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This chapter attempts to clarify the underlying mechanisms of the relationship between socioeconomic status and health outcomes. Former studies of this relationship have largely focused on the materialist predictors of health outcomes, examining variables such as income, access to healthcare, or quality of housing. The current study, by contrast, looks at individuals’ behaviors and attitudes, particularly in relation to physicians, and their impact on the quality of care patients receive. Using data from a sample of 64 hemodialysis patients in a middle-class suburb of Long Island, I examined the effect of comfort and ease with doctors and willingness to engage them on patient compliance. The findings suggest that patients who are more comfortable asking their doctors how they feel, and those that push for more information in general, tend to be more compliant, and therefore enjoy better and more successful patient outcomes.

Purpose – To estimate the impact of diabetic drug adherence on hospitalizations, emergency room (ER) visits, and hospital costs.

Methods – It is often difficult to measure the impact of drug adherence on hospitalizations since both adherence and hospitalizations may be correlated with unobservable patient severity. We control for such unobservables using propensity score methods and instrumental variables for adherence such as drug coinsurance levels and direct-to-consumer advertising.

Findings – We find a significant bias due to unobservable severity in that patients with more severe health are more apt to comply with medications. Thus, the relationship between adherence and hospitalization will be underestimated if one does not control for unobservable severity. Overall, we find that increasing diabetic drug adherence from 50% to 100% reduces the hospitalization rate by 23.3% from 15% to 11.5%. ER visits reduce by 46.2% from 17.3% to 9.3%. Although such an increase in adherence increases diabetic drug spending by $776 a year per diabetic, the cost savings for averted hospitalizations and ER visits are $886 per diabetic, a cost offset of $1.14 per $1.00 spent on diabetic drugs.

Originality – Most of the drug cost-offset literature focuses only on the impact of cost-sharing and drug spending on cost-offsets, making it impossible to back-out the empirical impact of actual drug adherence on cost-offsets. In this chapter, we estimate the direct impact of adherence on hospitalizations and costs.

Medical uncertainty is recognized as a critical issue in the sociology of diagnosis and medical sociology more generally, but a neglected focus of this concern is the question of patient decision making. Using a mixed methods approach that draws upon autoethnographic accounts and third-party interviews, we aim to illuminate the dilemmas of patient decision making in the face of uncertainty. How do patients and supportive caregivers go about navigating this state of affairs? What types of patient–doctor/healthcare professional relationships hinder or enhance effective patient decision making? These are the themes we explore in this study by following patients through the sequence of experiencing symptoms, seeking a diagnosis, evaluating treatment protocols, and receiving treatments. In general, three genres of culturally available narratives are revealed in the data: strategic, technoluxe, and unbearable health narratives.

Introduction: Lately, various tendencies to approach personalized medicine (PM) have developed. However, their result is a mutual application of technology without considering the essence of this field. The comprehensive approach to the concept of PM reveals some aspects that need to be dealt with for a successful implementation.

Aim: Identifying possible ways of implementing PM through person-centered care, with an overall positive economic impact, improved medical services, and customer satisfaction.

Methods: The research carried out represents a retrospective descriptive cross-sectional study. Qualitative and quantitative methods were used.

Findings: PM plays an increasingly important role in the political agenda of different countries, to approve an effective method of prevention, diagnosis, and treatment of various diseases. The postponement of its implementation by the authorities and the lack of public policies lead to the unjustified expenditure of public money and contribute to halting the development of the medical system through managerial inefficiency.

The originality of the study: Different approaches to PM and its implementations are analyzed in the context of the challenges of the contemporary economy.

Implications: The research is carried out in the Academy of Economic Studies of Moldova within the state research programs.

Background – Studies suggest text messaging is beneficial to health care; however, no one has synthesized the overall evidence on texting interventions. In response to this need, we conducted a systematic review of the impacts of text messaging in health care.

Methods – PubMed database searches and subsequent reference list reviews sought English-language, peer-reviewed studies involving text messaging in health care. Commentaries, conference proceedings, and feasibilities studies were excluded. Data was extracted using an article coding sheet and input into a database for analysis.

Results – Of the 61 papers reviewed, 50 articles (82%) found text messaging had a positive effect on the primary outcome. Average sample sizes in articles reporting positive findings (n=813) were significantly larger than those that did not find a positive impact (n=178) on outcomes (p=0.032). Articles were categorized into focal groups as follows: 27 articles (44.3%) investigated the impact of texting on disease management, 24 articles (39.3%) focused texting's impact to public health related outcomes, and 10 articles (16.4%) examined texting and its influence on administrative processes. Articles in focal groups differed by the purpose of the study, direction of the communication, and where they were published, but not in likelihood of reporting a positive impact from texting.

Conclusions – Current evidence indicates that text messaging health care interventions are largely beneficial clinically, in public health related uses, and in terms of administrative processes. However, despite the promise of these findings, literature gaps exist, especially in primary care settings, across geographic regions and with vulnerable populations.

This study explored HIV-positive patients' preferences and beliefs about physician gender, sexual orientation, and race/ethnicity. In-depth interviews were conducted with 28 HIV-positive patients, including 15 men and 13 women. Results showed that over half (54%) of respondents had a preference regarding physician gender. Of these respondents, 60% (six women and three men) preferred to have women as their providers. Forty-three percent of respondents had a preference regarding physician sexual orientation. Of these eight men and four women, most (75%) stated that they preferred to see a homosexual health care professional as compared to a heterosexual one. Fewer respondents (18%) had a preference regarding physician race/ethnicity; however, all of those who had a preference regarding physician race/ethnicity stated that they preferred to see Caucasian physicians. Results suggest that physician gender, sexual orientation, and race/ethnicity are not neutral characteristics in the health care setting. Rather, these are dynamic variables that may have important implications for physician-patient relationships in HIV/AIDS care. Patients are most apt to receive optimal health care when they are able to find a physician with the sociodemographic characteristics that they prefer.

Purpose: We analyze how medical providers use accountability processes or the regulatory means through which individuals hold themselves or others accountable to social norms, to uphold their medical authority. We use the case of trans medicine because in this medical domain, providers often have little to no expertise and few are trained specifically in delivering trans medicine or working with trans patients. As a result, providers experience uncertainty and are left without the typical tools and expertise on which they depend in most other areas of medical decision-making.

Design/methodology/approach: We conducted in-depth interviews with 23 medical providers and observations of transgender healthcare conferences in the United States between 2012 and 2015.

Findings: Our work offers insight into the provider side of patient-provider encounters and medical decision-making in gender minority health. The first accountability strategy providers employed was to invoke the language of evidence as a method to maintain their authority, in spite of the paucity of scientific evidence that undergirds this emergent medical domain. The second strategy was to mandate compliance by holding trans people accountable to the expectation of acquiescing to medical authority.

Originality/value: We contribute to the scholarship on gender minority health by examining how high power actors use accountability processes to restore order in interactions with trans and nonbinary patients. We demonstrate how enforcement to expectations through accountability processes is a plausible, though oft-overlooked, dimension of health inequalities.

The purpose of this chapter is to use sociological theory and research to develop an explanation for how chronic illnesses are managed at home and to thereby suggest some ways in which a sociological perspective can be applied to improve health care for persons with chronic illnesses. Self-care illness management is crucial to the prevention of and reduction of morbidity and mortality from chronic illness.

Review and synthesis of research literature.

Sociological research and theory suggest two important insights that should inform health care services aimed at improving self-care; chronic illness care occurs in the context of the household, neighborhood, and community and, therefore, the “patient” (i.e., the object of health services) is really the caregiving social network around the patient, and because the risk of chronic illness and the resources available to deal with it are socially (and unequally) distributed, “health care” interventions need to take account of disparities in risks and resources that will affect the patient’s ability to successfully comply with self-care regimens.

The review does not include an examination of the clinical research literature. It does, however, suggest that sociologists need to explicitly study chronic illness and health care related to it.

The chapter links the long history of research on family caregiving to the concern with the success of self-management of chronic illness. It also links concerns about that success to social disparities in the distribution of social resources and hence to morbidity and mortality disparities.