Preventive medicine
-
Preventive medicine · Dec 2020
ReviewContributing factors to personal protective equipment shortages during the COVID-19 pandemic.
This study investigates the forces that contributed to severe shortages in personal protective equipment in the US during the COVID-19 crisis. Problems from a dysfunctional costing model in hospital operating systems were magnified by a very large demand shock triggered by acute need in healthcare and panicked marketplace behavior that depleted domestic PPE inventories. ⋯ We conclude that market prices are not appropriate mechanisms for rationing inputs to health because health is a public good. Removing the profit motive for purchasing PPE in hospital costing models, strengthening government capacity to maintain and distribute stockpiles, developing and enforcing regulations, and pursuing strategic industrial policy to reduce US dependence on imported PPE will help to better protect healthcare workers with adequate supplies of PPE.
-
Preventive medicine · Dec 2020
ReviewExamining aspects of successful community-based programs promoting cancer screening uptake to reduce cancer health disparity: A systematic review.
Certain minorities in the US are disproportionately burdened with higher cancer incidence and mortality rates. Programs encouraging timely uptake of cancer screening measures serve to reduce cancer health disparities. A systematic literature review was conducted to assess the effectiveness and the qualities of these programs, and to elucidate characteristics of success programs to aid in designing of future ones. ⋯ Only 7 programs had control groups, only 4 programs independently verified screening uptake, and 2 programs had long-term follow-up (defined as more than one screening cycle). Only one program demonstrated elimination of cancer health disparity at a population level. While most community-based cancer prevention programs have demonstrated efficacy in terms of increased knowledge and/or screening uptake, scalability and demonstration in reduction at a population level remain a challenge.
-
Preventive medicine · Dec 2020
Private/marketplace insurance in community health centers 5 years post-affordable care act in medicaid expansion and non-expansion states.
Community health centers (CHCs) play an important role in providing care for the safety net population. After implementation of the Affordable Care Act, many patients gained insurance through state and federal marketplaces. Using electronic health record data from 702,663 patients in 257 clinics across 20 states, we sought to explore the following differences between Medicaid expansion and non-expansion state CHCs: (1) trends in private/marketplace insurance post-expansion, and (2) whether CHC patients retain private/marketplace insurance. ⋯ While a greater percentage of patients in non-expansion states retained private/marketplace insurance than in expansion states, a greater percentage of those who did not retain it became uninsured. In comparison, a greater percentage of patients in expansion states who lost private/marketplace insurance gained other types of health insurance. CHCs' ability to provide adequate care for vulnerable populations relies, in part, on federal grants as well as reimbursement from insurers: decreases in either could result in reduced capacity or quality of care for patients seen in CHCs.
-
Preventive medicine · Dec 2020
Exceptional mortality risk among police-identified young black male gang members.
Gang membership is associated with many risky behaviors but is often overlooked as a source of mortality among young Americans. Gang Member-Linked Mortality Files (GM-LMFs) match St. Louis, Missouri gang members listed in a law enforcement gang database to mortality records in the National Death Index. ⋯ Louis MSA, Missouri, and the USA. These results identify a key source of excess mortality among young black Americans. Health policies and interventions may be most efficacious when they acknowledge, address, and incorporate information about and target high-risk populations, including gang members, that contribute to relatively high mortality risk in the USA.
-
Preventive medicine · Dec 2020
Randomized Controlled TrialUse of a GP-endorsed non-participant reminder letter to promote uptake of bowel scope screening: A randomised controlled trial in a hard-to-reach population.
Previous research suggests that sending non-participants a reminder letter, 1 year after their initial invitation, can improve coverage for bowel scope screening (BSS), also known as flexible sigmoidoscopy screening. We hypothesised that adding a general practitioner's (GPs) endorsement to the reminder letter could improve coverage even further. We conducted a randomised controlled trial in North West London, UK. ⋯ Adding a GP-endorsement to the annual reminder letter did not have an effect on attendance at BSS. One possible explanation for this is that the endorsement used was not personalised enough. Future research should examine stronger GP-endorsements or other methods to promote uptake.