J Gen Intern Med
Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, USA.
Published: January 2020
Objective: To describe how access to primary and specialty care differs for Medicaid patients relative to commercially insured patients, and how these differences vary across rural and urban counties, using comprehensive claims data from Oregon.
Design: Cross-sectional study of risk-adjusted access rates for two types of primary care providers (physicians; nurse practitioners (NPs) and physician assistants (PAs)); four types of mental health providers (psychiatrists, psychologists, advanced practice NPs or PAs specializing in mental health care, behavioral specialists); and four physician specialties (obstetrics and gynecology, general surgery, gastroenterology, dermatology).
Participants: 420,947 Medicaid and 638,980 commercially insured adults in Oregon, October 2014-September 2015.
Outcome: Presence of any visit with each provider type, risk-adjusted for sex, age, and health conditions.
Results: Relative to commercially insured individuals, Medicaid enrollees had lower rates of access to primary care physicians (- 11.82%; CI - 12.01 to - 11.63%) and to some specialists (e.g., obstetrics and gynecology, dermatology), but had equivalent or higher rates of access to NPs and PAs providing primary care (4.33%; CI 4.15 to 4.52%) and a variety of mental health providers (including psychiatrists, NPs and PAs, and other behavioral specialists). Across all providers, the largest gaps in Medicaid-commercial access rates were observed in rural counties. The Medicaid-commercial patient mix was evenly distributed across primary care physicians, suggesting that access for Medicaid patients was not limited to a small subset of primary care providers.
Conclusions: This cross-sectional study found lower rates of access to primary care physicians for Medicaid enrollees, but Medicaid-commercial differences in access rates were not present across all provider types and displayed substantial variability across counties. Policies that address rural-urban differences as well as Medicaid-commercial differences-such as expansions of telemedicine or changes in the workforce mix-may have the largest impact on improving access to care across a wide range of populations.
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http://dx.doi.org/10.1007/s11606-019-05439-z | DOI Listing |
Dig Dis Sci
January 2025
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan, 70401, Taiwan.
Aim: Sarcopenic obesity (SO) is associated with adverse outcomes in diseased patients. This study aimed to examine the prevalence and risks associated with SO, with a focus on the impact of SO on cardiovascular risk in patients with MASLD.
Materials And Methods: In this cross-sectional study, patients with MASLD were prospectively enrolled.
Indian J Pediatr
January 2025
Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India.
Objectives: To evaluate the predictive ability of furosemide stress test (FST), serum and urine cystatin-C in identifying progressive acute kidney injury (AKI) and the need for kidney replacement therapy (KRT).
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J Endocrinol Invest
January 2025
Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy.
Purpose: The delayed or missed diagnosis of secondary hypertension contributes to the poor blood pressure control worldwide. This study aimed to assess the diagnostic approach to primary aldosteronism (PA) and pheochromocytoma (PHEO) among Italian centers associated to European and Italian Societies of Hypertension.
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J Occup Rehabil
January 2025
Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Purpose: This qualitative study investigated the needs, barriers, and facilitators that affect primary care providers' involvement in supporting patients' stay-at-work and return-to-work following injury or illness. It also aims to understand the lived experiences of primary care providers who participated in the Extension for Community Healthcare Outcomes training program for Occupational and Environmental Medicine (ECHO OEM). By examining both the structural and experiential aspects of the program, this study seeks to provide insights into how ECHO OEM influences providers' approaches to occupational health challenges.
View Article and Find Full Text PDFCurr Diab Rep
January 2025
Department of Family Medicine, University of Colorado School of Medicine, 13199 E Montview Blvd, Aurora, CO, 8004, USA.
Purpose Of Review: Addressing diabetes distress (DD), the emotional demands of living with diabetes, is a crucial component of diabetes care. Most individuals with type 2 diabetes and approximately half of adults with type 1 diabetes receive their care in the primary care setting. This review will provide guidance on addressing DD and implementing targeted techniques that can be tailored to primary care patients.
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