Military Medical Readiness and Patient Experience with Access to Care.

OBJECTIVES: Introduction: Medical readiness is an integral component of total readiness and a prime indicator of an individual's overall fitness to deploy. Promoting medical readiness is the prime directive for military medical departments; however, there are few studies evaluating specific factors of care delivery that will improve medical readiness. In this study, we evaluated one of the common patient perceptions that access to routine and specialty care will have a positive effect on military medical readiness. Surprisingly, there appeared to be a reverse relationship between a patient's perception of access to care and the correlation to their medical readiness. MATERIALS AND METHODS: This study uses the Joint Outpatient Experience Survey data of Army active duty soldiers (December 2017 through May 2018) to investigate the relationship between access to care and medical readiness. Medical readiness scores were examined a month before and a month after a medical encounter. Medical Readiness Categories (MRC) were collected from the Army Medical Operational Data System Mainframe. Respondents of the survey were matched to MRC data. Comparisons were made using chi-square tests and Wilcoxon rank-sum non-parametric tests to determine whether there were differences in readiness and patient experience ratings before and after the encounter. Logistic regressions were also conducted to predict the odds of non-readiness based on the type of health care visit. RESULTS: Soldiers who were medically non-ready were more likely to be above age 35 years or have specialty care encounters. Results indicated those meeting all medical readiness requirements or having minor medical issues that could be resolved quickly, generally rated access to care slightly lower compared to those who were medically non-ready. Musculoskeletal Injuries (MSKIs) are the leading cause of medical non-readiness. As a result, this study explored access to care for MSKIs. Although there were no statistical differences in access ratings for those with MSKIs compared to those without MSKIs, there were statistically significant differences in self-reported health. Individuals with MSKIs tended to report poorer health status. Those with specialty care visits had 1.79 times significantly greater odds (p is less than .05) of being non-medically ready compared to those with primary care. For visits related to MSKI (e.g., physical medicine, orthopedic, or chiropractic etc.), those with an orthopedic or occupational therapy visit had 1.25 and 1.59 significantly greater odds (p is less than .05) of being considered not medically ready compared to all other MSKI related visits before the encounter. However, after the encounter, those with orthopedic care had significantly higher odds of improved readiness. CONCLUSIONS: Findings from this study help contextualize who is considered medically non-ready as well as differences in access to care experiences for this group. The lowest scoring areas for improving access to care include ease of making appointment, time between scheduling an appointment and the visit, and being seen past the scheduled time. Given that musculoskeletal injuries tend to require long term specialized treatments such as physical and occupational therapy, findings from the logistic regressions suggest that access and adherence to such treatments, particularly for orthopedic care, are helpful in improving medical readiness.

An Analysis of Patient Experience and Adherence to Diabetes Medication among Military Health System Beneficiaries.

OBJECTIVE: Few studies have investigated the relationship between patient experience and diabetes medication adherence among Military Health System (MHS) beneficiaries. We explored the link between patient experience survey ratings and adherence to diabetes medication. The hypothesis was that adherent patients would report better provider-patient experience than non-adherent patients. METHODS: Data included 2,599 patient surveys and pharmacy refill records. Adherence was determined using proportion of days covered (PDC) methodology where a patient must have had medications available 80% or more of the time during the observation period. Analysis involved multivariable logistic regression. RESULTS: Medication adherence was 60.2%. Regarding patient experience, those who were with their provider for 5 years or more had greater odds of adherence (OR 1.86[95%CI 1.19, 2.90]) Most of the patients in this study had high morbidity and high care utilization. Patient characteristics that significantly (p is less than 0.05) differentiated adherent versus non-adherent patients were race, mental health status, multiple medication use, glycated hemoglobin (HbA1c) levels, and health utilization. CONCLUSION: Two key factors of adherence that emerged from this study are that moderate (OR 2.54[95%CI 1.35, 4.75]) and elevated (OR 2.35[95%CI 1.29, 4.30]) HbA1c and patients with 7+ health care providers (OR 1.56[95%CI 1.06,2.29]) had greater odds of adherence. Findings suggest that ability to see provider when needed and provider continuity support adherence to treatment. The practice implications of this study are health practitioners can leverage patient experience and pharmacy data to identify patterns of adherence among patients in the MHS.

Military Health System Access to Care: Performance and Perceptions.

INTRODUCTION: Access to care (ATC) is an important component of providing quality healthcare. Clinics need to be able to accurately measure access; however, patients' reports of access may be different from performance-based data gathered using administrative measures. The purpose of this research is to examine the relationship between ATC administrative data and patient survey results. MATERIALS AND METHODS: This is a retrospective study performed in military medical treatment facilities. Survey data were obtained from the Joint Outpatient Experience Survey (JOES), and administrative data were collected from the Military Health System Data Repository. The data period was from May 2016 through March 2017 for 135 parent Military Treatment Facilities. This study was approved under the Defense Health Agency Internal Review Board (IRB number: CDO-15-2025). The analyses compare JOES ATC measures to administrative ATC measures. Overall correlation analyses and multivariate regression analyses were performed in order to generate observable correlations between access and healthcare measures (both administrative measures and patient survey items). RESULTS: Results show moderate correlations between the facilities' ATC survey items and administrative measures. These correlations were affected by the composition of the facility patient mix. The patient-based ATC measures from the JOES survey are related to administrative ATC measures collected and monitored by the facilities. In each final regression model, the coefficients for the ATC administrative variables were significant and negative which indicates that as the wait time for an appointment increases, patients' ratings of the time between scheduling and appointment dates declines and patients' assessments of being able to see a provider declines as well. CONCLUSIONS: Measuring ATC is a vital step in ensuring the health of patients and the provision of high quality care. Both patient surveys and administrative data are widely used for measuring ATC. This study found statistically significant moderate associations between survey and administrative ATC measures, which remained significant even after controlling for patient characteristics of the facilities. These study results suggest that administrative data can provide an accurate assessment of access; however, survey items can be useful for diagnosing potential issues with access, such as call center scheduling and provider availability. Future studies should explore the gaps in research surrounding best practices at facilities which have high patient experience with access, and look at other survey measures related to access, such as telephone resources and web-based communication programs.

Guns in the Home and the Possibility of Aggressive Tendencies: Exploring a Community Sample of Adolescents in Low-Income Communities.

Firearm violence has been the second leading cause of death among adolescents and young adults in the United States since 2000 and is a major public health concern. But firearms may be related to less lethal forms of violence as well. Here we examine the relationship between the presence of a gun in the home and several behavioral and psychosocial measures related to aggression and violence among adolescents using data from a community-based survey of nearly 2,000 youths living in low-income neighborhoods. Our results indicate that adolescents living in homes where a gun is present display more aggressive attitudes and behaviors than their counterparts living in homes with no gun present. More research is needed to better understand the mechanisms underlying the relationships, but they may relate to a weapon's effect or social learning.

Maternal Health Status and Parenting Stress in Low-Income, Ethnic-Minority Mothers of Children with Conduct Disorder Problems: the Role of Daily Parenting Hassles.

OBJECTIVES: Minimal attention has been given to understanding parenting stress among low-income, ethnically diverse mothers of children with conduct problems. Maternal health and parenting hassles may serve as important risk factors for parenting stress. This study examined whether parenting hassles mediated the relations between maternal physical and mental health and parenting stress in a sample of low-income, ethnically diverse mothers of children with behavioral problems. METHODS: The sample included 177 low-income black, Latina, and white mothers of kindergartners with behavior problems. Path analysis was employed to assess the associations between maternal mental and physical health and parenting stress, as well as the moderating role of parenting hassles in this cross-sectional study. RESULTS: After adjusting for covariates, we found that parenting hassles mediated the relationship between social support and parenting stress as well as maternal health and parenting stress. CONCLUSION: Findings suggest that promoting coping resources for daily parenting hassles and supporting the physical and mental health of minority mothers may have important implications for parenting children with high behavior problems.

A cultural lens to understanding daily experiences with type 2 diabetes self-management among clinic patients in M'bour, Senegal.

Diabetes is a steadily increasing threat in Sub-Saharan Africa (SSA). Factors such as urbanization, obesity, physical inactivity, and inadequate access to healthcare are believed to contribute to the increasing burden of diabetes. Interventions that optimize diabetes self-management are critically important since obtaining diabetes medications is challenging due to cost constraints and availability. Culture is a significant factor in shaping health behaviors such as diabetes self-management, where individual health behaviors operate in confluence with family, community, and social structures. This study examined experiences with diabetes self-management among clinic patients residing in M'bour, Senegal, using the PEN3 model as a cultural framework. Results indicate that financial challenges related to accessing medical care and adhering to the prescribed diabetic diet were the main barriers to diabetes management. Family dynamics serve as both supportive and inhibiting forces that influence the aforementioned barriers.