Browsing by Subject "Health Services Accessibility"

Now showing 1 - 4 of 4
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    Access to Emergency Contraception After Removal of Age Restrictions
    (American Academy of Pediatrics, 2017-07) Wilkinson, Tracey A.; Clark, Porsche; Rafie, Sally; Carroll, Aaron E.; Miller, Elizabeth; Pediatrics, School of Medicine
    BACKGROUND: Levonorgestrel emergency contraception (EC) is safe and effective for postcoital pregnancy prevention. Starting in 2013, the US Food and Drug Administration removed age restrictions, enabling EC to be sold over the counter to all consumers. We sought to compare the availability and access for female adolescents with the 2012 study, using the same study design. METHODS: Female mystery callers posing as 17-year-old adolescents in need of EC used standardized scripts to telephone 979 pharmacies in 5 US cities. Using 2015 estimated census data and the federal poverty level, we characterized income levels of pharmacy neighborhoods. RESULTS: Of 979 pharmacies, 827 (83%) indicated that EC was available. This proportion did not vary by pharmacy neighborhood income level, nor was significantly different from the 2012 study (P = .78). When examining access, 8.3% of the pharmacies reported it was impossible to obtain EC under any circumstances, which occurred more often in low-income neighborhoods (10.3% vs 6.3%, adjusted odds ratio 1.5; 95% confidence interval 1.20-1.94). This was not significantly different from 2012 (P = .66). Correct information regarding over-the-counter access was conveyed only 51.6% of the time; accuracy did not differ by pharmacy's neighborhood income (47.9% vs 55.3%, adjusted odds ratio 0.89; 95% confidence interval 0.71-1.11) and was not significantly different from 2012 (P = .37). CONCLUSIONS: A majority of pharmacies have EC available; however, barriers to and disparities in access for adolescents persist and have not changed since the previous study despite regulatory changes that were designed to improve access to EC.
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    COVID-19 Pandemic Highlights Access Barriers for Children with Autism Spectrum Disorder
    (Wolters Kluwer, 2021-09) McNally Keehn, Rebecca; Tomlin, Angela; Ciccarelli, Mary R.; Pediatrics, School of Medicine
    Engagement in early intensive behavioral intervention has been shown to improve outcomes and lower lifetime care costs for children with autism spectrum disorder (ASD). However, in most regions of the United States, a medical diagnosis of ASD is necessary to access these interventions. A shortage of expert diagnosticians, inefficient evaluation models, and long evaluation wait times result in substantial delays in ASD diagnosis and markedly later entry into services. These delays are increased for children from diverse racial and socioeconomic backgrounds and underresourced regions. Although systemic barriers require ongoing attention, we highlight here the critical role that insurers play in limiting intervention access through application of inappropriate medical review criteria for ASD diagnostic evaluations. Specifically, to consider a medical diagnosis as valid and authorize specialized interventions, many insurers mandate the use of a specific assessment tool(s) instead of allowing qualified clinicians to use a flexible evidence-informed evaluation protocol. This has become especially problematic during COVID-19, when evaluation practices have rapidly shifted to meet demands for remote and/or socially distanced procedures through implementation of telehealth and use of novel diagnostic tools that are not yet accepted by insurers. When insurers erroneously deem ASD diagnoses as invalid, children are unable to benefit from needed interventions, resulting in a cascade of deleterious consequences.
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    Health facility barriers to HIV linkage and retention in Western Kenya
    (Springer (Biomed Central Ltd.), 2014) Wachira, Juddy; Naanyu, Violet; Genberg, Becky; Koech, Beatrice; Akinyi, Jacqueline; Kamene, Regina; Ndege, Samson; Siika, Abraham M.; Kimayo, Sylvester; Braitstein, Paula; Department of Medicine, IU School of Medicine
    BACKGROUND: HIV linkage and retention rates in sub-Saharan Africa remain low. The objective of this study was to explore perceived health facility barriers to linkage and retention in an HIV care program in western Kenya. METHODS: This qualitative study was conducted July 2012-August 2013. A total of 150 participants including; 59 patients diagnosed with HIV, TB, or hypertension; 16 caregivers; 10 community leaders; and 65 healthcare workers, were purposively sampled from three Academic Model Providing Access to Healthcare (AMPATH) sites. We conducted 16 in-depth interviews and 17 focus group discussions (FGDs) in either, English, Swahili, Kalenjin, Teso, or Luo. All data were audio recorded, transcribed, translated to English, and a content analysis performed. Demographic data was only available for those who participated in the FGDs. RESULTS: The mean age of participants in the FGDs was 36 years (SD = 9.24). The majority (87%) were married, (62.7%) had secondary education level and above, and (77.6%) had a source of income. Salient barriers identified reflected on patients' satisfaction with HIV care. Barriers unique to linkage were reported as quality of post-test counseling and coordination between HIV testing and care. Those unique to retention were frequency of clinic appointments, different appointments for mother and child, lack of HIV care for institutionalized populations including students and prisoners, lack of food support, and inconsistent linkage data. Barriers common to both linkage and retention included access to health facilities, stigma associated with health facilities, service efficiency, poor provider-patient interactions, and lack of patient incentives. CONCLUSION: Our findings revealed that there were similarities and differences between perceived barriers to linkage and retention. The cited barriers reflected on the need for a more patient-centered approach to HIV care. Addressing health facility barriers may ultimately be more efficient and effective than addressing patient related barriers.
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    The value of information and the ethics of personal-genomic screening.
    (The American Journal of Bioethics: AJOB, 2009-04) Schwartz, Peter H.
    Personal genomic screening, especially when marketed direct-to-consumers, threatens to worsen the inefficient use of healthcare resources that Burger and Kass discuss in the case of unproven screening tests. The information that genomic and other screening tests can provide may well have value for many patients, but its effective use in healthcare depends on careful thought about the ethics of testing and the proper regulation of unproven interventions.