Research in Canada and abroad has shown that newcomers face multiple obstacles in their search for health care during their resettlement and integration to the host society. In Ontario, primary care services are organized in three main models based on the remuneration scheme to physicians: fee for service, capitation, and salaried. During the Primary Care reforms in early 2000s, the province introduced new models of primary care practices to enhance the quality of care through the expansion of comprehensive multidisciplinary care, applying more preventive measures and enhanced chronic disease management strategies. Along with these innovative reforms, the province promoted an enrollment system with a family doctor in the primary care practices. This research examined the access of immigrants to the enrollment system in Ontario. A review of the literature contrasting a PMC and PHC approaches showed that the latter has more potential to address social determinants of health of immigrant populations. Taking into account the organization of health services in the province, immigrants can receive primary care services mainly through PMC practices (FFS and capitation-based), but also through PHC-type of models, such as Community Health Centers. The analysis of enrollment in primary care was conducted using a secondary analysis of administrative data. The main findings have shown that immigrants’ enrollment in primary care services has increased over time, but the levels of enrollment remain lower compared to long-term residents. Moreover, compared to long-term residents, immigrants have less access to the most comprehensive models of care, which represents an important inequity. In exploring the perceptions of immigrants in two major cities of the province, most of the participants perceived that important factors, such as information, knowledge, language barriers, cultural issues; are affecting their capacity to understand and navigate the system. Hence, it takes a long time for them to make sense and learn how to connect and use the system.

Background: Rates of physical disability are higher in women than in men, and economically disadvantaged women are at greater risk for physical disability than women with higher incomes. Chronic diseases increase the risk of physical disability, and people with physical disability experience some added risks of secondary conditions including chronic disease. Yet, little is known about the prevalence of chronic disease among women living with a physical disability who use Medicaid, a particularly disadvantaged population. Objective: This study described the prevalence of chronic disease among adult (18-64 years), female, Florida Medicaid beneficiaries living with a physical disability between 2001 and 2005. Methods: Using Medicaid eligibility and claims files, we extracted ICD-9 codes for physically-disabling conditions and Current Procedure Terminology codes for mobility-assistive devices to define three levels of physical disability. Results: Participants appeared to be at high risk for both physical disability and chronic diseases. Close to half of the women had been diagnosed with one or more physically-disabling conditions, and 5.3% used mobility devices. One-third of the women had hypertension and sizeable proportions had other chronic diseases. Women with physical disability were more likely to have co-morbid chronic diseases than their able-bodied counterparts. Discussion: Our findings support the need for improved chronic disease prevention among female Medicaid beneficiaries, particularly those with physical disability. Strategies to improve prevention, screening and treatment in this population may mitigate the trends toward higher physical disability rates in the low-income, working-age population and may prevent high Medicare and Medicaid costs in the long-run.

Background: Rates of physical disability are higher in women than in men, and economically disadvantaged women are at greater risk for physical disability than women with higher incomes. Chronic diseases increase the risk of physical disability, and people with physical disability experience some added risks of secondary conditions including chronic disease. Yet, little is known about the prevalence of chronic disease among women living with a physical disability who use Medicaid, a particularly disadvantaged population. Objective: This study described the prevalence of chronic disease among adult (18-64 years), female, Florida Medicaid beneficiaries living with a physical disability between 2001 and 2005. Methods: Using Medicaid eligibility and claims files, we extracted ICD-9 codes for physically-disabling conditions and Current Procedure Terminology codes for mobility-assistive devices to define three levels of physical disability. Results: Participants appeared to be at high risk for both physical disability and chronic diseases. Close to half of the women had been diagnosed with one or more physically-disabling conditions, and 5.3% used mobility devices. One-third of the women had hypertension and sizeable proportions had other chronic diseases. Women with physical disability were more likely to have co-morbid chronic diseases than their able-bodied counterparts. Discussion: Our findings support the need for improved chronic disease prevention among female Medicaid beneficiaries, particularly those with physical disability. Strategies to improve prevention, screening and treatment in this population may mitigate the trends toward higher physical disability rates in the low-income, working-age population and may prevent high Medicare and Medicaid costs in the long-run.

Indiana University-Purdue University Indianapolis (IUPUI) / Advancement of preconception and interconception health is a key element to improve women’s health as well as pregnancy outcomes. Little is known about the preconception and interconception health status of rural Midwestern populations in the United States. The primary objective of this study was to determine the preconception and interconception health status as well as behaviors of reproductive age women living in a rural Midwestern area. Secondary objectives were to quantify process measures of health care access and barriers to care, as well as determine disparities in preconception and interconception health status among women in this rural area as compared to statewide estimates. As existing national or state secondary data sources often have limitations in data derived from areas with low population densities or insufficient sample sizes to generate reliable estimates, a cross-sectional study was performed using a 34- item survey. Data were collected from February to May 2019 from 315 non-pregnant women ages 18-45 years in a rural county in northwestern Ohio. Nearly all women surveyed had at least one risk factor associated with poor pregnancy outcomes, many of which were modifiable. Nearly half of all respondents reported at least one barrier to receipt of health care services. Women in this rural county fared worse for several preconception and interconception health measures when compared to statewide estimates derived from Behavioral Risk Factor Surveillance System and Ohio Pregnancy Assessment Survey data. These findings illustrate the need for continued development of interventions to improve preconception and interconception health for rural women as well as improved methods to capture and analyze data on important subpopulations at risk. / 2021-03-09

That nurse practitioners (NPs) delivery high-quality care, equivalent to that provided by physicians, is well documented. However, many states have laws that restrict NPs from full practice authority, limiting their ability to comprehensively meet patient needs. North Carolina is a state that has very restrictive laws, with NPs working under physician supervision. In this article we address the effect restricted practice has had in North Carolina and the introduction of Senate Bill 695 (the Modernize Nursing Practice Act) that, if passed, would legislate full practice authority for NPs in our state.

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Yes / Refugees often face barriers to accessing health services, especially after resettlement. The aim of this study is to identify key elements of effective public health interventions that address barriers to health services for refugees. Methods: Key online databases were searched to identify studies published between 2010 and 2019. Six studies met the inclusion criteria: two qualitative, one quantitative and three mixed-methods studies. An adapted narrative synthesis framework was used which included thematic analysis for systematic reviews. Results: Five themes were identified: peer support, translation services, accessible intervention, health education and a multidisciplinary approach. Conclusion: These key elements identified from this review could be incorporated into public health interventions to support refugees’ access to health services. They could be useful for services targeting refugees generally, but also supporting services targeting refugee resettlement programmes such as the Syrian resettled refugees in the UK. Future research is needed to evaluate the impact of public health interventions where these elements have been integrated into the intervention.