Younger stroke survivors have reduced access to physician care and medications: National Health Interview Survey from years 1998 to 2002
AuthorsLevine, Deborah A.
Kiefe, Catarina I.
Houston, Thomas K.
Allison, Jeroan J.
McCarthy, Ellen P.
Ayanian, John Z.
UMass Chan AffiliationsDepartment of Quantitative Health Sciences
Document TypeJournal Article
Health Care Costs
*Health Care Surveys
Health Services Accessibility
Health Services Needs and Demand
Interviews as Topic
Health Services Research
MetadataShow full item record
AbstractBACKGROUND: More than 5 million US stroke survivors require comprehensive care for risk factor modification and secondary prevention. Younger stroke survivors may have reduced access to physician care and medications because they are more frequently uninsured. OBJECTIVE: To assess age-related differences in access to physician care and medications among stroke survivors (aged 45-64 years vs > or = 65 years). DESIGN: National Health Interview Survey from years 1998 to 2002. SETTING: A US population-based survey. PARTICIPANTS: Stroke survivors (n = 3681) aged 45 years and older among 159 985 survey respondents. MAIN OUTCOME MEASURES: General doctor visit, medical specialist visit, and inability to afford medications within the last 12 months. RESULTS: Compared with older stroke survivors, younger stroke survivors more frequently reported no general doctor visit (10% vs 14%, respectively; P = .002), no general doctor or medical specialist visit (5% vs 8%, respectively; P = .003), and the inability to afford medications (6% vs 15%, respectively; P<.001). Younger age was independently associated with no general doctor visit (odds ratio, 1.40; 95% confidence interval, 1.04-1.88), no general doctor or medical specialist visit (odds ratio, 1.69; 95% confidence interval, 1.14-2.52), and the inability to afford medications (odds ratio, 2.94; 95% confidence interval, 2.19-3.94) after adjusting for sex, race, income, neurological disability, health status, and comorbidity. With further adjustment for health insurance, younger age remained independently associated with the inability to afford medications but not the lack of physician visits. CONCLUSIONS: Stroke survivors younger than 65 years reported worse access to physician care and medication affordability than older stroke survivors. Inadequate access among younger stroke survivors may lead to inadequate risk factor modification and recurrent cardiovascular events.
SourceArch Neurol. 2007 Jan;64(1):37-42. Epub 2006 Nov 13. Link to article on publisher's site
Permanent Link to this Itemhttp://hdl.handle.net/20.500.14038/47291
Related ResourcesLink to Article in PubMed
Showing items related by title, author, creator and subject.
Policy Brief: Addressing Social Determinants of Health through Community Health Workers: A Call to ActionLondon, Katharine; Damio, Grace; Ferrazo, Meredith; Perez-Escamalla, Rafael; Wiggins, Noelle (2018-01-30)This technical report was compiled by the Hispanic Health Council in partnership with Southwestern AHEC and a panel of Community Health Worker Policy Research Experts which included our Katharine London from the Center for Health Law and Economics. The report offers a number of policy recommendations for community health workers for communities that might benefit from community-based services. The report offers recommendations on; payment of community health workers; community health worker caseloads; community health worker recruitment; community health worker training; reflective and trauma-informed mentoring and supportive supervision of community health workers; integration of community health workers into care teams; documenting the effect of community heal worker services on social determination of health. The Hispanic Health Council believes a service design that effectively supports community health workers would incorporate the seven areas of policy recommendation included in this report.
A Public Health Framework for the State Mental Health Authority: A Call for Action by Massachusetts Consumers and Family MembersDelman, Jonathan (2006-01-01)During the Spring of 2006, Consumer Quality Initiatives (CQI) conducted 20 focus groups across the state, 12 with adults with mental illness, 3 with parents of youth with serious emotional disorder, 2 with youth with SED, 1 with family members of adult consumers, and 2 with youth in transition. Supported by a contract with Massachusetts Department of Mental Health (DMH), the goal was to assist DMH in framing the criteria for its upcoming reprocurement. Our findings reveal a frustration with an approach to health care delivery that focuses primarily on the provision of psychiatric care (egs, medication, therapy, hospitalization). We reviewed the focus group reports to identify the most significant themes, which clustered within eight broad categories.
Making the Case for Sustainable Funding for Community Health Worker Services: Talking to Payers and ProvidersLondon, Katharine (2018-01-27)In this presentation, Katharine London of the Center for Health Law and Economics makes her case for offering sustainable funding for community health worker services. Research has shown community health workers can have a distinct impact on health systems, helping them improve population health and contain costs, while also promoting health equity and community engagement. This presentation was designed to assist CHWs and other advocates in engaging with policymakers and payers to support CHW sustainability and develop a financial plan for their CHW work. It was presented as part of a CHW Sustainability event held at the Families USA’s annual conference, Health Action 2018: Staying Strong for America’s Families, in Washington, DC. See Katharine London's blog post on payment delivery methods for community health workers here.