Comparing Rates of Multiple Chronic Conditions at Primary Care and Mental Health Visits to Community Health Centers Versus Private Practice Providers

Corallo, Bradley; Proser, Michelle; Nocon, Robert S.

doi:10.1097/jac.0000000000000324

Cited by 13 publications

(9 citation statements)

References 23 publications

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“…a | Prevalence estimates of multimorbidity according to age in high-income countries; data from reFs. 27,[313][314][315][316][317][318][319] . b | Prevalence estimates of multimorbidity according to age in low-income and middle-income countries; data from reFs.…”

Section: Complex Multimorbidity 5162mentioning

confidence: 99%

Multimorbidity

Skou

Mair

Fortin

et al. 2022

Nat Rev Dis Primers

443

283

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Interest in multimorbidity -commonly defined as the co-occurrence of at least two chronic conditions in the same individual 1 -has increased in the past few years owing to its substantial effect on the individual and the individual's family, as well as on health systems and on society, particularly in resource-poor settings 2-4 . Multimorbidity is distinct from the related concept of comorbidity, which refers to the combined effects of additional conditions in relation to the index condition in an individual [5][6][7][8] . By contrast, care for multimorbidity is patient-centred and does not routinely give priority to any single condition, although in clinical care, patients and clinicians will usually focus on the most pressing problems that the patient is experiencing.People with multimorbidity are more likely to die prematurely, be admitted to hospital and have an increased length of stay than people with a single chronic condition 9,10 . Multimorbidity is also associated with poorer function and health-related quality of life (HRQOL), depression and intake of multiple drugs (polypharmacy) and greater socioeconomic costs [11][12][13][14][15][16][17][18] . Most health care is designed to treat individual conditions rather than providing comprehensive, person-centred care 2,19,20 , which often leads to fragmented and sometimes contradictory care for people with multimorbidity and increases their treatment burden 21 Moreover, treating one condition at a time is inefficient and unsatisfactory for both people with multimorbidity and their health-care providers [22][23][24] .Multimorbidity is increasingly common owing to changes in lifestyle risk factors, notably physical inactivity and obesity, and population ageing that in part reflects improvements in survival from acute and chronic conditions 2,19,25,26 . Multimorbidity is associated with socioeconomic status and age 3,19,25,27 . However, although age is the strongest driver of multimorbidity, in absolute numbers, more people <65 years of age have multimorbidity than people ≥65 years of age, partly because more people in the general population are in that age group. Moreover, this emphasizes that multimorbidity is not just a feature of ageing 19,26 .Multimorbidity is further complicated in low-income and middle-income countries (LMICs) by the overlap of compounding factors, including adverse environmental and early life stressors linked to poverty, limited social infrastructure and poorer family coping mechanisms, that translate into chronic diseases occurring at earlier ages [28][29][30][31] . LMICs also have a higher prevalence of multimorbidity-related financial burden 32,33 and have weaknesses in health systems including a greater focus Treatment burdenThe workload associated with managing treatments and health-care recommendations and the impact of this on an individual and their supporters.

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Section: Complex Multimorbidity 5162mentioning

confidence: 99%

Multimorbidity

Skou

Mair

Fortin

et al. 2022

Nat Rev Dis Primers

443

283

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“…First, the pandemic has hit community-based health systems particularly hard financially. 49 Second, the pandemic disproportionately impacts the physical and psychological health of communities of color, 50 particularly Black, Latinx, and Asian American communities, leaving more diverse programs like community-based programs understaffed and overstressed.…”

Section: Recommendation 3—the Eras Opening For Programs and The Overa...mentioning

confidence: 99%

Responding to Recommended Changes to the 2020–2021 Residency Recruitment Process From a Diversity, Equity, and Inclusion Perspective

et al. 2022

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In May 2020, the Coalition for Physician Accountability’s Work Group on Medical Students in the Class of 2021 Moving Across Institutions for Post Graduate Training (WG) released its final report and recommendations. These recommendations pertain to away rotations, virtual interviews, Electronic Residency Application Service opening for programs and the overall residency timeline, and general communications and attempt to provide clarity and level the playing field during the 2020–2021 residency application cycle. The WG’s aims include promoting professional accountability by improving the quality, efficiency, and continuity of the education, training, and assessment of physicians. The authors argue the first 3 WG recommendations may disproportionately impact candidates from historically excluded and underrepresented groups in medicine (HEURGMs) and may affect an institution’s ability to ensure equity in the selection of residency applicants and, thus, warrant further consideration. The authors examine these recommendations from a diversity, equity, and inclusion (DEI) perspective. For each of the first 3 WG recommendations, the authors highlight new opportunities created by the recommendations and detail challenges that programs must carefully navigate to ensure equity for all candidates. The authors also recommend solutions to guide programs as they address these challenges, meet new common program requirements, and attempt to promote equity for HEURGMs. Finally, the authors recommend that after the 2020–2021 recruitment cycle, the medical education community evaluate DEI-related outcomes of both the WG’s and the authors’ recommendations and incorporate the findings into future application cycles.

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“…While the impact of COVID-19 on general health services among vulnerable populations has been well investigated ( Corallo and Tolbert 2020 ; Halperin et al 2021 ; Simon et al 2021 ), its impact on dental practices and dental care utilization at FQHCs has not been investigated on a granular level. Existing studies focused on dental services include the surveys of dentists conducted by the American Dental Association’s (ADA’s) Health Policy Institute and analyses of claims data, evaluating overall changes in dental care utilization due to COVID-19 ( FAIR Health 2020 ; ADA 2021a ; Choi et al 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on Dental Care Utilization and Oral Health Conditions in the United States

Choi

Mo²,

Sima

et al. 2023

JDR Clinical & Translational Research

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Purpose: We aim to understand the impact of the COVID-19 on health care utilization and oral health conditions of patients at federally qualified health centers (FQHCs), where patients are disproportionately low income, publicly insured, or uninsured. Methods: Using deidentified electronic health records of patients at FQHCs in the United States from January 2019 through December 2020 ( n = 431,509), variations in health care utilization since the COVID-19 outbreak were observed by procedure types and patient characteristics. Changes in dental utilization and oral health conditions were characterized using mixed-effect negative binomial and logistic regression models. Results: Dental utilization decreased more drastically than medical utilization during shelter-in-place periods in 2020 and rebounded more slowly after the reopening. Greater demands for oral surgery and teledentistry and less demands for preventive services were observed in 2020. As compared to 2019, patients experienced more psychological stress–related dental conditions with odds ratios of 1.52 (95% confidence interval [CI], 1.31–1.76) for uninsured, 1.48 (95% CI, 1.07–2.02) for Medicaid enrollees, and 2.38 (95% CI, 1.68–3.40) for private insurance beneficiaries. Conclusion: As a result of COVID-19, patients received more invasive dental procedures due to delayed treatment and experienced a higher risk of psychological stress–related dental conditions. Continued support for statewide policies to expand access to oral health care and oral health promotion strategies for the vulnerable populations would be encouraged. Knowledge Transfer Statement: Our study describes the impact of COVID-19 on dental care use and oral health conditions at Federally Qualified Health Centers, targeted to provide care for some of the most vulnerable populations in the United States. The results of this retrospective cohort study can be used by clinicians and policymakers on understanding the clinical needs of the vulnerable populations after the pandemic. It highlights the need for continued support to expand access to oral health care and oral health promotion to these populations.

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Comparing Rates of Multiple Chronic Conditions at Primary Care and Mental Health Visits to Community Health Centers Versus Private Practice Providers

Cited by 13 publications

References 23 publications

Multimorbidity

Multimorbidity

Responding to Recommended Changes to the 2020–2021 Residency Recruitment Process From a Diversity, Equity, and Inclusion Perspective

Impact of COVID-19 on Dental Care Utilization and Oral Health Conditions in the United States

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