Equity of access to healthcare services is a concept which underpins current UK health policy. However evidence suggests that this is not achieved within community palliative care. Referrals can be tardy or not made at all. Most literature describes inequality in service utilisation, but does not aid understanding of why such inequalities exist. There is little research exploring the processes underpinning referral making rather than the outcomes of referrals such as service utilisation. The aim of this research was to investigate the influences on referral decisions made within community palliative care services. A qualitative case study strategy was chosen as the research approach as it provided a framework for facilitating the incorporation of multiple perspectives in a complex context, in a field where there has been little previous research, and where there is little theory to guide the investigation. Three cases (Primary Care Trusts) were studied. Data collection used multiple methods (interviews, observation and documentary analysis, as well as mapping and profiling the palliative care services provided within the cases) from multiple perspectives (general and specialist palliative care professionals, managers, commissioners and patients). Detailed data analysis followed a framework approach, comparing and contrasting patterns within and across cases with existing and developing theoretical propositions. Two core influences on the way health care professionals made referral decisions were found. First, their perception of their own role in providing palliative care. Autonomous professionals made independent judgements about referrals, influenced by their expertise, workload, the special nature of palliative care and the relationship they developed with patients. Second, their perception about those to whom they may refer. Professionals needed to know about services to refer, and then made a complex judgement about the professionals involved and what they could offer the referrer as well as the patient. These findings indicate that many more factors than an assessment of patients' clinical need affect referrals within community palliative care services. It appears that personal, inter-personal and inter-professional factors have the potential to shape referral practices. It may be that the combination of these factors has an influence on equitable access to community palliative care services. Practitioners could be more explicit about referral or non-referral rationales, and policy makers take account of these complex influences on referrals rather than just mandating change.

Maternal mortality is an important public health problem in Mexico. Although the Mexican government has invested many physical and economic resources to strategies specifically created to reduce this problem and reach the Millennium Development Goals, Mexico is not going to achieve this goal on time. Maternal Mortality is a problem of inequality and social injustice. Access to health services is unequally distributed among regions and among population within those regions. Despite a general decline in childbirth deaths worldwide, differences still exist depending on the level of urbanization and size of residence. Because of extreme inequality in Mexico, pregnant women living in rural and highly marginalized areas face the highest risk of dying for maternal causes. The main strategies Mexican government has adopted to reduce maternal mortality target the unsecure, rural and poor population, with the aim of closing the significant gap between geographic regions and social groups. / text

Background: Uncorrected Refractive Errors (UREs) are the most common cause of vision loss globally. The burden is particularly worse in low- and middle-income countries like Zambia, where access to Refractive Error Correction Services (RECS) is limited. This study aimed to assess the user's accessibility to RECS in selected Zambian Hospitals. Methods: Twenty (20) public health facilities offering RECS were conveniently selected using a crosssectional design. These represented 20 districts in eight provinces of Zambia. A questionnaire-based on access to health care services framework was administered. The framework assessed service accessibility in terms of availability, geographical accessibility, and affordability. Facility managers completed and submitted the questionnaire via email. Results: Completed questionnaires were received from 20 facilities. Nineteen facilities were located in rural areas whilst one facility was located in an urban area. Most facilities (84%) had the Ministry of Health recommended equipment, though essential equipment such as tonometers were lacking in most facilities (70%). Fifteen facilities (75%) reported having Optometry Technologists as the main staff offering services. Only two facilities (10%) had an Ophthalmologist each and no facility had an Optometrist. School-based programmes were not carried out in all facilities. Only one (5%) facility was able to dispense spectacles soon after refraction as it had a spectacle manufacturing workshop. For some facilities (60%), a poor road network posed a challenge to geographical accessibility. Insufficient funding limited access to RECSs. Facility representative stated that not all patients could meet the cost of services in all the facilities. Conclusion: Access to refractive error correction services in the 20 facilities was limited due to a combination of eye health programme deficiencies and general challenges typical in low- and middle-income countries. Funding, human resources and equipment were insufficient. Inadequate road network and infrastructure undermined service delivery. The accessibility shortcomings identified should be used to improve user accessibility of refractive services.

Recent data show that immigrant women in the U.S. are generally in poorer health than U.S.-born women and immigrant men , and many immigrant women encounter some difficulties in obtaining health care assistance, such as health insurance. Yet American researchers are only beginning to make a contribution to this area of scholarship. This thesis examines in detail the health status of immigrant women, the means by which immigrant women obtain health insurance, and several factors that are likely to influence their health care access. I mainly examine the associations between three factors (public policy, employment status, and marital status) and access to health care assistance. I do so because employers and government-sponsored health care programs are both major insurance providers, and being married is an important factor in accounting for immigrant women's health insurance coverage. The project consists of case studies in three states — California, Florida and New York — using both qualitative and quantitative research methods. The data come from two rounds of the National Survey of America's Families (NSAF 1997 and NSAF 1999) and documentation of welfare reform rules. The results of this study demonstrate that all three factors contribute to immigrant women's health insurance coverage and that anti-immigrant sentiments are inadequate for explaining immigrants' health care circumstances. / Master of Arts

Background: To curb the transmission of HIV/AIDS and other infectious diseases several studies indicate the need for improved access to medical care for injection drug users (IDUs) including those already linked to syringe exchange programs (SEPs). However, availability and access to services remains a problem for many IDUs. This study seeks to examine perceptions of medical care access among a pharmacy-based sample of IDUs, utilization of medical services among IDUs and, identify barriers to accessing health care services to help ensure that IDUs receive appropriate care when needed and reduce the transmission of diseases. Methods: Data was obtained from the Pharmacists As Resources Making Links to Community Services (PHARM-Link) study. Dependent variables: health care access to the same provider and receiving care a usual source, health care utilization of services including the emergency room, clinic, medical office, medical mobile unit and hospital; and health care barriers categorized as personal or structural. Independent variables were insurance status, homelessness in the prior six months, case management, drug treatment and socio-demographic characteristics such as age, sex, income, education and employment status. Descriptive statistics analysis and logistic regression were performed using SAS version 9.4 (2013) with significance set at p<0.05. Results: Our sample included 615 IDUs participating in the PHARM-Link study. Overall, IDUs accessed health services and having the same provider remained statistically higher among those with legal income above $5,000 OR: 1.60 (95% CI: 1.03- 2.48), the insured OR: 4.11 (95% CI: 2.48-6.79), and those with positive HIV status OR: 7.64 (95% CI: 3.18 – 18.36), while those who were homeless reported lower access to the same provider OR: 0.63 (95% CI: 0.43 – 0.92). Only the older age group OR: 2.85 (95% CI: 1.42-5.73) and the insured OR: 3.42 (95% CI: 1.81-6.46) remained significantly associated with more access to receiving health needs at the same location. Those with some college education had less frequent visits to the clinic OR: 0.59 (95% CI: 0.38-0.92) and medical office OR: 0.64 (95% CI: 0.41-0.99), while the homeless were more likely to visit the emergency room OR: 1.49 (95% CI: 1.06-2.11). Females were less likely to go to a mobile unit OR; 0.52 (95% CI: 0.33-0.83) and married people were more likely OR: 1.95 (95% CI: 0.28-0.91). Visit to the hospital were less likely among females OR: 0.54 (95% CI: 0.36-0.81) and among those with some college education OR: 0.63 (95% CI: 0.41-0.96). Those with legal income above $5,000 were less likely to have any personal barriers OR: 0.64 (95% CI: 0.45 – 0.92). Structural barriers remained more likely among those who were homeless OR: 1.62 (95% CI: 1.13-2.39), but less likely among those 44 years and older OR: 0.58 (95% CI: 0.40-0.85), the insured OR: 0.60 (95% CI: 0.38-0.94), those with positive HIV status OR: 0.53 (95% CI: 0.28-0.99), as well as Non-Hispanic Blacks OR: 0.47 (95% CI: 0.14-0.83) and Latinos OR: 0.47 (95% CI: 0.25-0.86). Conclusion: Our results suggest that most IDUs linked to care through pharmacy-based SEP programs established to expand health services and improve health, did access available health services. However, some continue to experience difficulties such as structural barriers among the homeless as well as few reported visits to the clinic, medical office and the hospital among the employed believed to have resources to pay for such services. These services may have been underutilized because the participants were unsatisfied with the services provided. Therefore, interventions should target structural barriers such as homelessness among IDUs as well as health insurance coverage to help increase access to and utilization of health services.

No description available.

No description available.

There is the desire amongst elderly Canadians to remain living at home, maintaining their independence. As the population ages, the health care system is faced with the challenge of allocating limited resources. Home care in Ontario is provided through Community Care Access Centres (CCAC) or Community Support Agencies (CSA). This study made comparisons among CSA clients (using the interRAI-Community Health Assessment, n=796), a sub-population of CCAC clients with lighter-care needs (n=8163) and all other CCAC clients (n=31,078), both using the Minimum Data Set-Home Care (MDS HC). The majority of clients in all groups were female, widowed, and spoke English as their primary language. CCAC clients had more health conditions than did CSA clients. Light-care CCAC clients received less hours of formal support than other CCAC clients and were less likely to have informal support caregivers who reported caregiver burden. Between 1998 and 2005, Ontario provided services to an increasingly impaired home care population, although overall impairment among home care client remained low. For the purposes of benchmarking, MDS HC data from Ontario was compared with MDS HC data from 11 European countries and was found to fall within the range of the other countries in terms of average impairment level of home care clients. Logistic regression was used to predict the likelihood of receiving CCAC services. Not being self-reliant, having decline in activities of daily living, having experienced falls, self-reporting one's health to be poor and reporting less loneliness were all correlates for CCAC service use. Implications and direction for future research were discussed.

Hospital-based specialist palliative care services are designed to address the needs of critically ill patients by psychosocial and spiritual support, improving symptoms management, and offering discussions on goals of care. Integrating palliative care upstream in the care continuum for patients who eventually die in the hospital will help to address the many individualistic needs of the critically ill patient. The diffusion of specialist hospital-based palliative care services requires an understanding of patterns of utilization by patients. The purpose of this study was to examine the population characteristics of decedents who may or may not have utilized specialist palliative care services in a hospital setting in order to develop a model of predictors of access to specialist palliative care services. The basic constructs of this study are grounded in the Behavioral Model of Health Services Use. Potential access is measured in terms of population characteristics, which include predisposing characteristics, enabling resources, and evaluated need. Building on this theoretical model, the study sought to better understand equitable and inequitable access to specialized palliative care services and to define which predictors of realized access were dominant. The research question asked was: What are predictors of access to specialized palliative care within a large urban public teaching hospital? A model of access to a palliative consult and a predictor of access to a palliative care unit were explored. Findings from this study revealed that factors encouraging access to a palliative care consult include older age, White non-Hispanic ethnic membership, a diagnosis with solid cancer and insurance. Factors encouraging access to a palliative care unit include older age, gender (female), insurance, and either a solid cancer or hematologic malignancy diagnosis.

Student Number 9705165A Master of Arts in Forced Migration Studies Faculty of Humanities / Objective: To identify and investigate barriers faced by Somali forced migrants when accessing health care in Johannesburg. In particular, the study seeks to compare perceptions of health personnel and migrants as to the nature of such access constraints. Design and Methods: The study made use of semi-structured and in-depth interviews with a snowball sample of health personnel and migrants. Ten health personnel were interviewed and twenty migrants (ten male and ten female). Results: Constraints of language and xenophobia were identified by both health personnel and forced migrant interviewed. Constraints related to the shortage of resources and the poor functioning of the referral system are experienced by all users of the public health system, irrespective of their nationality. No mention was made of traditional or allopathic medicine. Conclusions: There exists a gap between the access to health care guaranteed in the Refugees Act and practices at facility level. There are many similarities across interviews in the constraints identified by migrants and some agreement in the constraints identified by migrants and health personnel. These results confirm that migrants experience a fairly severe level of constraint when attempting to utilize formal health care services in Johannesburg.