AIM To describe the characteristics of adults who needed to see a doctor in the past year but could not due to the extra cost and assess the impact of limited financial resources on the receipt of routine fecal occult...AIM To describe the characteristics of adults who needed to see a doctor in the past year but could not due to the extra cost and assess the impact of limited financial resources on the receipt of routine fecal occult blood test, sigmoidoscopy, or colonoscopy for colon cancer screening among insured patients. METHODS Data obtained from the 2012 Behavioral Risk Factor Surveillance System included 215436 insured adults age 50-75 years. We computed frequencies, adjusted odds ratios(a ORs), and 95%CIs using SAS v9.3 software. RESULTS Nine percent of the study population needed to see a doctor in the past year but could not because of cost. The numbers were significantly higher among those aged 50-64(P < 0.0001), Non-Hispanic Whites(P < 0.0001), and those with a primary care physician(P < 0.0001) among other factors. Adjusting for possible confounders, a ORs for not seeing the doctor in the past year because of cost were: stool occult blood test within last year a OR = 0.88; 95%CI: 0.76-1.02, sigmoidoscopy within last year a OR = 0.72; 95%CI: 0.48-1.07, colonoscopy within the last year a OR = 0.91; 95%CI: 0.81-1.02. CONCLUSION We found that the limited financial resources within the past 12 mo were significantly associated with colorectal cancer(CRC) non-screening. Patients with risk factors identified in this study should adhere to CRC guidelines and should receive financial help if needed.展开更多
Background Social innovation(SI)in health holds potential to contribute to health systems strengthening and universal health coverage(UHC).The role of universities in SI has been well described in the context of high-...Background Social innovation(SI)in health holds potential to contribute to health systems strengthening and universal health coverage(UHC).The role of universities in SI has been well described in the context of high-income countries.An evidence gap exits on SI in healthcare delivery in the context of low-and middle-income countries(LMICs)as well as on the engagement of universities from these contexts.There is thus a need to build capacity for research and engagement in SI in healthcare delivery within these universities.The aim of this study was to examine the adoption and implementation of network of university hubs focused on SI in healthcare delivery within five countries across Africa,Asia and Latin America.The objectives were to describe the model,components and implementation process of the hubs;identify the enablers and barriers experienced and draw implications that could be relevant to other LMIC universities interested in SI.Methods A case study design was adopted to study the implementation process of a network of university hubs.Data from documentation,team discussions and post-implementation surveys were collected from 2013 to 2018 and analysed with aid of a modified policy analysis framework.Results/discussion SI university-based hubs serve as cross-disciplinary and cross-sectoral platforms,established to catalyse SI within the local health system through four core activities:research,community-building,storytelling and institutional embedding,and adhering to values of inclusion,assets,co-creation and hope.Hubs were implemented as informal structures,managed by a small core team,in existing department.Enablers of hub implementation and functioning were the availability of strong in-country social networks,legitimacy attained from being part of a global network on SI in health and receiving a capacity building package in the initial stages.Barriers encountered were internal institutional resistance,administrative challenges associated with university bureaucracy and annual funding cycles.Conclusion展开更多
文摘AIM To describe the characteristics of adults who needed to see a doctor in the past year but could not due to the extra cost and assess the impact of limited financial resources on the receipt of routine fecal occult blood test, sigmoidoscopy, or colonoscopy for colon cancer screening among insured patients. METHODS Data obtained from the 2012 Behavioral Risk Factor Surveillance System included 215436 insured adults age 50-75 years. We computed frequencies, adjusted odds ratios(a ORs), and 95%CIs using SAS v9.3 software. RESULTS Nine percent of the study population needed to see a doctor in the past year but could not because of cost. The numbers were significantly higher among those aged 50-64(P < 0.0001), Non-Hispanic Whites(P < 0.0001), and those with a primary care physician(P < 0.0001) among other factors. Adjusting for possible confounders, a ORs for not seeing the doctor in the past year because of cost were: stool occult blood test within last year a OR = 0.88; 95%CI: 0.76-1.02, sigmoidoscopy within last year a OR = 0.72; 95%CI: 0.48-1.07, colonoscopy within the last year a OR = 0.91; 95%CI: 0.81-1.02. CONCLUSION We found that the limited financial resources within the past 12 mo were significantly associated with colorectal cancer(CRC) non-screening. Patients with risk factors identified in this study should adhere to CRC guidelines and should receive financial help if needed.
文摘Background Social innovation(SI)in health holds potential to contribute to health systems strengthening and universal health coverage(UHC).The role of universities in SI has been well described in the context of high-income countries.An evidence gap exits on SI in healthcare delivery in the context of low-and middle-income countries(LMICs)as well as on the engagement of universities from these contexts.There is thus a need to build capacity for research and engagement in SI in healthcare delivery within these universities.The aim of this study was to examine the adoption and implementation of network of university hubs focused on SI in healthcare delivery within five countries across Africa,Asia and Latin America.The objectives were to describe the model,components and implementation process of the hubs;identify the enablers and barriers experienced and draw implications that could be relevant to other LMIC universities interested in SI.Methods A case study design was adopted to study the implementation process of a network of university hubs.Data from documentation,team discussions and post-implementation surveys were collected from 2013 to 2018 and analysed with aid of a modified policy analysis framework.Results/discussion SI university-based hubs serve as cross-disciplinary and cross-sectoral platforms,established to catalyse SI within the local health system through four core activities:research,community-building,storytelling and institutional embedding,and adhering to values of inclusion,assets,co-creation and hope.Hubs were implemented as informal structures,managed by a small core team,in existing department.Enablers of hub implementation and functioning were the availability of strong in-country social networks,legitimacy attained from being part of a global network on SI in health and receiving a capacity building package in the initial stages.Barriers encountered were internal institutional resistance,administrative challenges associated with university bureaucracy and annual funding cycles.Conclusion
