International Journal for Equity in Health最新文献

{"title":"Refraining from seeking dental care among the Sámi in Sweden: a cross-sectional study.","authors":"Negin Yekkalam, Christina Storm Mienna, Jon Petter Anders Stoor, Miguel San Sebastian","doi":"10.1186/s12939-024-02305-1","DOIUrl":"10.1186/s12939-024-02305-1","url":null,"abstract":"<p><strong>Background: </strong>While equity in health care is the core of the Swedish health system, social inequalities in accessing health care, particularly regarding dental care, exist. There is however no information on how the Sámi population is affected. This study aimed to assess the prevalence and risk factors for refraining from seeking dental care among the Sámi in Sweden.</p><p><strong>Methods: </strong>A Sámi sample was constructed from three pre-existing registers. Among the 9,249 invitations for individuals aged 18-84 years old, 3,779 answered the survey during February-May 2021. We first calculated frequencies and proportions of the independent variables in terms of socio-economic, socio-demographic, and cultural-related factors as well as the outcome, refraining from dental care. Then, we summarized the magnitude of the association between the independent variables and self-reported refrain from dental care with the prevalence difference (PD) using the 95% confidence interval (95% CI) for inferential purposes.</p><p><strong>Results: </strong>Overall, 17.5% of the participants refrained from seeking dental care despite self-reported need in the last three months, with almost the same proportion between men and women. Among the socio-demographic factors, being in the 30-44 years group (PD = 8.0; 95% CI: 3.59, 12.48), in the 45-64 group (PD = 7.3; 95% CI: 2.96, 11.61) and in the 65-84 group (PD = 5.4; 95% CI: 0.92, 9.78) as well as being divorced/widow-er (PD = 6.7; 95% CI: 2.73, 10.70) and unmarried (PD = 3.1; 95% CI: 0.23, 6.04) were statistically significantly associated with refraining from seeking dental care. Among the socio-economic variables, those in the middle-income quintile (PD = 5.3; 95% CI: 1.28, 9.35), in the poor (PD = 8.1; 95% CI: 3.64, 12.51) and poorest (PD = 8.0 95% CI: 3.48, 12.50) quintiles, and especially those experiencing economic stress once (PD = 9.2; 95% CI: 2.93, 15.48) and several times (PD = 26.5; 95% CI: 19.50, 33.43), were strongly associated with refraining.</p><p><strong>Conclusions: </strong>Approximately one in six of the Sámi participating in this study refrained from seeking dental care despite self-reported need in the last three months. Those who experienced economic difficulties were the most affected group. To achieve equity in dental health care in Sweden, policies removing economic barriers to access dental health care should be implemented.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"222"},"PeriodicalIF":4.5,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the role of non-state actors in health service delivery and health system resilience in Myanmar.","authors":"K Than, Maria Paola Bertone, T La, Sophie Witter","doi":"10.1186/s12939-024-02292-3","DOIUrl":"10.1186/s12939-024-02292-3","url":null,"abstract":"<p><strong>Background: </strong>Due to the weaknesses of the public health system and its low reach, especially in border areas, provision of health services by non-state actors (NSAs) has historically played an important role in Myanmar. NSAs include local and international NGOs and civil society organisations (CSOs), but also Ethnic Health Organisations (EHOs) in the border areas, as well as the private (for profit) sector. This study aims to understand the changing role of NSAs in the shifting political environment of Myanmar between 2010 and 2022, and to explore their contribution to health system resilience.</p><p><strong>Methods: </strong>Our study includes three main components: a documentary review (n = 22), key informant interviews (KIIs) at central level (n = 14) and two township-level case studies (13 KIIs, 4 FGDs). Mostly qualitative data were collected in 2022 and synthesized, using a health system resilience framework to structure the analysis.</p><p><strong>Results: </strong>During the transition period (2010-2014) and the new political era (2015-2020), while the country gradually transitioned to a democratic system, the government increasingly recognized NSAs. Initially, engagement with NSAs remained focused on disease-specific activities and government oversight was limited, but later it expanded to health system strengthening, including the start of a \"convergence\" with ethnic health systems. Progress was relatively slow, but defined by a clear vision and plans. The military coup of February 2021 brought a halt to this progress. Collaboration between government and NSAs was interrupted, and NSAs restored previous practices and parallel systems. Initially, most health service provision stopped, but with time coping strategies emerged, which showed the capacity of NSAs to absorb the shocks (focusing on basic services; using informal communication channels; maintaining buffer stocks of supplies) and adapt (changing modes of delivery and supply chains, and adjusting HRH training).</p><p><strong>Conclusions: </strong>The study highlights the role of NSAs during crises, and provides insights on how the resilience capacities built over time by NSAs to provide services in adverse circumstances have informed the response to the latest crisis. While strategies of absorption and adaptation are noted in the study, we did not identify any transformation strategy - which might indicate the difficulty of NSAs to introduce radical changes when subjected to multiple shocks and a hostile political environment.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"221"},"PeriodicalIF":4.5,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators of healthcare access for long COVID-19 patients in a universal healthcare system: qualitative evidence from Austria.","authors":"Peter Gamillscheg, Agata Łaszewska, Stefanie Kirchner, Kathryn Hoffmann, Judit Simon, Susanne Mayer","doi":"10.1186/s12939-024-02302-4","DOIUrl":"10.1186/s12939-024-02302-4","url":null,"abstract":"<p><strong>Background: </strong>Long COVID-19 challenges health and social systems globally. International research finds major inequalities in prevalence and healthcare utilization as patients describe difficulties with accessing health care. In order to improve long-term outcomes it is vital to understand any underlying access barriers, for which relevant evidence on long COVID-19 is thus far lacking in a universal healthcare system like Austria. This study aims to comprehensively identify access barriers and facilitators faced by long COVID-19 patients in Austria and explore potential socioeconomic and demographic drivers in health and social care access.</p><p><strong>Methods: </strong>Applying an exploratory qualitative approach, we conducted semi-structured interviews with 15 experts including medical professionals and senior health officials as well as focus groups with 18 patients with confirmed long COVID-19 diagnosis reflecting varying participant characteristics (age, gender, urbanicity, occupation, education, insurance status) (July-Nov 2023). Data were analysed following a thematic framework approach, drawing on a comprehensive 'access to health care' model.</p><p><strong>Results: </strong>Based on expert and patient experiences, several access barriers and facilitators emerged along all dimensions of the model. Main themes included scepticism and stigma by medical professionals, difficulties in finding knowledgeable doctors, limited specialist capacities in the ambulatory care sector, long waiting times for specialist care, and limited statutory health insurance coverage of treatments resulting in high out-of-pocket payments. Patients experienced constant self-organization of their patient pathway as stressful, emphasizing the need for multidisciplinary care and centralized coordination. Facilitators included supportive social environments, telemedicine, and informal information provided by a nationwide patient-led support group. Differences in patient experiences emerged, among others, as women and younger patients faced gender- and age-based stigmatization. Complementary health insurance reduced the financial strain, however, did not ease capacity constraints, which were particularly challenging for those living in rural areas.</p><p><strong>Conclusions: </strong>The findings of this study indicate a call for action to improve the long COVID-19 situation in Austria by empowering both providers and patients via increased information offerings, strengthened interdisciplinary treatment structures and telemedicine offerings as well as research funding. Our insights on potentially relevant socioeconomic and demographic drivers in access barriers lay the necessary foundation for future quantitative inequality research.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"220"},"PeriodicalIF":4.5,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic disparities in antibiotic-resistant outpatient urine cultures in a Boston hospital, 2015-2020: a cross-sectional analysis.","authors":"Courtney W Chan, Leo K Westgard, Andrew Romasco, Krisztian Gado, Shira Doron, Maya L Nadimpalli","doi":"10.1186/s12939-024-02308-y","DOIUrl":"10.1186/s12939-024-02308-y","url":null,"abstract":"<p><strong>Background: </strong>Antibiotic resistance in uropathogens has rapidly escalated over time, complicating treatment and increasing morbidity and mortality. Few studies have explored how the social determinants of health may be associated with patients' risks for acquiring antibiotic-resistant (AR) uropathogens.</p><p><strong>Methods: </strong>We identified urine cultures collected from outpatients presenting to Tufts Medical Center Primary Care Practices between 2015 and 2020. Specimens were included if patients' age, sex, and residential address were recorded in the electronic medical record (EMR) and if their urine culture yielded Enterococcus spp. or one or more gram-negative bacterial organism(s) or for which antibiotic susceptibility profiling and species identification was conducted. We abstracted patients' sociodemographic characteristics from the EMR and used US Census Bureau data to identify characteristics about patients' census tracts of residence. We evaluated associations between individual- and neighborhood-level characteristics and patients' risk of having a urine culture resistant to (1) three or more antibiotic classes (i.e., multidrug resistant [MDR]), (2) first-line treatments, (3) fluoroquinolones, (4) aminoglycosides, or (5) ceftriaxone using logistic regression models and a Bonferroni correction to account for multiple hypothesis testing.</p><p><strong>Results: </strong>We included urine cultures from 1,306 unique outpatients, most of whom were female (89%). Patients largely self-identified as Non-Hispanic White (36%), Asian (15%), or Non-Hispanic Black (11%). Over 60% lived in an environmental justice-designated census tract. Most included isolates were Escherichia coli (76%) or Klebsiella pneumoniae (7%). Using public insurance increased patients' odds of having a uropathogen resistant to first-line antibiotics, but living in a limited-income neighborhood reduced patients' odds of having a MDR uropathogen by 47%. We noted a strong but non-significant positive trend between speaking a language other than English and having an aminoglycoside-resistant uropathogen (p-value = 0.02). Most notably, after controlling for other factors, we observed no statistically significant associations between race or ethnicity and AR uropathogens.</p><p><strong>Conclusion: </strong>The social determinants of health may play important and intersecting roles in determining a patient's risk of having a resistant uropathogens that is more challenging or expensive to treat. It is crucial to acknowledge how race is likely to be a proxy for other factors affecting health, and to consider that some groups may be disproportionately impacted by antibiotic resistance.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"219"},"PeriodicalIF":4.5,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the availability, affordability, and market dynamics of innovative oncology drugs in Morocco: an original report.","authors":"Nada Benhima, Leila Afani, Mohammed El Fadli, Ismail Essâdi, Rhizlane Belbaraka","doi":"10.1186/s12939-024-02262-9","DOIUrl":"10.1186/s12939-024-02262-9","url":null,"abstract":"<p><strong>Background: </strong>The cost of cancer drugs presents a significant challenge to accessibility of treatment worldwide. Projections indicate that by 2040, two-thirds of cancer cases will occur in low- and middle- income countries. Paradoxically, despite this impending burden, LMICs command less than 5% share of global resources for treating cancer. Morocco, like many LMICs, faces significant obstacles in providing innovative cancer treatments to its population.</p><p><strong>Aim: </strong>Firstly, we aimed to conduct an original research investigating the availability and affordability of innovative cancer drugs in Morocco. Secondly, we sought to review the broader market dynamics, pricing, and reimbursement policies in the country.</p><p><strong>Methods: </strong>For the first objective, we identified a preliminary list of medicines approved for oncological indications in the Moroccan market based on resources from ANAM (National Agency for Health Insurance), pharmacy regulators, and online resources that compile information on approved medicines. For the second objective, we exhaustively reviewed the regulatory documents, legal texts and grey literature reports. All the informations were examined by pharma delegates and local experts.</p><p><strong>Results: </strong>As of January 2024, Morocco has 39 innovative anticancer medicines with market authorization. 30% of these drugs were approved after 2020. The majority of approved drugs were for breast, lung, colorectal, and prostate cancer. The period between FDA approval and entry into the Moroccan market ranges from 2 to 7 years, with a median of 3 years for breast cancer drugs and 7 years for more expensive drugs like Olaparib and Osimertinib. 22 out of the 39 drugs are not reimbursed, with an average reimbursement time of 4 years. Compared to prices in France, the most notable pricing disparities concern immunotherapy agents, priced 600 to 900 euros lower in France, while drugs like Pazopanib and Erlotinib cost 50% less in Morocco.</p><p><strong>Conclusion: </strong>Our study reveals significant disparities in the availability and affordability of innovative cancer drugs in Morocco. Regulatory hurdles, importation challenges, and pricing strategies contribute to this inequitable landscape. Addressing systemic barriers, fostering collaborations between stakeholders, and adopting a value-based pricing approach are imperative steps toward ensuring equitable access to high-quality interventions for patients, regardless of their geographical location.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"217"},"PeriodicalIF":4.5,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding educational inequalities in sports participation through structurally based resources and individual agency - a sequential mediation analysis.","authors":"Andrea L Mudd, Michèlle Bal, Frank J van Lenthe, Carlijn B M Kamphuis","doi":"10.1186/s12939-024-02303-3","DOIUrl":"10.1186/s12939-024-02303-3","url":null,"abstract":"<p><p>Educational inequalities in sports participation remain a public health issue in the Netherlands. Combining structurally based resources from Pierre Bourdieu's theory of capital with Amartya Sen's conceptualization of individual agency may offer new insights into the complex mechanisms that drive these inequalities. Specifically, we posited that the way individuals are able to exercise their agency within the structurally based economic, social, and cultural resources they have access to may help explain educational inequalities in sports participation.Data from two waves of the GLOBE study (2014, 2021) were used to test whether two sequential mediators, structurally based resources followed by individual agency, help explain the relationship between educational level and sports participation. Adults aged 25 and older residing in Eindhoven, the Netherlands self-reported highest attained educational level, structurally based resources (economic, social, and embodied cultural capital), individual agency (self-control, perceived choice, and reflexivity), and sports participation. A sequential mediation analysis using structural equation modelling was used to test the direct effect of education on sports participation, the sequential indirect effect through both mediators, and partial indirect effects through each mediator individually.Educational level was positively associated with sports participation. The hypothesized sequential mediation pathway was not supported; educational level was positively associated with structurally based resources and structurally based resources were positively associated with individual agency, but individual agency was not related to sports participation. Though not through individual agency, structurally based resources helped explain educational inequalities in sports participation.Having access to more economic, social, and cultural resources may empower individuals by increasing their agency. This increased agency was not associated with sports participation, which could be because sports participation is not universally valued as a goal. The conceptualization and operationalization of individual agency in the context of sports participation warrants more research. We found that structurally based resources helped explain a substantial portion of educational inequalities in sport, so we propose that policies alleviating more than just economic barriers to sports participation, but also social and cultural barriers, may help reduce educational inequalities in sports participation in the Netherlands.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"218"},"PeriodicalIF":4.5,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal trend in markers of nutritional status and food consumption of non-village indigenous people in Brazil.","authors":"Brena Barreto Barbosa, Greyceanne Cecília Dutra Brito, Larissa Loures Mendes, Lia Silveira Adriano, Aline Martins de Carvalho, Antonio Augusto Ferreira Carioca","doi":"10.1186/s12939-024-02281-6","DOIUrl":"10.1186/s12939-024-02281-6","url":null,"abstract":"<p><strong>Background: </strong>Non-village indigenous people may face urban lifestyle influences, impacting their nutritional profile. Therefore, this study aimed to analyze the temporal trends in the nutritional status (2008-2023) and food consumption (2015-2023) of non-village indigenous people in Brazil, using data from the Food and Nutrition Surveillance System (SISVAN).</p><p><strong>Methods: </strong>In this time series study, secondary data available on the SISVAN online platform were used. All records of non-village indigenous people from all regions of Brazil were evaluated. Nutritional status was assessed using height-for-age (H/A) and Body Mass Index-for-age (BMI/A) for children and adolescents, and BMI for adults and the elderly. Food consumption trends were analyzed using food consumption screeners, based on specific food groups consumed the day before the assessment. An annual percentage change (APC) was calculated using Prais-Winsten regression models.</p><p><strong>Results: </strong>There was a reduction in severe stunting among children aged 2 to 4 years old (APC = -0.80%; p = 0.025) and 5 to 9 years old (APC = -4.02%; p < 0.001). Adolescents showed an increase in thinness (APC = 0.91%; p = 0.016) and obesity (APC = 4.38%; p < 0.001). In adults and the elderly, there was a decrease in underweight (APC = -5.59%; p = 0.002 and APC = -3.12%; p < 0.001, respectively) and an increase in obesity grade 1 and overweight (APC = 3.81%; p < 0.001 and APC = 1.82%; p < 0.001, respectively). There was an increase in vegetable consumption among children, adolescents and the elderly, and a rise in the consumption of hamburgers and sausages across all age groups.</p><p><strong>Conclusion: </strong>There was an improvement in the nutritional status of children and adolescents, with reduced stunting, but a rise in obesity among adolescents, adults and the elderly. Food consumption trends showed increased consumption of vegetables and ultra-processed foods.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"216"},"PeriodicalIF":4.5,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of government chief nursing and midwifery officers in addressing the social determinants of health inequalities in the who European region.","authors":"Margrieta Langins, Alba Llop-Gironés","doi":"10.1186/s12939-024-02175-7","DOIUrl":"10.1186/s12939-024-02175-7","url":null,"abstract":"<p><p>Health inequalities continue to exacerbate in the European Region, this underlines the need to strengthen the equity impact of public health policies. Nurses and midwives, professional groups that account for 61.8% of the practicing health professionals, work at the point of care, interdisciplinary and see the effects of health inequalities in their everyday work supporting communities and the environment where they are born, live, work and age. The government chief nursing and midwifery officer (GCNMOs) influence, provide policy advice and lead health systems planning and delivery of services. Further to this, it is increasingly being document that they participate in public health policy and inspire others to commit to the implementation of a new vision to strengthen equity impact on population health outcomes. In 2023, a series of discussions with GCNMOs, multidisciplinary researchers and experts, representing 35 of 53 countries in the WHO European Region explored the implications as to how GCNMOs can contribute to addressing the social determinants of health inequalities. Based on this dialogue, we provide a proposal of public health actions for health equity that will benefit from GCNMOs in delivering co-benefits for better health and inclusive growth. These actions can include equity-responsive health systems and health promotion, universal social protection, secure employment and healthy working conditions, environmental protection, education, decent housing, or urban planning among others. Unless governments facilitate the process where GCNMOs have clear mandates, sufficient authority, recognition, and support to engage in policy advocacy, governments will miss out on building fairer and healthier societies that are truly intersectoral and collaborative.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"214"},"PeriodicalIF":4.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Improving accessibility to radiotherapy services in Cali, Colombia: cross-sectional equity analyses using open data and big data travel times from 2020.","authors":"Luis Gabriel Cuervo, Carmen Juliana Villamizar, Daniel Cuervo, Pablo Zapata, Maria B Ospina, Sara Marcela Valencia, Alfredo Polo, Ángela Suárez, Maria O Bula, J Jaime Miranda, Gynna Millan, Diana Elizabeth Cuervo, Nancy J Owens, Felipe Piquero, Janet Hatcher-Roberts, Gabriel Dario Paredes, María Fernanda Navarro, Ingrid Liliana Minotta, Carmen Palta, Eliana Martínez-Herrera, Ciro Jaramillo","doi":"10.1186/s12939-024-02285-2","DOIUrl":"https://doi.org/10.1186/s12939-024-02285-2","url":null,"abstract":"","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"215"},"PeriodicalIF":4.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profiling patterns of patient experiences of access and continuity at team-based primary healthcare clinics (Canada): a latent class analysis.","authors":"Nadia Deville-Stoetzel, Isabelle Gaboury, Djamal Berbiche, Mylaine Breton","doi":"10.1186/s12939-024-02300-6","DOIUrl":"https://doi.org/10.1186/s12939-024-02300-6","url":null,"abstract":"<p><strong>Background: </strong>Access to primary healthcare services is a core lever for reducing health inequalities. Population groups living with certain individual social characteristics are disproportionately more likely to experience barriers accessing care. This study identified profiles of access and continuity experiences of patients registered with a family physician working in team-based primary healthcare clinics and explored the associations of these profiles with individual and organizational characteristics.</p><p><strong>Methods: </strong>A cross-sectional e-survey was conducted between September 2022 and April 2023. All registered adult patients with an email address at 104 team-based primary healthcare clinics in Quebec were invited to participate. Latent class analysis was used to identify patient profiles based on nine components of access to care and continuity experiences. Multinomial logistic regression models were fit to analyze each profile's association with ten characteristics related to individual sociodemographics, perceived heath status, chronic conditions and two related to clinic area and size.</p><p><strong>Results: </strong>Based on 87,155 patients who reported on their experience, four profiles were identified. \"Easy access and continuity\" (42% of respondents) was characterized by ease in almost all access and continuity components. Three profiles were characterized by diverging access and/or continuity difficulties. \"Challenging booking\" (32%) was characterized by patients having to try several times to obtain an appointment at their clinic. \"Challenging continuity\" (9%) was characterized by patients having to repeat information that should have been in their file. \"Access and continuity barriers\" (16%) was characterized by difficulties with all access and continuity components. Female gender and poor perceived health significantly increased the risk of belonging to the three profiles associated with difficulties by 1.5. Being a recently arrived immigrant (p = 0.036), having less than a high school education (p = 0.002) and being registered at a large clinic (p < 0.001) were associated with experiencing booking difficulties. Having at least one chronic condition (p = 0.004) or poor perceived mental health (p = 0.048) were associated with experiencing continuity difficulties.</p><p><strong>Conclusions: </strong>These results highlight individual social and health characteristics associated with increased risk of experiencing healthcare access difficulties, such as immigration status and education level and/or continuity difficulties when having a chronic condition and poor perceived mental health. Facilitating appointment booking for recently arrived immigrants and patients with low education, integrating interprofessional collaboration practices for patients with chronic conditions and improving care coordination and communication for patients with mental health needs are recommended.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"213"},"PeriodicalIF":4.5,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}