RESUMEN
BACKGROUND: Care of the underserved remains one of the most compelling challenges to American healthcare. Federally Qualified Health Centers (FQHCs) address uninsurance and underinsurance by providing primary and preventive care to vulnerable populations with fees charged based on ability to pay. Our goal is to study the effectiveness of FQHCs system in engaging patients and the barriers to utilization, which have not been well defined. METHODS: Retrospective analysis was performed on data from "Living for Health" (L4H) program participants from 2008 to 2012. Univariate and multivariate logistic regression analysis were performed to determine factors associated with FQHC utilization. RESULTS: Among 9453 subjects screened, 1889 were referred to a FQHC, but only 201(11%) actually sought treatment. Public insurance, non-Hispanic ethnicity, and hypertension were associated with higher rates of FQHC utilization. Inability to afford costs, cultural factors and inflexible appointment times were the most common reasons for FQHC underutilization. CONCLUSION: The current status of FQHC utilization is sub-optimal. Community outreach programs like L4H can improve the access and utilization of FQHCs.
Asunto(s)
Centros Comunitarios de Salud , Relaciones Comunidad-Institución , Accesibilidad a los Servicios de Salud , Poblaciones Vulnerables , Adolescente , Adulto , Anciano , Citas y Horarios , Estudios Transversales , Femenino , Florida , Humanos , Modelos Logísticos , Masculino , Pacientes no Asegurados , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
Numerous interventions have been developed and implemented to decrease risk behaviors which lead to HIV infection and transmission. These interventions have been differentially successful in reducing high risk behaviors in various populations. Testing and evaluation of the interventions have been subject to various degrees of rigor. The CDC recommends the use of interventions which have been rigorously tested and meet the standards for evidence based intervention rather than the continuation of the development of new interventions. Project RESPECT is an evidence based intervention that proved efficacious in increasing condom use among patients of STD clinics. We tested the efficacy of the RESPECT intervention against the NIDA standard intervention to determine if the RESPECT intervention was more effective in reducing high risk behaviors among drug users. Both interventions showed changes from baseline to follow-up; RESPECT was more effective than the NIDA standard intervention in reducing high risk sex behaviors.
Asunto(s)
Consumidores de Drogas/psicología , Infecciones por VIH/prevención & control , Conducta de Reducción del Riesgo , Conducta Sexual , Condones/estadística & datos numéricos , Consejo , Femenino , Florida , Estudios de Seguimiento , Infecciones por VIH/transmisión , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Servicio Ambulatorio en Hospital , Atención Dirigida al Paciente , Factores de Riesgo , Asunción de Riesgos , Encuestas y CuestionariosRESUMEN
Most studies of unemployment among chronic drug users (CDUs) are drug-user treatment-based and there is little information on employment/unemployment among CDUs not in treatment. Between June 2003 and September 2004, 492 CDUs in Miami-Dade, Florida, were administered a quantitative survey at baseline and 6 months later; employment status was measured. Descriptive statistics showed that only 15% were employed at both periods, an equal percentage becoming employed and unemployed at 6 months. The majority of CDUs were unemployed at both time periods. Men were more likely than women to exhibit consistent employment over the two time periods. The study's limitations are noted and future research is suggested.
Asunto(s)
Empleo/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Prospectivos , Trastornos Relacionados con Sustancias/rehabilitación , Resultado del TratamientoRESUMEN
A cohort of 111 injection drug users (IDUs) and their sex partners was assessed in 1988 concerning risk behaviors for HIV and knowledge of HIV/AIDS. Ten years later, in 1998, the cohort was reassessed using the same instrument. All who were HIV negative in 1988 were retested by blood draw for antibodies to HIV. A paired analysis was utilized to determine individual changes in risk behaviors for three serostatus groups--those who remained HIV negative (long-term HIV negatives), seroconverters, and those positive in 1988 (long-term HIV positives). Incidence was twice as high for sex partners (37.5%) as for IDUs (18.0%). Drug and needle use risk behaviors, except crack use, showed decreases; sexual risk behaviors were less amenable to change. Knowledge significantly increased among the long-term HIV negatives and seroconverters but not among those HIV positive in 1988. This analysis demonstrates the need for continued intervention among IDUs and their sex partners.
Asunto(s)
Trastornos Relacionados con Cocaína/epidemiología , Seropositividad para VIH/transmisión , Dependencia de Heroína/epidemiología , Asunción de Riesgos , Parejas Sexuales/psicología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Sexo Inseguro/estadística & datos numéricos , Adulto , Trastornos Relacionados con Cocaína/psicología , Estudios de Cohortes , Estudios Transversales , Femenino , Florida , Estudios de Seguimiento , Seronegatividad para VIH , Seropositividad para VIH/epidemiología , Seropositividad para VIH/psicología , Dependencia de Heroína/psicología , Humanos , Incidencia , Masculino , Compartición de Agujas/psicología , Compartición de Agujas/estadística & datos numéricos , Conducta de Reducción del RiesgoRESUMEN
The prevalence of HIV and associated risk behaviors were assessed among three groups of heroin users: long term injection drug users (LTIDUs), new injection drug users (NIDUs), and heroin sniffers (HSs) with no history of injection. HIV seroprevalence was similar among NIDUs (13.3%) and HSs (12.7%). LTIDUs had almost twice as high a level of HIV infection (24.7%). After including drug use and sex behavior variables in logistic regression models, both drug and sexual risk factors remained in the models. Attributable risk percent (APR) from injection for HIV infection among injection drug users was estimated to be 55.7% for LTIDUs and 5.8% for NIDUs. High-risk sex behavior plays an important role in the prevalence of HIV among drug users and accounts for nearly all the infection among NIDUs. Both injection and sexual risk behaviors need to be stressed in HIV prevention and intervention programs aimed at drug users.
Asunto(s)
Infecciones por VIH/epidemiología , Heroína , Abuso de Sustancias por Vía Intravenosa/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Intervalos de Confianza , Femenino , Infecciones por VIH/complicaciones , Humanos , Modelos Logísticos , Masculino , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Conducta Sexual/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/complicaciones , Trastornos Relacionados con Sustancias/complicacionesRESUMEN
This article examines the satisfaction of users of cocaine and/or opiates and non-drug users with access to the health care system. Data were obtained from a sample of 1,477 injection drug users, non-injection drug users, and non-drug users recruited from neighborhoods with high drug use. Multiple regression examined the relationship between satisfaction with access to health care and demographic, health status and health care utilization, ability to pay, and alcohol and drug use variables. Age, ethnicity, health status, having received health care in the last 12 months, not having received health care when needed, having received preventive health care, health insurance, and drug use were independently associated with satisfaction. Injection drug users and non-injection drug users were less satisfied with access to health care. The article discusses strategies to improve health care delivery to drug users.