Bakgrund: Hemlöshet är ett utbrett globalt problem. I Sverige lever cirka 33 000 personer i någon form av hemlöshet. Personer i hemlöshet har ofta både fysisk och psykisk ohälsa förutom multipla sociala besvär. För att personer i hemlöshet, med komplexa behov, ska få adekvata insatser gällande vård-och omsorgsinsatser behövs individuella åtgärder och samverkan mellan olika instanser. Ledorden för Agenda 2030 understryker att ingen ska lämnas utanför och möjlighet till hälsa och tillgång till vård ska ses som mänskliga rättigheter. Samtidigt undviker personer i hemlöshet att söka vård i större utsträckning än andra. Att vård- och omsorgsinsatser samordnas och organiseras så att de används och uppskattas av personer som lever i hemlöshet är en förutsättning för att nå ambitionen om jämlik vård. Syfte: Syftet var att beskriva vilka erfarenheter personer som lever i hemlöshet har kring samverkan av vård- och omsorgsinsatser.   Metod: En litteraturöversikt vars resultat grundas på tio vetenskapliga artiklar. Resultat: Resultat presenteras i två kategorier; Brister i planering, samverkan och utskrivning och Behov att skapa tillgänglig kontinuerlig och individanpassad vård. Det framkom att de hinder som fanns för att personer i hemlöshet skulle söka vård reducerades genom uppsökande verksamhet och samverkan vilket gav tillgång och kontinuitet i vård- och omsorgsinsatser. Med hjälp av vårdsamordnare kunde förtroendefulla vårdrelationer formas där komplexa behov tillgodosågs.  Sammanfattning: Personer som lever i hemlöshet upplever bristande tillgång till vård och stöd de är i behov av. Bristande kommunikation mellan huvudmän leder till att personer i hemlöshet känner sig negligerade. Ansvar läggs idag på att personer i hemlöshet själva ska navigera i svårtolkade strukturella system. Vårdsamordnare behövs för att kunna främja vårdkontinuitet. Personcentrerade insatser behövs för att tillgodose behov hos personer som lever i hemlöshet. / Background: Homelessness is a widespread global problem. In Sweden, approximately 33,000 people live in some form of homelessness. People in homelessness often have both physical and mental illnesses in addition to multiple social struggles. In order for homeless people with complex needs to receive adequate care and care interventions, individual measures and cooperation between different agencies are needed. The guiding word for Agenda 2030 emphasize that no one should be left out and the opportunity for good health and access to care should be seen as human rights. At the same time, people in homelessness avoid seeking care to a greater extent than others. That care and care interventions are coordinated and organized so that they are used and appreciated by people living in homelessness is a prerequisite for achieving the ambition of equal care. Aim: The aim was to describe the experiences people who live in homelessness have regarding health and welfare interventions.  Method: A literature review based on ten scientific articles. Results: The results are presented in two categories; Deficiencies in planning, collaboration and discharge and the need to create accessible continuous and individually tailored care. The results showed that the obstacles that existed for homeless people to seek care were reduced with the help of outreach services and cooperation. This gave homeless people access and continuity of care and social care efforts. Through a care coordinator, trusting care relationships could be formed where complex needs were met.  Summary: People living in homelessness feel that they do not receive the care and support they need. Lack of communication between organizers leaves people experiencing homelessness feeling neglected. Today, responsibility is placed on people living in homelessness to navigate difficult-to-interpret structural systems themselves. Care coordinators are needed in order to promote continuity of care. Person-centered interventions are needed to meet the needs of people living in homelessness.

The tremendous need for comprehensive healthcare among underserved populations has been well documented. Most of the healthcare resources have been allocated to major metropolitan areas and largely populated cities. In Massachusetts alone, 500,000 people are not serviced by proper healthcare because they are unemployed or underinsured. They do not have a home base for their needs, most visit emergency rooms or minute clinics for care. They lack continuity of care. For minorities and underserved populations, there is a gap in the healthcare system. Statistics have shown that the lower your socioeconomic status, the more advanced the disease has progressed before it is diagnosed, leading to fewer treatment options and poorer outcomes. This is often due to Healthcare Deserts / Health Professions Shortage Areas in the US where there is a true lack of access to healthcare resources. One effective system for healthcare belongs to the Cuban government. Since the revolution in 1949, one of the main goals of the Cuban government was to provide primary care to all its population. The system before the revolution was centralized in the cities and was available mostly to the wealthy and urban populations while the remaining population was left with a substandard and underfunded system like many developed and undeveloped countries. In this paper, we will explore the success of the Cuban system and extrapolate some aspects of its system to use in the underserved populations that inhabit Healthcare Deserts. Implementation of systems will create an Oasis of providers that will naturally improve the well-being of populations leading to the well-being of federally funded state and local resources. The Cuban system divided the country into a grid system and each grid was subsequently divided into even smaller areas with a population of approximately one thousand. A primary care team consisting of a doctor and a nurse was assigned to each grid, including a dental component, and charged with the health and well-being of the population. This system was so successful that it was exported to other countries such as Venezuela, and it was adopted by the World Health Organization as the healthcare model standard to be followed in their world efforts. These programs have been implemented in Latin America, Africa, and Asia with different levels of success due to resource availability and financial constraints. In Venezuela during the Chavez administration, the system was implemented and achieved its highest level of success by benefiting the poor and underserved while Chavez was in power, creating thousands of clinics and improving the healthcare of the population. In Africa, Tanzania adopted the primary care approach at its new dental school and is producing strong clinicians versed with this approach. In Asia, the WHO has made progress in some areas; however, success has proven dependent on the country’s political and financial situation. The primary care approach that the system embraces, emphasizes prevention and education at a very early stage. This is key, and the data proves the success of campaigns even with limited resources provided there is the involvement of the local population. In contrast, United States resources are concentrated on the coasts and urban locations such that the rural areas have the least resources, and people in rural locations often travel long distances to access healthcare. A few states in the US have implemented programs that have been successful – Colorado, North Carolina, and New Mexico. If we successfully transplant teams of healthcare providers, including doctors, dentists, nurses, pharmacist, optometrist, obstetrics /gynecology, pediatricians, and a complete and sustainable health center into empty grids, slowly a series of Oasis will be created and access to care will improve. This change needs to happen at multiple levels, it is a task that must be taken collectively, from the teaching institutions exposing healthcare students to the need for providers in these rural and underserved areas, increasing funding to provide more scholarships and programs that funnel recent graduates into these areas with a sustainable and self-replenishing model, and most important, emphasizing education and prevention in dental school curriculum as the key to improving healthcare, and creating Oases in the current deserts.

No description available.

The purpose of this study was to find out the attitudes and beliefs of minority college students enrolled at Missouri College in Brentwood, Missouri in reference to the dental hygiene profession. In particular, does their oral health and dental knowledge relate to their knowledge of profession of dental hygiene? One hundred and six students gave their consent to participate in the study via Survey Monkey. The study was conducted in May 2015 for a period of four weeks. Four statements were designed to gauge minority students’ knowledge of dental hygiene as a career. No differences were found based on gender, age, education and ethnicity. A difference was found based upon the respondent’s program of study. Further research is needed spread the word about dental hygiene programs and to explain the role of the dental hygienist.

The purpose of this study was to examine patient attitudes and opinions regarding the advancement of a mid-level dental provider, such as the ADHP, in an effort to better understand the perceptions of those who may one day be in a position to receive care from this type of provider. In this quantitative study, I analyzed the differences between those with and without access to dental care and evaluated differences among respondents based upon their socioeconomic and demographic attributes. I collected data from patients treated at Mt. Juliet Family & Cosmetic Dentistry and at the Coweta Samaritan Clinic via a 17-item questionnaire. Most respondents would be willing to accept treatment from someone in this role. The majority of respondents also believed it would be a positive step towards meeting the needs of the uninsured and underserved. Demographic data had no significant impact on their opinion of this role.

This qualitative study focused on the dental disparities in Blount County, TN and sought to determine if there are enough dental clinics within the dental safety net. Interviews were conducted with 18 individuals who were either service providers or clients of organizations such as the Salvation Army, Alcoa Good Samaritan Clinic, the local health department, Trinity Dental Clinic, Volunteer Ministry Center, Remote Area Medical, and Blount Memorial Hospital. Inclusion criteria for clients included: homeless or living below the poverty level, uninsured, 18 to 65 years of age, has not seen a dentist in the past year and currently suffering a dental problem. The most obvious common theme among the 11 clients interviewed was that they struggle with getting dental care. Patients were asked when the last time they had seen a dentist and they answered years ago, most over ten years ago. Eight of the eleven clients did not know of any facilities they could go to. Cost was the main reason for these clients not seeking dental care. Two dentists were asked about the reasons for disparities in dental care. The major common themes between the dentists were cost, access to care, and education. All five case managers said that they had clients experiencing dental needs ranging from a simple cleaning to an abscess. Currently in Blount County only one dental clinic serves over 17,000 residents who live in poverty.

Primary care physician (PCP) shortages have been a barrier to accessing care for millions of Americans, particularly those living in areas facing the worst shortages - primary care health professional shortage areas (HPSAs). Increased use of nurse practitioners (NPs) has been proposed as a solution to the shortages as NPs can effectively substitute for PCPs. However, this proposal has been hampered by regulatory restrictions on NP scope-of-practice (SOP) that exist in many states. While some states permit NPs to practice and prescribe medications independent of physicians (NP independence), others require extensive physician supervision that limit NPs ability to provide care and substitute for PCPs. Despite the limitations that restrictive regulations pose to improving access to primary care, research evidence of their effect on access in primary care HPSAs is limited. This dissertation fills this gap in the literature. Using individual-level data from the Medical Expenditure Panel Surveys (1996-2015) and a difference-in-differences approach, I exploit variation in NP independence across states and over time to evaluate the impact of NP independence on access to primary care in HPSAs Further, I examined for heterogeneity in the effect of NP independence between HPSAs and non-HPSAs as well as effect heterogeneity in HPSAs based on individual (age, insurance status, and insurance type) and health system characteristics (availability of primary care facilities and NP Medicaid reimbursement rate) I find that NP independence led to a 5% increase in the number of individuals with a primary care provider and a 2% increase in the use of non-physicians (relative to physicians) as the primary care provider in HPSAs. However, non-HPSAs experienced no significant changes in access to care. Further, I find evidence of heterogeneity in the effect of NP independence in HPSAs for all three individual characteristics but find no significant effect heterogeneity for any of the health system characteristics. Non-elderly individuals experienced greater improvements in access following NP independence compared to their elderly counterparts, and while both insured and uninsured individuals experienced improvements in access to care, uninsured individuals benefitted more from NP independence. Further, I find evidence of greater improvements in access to care among Medicaid beneficiaries relative to their privately insured and Medicare counterparts. These findings imply that removing regulatory restrictions on NP SOP could be an effective policy strategy for mitigating the effects of PCP shortages and improving access to care in HPSAs. Further, they demonstrate that NP independence could be a viable tool for addressing access to care issues in two traditionally underserved populations – the uninsured and Medicaid beneficiaries. Beyond addressing access issues, NP independence could also mitigate rising health care costs. The finding of increased use of lower-cost non-physicians rather than their more costly physician counterparts after NP independence indicates that this policy change could also bring about cost savings for society.

Expansion of Medicaid and private health insurance coverage through passage of the Affordable Care Act of 2010 was expected to increase primary care access and reduce emergency department (ED) use by reducing financial burden and improving affordability of care. The aim of this study was to examine the differences in utilization patterns that exist among the Medicaid population that participated in an optimal level of care (OLC) intervention inclusive of appointments scheduled to primary care providers. Using the integrated behavior model as a theoretical framework, the key research question focused on determining if there was a difference in ED use among Medicaid individuals who scheduled follow-up appointments compared to those that did not schedule follow-up appointments. The sample population consisted of 176 Medicaid enrollees who presented to the ED for treatment of nonurgent conditions and participated in an OLC intervention from June 2016 to July 2017. The results showed that there were no differences in ED utilization between the population that had scheduled appointments compared to the population that did not have scheduled appointments. A bivariate analysis on demographic variables also showed no differences in ED utilization among the variables. The social change implications of this study are that the practice of scheduling appointments with primary care providers does not reduce or affect ED utilization in the Medicaid population. This study contributes to positive social change through the findings that reducing ED utilization requires more than follow-up appointment scheduling with primary care providers. Further studies are warranted to understand the potential barriers and factors that affect ED utilization.

Dental caries is the most prevalent childhood illness and disproportionately affects children from low socioeconomic backgrounds. Dental organizations are collaborating within communities to decrease oral health disparities among children by offering free preventive oral health events. These programs face the problem of low enrollment due to lack of informed parental consent. Also, gaps in the literature indicated the need to examine oral health perceptions and dental-care-seeking practices of culturally diverse low-income parents regarding preventive care for their children. The purpose of this qualitative case study was to explore the reasons why parents are not allowing their children to participate in the aforementioned programs. This inquiry examined how perceived barriers impede parents from seeking free preventive dental care for their children. The transtheoretical model and social cognitive theory were used in this study. Open-ended questions were used to interview 20 purposefully sampled parents regarding perceptions of free preventive dental care programs until saturation. Interviews were audio recorded, and all data were transcribed verbatim, coded, and analyzed thematically. The main themes revealed through this analysis were lack of trust and cultural dissimilarities as potential barriers. Additional themes of money, fear, lack of insurance, transportation, time, and access to care were also confirmed. This study may contribute to positive social change by increasing knowledge that may inform the development of clinical and policy solutions aimed at improving parents' awareness regarding children's oral health, ultimately enabling a reduction in childhood caries and oral health disparities.

The rising cost of health care in the Philippines is a concern for the Department of Defense and TRICARE beneficiaries. The purpose of this quantitative cross-sectional research study was to determine the efficacy and acceptability of a different method to deliver health care to increase access to health care and decrease out-of-pocket costs while maintaining quality of care for TOP Standard beneficiaries who receive health care under the Philippine Demonstration. Secondary data was used to determine the acceptability of an alternative reimbursement methodology to decrease cost but maintain access to quality care. The Andersen's behavioral health care model and the Donabedian quality health care model were used to interpret the study results. A data set of 180 participants was evaluated using a cross-sectional quantitative methodology. Two Spearman correlations were used to examine the relationship between financial burden and satisfaction (r = .41, p < .001) and financial burden and confidence (r = .44, p < .001). Linear and binary regressions assessed the effects of age and gender on satisfaction with health care finder functionality when requesting a waiver (F (2,26) = 1.22, p = .313, R2 = .09). A computation of one-sample t-tests to determine the impact of a closed network, beneficiary out-of-pocket cost, and quality health care in Demonstration areas found the beneficiaries were satisfied with the demonstration. An analysis of the claims data pre and post demonstration showed a difference in the patients' out-of-pocket expenses and the acceptability and preference for a closed network. Social change was demonstrated by a decrease in the cost for TRICARE standard beneficiaries in the Philippines.