Farming effects regarding sustainable water used in the United States

Latino immigrants reported a small but significant decrease in the usual source of care (-2.8 percentage points) and an increase in emergency department utilization (2.9 percentage points) after the ACA. No significant changes were found after the ACA in health care access and utilization among NL White and NL Asian immigrants.
Insurance coverage increased significantly for these 3 immigrant groups after the ACA. While Latino immigrants had the largest gain in insurance coverage, the proportion of Latino immigrants with insurance remained the lowest among the 3 immigrant racial/ethnic groups.
Insurance coverage increased significantly for these 3 immigrant groups after the ACA. While Latino immigrants had the largest gain in insurance coverage, the proportion of Latino immigrants with insurance remained the lowest among the 3 immigrant racial/ethnic groups.
Prescription opioid mortality doubled 2002-2016 in the United States. Given the association between high-dose opioid prescribing and opioid mortality, several states have enacted morphine equivalent daily dose (MEDD) policies to limit high-dose prescribing. The study objective is to evaluate the impact of state-level MEDD policies on opioid prescribing among the privately insured.
Claims data, 2010-2015 from 9 policy states and 2 control states and a comparative interrupted time series design were utilized. Primary outcomes were any monthly opioid use and average monthly MEDD. Stratified analyses evaluated theorized weaker policies (guidelines) and theorized stronger policies (passive alert systems, legislative acts, and rules/regulations) separately. ZEN3694 Patient groups explicitly excluded from policies (eg, individuals with cancer diagnoses or receiving hospice care) were also examined separately. Analyses adjusted for covariates, state fixed effects, and time trends.
Both guideline and strong policy impleence of MEDD policy impact, specifically. Further research is needed to understand the mechanisms through which MEDD policies may influence prescribing behavior.
Burnout (BO) is a serious phenomenon affecting US physicians. Female physicians, now accounting for a larger share of the workforce, are thought to experience higher levels of BO in some situations compared with their male counterparts. The current review aimed to systematically examine extant literature on physician BO as it relates especially to the female physician.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided search of 4 databases yielding empirical studies with relevant findings regarding female physician BO, published during the time period 2010-2019.
A total of 43 studies were included in the current review. Both male and female doctors have higher percentages of burned out doctors, with a third or more of each group indicating BO in each of the studies examined. These higher levels of BO remained regardless of where physicians worked, their clinical specialty, workloads, or age. However, the review supports the notion that for women doctors, there is generally a higharticular. Additional research is needed to better understand the full extent to which physician gender plays a role in BO.
Hepatitis C virus (HCV) infection remains underdiagnosed and undertreated, but treatment advances may allow primary care providers to address gaps in care by delivering HCV treatment themselves.
The objective of this study was to evaluate results of an HCV treatment program at a federally qualified health center (FQHC) in rural North Carolina and assess the extent to which program success depends upon ongoing consultative support from specialists.
In this retrospective cohort study, we used data on 381 FQHC patients internally referred for HCV care from January 2015 to December 2018, with follow-up through December 2019. Using modified Poisson regression analyses we compared outcomes during periods with (2015-2016) and without (2017-2018) consultative support. Outcomes included treatment initiation, completion, and cure. We also modeled the likelihood of keeping the first appointment, but because multiple referral attempts were made among nonresponsive patients throughout the study period, we could not primary care settings.
Hepatitis C virus (HCV) remains under-treated in the United States and treatment by nonspecialist providers can expand access. We compare HCV treatment provision and treatment completion between nonspecialist and specialist providers.
This retrospective study used claims data from the Healthcare Cost Institute from 2013 to 2017. We identified providers who prescribed HCV therapy between 2013 and 2017, and patients enrolled in private insurance or Medicare Advantage who had pharmacy claims for HCV treatment. We measured HCV treatment completion, determined based on prescription fills for the minimum expected duration of the antiviral regimen. Using propensity score-weighted regression, we compared the likelihood of early treatment discontinuation by the type of treating provider.
The number of providers prescribing HCV treatment peaked in 2015 and then declined. The majority were gastroenterologists, although the proportion of general medicine providers increased to 17% by 2017. Among the 23,463 patients from general medicine or nonphysician providers had a similar likelihood of treatment completion, suggesting that removing barriers to the scale-up of treatment by nonspecialists may help close treatment gaps for hepatitis C.
Quantifying health care quality has long presented a challenge to identifying the relationship between provider level quality and cost. However, growing focus on quality improvement has led to greater interest in organizational performance, prompting payers to collect various indicators of quality that can be combined at the provider level.
To explore the relationship between quality and average cost of medical visits provided in US Community Health Centers (CHCs) using composite measures of quality.
Using the Uniform Data System collected by the Bureau of Primary Care, we constructed composite measures by combining 9 process and 2 outcome indicators of primary care quality provided in 1331 US CHCs during 2015-2018. We explored different weighting schemes and different combinations of individual quality indicators constructed at the intermediate domain levels of chronic condition control, screening, and medication management. We used generalized linear modeling to regress average cost of a medical visit on composite quality measures, controlling for patient and health center factors.