RESUMO
The prevalence of overweight/obesity is disproportionately higher among racial/ethnic minority and low-income patients. The purpose of this study was to survey racially diverse, low-income patients regarding their experiences with and desires regarding their providers' involvement in weight management. Adult patients (N = 529), including mostly African American (42.7%), White (44.6%) and low-income (55.5% with incomes <$30 000) patients from 7 Patient-Centered Medical Homes voluntarily completed a brief anonymous survey while waiting to see their providers. Only 19.8% of the patients said that their primary care provider frequently or very frequently talked with them about their weight. Older patients as compared to younger patients, as well as males compared to females, were more likely to have their primary care provider talk to them about their diet and physical activity during the last year. It was also found that 56.9% of the patients were interested in getting help from their doctor to connect with resources for weight management in their community. African American patients, as compared to White patients, were more interested in getting such help. These results suggest that there is a need to establish healthcare policies and training in primary care settings that are designed to ensure that primary care providers routinely talk with all of their patients, including their female and older patients, about their weight and weight management services. Additionally, primary care administrators need to play an increased role in identifying, developing, and advocating for affordable weight management services, particularly in African American and low-income communities.
Assuntos
Atitude do Pessoal de Saúde , Negro ou Afro-Americano/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Obesidade/terapia , Pacientes/psicologia , Papel do Médico , Médicos de Atenção Primária/psicologia , Atenção Primária à Saúde , População Branca/psicologia , Adolescente , Adulto , Fatores Etários , Idoso , Comunicação , Assistência à Saúde Culturalmente Competente , Feminino , Pesquisas sobre Atenção à Saúde , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Disparidades em Assistência à Saúde , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Obesidade/fisiopatologia , Obesidade/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Assistência Centrada no Paciente , Relações Médico-Paciente , Pobreza , Comportamento de Redução do Risco , Fatores Sexuais , Programas de Redução de Peso , Adulto JovemRESUMO
Recent increases in pathology costs per scheme member are a concern to medical schemes and pathologists alike. To better understand the observed increasing costs, the National Pathology Group commissioned Prognosys to analyse the trends affecting these increases. We found that these increases are driven by inflation, increases in utilisation, and redistribution of the burden of cost. The identification of utilisation as a cost driver for pathology services is noteworthy as almost all pathology services are by referral from another doctor.
Assuntos
Técnicas de Laboratório Clínico/economia , Técnicas de Laboratório Clínico/estatística & dados numéricos , Custos de Cuidados de Saúde , Patologia Clínica/organização & administração , Humanos , África do SulRESUMO
Cancer screening participation shows a strong, graded association with socioeconomic status (SES) not only in countries such as the United States, where insurance status can be a barrier for lower income groups, but also in the United Kingdom, where the National Health Service provides all health care to residents, including screening, for free. Traditionally, the literature on socioeconomic inequalities has focused on upstream factors, but more proximal (downstream) influences on screening participation also need to be examined, particularly those that address the graded nature of the association rather than focusing specifically on underserved groups. This review offers a framework that links some of the components and corollaries of SES (life stress, educational opportunities, illness experience) to known psychosocial determinants of screening uptake (beliefs about the value of early detection, fatalistic beliefs about cancer, self-efficacy). The aim is to explain why individuals from lower SES backgrounds perceive cancer screening tests as more threatening, more difficult to accomplish, and less beneficial. A better understanding of the mechanisms through which lower SES causes negative attitudes toward screening could facilitate the development of intervention strategies to reduce screening inequalities.
Assuntos
Disparidades em Assistência à Saúde , Programas de Rastreamento , Neoplasias/prevenção & controle , Atitude Frente a Saúde , Escolaridade , Pesquisa sobre Serviços de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Programas de Rastreamento/economia , Programas de Rastreamento/estatística & dados numéricos , Modelos Teóricos , Neoplasias/diagnóstico , Psicologia , Fatores SocioeconômicosRESUMO
BACKGROUND: Introduction of organised, population-based, colorectal cancer screening in the United Kingdom using the faecal occult blood test (FOBT) has the potential to reduce overall colorectal cancer mortality. However, socio-economic variation in screening participation could exacerbate existing inequalities in mortality. METHODS: This study examined FOBT uptake rates in London, England in relation to area-level socio-economic deprivation over the first 30 months of the programme during which 401 197 individuals were sent an FOBT kit. Uptake was defined as return of a completed test kit within 3 months. Area-level deprivation in each postcode sector was indexed with the Townsend Material Deprivation Index. Analyses controlled for area-level household mobility, ethnic diversity and poor health, each of which was associated with lower return rates. RESULTS: The results showed a strong socio-economic gradient in FOBT uptake, which declined from 49% in the least deprived quintile of postcodes to 38% in the middle quintile and 32% in the most deprived quintile. Variation in socio-economic deprivation between sectors accounted for 62% of the variance in return rates, with little attenuation as a result of controlling for ethnic diversity, household mobility or health status. CONCLUSION: These results highlight the need to understand the causes of socio-economic gradients in screening participation and address barriers that could otherwise increase disparities in colorectal cancer survival.
Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer , Programas de Rastreamento , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/prevenção & controle , Inglaterra , Humanos , Sangue Oculto , Fatores SocioeconômicosRESUMO
Postmenopausal women should undergo endometrial assessment when bleeding occurs in the absence of replacement hormone therapy, after a 1-year regimen of continuous-combined hormone replacement therapy, or at an unexpected time during cyclic replacement therapy. Endometrial assessment can be accomplished by endometrial biopsy, transvaginal ultrasonography, or hysteroscopy. Dilation and curettage should be reserved for those rare cases when the other methods are infeasible. Each method of assessment has advantages and disadvantages, and the choice of method should be made accordingly.