Statement of the Problem: The purpose of this study was to determine if health status as perceived by the prisoners at the time of their incarceration in a local jail could be used as a predictor of their utilization of medical services during the following twenty-eight (28) days of confinement. The ability to predict who would utilize medical services, and to what extent, could assist medical personnel in projecting and planning for these needs. This was especially important in local jails where budgets were usually low, the number of persons being confined was large, and the period of incarceration was short. Can the utilization of health services be predicted? Can perceived health status at the beginning of incarceration be the predictor? If so then an inmate population could be studied, and a medical program that was efficient, effective, and dynamic could be established. The ability to identify consumers of health services early could facilitate planning Method and Material: Data was gathered from the medical and correctional records at the Jefferson Parish Community Correctional Center. The required information was transferred from the records to data sheets without identifying the inmate. Only inmates incarcerated for a minimum of 28 days were included in the study. The utilization of medical services was determined by the number of sick call visits. The study population consisted of 382 cases Findings and Conclusions: It was found that females made significantly more sick calls than males (almost 2:1). Whites made considerably more sick call visits than non-whites. Educational level did not seem to be a factor in the utilization of health services. In general a positive response to almost any medical history question was associated with a significant increased number of sick call visits being made. There appeared to be a relationship between the number of health problems identified and the number of sick call visits made. Positive responses to the questions regarding current illness, currently under treatment, and a history of mental illness were statistically significant when compared to the mean number of sick call visits made. Those inmates found to have at least one (1) abnormality on physical examination made significantly more sick call visits than those with none. When the physician felt that an inmate had a medical problem, regardless of how the inmate perceived their health status, the inmate made significantly more sick call visits by an estimated 2:1. The same trend applied when medical assistants felt that an inmate had a health problem It is clear for the outcome of this study that these are factors which could be used as predictors of the utilization of health services for an inmate population. These factors, medical history questions, could be asked at any correctional facility, and help medical personnel identify that segment of the inmate population that would utilize medical services more. With early identification, medical programs could operate more effectively and efficiently / acase@tulane.edu

Village Malaria Workers (VMWs) play an important role in the prevention and treatment of malaria as frontline volunteers in Cambodia, a nation implementing decentralisation initiatives and that is reliant on task shifting to address health worker shortages. Studying the performance of VMWs and understanding the social capital that they are able to mobilise, including enabling and reinforcing factors while fighting malaria in Cambodia’s Pailin province, will benefit performance enhancement and program scale up. This dissertation examines the factors associated with the perceived performance of VMWs, which has the potential to provide practical guidance for Cambodian health system managers and local health practitioners to capitalize on locally-available human resources to implement their health initiatives as per the country’s decentralisation plans. The study was done in 2 districts of Pailin province in Cambodia. The findings were based on 35 semi-structured surveys, 13 key informant interviews, 6 focus group discussions, 3 group interviews and 2 in-depth interviews covering VMWS and stakeholders from the commune council, village health support groups, health center management committee, provincial health offices, a referral hospital, a pharmacy, village chiefs, and administrative officials. The interviews and discussions were conducted using set guides, which allowed for flexibility and asking for follow-up questions as well as probing for more information and clarification. Pre-determined themes were used in designing the instruments, and data from the survey, focus groups, and interviews were thematically coded for manual data analysis. This study showed that VMWs’ performance is affected by a variety of factors that emerge from the complex context in which they work. These include socio-demographic variables; their health system knowledge; access to enabling and reinforcing factors, including family and social support; personal motivation; resource availability, including budget, supplies, and equipment; ways of being selected; access to learning, training and capacity-building opportunities; and institutional communication and implementation of decentralised health program. Factors such as perceived corruption also were seen to affect VMW’s performance. The participants suggested various ways to address these challenges. In order to improve the performance of VMWs, people’s participation in all local governance arms, including the CC, VHSG, HCMC and the HC, needs to be strengthened. The roles and expectations regarding citizen participation need to be clarified using simple messages. Training and capacity-building support needs to be made available for learning key new skills as relevant. The equipment and supplies necessary for work as well as adequate reimbursement of transportation allowances need to be provided along with instilling a proper system of VMW supervision and mentoring that adequately recognises those that are high performing. Targeted capacity assessments for VMWs and the VHSG, HC and HCMC need to be undertaken followed by needed training and mentoring in order to address areas that need further support to enhance productivity. A volunteer selection process needs to follow the rules described in the CPP policy ensuring deliberate attempts to open up entry points for public service to those that have been excluded on the basis of formal qualifications, lack of kinship, or political affiliation. / acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

Background An ongoing public policy concern in the United States is disparities in health care for racial/ethnic minority populations. The National Healthcare Disparities Report (NHDR) addresses these disparities for chronic diseases such as diabetes that impose economic and health burdens on society that need to be partly managed by health care policies. One understudied aspect of diabetes care is racial/ethnic disparities in the pharmacological management of the disease. Objective The objective of this study was to determine whether racial/ethnic disparities exist in the pharmacological treatment of diabetes, and if so, how do individual characteristics such as socioeconomic status (SES) influence the differences. Methods This study used national survey data collected through the 2010 Medical Expenditure Panel Survey (MEPS). Racial/ethnic disparities in diabetes treatment were examined using a methodology based on the Institute of Medicine (IOM) definition of disparity that adjusts for health status factors while allowing SES factors to mediate differences. The effects of independent variables on receipt of antidiabetic medication prescriptions among individuals who self-reported a diagnosis of diabetes were examined. Regression analyses were performed on unadjusted data and on data transformed by a rank-and-replace method to approximate the IOM definition. Results Among 1,844 survey respondents with self-reported diabetes, significant differences were found for race/ethnicity, education, health insurance, and the co-morbidities of heart disease and eye problems/retinopathy. Race/ethnicity was a significant predictor of the receipt of antidiabetic prescriptions, with Hispanics being more than 2 times as likely as non-Hispanic whites to have received a prescription. This difference was magnified in the IOM model that controlled for health status. In the IOM model, no significant differences were observed between non-Hispanic whites and non-Hispanic blacks or other minorities. Having health insurance, higher education, or eye problems/retinopathy were also significant predictors of receiving antidiabetic prescriptions. Conclusion Using a methodology that adjusts for factors related to health status while allowing factors related to SES to mediate racial/ethnic differences, disparities were observed between non-Hispanic whites and minorities, particularly Hispanics, in the likelihood of receiving a prescription for antidiabetic medication. The agreement of these results with the few studies on the pharmacological management of diabetes is mixed, and suggests the need for additional studies. Application of a rigorous definition of racial/ethnic disparities and the implementation of methodologies that adjust for health status while allowing mediation by SES factors are needed to address important gaps in the treatment of diabetes. / acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu