Browsing by Author "Department of Health Policy and Management, School of Public Health"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    The corporatization of global health: The impact of neoliberalism
    (Jacobs Verlag, 2018-06-14) Marstein, Egil; Babich, Suzanne M.; Department of Health Policy and Management, School of Public Health
    Concomitant with the emergence of a neoliberal precept for global health is the decline in support for publicly funded programs working to alleviate health disparities in poor countries. An unequivocal faith in the privatization and marketization of public health services is evident in current day national policy reforms. Commodification of health services is perceived as a cure-all. Privatization of global health initiatives contrasts with the past institutional paradigm. Corporate and philanthropic power trumps intergovernmental governance. The epistemological precept is clear: Global health is best served with mandated private initiatives. Powerful foundations cause critical shifts in the balance of power among stakeholders and become preeminent players in global health policy agenda formation. The ethics of consequentialism have attained current day prominence. This contrasts with the merits and relevancy of de-ontological ethics in which rules and moral duty are central. In this paper, authors make a case for contesting the ethos of effective altruism or venture philanthropy, suggesting that this approach keeps nations and people from recognizing the oppressive nature of neoliberalism as a governing precept for global health.
  • Thumbnail Image
    Item
    The Effect of EHR-Integrated Patient Reported Outcomes on Satisfaction with Chronic Pain Care
    (2016-12-01) Harle, Christopher A.; Marlow, Nicole M.; Schmidt, Siegfried O. F.; Shuster, Jonathan J.; Listhaus, Alyson; Fillingim, Roger B.; Hurley, Robert W.; Department of Health Policy and Management, School of Public Health
    Objective Given its complexity, chronic noncancer pain presents an opportunity to use health information technology (IT) to improve care experiences. The objective of this study was to assess whether integrating patient-reported outcomes (PRO) data in an electronic health record (EHR) affects providers and patient satisfaction with chronic noncancer pain care. Study Design We conducted a pragmatic cluster randomized trial involving four family medicine clinics. Methods We enrolled primary care providers (PCPs) and their patients with chronic noncancer pain. In the first seven months (education phase), PCPs in intervention practices received education on how to use PROs for pain care. In the second seven months (PRO phase), patients in intervention practices reported pain-related outcomes upon arrival at their visits. PROs were immediately reported to PCPs through the EHR. Control group PCPs provided usual care. We compared intervention and control practices in terms of provider and patient satisfaction with care. Results During the education phase, patients’ mean ratings of their visits did not differ between control and intervention (9.33 vs. 9.08, p=0.20). During the PRO phase, patients’ mean ratings did not differ between control and intervention (9.28 vs 9.01, p=0.20). Similarly, there were no differences between the intervention and control groups in terms of provider satisfaction. Conclusion Delivering EHR-integrated PROs did not consistently improve patient or provider satisfaction. Positively, we found no evidence that the PRO tools negatively affected satisfaction. Future studies and technological innovations are needed to translate point-of-care health IT tools to improvements in patient and provider experiences.
  • Thumbnail Image
    Item
    Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: a systematic literature review
    (2017) Hansotte, Elinor; Payne, Shirley I.; Babich, Suzanne M.; Department of Health Policy and Management, School of Public Health
    Problem statement and significance Left undiagnosed and/or untreated, the short-and long-term sequelae of postpartum depression may negatively impact both mother and child. In Western countries, access to mental health care is influenced by socioeconomic factors. The objective of this systematic literature review is to compile factors that hinder and improve access to postpartum depression treatment in low-income women after a positive screen for postpartum depression. The key question of focus is: what are the characteristics associated with access to mental health treatment for low-income women with a positive postpartum depression screen in Western countries? Methods A PRISMA-based systematic literature review was conducted of studies published in English before February 2016 that looked at treatment for postpartum depression in low-income women who had been identified with the condition. PubMed and EBSCO databases were searched using MESH and key terms and found 100 articles that met the selection criteria. After review by two independent researchers, 18 studies with 17 unique populations were included in the literature review. Results Two independent abstractors searched the included articles for themes surrounding impediments and advantages for low-income women identified with postpartum depression in obtaining mental health treatment. Characteristics of successful mental health treatment included studies that employed the use of a home visitor and those that separated outcomes for women with previous mental health treatment. Themes that emerged as treatment obstacles included cultural barriers, physical barriers, systemic health care barriers, and social barriers. Implications for practice This review will help to better inform screening and treatment priorities for those in the medical field who may encounter women experiencing postpartum depression and are not aware of the various barriers to care specific to low-income women. This review will also help policymakers identify specific obstacles that are not addressed in postpartum screening mandate policies which can affect the implementation of these policies.
  • Thumbnail Image
    Item
    The Relationship between External Environment and Physician E-mail Communication: The Mediating Role of Health Information Technology (HIT) Availability
    (Lippincott Williams & Wilkins, 2015-11) Mazurenko, Olena; Hearld, Larry R.; Menachemi, Nir; Department of Health Policy and Management, School of Public Health
    Background: Physician e-mail communication, with patients and other providers, is one of the cornerstones of effective care coordination but varies significantly across physicians. A physician's external environment may contribute to such variations by enabling or constraining a physician's ability to adopt innovations such as health information technology (HIT) that can be used to support e-mail communication. Purpose: The aim of the study was to examine whether the relationship of the external environment and physician e-mail communication with patients and other providers is mediated by the practice's HIT availability. Methodology: The data were obtained from the Health Tracking Physician Survey (2008) and the Area Resource File (2008). Cross-sectional multivariable subgroup path analysis was used to investigate the mediating role of HIT availability across 2,850 U.S. physicians. Findings: Solo physicians' perceptions about malpractice were associated with 0.97 lower odds (p < .05) of e-mail communication with patients and other providers, as compared to group and hospital practices, even when mediated by HIT availability. Subgroup analyses indicated that different types of practices are responsive to the different dimensions of the external environment. Specifically, solo practitioners were more responsive to the availability of resources in their environment, with per capita income associated with lower likelihood of physician e-mail communication (OR = 0.99, p < .01). In contrast, physicians working in the group practices were more responsive to the complexity of their environment, with a physician's perception of practicing in environments with higher malpractice risks associated with greater information technology availability, which in turn was associated with a greater likelihood of communicating via e-mail with patients (OR = 1.02, p < .05) and other physicians (OR = 1.03, p < .001). Practical Applications: The association between physician e-mail communication and the external environment is mediated by the practice's HIT availability. Efforts to improve physician e-mail communication and HIT adoption may need to reflect the varied perceptions of different types of practices.