Patrick A. Rivers

Racial and Ethnic Disparities in the Use of Mental Health Services

The authors used data from the 1998–1999 Community Tracking Study (CTS) household survey to examine variations in predictors of use of mental health services among different racial and ethnic groups (white, African American, Hispanic, and other). African Americans and Hispanics were less likely to have visited a mental health professional (MHP) in the prior year than were whites. Independent of health insurance and health status, low- to middle-income African Americans may be at particular risk for inadequate use of an MHP compared to higher-income African Americans. Similarly, upper-income Hispanics were more likely to have visited an MHP than Hispanics in the lowest income range. Adults aged 50 and older were less likely to visit an MHP than individuals aged 18–49. Depressed men were more likely to visit an MHP than depressed women. Efforts to reduce disparities should focus on lower-income racial and ethnic minorities.

High blood pressure in school children: prevalence and risk factors

BackgroundThe purpose of this study was to determine the prevalence of high blood pressure (HBP) and associated risk factors in school children 8 to 13 years of age.MethodsElementary school children (n = 1,066) were examined. Associations between HBP, body mass index (BMI), gender, ethnicity, and acanthosis nigricans (AN) were investigated using a school based cross-sectional study. Blood pressure was measured and the 95th percentile was used to determine HBP. Comparisons between children with and without HBP were utilized. The crude and multiple logistic regression adjusted odds ratios were used as measures of association.ResultsFemales, Hispanics, overweight children, and children with AN had an increased likelihood of HBP. Overweight children (BMI ≥ 85th percentile) and those with AN were at least twice as likely to present with HBP after controlling for confounding factors.ConclusionTwenty one percent of school children had HBP, especially the prevalence was higher among the overweight and Hispanic group. The association identified here can be used as independent markers for increased likelihood of HBP in children.

Assessing the effects of race and ethnicity on use of complementary and alternative therapies in the USA

Objective To investigate the use of alternative therapies among different racial/ethnic groups in the USA. Specifically, we examined whether alternative medicine use differs for working aged whites, Asian Americans, African Americans, and Hispanics. Design Using the 1996 Medical Expenditure Panel Survey, racial differences in utilization were investigated at two levels: (1) the bivariate level with no controls for other factors and (2) at the multivariate level with controls for age, sex, region, marital status, education, income, health status, satisfaction with conventional healthcare, and access measures. Results Americans in this sample population used alternative and complementary therapies at a fairly low rate (6.5%). This 6.5%, however, was not consistent across all groups. African Americans and Hispanics were less likely than whites to utilize alternative therapies, whereas Asian Americans did not differ significantly from whites. Conclusions The use of alternative and complementary therapies varied across racial/ethnic groups. Evidence showed that individuals who were dissatisfied with the availability of conventional healthcare, who were in poor health, but very satisfied with their conventional provider were more likely to use complementary and alternative medicine (CAM) therapies. The addition of these variables to a logistic regression model did not change the findings for differential use by ethnicity, the relative ranking of groups, or the overall strength of the relationship.

Obstacles to the application of total quality management in health-care organizations

This paper involves a significant review of the obstacles that face health-care organizations that undertake total quality management (TQM) implementation. A definition of the concept of quality is thoroughly explored, along with the concept of total quality. The importance of TQM in the health-care industry is discussed, and a comparison of TQM in manufacturing environments to TQM in a health-care organization environment is made. Obstacles to the application of TQM in health-care organizations are presented and discussed and conclusions and recommendations regarding the philosophy and practice of quality management and dignified leadership are made.

Risky Behaviors and Factors Associated with Suicide Attempt in Adolescents

ABSTRACT The objective of this study was to identify the behavior risk factors associated with suicide attempt in adolescents and to determine gender-specific patterns of risk factors. In 2001, Center for Disease Control and Prevention (CDC) conducted National Youth Risk Behavior Survey for 13,601 high school students in the U.S. Data were analyzed with logistic regressions to identify the risk behaviors. New significant risk factors (being offered illegal drugs at school, being abused by a boyfriend/girlfriend, gender, and ethnicity) were identified for suicidal attempt in adolescents. Patterns of risk behaviors differed among male and female groups. Several new risk behaviors associated with suicide attempt in adolescents were identified. There were notable differences in risk behaviors between two gender groups, especially in the area of depression. These findings could have potentially important implications for preventing adolescent suicide attempts.

Health information technology capacity at federally qualified health centers: a mechanism for improving quality of care

BackgroundThe adoption of health information technology has been recommended as a viable mechanism for improving quality of care and patient health outcomes. However, the capacity of health information technology (i.e., availability and use of multiple and advanced functionalities), particularly in federally qualified health centers (FQHCs) on improving quality of care is not well understood. We examined associations between health information technology (HIT) capacity at FQHCs and quality of care, measured by the receipt of discharge summary, frequency of patients receiving reminders/notifications for preventive care/follow-up care, and timely appointment for specialty care.MethodsThe analyses used 2009 data from the National Survey of Federally Qualified Health Centers. The study included 776 of the FQHCs that participated in the survey. We examined the extent of HIT use and tested the hypothesis that level of HIT capacity is associated with quality of care. Multivariable logistic regressions, reporting unadjusted and adjusted odds ratios, were used to examine whether ‘FQHCs’ HIT capacity’ is associated with the outcome measures.ResultsThe results showed a positive association between health information technology capacity and quality of care. FQHCs with higher HIT capacity were significantly more likely to have improved quality of care, measured by the receipt of discharge summaries (OR=1.43; CI=1.01, 2.40), the use of a patient notification system for preventive and follow-up care (OR=1.74; CI=1.23, 2.45), and timely appointment for specialty care (OR=1.77; CI=1.24, 2.53).ConclusionsOur findings highlight the promise of HIT in improving quality of care, particularly for vulnerable populations who seek care at FQHCs. The results also show that FQHCs may not be maximizing the benefits of HIT. Efforts to implement HIT must include strategies that facilitate the implementation of comprehensive and advanced functionalities, as well as promote meaningful use of these systems. Further examination of the role of health information systems in clinical decision-making and improvements in patient outcomes are needed to better understand the benefits of HIT in improving overall quality of care.

Health care competition, strategic mission, and patient satisfaction: research model and propositions

PURPOSE In all industries, competition among businesses has long been encouraged as a mechanism to increase value for patients. In other words, competition ensures the provision of better products and services to satisfy the needs of customers This paper aims to develop a model that can be used to empirically investigate a number of complex issues and relationships associated with competition in the health care industry. DESIGN/METHODOLOGY/APPROACH A literature review was conducted. A total of 50 items of literature related to the subject were reviewed. Various perspectives of competition, the nature of service quality, health system costs, and patient satisfaction in health care are examined. FINDINGS A model of the relationship among these variables is developed. The model depicts patient satisfaction as an outcome measure directly dependent on competition. Quality of care and health care systems costs, while also directly dependent on the strategic mission and goals, are considered as determinants of customer satisfaction as well. The model is discussed in the light of propositions for empirical research. PRACTICAL IMPLICATIONS Empirical studies based on the model proposed in this paper should help identify areas with significant impact on patient satisfaction while maintaining high quality of service at lower costs in a competitive environment. ORIGINALITY/VALUE The authors develop a research model which included propositions to examine the complex issues of competition in the health care industry.

Aligning information systems for effective total quality management implementation in health care organizations

This paper explores the history and current status of information systems in health care organizations. A definition of the concept of quality is explored along with the concept of total quality management. Moreover, the gaps in the current information system are discussed. Recommendations for altering the current infrastructure so that it is aligned with the TQM environment are presented.

Geographic variations of childhood asthma hospitalization and outpatient visits and proximity to ambient pollution sources at a U.S.-Canada border crossing.

BackgroundChildhood asthma is a significant public health problem in the United States and evidence is accumulating regarding the contribution from traffic and ambient air pollution. This study is a companion piece of a related Buffalo asthma study in adults recently published in the July 2004 issue of American Journal of Public Health. This study focuses on children under 18 years of age diagnosed with asthma during a three-year period (2000–2002). In order to determine the effects of particulate air pollution on public health, we conducted an ecologic study of childhood asthma and point-source respirable particulate air pollution in patients diagnosed with asthma (n = 6,425). Patients diagnosed with gastroenteritis (n = 5,132) were used as controls.ResultsAlthough the results of this study show spatial patterns similar to the ones observed in the adult study, a multiple-comparison test shows that EPA-designated focus sites located in Buffalos east side are statistically (p < 0.008) more linked to childhood asthma than sites located elsewhere.ConclusionFindings of this study can be useful in geographic targeting and in the design of optimal and preventive measures.

Barriers to health care access for Latino immigrants in the USA

Purpose – Latinos comprise 12.5 percent of the overall population in the USA, and are the fastest-growing minority, among which the Mexican-origin population makes up about 66 percent. Undocumented Latino immigrants are a small, yet important group within the immigrant population. The purpose of this paper is to review the literature and discuss the most important factors that prevent immigrants from accessing health care. Design/methodology/approach – Literature review was conducted from the library database. A total of 50 items of literature related to the subject were reviewed. Findings – Border states have the highest concentration of Mexican-origin people. The concentration of immigrants in the border has unique health and economic implications due to the vital role they have in US society, contributing both to the economy and diversity of the USA. Despite their important role, they disproportionately lack health insurance, and receive fewer health care services than US-born citizens. This lack of insurance puts a burden on the nations economy, and their health status deteriorates as they become more prone to chronic health conditions, and their complications due to lack of primary medical attention. Originality/value – Tailored public health interventions that address the health needs of Latino immigrants in the USA need to be based on reliable data and statistics in order to effectively place resources, and to track achievements and flaws.