to increasing access. Lessons from these programs show that a variety of public and private funding sources are needed to ensure access to telemedicine for North Carolina farmworkers. It is recommended that policymakers (a) develop incentives for nongovernmental entities to partake in the expansion of broadband connectivity and telehealth programs, (b) require health insurance companies to provide reimbursement parity for all appointment modalities, and (c) require future migrant housing to have internet access. There is also a need to increase the availability of Spanish-language telehealth services.