Needing Primary Care But Not Getting It: The Role of Trust, Stigma and Organizational Obstacles reported by Homeless Veterans.

Abstract:

:We describe data from a multi-center community-based survey of homeless veterans who were not accessing available primary care to identify reasons for not getting this care as well as for not seeking health care when it was needed. Overall, 185 homeless veterans were interviewed: The average age was 48.7 years (SD 10.8), 94.6% were male, 43.2% were from a minority population. The majority identified a recent need for care and interest in having a primary care provider. Reasons for delaying care fell into three domains: 1) trust; 2) stigma; and 3) care processes. Identifying a place for care (OR 3.3; 95% CI: 1.4-7.7), having a medical condition (OR 5.5; 95% CI 1.9-15.4) and having depression (OR 3.4; 95% CI: 1.4-8.7) were associated with receiving care while not being involved in care decisions was associated with no care (OR 0.7; 95% CI 0.5-0.9). Our findings support the importance of considering health access within an expanded framework that includes perceived stigma, inflexible care systems and trust issues.

authors

O'Toole TP,Johnson EE,Redihan S,Borgia M,Rose J

doi

10.1353/hpu.2015.0077

subject

Has Abstract

pub_date

2015-08-01 00:00:00

pages

1019-31

issue

3

eissn

1049-2089

issn

1548-6869

pii

S1548686915300334

journal_volume

26

pub_type

杂志文章,多中心研究,随机对照试验
  • Health information technology use in a rural clinic: the pharmacist's perspective.

    abstract::Poor communication of medical information during care transitions can lead to medication errors, adverse drug events, and increased health care costs. The crucial pharmacist's role sometimes requires efforts to improve documentation. Here, we describe our experience integrating a pharmacist into a medical team at a fe...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2013.0045

    authors: Brown MA,Bloodworth L,Ross LA

    更新日期:2013-02-01 00:00:00

  • Collaborative development of a randomized study to adapt a diabetes quality improvement initiative for federally qualified health centers.

    abstract::This case study describes how we are translating a diabetes care quality improvement initiative from an insured (HMO) setting into federally qualified health centers (FQHCs). We outline the innovative collaborative processes whereby researchers and FQHC providers adapted this initiative, which includes health informat...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章,随机对照试验

    doi:10.1353/hpu.2012.0132

    authors: Gold R,Muench J,Hill C,Turner A,Mital M,Milano C,Shah A,Nelson C,DeVoe JE,Nichols GA

    更新日期:2012-08-01 00:00:00

  • Racial and ethnic disparities in health: a view from the South Bronx.

    abstract::This study seeks to understand the perspective of Black and Hispanic/Latino residents of the South Bronx, New York, on the causes of persistent racial and ethnic disparities in health outcomes. In particular, it focuses on how people who live in this community perceive and interact with the health care system. Finding...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2006.0026

    authors: Kaplan SA,Calman NS,Golub M,Davis JH,Ruddock C,Billings J

    更新日期:2006-02-01 00:00:00

  • The costs and adequacy of safety net access for the uninsured in Genesee County, Michigan.

    abstract::This commentary examines Genesee County (Flint) Michigan to explore whether a well-structured safety net system is able to provide low-income uninsured people adequate access to care at a reasonable cost. Genessee County is one of the more economically challenged communities in the country. This commentary explores th...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 评论,杂志文章

    doi:10.1353/hpu.2012.0025

    authors: Hall MA,Hamacher L,Johnson JM

    更新日期:2012-02-01 00:00:00

  • Prenatal care use and health insurance status.

    abstract::Many observers explain the prevalence of inadequate prenatal care in the United States by citing demographic or psychosocial factors. But few have evaluated the barriers faced by women with different health insurance status and socioeconomic backgrounds. In this study of 149 women at six hospitals in Minneapolis, insu...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2010.0472

    authors: Oberg CN,Lia-Hoagberg B,Skovholt C,Hodkinson E,Vanman R

    更新日期:1991-10-01 00:00:00

  • Allocating HIV treatment to the adherent: a qualitative study of patient perceptions of their HIV care in the Dominican Republic.

    abstract:BACKGROUND:The Dominican Republic (DR) has provided free antiretrovirals (ARVs) since 2004. Little is known about adherence to ARV regimens in the DR. METHODS:We audio-recorded 53 HIV care visits at a hospital-based clinic in the DR, conducted post-visit interviews with each patient, and observed clinic policies and p...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2014.0190

    authors: Brooks K,Laws MB,Wilson I

    更新日期:2014-11-01 00:00:00

  • Predictors of smoking cessation counseling adherence in a socioeconomically disadvantaged sample of pregnant women.

    abstract::Implementing and evaluating smoking cessation interventions in underserved populations has been found difficult due to high rates of non-adherence to the prescribed protocol. To understand better the barriers to cessation participation, we studied low-income inner-city pregnant women who were enrolled in either a stan...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章,随机对照试验

    doi:10.1353/hpu.2012.0096

    authors: Wen KY,Miller SM,Lazev A,Fang Z,Hernandez E

    更新日期:2012-08-01 00:00:00

  • Impact of perceived racial discrimination on health screening in black women.

    abstract::Perceived discrimination has been shown to be related to health screening behavior. The present study examines the effect of discrimination on cancer screening among women in the Black Women's Health Study. Five self-report items measured discrimination in everyday life and three items measured experiences of major di...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.0.0273

    authors: Mouton CP,Carter-Nolan PL,Makambi KH,Taylor TR,Palmer JR,Rosenberg L,Adams-Campbell LL

    更新日期:2010-02-01 00:00:00

  • Utilization and Cost Analysis of a Chronically Ill, Newly Insured Indigent Population.

    abstract::The Affordable Care Act expanded health insurance for low-income, uninsured individuals. Few longitudinal analyses have investigated how insurance expansion influences cost and utilization among adults with chronic conditions. This study conducted longitudinal analysis investigating time trends in utilization and cost...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2017.0119

    authors: Baek JD,Seidman RL,Finlayson TL

    更新日期:2017-01-01 00:00:00

  • Mental health services: critical component of integrated primary care and substance abuse treatment.

    abstract::The documented high incidence of mental health disorders among individuals in substance abuse treatment argues for the importance of studying the provision of mental health services to this population. This survey documents how the Linkage Programs assembled an array of mental health services based on the assessed hea...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章,多中心研究

    doi:10.1353/hpu.2010.0377

    authors: Brach C,Falik M,Law C,Robinson G,Trent-Adams S,Ulmer C,Wright A

    更新日期:1995-01-01 00:00:00

  • Severity of illness, race, and choice of local versus distant hospitals among the elderly.

    abstract::This study examines travel patterns for hospitalization among elderly patients to address whether there are differences by age and race/ethnicity, and whether the differences persist even when a severe illness occurs. Using the Healthcare Cost and Utilization Project (HCUP) State Inpatient database (SID) of the Agency...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2005.0023

    authors: Basu J

    更新日期:2005-05-01 00:00:00

  • Correlates of HIV Risk-taking Behaviors among African-American College Students: HIV Knowledge and Ethnic Identity.

    abstract::We examined ethnic identity in relation to hazardous alcohol use, illicit drug use, and risky sexual behavior in 266 college students recruited on the campus of a historically Black college/university (HBCU). Participants were primarily African American students participating in HIV education and prevention outreach e...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2017.0058

    authors: Heads AM,Dickson JW,Asby AT

    更新日期:2017-01-01 00:00:00

  • Under the ACA Higher Deductibles and Medical Debt Cause Those Most Vulnerable to Defer Needed Care.

    abstract:OBJECTIVE:Study occurrence and consequences of deductibles and medical debt among privately insured under the Affordable Care Act. METHODS:Analysis of 2012-2016 National Health Interview Survey data on privately insured adults younger than age 65 on the effect of deductibles on medical debt, deferred medical care, and...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2020.0031

    authors: Rabin DL,Jetty A,Petterson S,Froehlich A

    更新日期:2020-01-01 00:00:00

  • Does continuity of care have an effect on diabetes quality measures in a teaching practice in an urban underserved community?

    abstract::Teaching clinics are an important source of care for urban, minority, underserved communities and face great challenges to improve quality of care for diabetics. This study examined the impact of continuity with the same primary care provider on health care process and outcome measures for patients with diabetes treat...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2012.0193

    authors: Younge R,Jani B,Rosenthal D,Lin SX

    更新日期:2012-11-01 00:00:00

  • Impact of providing a medical home to the uninsured: evaluation of a statewide program.

    abstract::Lack of health insurance and a regular source of care (RSOC) are associated with suboptimal health care. This study examined the impact of a statewide program called the Community Healthcare Access Program (CHAP), which provided a RSOC for uninsured persons in Delaware. This cohort study used survey data to compare he...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2005.0050

    authors: Gill JM,Fagan HB,Townsend B,Mainous AG 3rd

    更新日期:2005-08-01 00:00:00

  • An exploration of patients' trust in physicians in training.

    abstract::Several characteristics associated with patient trust are identified. To determine the level of trust patients from disadvantaged circumstances have in their primary care resident physician, and to determine patient and physician characteristics that predict trust, we administered a survey to randomly selected primary...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2004.0018

    authors: Bonds DE,Foley KL,Dugan E,Hall MA,Extrom P

    更新日期:2004-05-01 00:00:00

  • Use of the Health Care for the Homeless Program services and other health care services by homeless adults.

    abstract::This study examined factors associated with the use of the Health Care for the Homeless Program and other health care services by homeless adults. A total of 941 homeless adults were identified in 52 soup kitchens in U.S. communities. Descriptive statistics and logistic regression models were applied. Among homeless a...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:

    authors: Han B,Wells BL,Taylor AM

    更新日期:2003-02-01 00:00:00

  • A community-based pilot study of a diabetes pharmacist intervention in Latinos: impact on weight and hemoglobin A1c.

    abstract::Type 2 diabetes disproportionately affects Latinos increasing their risk of diabetes-related complications. This study used a randomized controlled design with a community-based approach to evaluate the impact of a culturally tailored pharmacist intervention on clinical outcomes in Latino diabetics. The intervention i...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章,随机对照试验

    doi:10.1353/hpu.2014.0003

    authors: Castejón AM,Calderón JL,Perez A,Millar C,McLaughlin-Middlekauff J,Sangasubana N,Alvarez G,Arce L,Hardigan P,Rabionet SE

    更新日期:2013-11-01 00:00:00

  • Patient Experience Of Provider Refusal Of Medicaid Coverage And Its Implications.

    abstract::Previous studies show that many physicians do not accept new patients with Medicaid coverage, but no study has examined Medicaid enrollees' actual experience of provider refusal of their coverage and its implications. Using the 2012 National Health Interview Survey, we estimate provider refusal of health insurance cov...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2016.0096

    authors: Bhandari N,Shi Y,Jung K

    更新日期:2016-01-01 00:00:00

  • Barriers to health care access among refugee asylum seekers.

    abstract:OBJECTIVE:Asylum seekers have poor access to health care. Qualitative data portraying their experience is lacking. METHODS:We conducted focus groups and comprehensive interviews with 35 asylum seekers and 15 expert providers/advocacy organization representatives. Purposive sampling was used to recruit subgroups. Inter...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2011.0047

    authors: Asgary R,Segar N

    更新日期:2011-05-01 00:00:00

  • Challenges to tuberculin screening and follow-up in an urban Aboriginal sample in Montreal, Canada.

    abstract::We sought to describe the prevalence and predictors of tuberculin skin test (TST) reactors in a high-risk sample of urban Aboriginal people, and to evaluate adherence to medical evaluation and latent tuberculosis infection (LTBI) treatment among those with TST reactivity. Of the 164 participants tested, 86% returned f...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.0.0029

    authors: Brassard P,Anderson KK,Schwartzman K,Macdonald ME,Menzies D

    更新日期:2008-05-01 00:00:00

  • The effect of living in the United States on body mass index in refugee patients.

    abstract:BACKGROUND:We describe body mass index (BMI) trajectories over 20 months in newly settled refugees in the United States. METHODS:Growth curves were modeled in in hierarchical linear modeling for cohorts from Southeast Asia, Africa, and the Middle East. RESULTS:For refugees from Southeast Asia and Africa, coefficients...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2015.0046

    authors: Careyva B,LaNoue M,Bangura M,de la Paz A,Gee A,Patel N,Mills G

    更新日期:2015-05-01 00:00:00

  • Inadequate access to care among children with asthma from Spanish-speaking families.

    abstract::Despite substantial asthma prevalence and morbidity, children from Spanish-speaking families are at high risk of inadequate maintenance therapy. The reasons for this remain unclear. The objective of this study was to compare patterns of asthma morbidity and access to care of children with asthma from Spanish-speaking ...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2005.0005

    authors: Brotanek JM,Halterman J,Auinger P,Weitzman M

    更新日期:2005-02-01 00:00:00

  • Community based health insurance schemes: lessons from rural Kenya.

    abstract:BACKGROUND:Health care costs are often a hindrance to seeking health care. Community-based health care insurance schemes (CBHIS) is a suitable alternative to conventional health insurance schemes which are often beyond the budget of majority of rural residents in Africa. Following establishment of a model CBHIS in the ...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2014.0023

    authors: Kamau N,Njiru H

    更新日期:2014-02-01 00:00:00

  • Disparities in adherence to hypertensive care in urban ambulatory settings.

    abstract::Nationally, a higher proportion of the medically underserved than of the general population suffer from hypertension. Poorer adherence to recommended therapies (including medication regimens, salt intake reduction, and regular visits with provider) has been linked to poorer blood pressure control. To identify whether ...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.0.0259

    authors: Ndumele CD,Shaykevich S,Williams D,Hicks LS

    更新日期:2010-02-01 00:00:00

  • Racial Disparities in PAD-Related Amputation Rates among Native Americans and non-Hispanic Whites: An HCUP Analysis.

    abstract:INTRODUCTION:This study analyzed the impact of sociodemographic characteristics, patient comorbidities, risk factors for critical limb ischemia and hospital characteristics on racial disparities in amputation rates for Native American patients with peripheral artery disease (PAD). METHODS:The study used the Healthcare...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2018.0058

    authors: Rizzo JA,Chen J,Laurich C,Santos A,Martinsen BJ,Ryan MP,Kotlarz H,Gunnarsson C

    更新日期:2018-01-01 00:00:00

  • Creating Culturally-Specific and Community-Specific Approaches to Linking Low Socioeconomic Smokers to Cessation Services.

    abstract::While smoking has declined, rates remain alarmingly high for people of low socioeconomic status. Funding community-based organizations to link low socioeconomic status smokers to cessation services holds promise for reaching this population. This approach also shows potential for elevating addressing tobacco use as a ...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2019.0065

    authors: Specktor C,Keller PA

    更新日期:2019-01-01 00:00:00

  • Quality of hepatitis C care at an urban tertiary care medical center.

    abstract:BACKGROUND:More effective treatment for hepatitis C virus (HCV) creates an opportunity to improve health outcomes. OBJECTIVE:To use Centers for Medicare and Medicaid Services (CMS)-defined HCV quality indicators (QI) as a framework to assess the quality of care at an urban safety net hospital. DESIGN:Retrospective co...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2014.0093

    authors: Assoumou SA,Huang W,Horsburgh CR,Mus,Linas BP

    更新日期:2014-05-01 00:00:00

  • Prevalence of Untreated Hearing Loss by Income among Older Adults in the United States.

    abstract::Age-related hearing loss is highly prevalent and only 20% of adults with hearing loss report using hearing aids. A major barrier to increased hearing aid use is the high out-of-pocket costs associated with hearing aids. The objective of this brief report is to estimate the numbers of millions of Americans 60 years or ...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2016.0164

    authors: Mamo SK,Nieman CL,Lin FR

    更新日期:2016-01-01 00:00:00

  • "The god of death takes half of our children": health of women and children in the Sundarbans Islands.

    abstract::Grassroots level health care workers provided insights into rural women's health concerns at a program development workshop held at Sundarban Islands in West Bengal, India. This report describes these narratives and identifies strategies for potential intervention plans. The narratives suggest layers of disenfranchise...

    journal_title:Journal of health care for the poor and underserved

    pub_type: 杂志文章

    doi:10.1353/hpu.2013.0069

    authors: Biswas B

    更新日期:2013-05-01 00:00:00