Perceived Barriers to Health Care Access in a Treated Population

Bauer, Mark S.; Williford, William O.; McBride, Linda; McBride, Katherine; Shea, Nancy

doi:10.2190/u1d5-8b1d-uw69-u1y4

Cited by 37 publications

(39 citation statements)

References 16 publications

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“…Contrary to findings from other studies (Bauer et al, 2005;Sherkat et al, 2005), the results here suggest that older residents in this community reported regular use of healthcare and having a regular source of care. Older respondents experienced more barriers to accessing healthcare because of location of the facilities, availability of needed services, and transportation to the facilities.…”

Section: Discussioncontrasting

confidence: 99%

“…Understanding the full range of barriers for vulnerable populations such as the poor and minorities is important to optimizing healthcare and health outcomes (Bauer Williford, McBride, McBride, & Shea, 2005). This study was a component of a Centers for Disease Control and Prevention-funded communitybased initiative, REACH 2010 (Racial and Ethnic Approaches to Community Health), that aims to reduce and ultimately eliminate disparities in diabetes and heart disease between African Americans and whites in Nashville, Tenn (McClellan & Schlundt, 2006).…”

mentioning

confidence: 99%

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Disparities in Perceptions of Healthcare Access in a Community Sample

Larson

Schlundt²,

Patel³

et al. 2007

Journal of Ambulatory Care Management

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Disparities in health status persist for many sociodemographic groups in the United States. An understanding of barriers to healthcare access and utilization can assist community-based initiatives in developing strategies to improve the health of minority and low-income populations. Using self-reported information from 3014 community residents, a factor analysis was conducted that defined barriers to healthcare by 4 dimensions: (1) time and competing priorities, (2) convenience and availability, (3) healthcare utilization, and (4) healthcare affordability. Differential effects of demographics were observed on all factors. Racial disparities were found where African Americans experienced more problems based on the convenience and availability of services (P < .02) than did whites, after controlling for income, education, age, and marital status. In addition, gender differences showed that women experienced greater difficulty with time and competing priorities than men (P < .001); however, women experienced fewer problems related to utilization (P < .001). Of the covariates, income was significant (P < .01) on 3 of the 4 indicators. This study points to the need to develop interventions that address the unique challenges faced by different population groups to ensure timely healthcare. In addition, the reduction of economic disparities should be considered as an important strategy to improve public health.

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Section: Discussioncontrasting

confidence: 99%

mentioning

confidence: 99%

Disparities in Perceptions of Healthcare Access in a Community Sample

Larson

Schlundt²,

Patel³

et al. 2007

Journal of Ambulatory Care Management

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show abstract

“…For example, it is possible that gay and lesbian clients would report similar perceived barriers to accessing treatment. Indeed, when compared to similar studies (e.g., Bauer et al, 2005;Green & McCrady, 2009), it appears that many of the perceived barriers reported in this sample of transgender individuals are similar to those reported in nontransgender samples. Thus, there is no evidence to support that the reported barriers are specific to this sample.…”

Section: Discussionsupporting

confidence: 72%

“…However, two studies were identified for rudimentary comparison, including a study of veterans and a study from the general population where barriers to healthcare use were reported. Bauer (2005) assessed veterans engaged in healthcare services in the VA system (N = 324). In the sample of veteran healthcare users, life commitments and telephone/travel difficulties constituted two domains of barriers that affected service utilization.…”

Section: Discussionmentioning

confidence: 99%

“…The SUBS was used because no existing measure assessed a comprehensive list of potential barriers that might prevent individuals from utilizing mental health services. Therefore, the SUBS was developed by incorporating aspects of various validated measures (Bauer, Williford, McBride, McBride, & Shea, 2005;Hoge et al, 2004;Miller, Sovereign, & Krege, 1988) to form a composite measure that assessed institutional/systemic barriers and internal/intrapersonal barriers to mental health services. Items were phrased as beliefs/cognitions and are listed in Table 2.…”

Section: Service Utilization Barriers Scalementioning

confidence: 99%

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Transgender Clients: Identifying and Minimizing Barriers to Mental Health Treatment

Shipherd

Green

Abramovitz

2010

Journal of Gay & Lesbian Mental Health

207

131

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This study examined mental healthcare use and barriers to mental healthcare utilization in a sample of 130 transgender volunteers. Roughly a third of participants sought treatment for mental health issues including depression, anxiety, and relationship problems. Sixty-eight participants (52% of sample) showed evidence of psychological distress but had not received mental health services in the past year. Results point to potential barriers to seeking mental health services. Specifically, cost of treatment, previous bad experiences with healthcare, fear of treatment, and stigma concerns were the most frequently endorsed barriers related to seeking mental health services. Implications for practitioners are discussed.

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Telemedicine-Based Collaborative Care for Posttraumatic Stress Disorder

Fortney¹,

Pyne²,

Kimbrell³

et al. 2015

JAMA Psychiatry

247

190

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IMPORTANCE Posttraumatic stress disorder (PTSD) is prevalent, persistent, and disabling. Although psychotherapy and pharmacotherapy have proven efficacious in randomized clinical trials, geographic barriers impede rural veterans from engaging in these evidence-based treatments.OBJECTIVE To test a telemedicine-based collaborative care model designed to improve engagement in evidence-based treatment of PTSD. DESIGN, SETTING, AND PARTICIPANTSThe Telemedicine Outreach for PTSD (TOP) study used a pragmatic randomized effectiveness trial design with intention-to-treat analyses. Outpatients were recruited from 11 Department of Veterans Affairs (VA) community-based outpatient clinics serving predominantly rural veterans. Inclusion required meeting diagnostic criteria for current PTSD according to the Clinician-Administered PTSD Scale. Exclusion criteria included receiving PTSD treatment at a VA medical center or a current diagnosis of schizophrenia, bipolar disorder, or substance dependence. Two hundred sixty-five veterans were enrolled from November 23, 2009, through September 28, 2011, randomized to usual care (UC) or the TOP intervention, and followed up for 12 months.INTERVENTIONS Off-site PTSD care teams located at VA medical centers supported on-site community-based outpatient clinic providers. Off-site PTSD care teams included telephone nurse care managers, telephone pharmacists, telepsychologists, and telepsychiatrists. Nurses conducted care management activities. Pharmacists reviewed medication histories. Psychologists delivered cognitive processing therapy via interactive video. Psychiatrists supervised the team and conducted interactive video psychiatric consultations. MAIN OUTCOMES AND MEASURESThe primary outcome was PTSD severity as measured by the Posttraumatic Diagnostic Scale. Process-of-care outcomes included medication prescribing and regimen adherence and initiation of and adherence to cognitive processing therapy. RESULTSDuring the 12-month follow-up period, 73 of the 133 patients randomized to TOP (54.9%) received cognitive processing therapy compared with 16 of 132 randomized to UC (12.1%) (odds ratio, 18.08 [95% CI, 7.96-41.06]; P < .001). Patients in the TOP arm had significantly larger decreases in Posttraumatic Diagnostic Scale scores (from 35.0 to 29.1) compared with those in the UC arm (from 33.5 to 32.1) at 6 months (β = −3.81; P = .002). Patients in the TOP arm also had significantly larger decreases in Posttraumatic Diagnostic Scale scores (from 35.0 to 30.1) compared with those in the UC arm (from 33.5 to 31.7) at 12 months (β = −2.49; P=.04). There were no significant group differences in the number of PTSD medications prescribed and adherence to medication regimens were not significant. Attendance at 8 or more sessions of cognitive processing therapy significantly predicted improvement in Posttraumatic Diagnostic Scale scores (β = −3.86 [95% CI, −7.19 to −0.54]; P = .02) and fully mediated the intervention effect at 12 months. CONCLUSIONS AND RELEVANCETelemedicine-based collaborative car...

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Perceived Barriers to Health Care Access in a Treated Population

Cited by 37 publications

References 16 publications

Disparities in Perceptions of Healthcare Access in a Community Sample

Disparities in Perceptions of Healthcare Access in a Community Sample

Transgender Clients: Identifying and Minimizing Barriers to Mental Health Treatment

Telemedicine-Based Collaborative Care for Posttraumatic Stress Disorder

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