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Biomedical subjects

H E Freeman

Publications and source records attributed to H E Freeman.

At least 19 recordsLinked to original sources
PubMed1994

Emotional and behavioral problems and severe academic delays among sheltered homeless children in Los Angeles County.

OBJECTIVES: Few studies have estimated the extent of specific emotional, behavioral, and academic problems among sheltered homeless children. The objectives of this study were to describe such problems, identify those children with the problems, and evaluate the relationship between child problems and use of physical and mental health services. METHODS: From February through May 1991, 169 school-age children and their parents living in 18 emergency homeless family shelters in Los Angeles County were interviewed. To evaluate the answers, interviewers used standardized measures of depression, behavioral problems, receptive vocabulary, and reading. RESULTS: The vast majority (78%) of homeless children suffered from either depression, a behavioral problem, or severe academic delay. Among children having a problem, only one third of the parents were aware of any problem, and few of those children (15%) had ever received mental health care or special education. CONCLUSIONS: Almost all school-age sheltered homeless children in Los Angeles County have symptoms of depression, a behavioral problem, or academic delay severe enough to merit a clinical evaluation, yet few receive specific care. Programs targeted at sheltered homeless school-age children are needed to close this gap.

Child↗
PubMed1992

Patient care and professional staffing patterns in McKinney Act clinics providing primary care to the homeless.

OBJECTIVE: To describe the patient care and staffing patterns of the 157 clinics that receive federal funding to provide health care to the homeless. DATA SOURCES: Telephone interviews with clinic medical directors. RESULTS: Clinics treated a mean of 96 homeless patients per week, approximately 50% of the estimated homeless population. Three quarters treated homeless patients only, the others integrated homeless patients into an existing setting. One third of the clinics had no physician more than 5 hours per week, 10% had no physician staff at all, and 80% employed a nurse practitioner. The proportion of patients initially examined by a nurse practitioner and the proportion subsequently referred to a physician ranged between 10% and 100%. Clinic directors reported that in over 50% of clinics, physician recruitment was hampered by poor working conditions, inadequate salaries, physician biases against working with the homeless, and the lack of respect this work receives from the medical profession. CONCLUSIONS: Current financial constraints may be impeding the ability of clinics serving the homeless to ensure adequate access to high quality care. Additional research should evaluate the impact various staffing patterns have on access and quality of care and develop methods to improve physician recruitment.

Community Health Centers↗
PubMed1992

Are poor families satisfied with the medical care their children receive?

While access to care has been shown to be worse for poor populations, few studies have examined the quality of care received by the poor vs the nonpoor. Furthermore, serious concerns have been raised about the impact of cost-containment efforts on the quality of health care for both the poor and nonpoor. The authors examine the interpersonal quality of medical care received by children from poor and nonpoor families by assessing parental satisfaction with physician-patient communication in a telephone survey of a nationally representative sample of households containing 2182 children and adolescents 17 years or younger. The majority of parents were satisfied with many aspects of their interactions with physicians. However, poor families were more likely to be not completely satisfied with the medical care their children received at their last health visit than nonpoor families (27% vs 12%, P less than .001). With regard to specific aspects of the physician-patient communication, poor families were more likely to be not satisfied with the physician's provision of information about the illness (40% vs 21%, P greater than .001); the physician's discussion of examination findings (21% vs 9%, P less than .001); and the opportunity provided by the physician to express their concerns (12% vs 6%, P less than .001). Logistic regression demonstrated that poor patients were approximately twice as likely to be not satisfied with the medical encounter and with various aspects of their communication with the physician. It is concluded that the parents of poor children are less satisfied with their care. Both policy and educational interventions may be needed to address this problem.

Adolescent↗
PubMed1991

HIV testing of asymptomatic patients in U.S. hospitals.

The human immunodeficiency virus (HIV) epidemic and the prevalence of HIV-positive persons in the population has provoked marked anxiety among hospital staffs of acquiring nosocomially transmitted HIV infections. A national telephone survey of key staff in a sample of 561 acute-care hospitals was undertaken to describe the extent of asymptomatic HIV testing of patients, and variations between hospitals in testing practices. The interviews with the chiefs of medicine and surgery and the directors of nursing confirm the high level of anxiety among staff members about acquiring HIV from patients. In three of four hospitals, one or more of the three key clinical staff report asymptomatic testing of at least some patients. In 16.4% of the hospitals where asymptomatic testing is undertaken, one or more staff report that patients are either sometimes or never informed before testing and 38% are not counselled before testing. In 4.2% of the hospitals in which testing identified seropositive patients, infected persons are not always notified; one or more staff interviewed in 25.2% of the hospitals report that seronegative patients may not always be notified of results; likewise, 33.1% of the hospitals do not always include positive test results in hospital records, and 37.7% sometimes or always transfer seropositive patients to another hospital. A major finding is that there is a lack of congruence between the reports of the three different staff members interviewed in each hospital. These conclusions consider the likelihood of developing uniform practices between and within hospitals.

AIDS Serodiagnosis↗
PubMed1991

Regular source of ambulatory care and access to health services.

BACKGROUND: To examine why people lack a regular source of ambulatory care (RSAC) and explore whether this commonly used access measure accurately identifies population subgroups at risk for barriers to continuity care. METHODS: Using data from a 1986 national telephone survey, we performed a content analysis of subjects' verbatim reports as to why they lacked an RSAC (n = 5,748). RESULTS: The 16.4 percent of respondents who lacked an RSAC gave the following reasons: 1) financial problems, 8 percent; 2) local resource inaccessibility, 5 percent; 3) not wanting a regular source of ambulatory care, 61 percent; and 4) transitory loss of their regular source of ambulatory care, 18 percent. However, some sociodemographic subgroups reported substantially more problems with access barriers, and these disparities were often not detected by the global measure, RSAC. The poor were not more likely than the non-poor to lack an RSAC (odds ratio [OR] = 0.8; 95% confidence interval, [0.6, 1.1]), but were much more likely to lack an RSAC for financial reasons (OR = 5.2 [2.6, 10.6]). Similarly, rural respondents were not more likely than urban dwellers to lack an RSAC, but were more likely to lack an RSAC because of local resource inaccessibility (OR = 5.8 [2.8, 11.9]). CONCLUSIONS: We conclude that the global measure, RSAC, is not an accurate indicator of whether population subgroups have access barriers to obtaining a source of continuity care.

Adolescent↗
PubMed1990

Access to medical care for children and adolescents in the United States.

To evaluate access to health care for American children and adolescents, a telephone survey of a national random sample of households was conducted in which 2182 children 17 years or younger were studied. Approximately 10% had no medical insurance; 10% had no regular source of care; and 18% identified emergency rooms, community clinics, or hospital outpatient departments as their usual site of medical care. Children who were uninsured, poor, or nonwhite were less likely to have seen a physician in the past year (P less than .001), and uninsured children were less likely to have up-to-date immunizations. Logistic regression analyses revealed that poor, uninsured, or nonwhite children less frequently had a regular source of care; more frequently used emergency rooms, community clinics, and hospital outpatient departments as their regular providers; and more frequently encountered financial barriers to health care. Low-income or nonwhite children had much less access to care compared with children from more affluent or white families, independent of insurance status or health status.

Adolescent↗
PubMed1990

Uninsured working-age adults: characteristics and consequences.

While estimates of the country's uninsured vary, ranging from 10 to 18 percent of the general population, virtually every study on use of medical services reports that lack of health insurance represents a major barrier to medical care. Based on the 1986 national Robert Wood Johnson Access Survey of 10,130 noninstitutionalized persons, the characteristics of working-age adults without health insurance, and the consequences, are examined. Among working-age adults, the uninsured are most likely to be poor or near-poor, Hispanic, young, unmarried and unemployed. Compared with the insured, they have significantly fewer ambulatory visits during a year, are less likely to have contact with a medical provider during a 12-month period, and are more likely to receive their care in a hospital outpatient clinic or emergency room. Differences in health status do not account for these findings. Especially among persons with chronic and serious illnesses, the uninsured are less likely than the insured to receive medical care. Further, the uninsured are significantly more likely to report needing but not receiving medical care, primarily for economic reasons, and although poorer, they have higher out-of-pocket medical expenses than others in the population.

Adult↗
PubMed1990

Use of telephone interviewing in health care research.

Increasingly, telephone interviewing has become the data collection procedure of choice in large-scale health services research surveys. Previous analyses indicate that excluding nontelephone households does not seriously affect most national parameter estimates, such as yearly estimates of number of ambulatory visits, mainly because the proportion of households without telephones is small. Moreover, if the exclusion of nontelephone households simply underestimates the proportions in the population with certain characteristics, such as age and ethnicity, and the "true" proportions are known, it is possible to appropriately weight the study group in order to mitigate the telephone-exclusion bias. However, regression analyses undertaken on three years of national Health Interview Surveys indicate, at least on some key measures such as having health insurance, that persons living in households with and without telephones represent different populations, and parameter estimates are distorted by excluding nontelephone households. Under these circumstances, it is not possible to adjust parameter estimates to take into account nontelephone households.

Ambulatory Care↗
PubMed1989

Access to medical care for black and white Americans. A matter of continuing concern.

A 1986 national survey of use of health services shows a significant deficit in access to health care among black compared with white Americans. This gap was experienced by all income levels of black Americans. In addition, the study points to significant underuse by blacks of needed medical care. Moreover, blacks compared with whites are less likely to be satisfied with the qualitative ways their physicians treat them when they are ill, more dissatisfied with the care they receive when hospitalized, and more likely to believe that the duration of their hospitalizations is too short.

Adolescent↗
PubMed1989

Utilization of dental services: 1986 patterns and trends.

Data from the 1986 Access to Health Care Survey of the Robert Wood Johnson Foundation, a nationwide telephone survey, were used to provide information on changes and trends in dental utilization in the United States. Sixty-three percent of the respondents five years or older (N = 9,352) had had a dental visit within the past year. Being elderly, having lower socioeconomic status, and being black were independent risk factors for having fewer dental visits. Persons who had dental check-ups during the past year also demonstrated higher rates of other preventive health procedures (i.e., Pap smears, mammograms, breast examinations, and routine medical examinations). Among those without a dental visit within the past year, a financial barrier to receiving such care was reported by 12 percent of those surveyed, compared to 37 percent in 1976. We concluded that during the past decade there has been a continued trend toward increased dental visits and decreased financial problems relating to receiving dental care; however, the poor, ethnic minorities, and those with less education continue to have much lower rates of dental care utilization compared to the general population.

Adolescent↗
PubMed1989

Out-of-pocket payments and use of care for serious and minor symptoms. Results of a national survey.

To assess the effect of out-of-pocket payments on use of care for symptoms that physicians consider serious and meriting care, and for minor symptoms, we evaluated data from a 1986 national survey. Among 5412 adults reporting one or more medical visits in the last year, 18.8% had experienced serious symptoms within the previous 30 days, among whom 63.0% sought care, while 31.3% had experienced minor symptoms, among whom 42.8% sought care. Subjects who had paid $15 or less out of pocket for their last medical visit were more likely to seek care for a serious symptom (67.1% vs 52.6%) or for a minor symptom (47.1% vs 32.2%) than were those who paid $30 or more. Large out-of-pocket payments are associated with significant reductions in use of care for both serious and minor symptoms.

Adult↗
PubMed1988

Inequities in health services among insured Americans. Do working-age adults have less access to medical care than the elderly?

To determine whether groups other than the elderly and the uninsured have difficulty obtaining access to medical care, we studied 7633 adults nationwide. As we expected, the insured had much greater access than the uninsured, but among the insured there were substantial disparities in access to care. Insured adults of working age were 3.5 times as likely (95 percent confidence interval, 2.7 to 4.4) as the elderly to have needed supportive medical services (including medications and supplies) but not to have received them, and 3.4 times (2.3 to 4.4) as likely to have had major financial difficulties because of illness. Among insured, working-age adults, the poor were 4.4 times (3.5 to 5.3) as likely as those who were not poor to have needed supportive services but not to have received them, and 5.2 times (3.6 to 6.8) as likely to have had major financial problems because of illness. Apart from insurance status and income, blacks were 1.7 times (1.1 to 2.2) as likely as whites to have needed supportive services but not to have received them. Hispanics with a medical illness were 2.2 times (1.3 to 3.2) as likely as whites not to have seen a physician within the past year. We conclude that insured, working-age adults have less access to medical care than the elderly, and that poor, black, or Hispanic persons in this group are at risk for even greater problems with access to care. Current policy strategies are unlikely to improve the ability of these groups to obtain care.

Adult↗
PubMed1988

The use of network sampling for locating the seriously ill.

Network sampling, based on the experience of conducting the large-scale 1986 Robert Wood Johnson Foundation National Access to Health Care Survey, was shown to be a viable alternative to more conventional procedures for oversampling persons with a low incidence and prevalence of health conditions. The network sampling approach was a more economical and methodologically less obtrusive means of increasing sample size of persons with desired characteristics than conventional procedures. The approach requires estimating the incidence, prevalence, or both of the required characteristics in the population. As the proportion of persons in the population with the characteristic increases, network sampling may lose its attractiveness. However, this has to be judged both in economic terms and in terms of the methodologic consequences of using other procedures to increase the size of subgroups of interest. As discussed, additional methodologic work is required on the consequences of network sampling for study group representativeness and sampling bias. However, network sampling, in the authors' opinion, is sufficiently promising to warrant methodologic explorations to answer these and other relevant questions about its use.

Adult↗
PubMed1988

Older Americans' access to oral health care.

To determine whether older Americans have difficulty obtaining access to dental care, we studied 7,265 adults nationwide. The objectives of this analysis are to: (1) determine the proportion of older Americans receiving dental services, (2) identify the types of services received, and (3) examine barriers to access to dental care in this population. Almost half of the respondents over the age of 60 reported a dental visit in the past year. This is consistent with the national trend of increasing utilization of dental services by older adults in the United States. However, older respondents reported significantly fewer dental visits in the past year than respondents aged 25-59. The mean time since the respondent's last dental visit increased with increasing age. Minority elders and those older adults with lower incomes, lower educational achievement, poorer perceived health status, chronic diseases, transportation problems, and those living in rural areas had disproportionately fewer dental visits than more socially advantaged respondents. In multivariate analyses, less education, lower income, increasing age, and poorer self-perceived health status were identified as independent risk factors for not having a dental visit, suggesting that certain subpopulations of older Americans are at risk for not receiving necessary oral health services.

Adult↗
PubMed1988

Who gets screened for cervical and breast cancer? Results from a new national survey.

To evaluate the adequacy of cervical and breast cancer screening in the United States, data were analyzed from a 1986 nationwide telephone survey (n = 4659). Papanicolaou smears within the recommended three- to five-year interval were reported by 79% of women aged 20 years or older. Within the preceding year, 55% of women aged 40 years or older had breast examinations performed by physicians, and 20% of women aged 50 years or older had mammograms. Women who were uninsured or lower in socioeconomic status were less likely to have each of these three preventive measures, independent of the age, health status, and frequency of physician visits of the respondent. In addition, women aged 50 years or older were less likely to have had Papanicolaou smears (63% vs 89%) and breast examinations (52% vs 68%) than those women aged 20 to 49 years. These findings suggest that women who are older, uninsured, or lower in socioeconomic status are at an increased risk for not receiving preventive care, and that screening mammography, although more common than a decade ago, is still markedly underused.

Adult↗
PubMed1987

The influence of domestic position on health status.

Data from the Robert Wood Johnson Foundation 1982 survey of access to health care are used to examine the influence of household composition and members' domestic position--e.g. age, sex, marital status, and presence of children, on health status and use of health services. A hierarchical analysis was undertaken to sort groups of individuals and households having different domestic structures. The results of the analyses of use and access for these groups show that, after controlling for age, domestic position and household arrangements are significant explanatory variables. Ways to refine the approach are discussed.

Adolescent↗