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Age-Friendly Health Systems (AFHS) commit to providing evidence-based, low-risk, coordinated care centered on what matters most to older adults, their families, and caregivers. Nova Southeastern University's South Florida Geriatric Workforce Enhancement Program (NSU SFGWEP) has partnered with primary care clinics to provide AFHS training and support to promote AFHS transformation in Broward and Miami-Dade Counties. NSU SFGWEP provides face-to-face and virtual training for AFHS and Electronic Health Record (EHR) documentation as part of the initiative. This project focuses on a group of primary care clinics in Broward County, Florida. In this paper, we evaluate the progress of AFHS transformation through six e-clinical measures that collectively provide indicators of the 4 M framework of AFHS (What Matters, Medication, Mentation, and Mobility). We used provider feedback and e-clinical measures aligned with the Center for Medicare & Medicaid Services (CMS) Merit-based Incentive Payment System (MIPS) to measure clinic outcomes. From Jan 1– Dec 31, 2019, to Jan 1–Dec 31, 2020, the clinics improved high-risk medication management (0–3.71%), advanced care planning (6.79%–20.74%), and fall risk assessment (no data- 46.72%). Results demonstrate some success and ongoing opportunities to continue and expand AFHS interventions for sustainability. [ABSTRACT FROM AUTHOR]

This paper explores the New Zealand Ministry of Health's (MOH) allocation of funding for the Hearing Aid Funding Scheme (HAFS) and the level of service delivery by public and private sectors. The crux of the paper centres on how the system is funded and in what ways the market structure may be affecting access to health care. The study involved three main sampling strategies with primary data being collected from the District Health Board (DHB) clinics and private providers. This was supported with secondary data of service utilization and claims, which was made available via the MOH. DHB and private provider data was collected online. This study found that the market structure and nature of the NZ hearing industry is consistent with an oligopoly – something, which has been assumed in the past but never formally acknowledged. Publicly funded DHB clinics are restricting access to adult hearing aid referrals, as well as referring rejected patients to private audiology providers for ongoing treatment. The findings were consistent with implementation of co-payment fees through DHB and private audiology providers. These findings indicate that high co-payment fees may be increasing the chance of negative externalities, due to a reduction in access and affordability. [ABSTRACT FROM AUTHOR]

This paper used a structural perspective to examine unmet healthcare needs in women at risk for eating disorders in Canada utilizing the Canadian Community Health Survey. The results revealed that body dissatisfied women had reported significantly higher unmet needs compared to body satisfied women (χ 2(1) =29.31, p <.05). Body dissatisfied women were also more likely to identify structural reasons for unmet needs. Considering the high costs associated with eating disorders, barriers creating inequitable health services need to be addressed in clinical practice, organizational structures, policy, and in research to improve treatment pathways. [ABSTRACT FROM AUTHOR]

Background. Robert Fortuine provided basic medical care to Alaska Native people, chronicled the Health Aspects of Arctic Exploration and through a number of influential publications, was the first to thoroughly document and analyse Alaska's Medical History. This overview of his published work will provide the reader with a detailed overview, so that they can begin to explore Dr. Fortuine's many published works in more detail. Objective. This review will explore Alaska's Medical History and the Health Aspects of Arctic Exploration through the research files and the 10 most significant publications of Dr. Robert Fortuine. Design. Review of Dr. Fortuine's major works and the master bibliography has over 3,000 references and 81 subjects. The master bibliography is a merger of 55 separate bibliographies, which provides a wealth of bibliographic information. This paper will describe his 10 most significant publications, 2 of which began as a journal issue. Results. Dr. Fortuine was a prolific writer throughout his career, publishing 134 articles and books. He wrote papers and books on Alaska's medical history, tuberculosis and health care delivery from Russian-America through the Public Health Service efforts in the territory and then the State of Alaska. The master bibliography has over 3,000 references and 81 subjects. This list has a significant number of entries for tuberculosis with almost one-third of the entries including this heading. Others dwell on the history of "precontact"health, the history of Alaska Native health care, the history of the Alaska Department of Health, especially the tuberculosis programme, the role of the US Public Health Service and traditional medicine. He completely reviewed every Governors' and the US Surgeon General's reports in regard to Alaska content. This paper describes his 10 most significant publications. Conclusions. Robert Fortuine's published works offer a wealth of information and insight into Alaska's Medical History and the Health Aspects of Arctic Exploration. As is probably true for many historians, he began small, creating a bibliography and adapting a talk before tackling his first full-length book. Readers who sample his many works will be enriched and enlightened. [ABSTRACT FROM AUTHOR]

The Massachusetts experience of health care reform before the Affordable Care Act of 2010 reveals a moral economy of care in which expanded access was met by neoliberal demands for accountability and cost control. Publicly subsidized health insurance programs in the U.S. are deeply concerned with managing and regulating low-income residents’ access to and coverage for medications. By focusing our attention on the new forms of social relations invoked by specific techniques of governing, analyses of accountability can help us understand the ways in which subjectivities are shaped through their encounters with overarching social and economic structures. This paper presents qualitative findings from a four-year, prospective study that combined two waves of survey and chart-based data collection with four qualitative methods. Medicaid patients are made accountable to their medication regimens as they must track their supply and obtain refills promptly; regular blood tests carried out by health care providers verify their adherence. Both patients and their physicians are subject to cost savings measures such as changing lists of covered medications. Finally, patients struggle to pay ever-increasing out-of-pocket costs for their medications, expenses which may keep patients from taking their medications as prescribed. The fraught relationship between trust, accountability, and verification finds emphatic expression in the moral economy of health care, where the vulnerability of the sick and their hope for a cure confront policies designed to hold down costs. [ABSTRACT FROM PUBLISHER]

This article deals with the social democratic aspiration of equitable access to health care in Bulgaria, a country in transition since 1989 from communism and a command economy to democracy and a free market. The focus is on access to health services and resources after the introduction of a universal health insurance system, with particular reference to formal and informal out-of-pocket payments for health care. The paper reports empirical results from a national household expenditure survey, supplemented with a semi-structured interview, conducted at the end of the survey period (April-May 2002). The results bring to light the groups in society who suffer most in this scenario: the poor, Roma, older persons and those living in towns and villages. The study reveals that the stated aim of the National Health Insurance Fund, to provide equitable access to health care, is a mirage rather than a reality, as the vast bulk of health care is self funded. This paper has particular significance for understanding the challenges faced by post-communist states in their attempts to achieve social democratic health care reforms. [ABSTRACT FROM AUTHOR]

This paper examines the extent to which US citizenship status affects the probability of a person's having a usual source of care and the predictors associated with access to health care among non-citizens. The research is founded on the analysis of data from the 2005 California Health Interview Survey (CHIS) (n = 33,187 adults, ages 18–64). Guided by a modified Andersen model of access to health care, the researchers conducted a series of logistic regression analyses using the survey data to compare native-born citizens with non-citizens who were 1.6 times less likely to access a usual source of care. Among non-citizens, insurance status, shorter duration of residence in the United States, and lower levels of English proficiency were related to a lower probability of having a usual source of care. Based on this research it is argued that affordable health care and health insurance options and access to culturally and linguistically sensitive services are needed to increase access to health care among these identified subgroups of non-citizens. [ABSTRACT FROM AUTHOR]

Due to the COVID-19 pandemic, access to medical care is restricted for nearly all non-acute conditions. Due to their status as a vulnerable social group and the inherent need for transition-related treatments, transgender people are assumed to be affected particularly severely by the restrictions caused by the COVID-19 pandemic. As an ad hoc collaboration between researchers, clinicians and 23 community organizations, we developed a web-based survey in German that was translated into 26 languages. Participants were recruited via community sources, social media channels, and snowball sampling since May 2020. The present sample is based on the data collected until August 9, 2020. We assessed demographical data, health problems, risk factors, COVID-19 data (e.g., contact history), and the influence of the COVID-19 pandemic on access to transgender health care services. To identify factors associated with the experience of restrictions, we conducted multiple logistic regression analysis. 5267 transgender people from 63 upper-middle-income and high-income countries participated in the study. Over 50% of the participants had risk factors for a severe course of a COVID-19 infection and were at a high risk of avoiding COVID-19 treatment due to the fear of mistreatment or discrimination. Access to transgender health care services was restricted for 50% of the participants. Male sex assigned at birth and a lower monthly income were significant predictors for the experience of restrictions to health care. 35.0% reported at least one mental health condition and 3.2% have attempted suicide since the beginning of the COVID-19 pandemic. Transgender people suffer under the severity of the pandemic due to the intersections between their status as a vulnerable social group, their high number of medical risk factors, and their need for ongoing medical treatment. The COVID-19 pandemic can potentiate these vulnerabilities, add new challenges for transgender people, and, therefore, can lead to devastating consequences, like severe physical or mental health issues, self-harming behavior, and suicidality. [ABSTRACT FROM AUTHOR]

Bangladesh has achieved notable success in improving maternal health by increasing women's access to good quality and low-cost maternal health care (MHC) services. However, the health system of Bangladesh has earned criticism for not ensuring equitable MHC access for all women, particularly for Indigenous women in the Chittagong Hill Tracts (CHT). Little is known about Indigenous communities' perspectives on these inequalities in MHC service access in the CHT. Therefore, this study aimed to explore Indigenous communities' perspectives on challenges and opportunities for improving MHC service access in the CHT. This qualitative descriptive study was conducted in two sub-districts of Khagrachhari between September 2017 and February 2018. Eight Indigenous key informants from three Indigenous communities (Chakma, Marma and Tripura) were recruited via snowballing and purposive techniques and participated in face-to-face, semi-structured interviews. Key informants comprised community leaders and health care providers. Data were analysed thematically using Nvivo12 software. Findings suggest that distance, poor availability of resources and infrastructure, lack of community engagement in the design of health interventions, Indigenous cultural beliefs, misconceptions about MHC services, and maltreatment from health care providers were the key barriers to accessing MHC services; all are interconnected. Indigenous women faced humiliation and maltreatment from MHC staff. Failure to provide a culturally-safe environment suggests a lack of cultural competency among health staff, including Indigenous staff. Findings suggest that cultural competency training for all health care providers is needed to improve cultural appropriateness and accessibility of services. Refresher training and undisrupted supply of basic MHC services for front-line care providers will benefit the entire community and will likely be cost-effective for the government. Designing health programmes through extensive community consultation is essential. [ABSTRACT FROM AUTHOR]

People who use illicit substances and experience socioeconomic disadvantage experience poor health as a result of structural vulnerabilities made worse by barriers to health care. In particular, stigma and discrimination often act as a barrier to health care for people who use illicit substances. Lack of respect for persons and judgements based on discrimination are in violation of core ethical principles of nursing practice. Harm reduction, as a guiding philosophy, is proposed as a way to promote respectful and non-judgmental care and minimize the harms associated with illicit substance use in alignment with principles of ethical nursing practice. Utilizing McLeroy's Ecological Model of Health Promotion as the guiding framework, we conducted an integrated review of relevant literature to identify recommendations for implementing harm reduction in nursing practice at the intrapersonal, interpersonal, and institutional levels. The search yielded 20 primary research articles published from 2008 until 2020 to identify the actions necessary to implement harm reduction in nursing practice. This integrative review summarizes evidence-based actions necessary from the micro- to meso-level to support the implementation of harm reduction as a guiding philosophy to enhance ethical practice in nursing. [ABSTRACT FROM AUTHOR]

Introduction: In an ongoing study, a new clinical role adapted from a patient navigator called the patient advocate (PA) met with patients before medical visits, attended appointments and afterwards reviewed provider instructions. This qualitative analysis examines the perspectives of PAs and providers regarding their experiences with patients to understand how a PA can help patients and providers achieve better asthma control. Methods: PAs recorded journal entries about their experiences with patients. Provider focus groups and interviews were conducted by researchers and transcribed. Analysis was based on the Grounded Theory approach for qualitative research, using open and then focused coding. Two researchers independently coded these sources until intercoder agreement was achieved. Results: Upon review of 31 journal entries on PA experiences with 24 patients and transcripts from 2 provider focus groups and 12 provider interviews, 5 themes emerged surrounding asthma care and self-management: medication adherence, follow-up, communication, social determinants of health and time. While patients shared with PAs specific socioeconomic barriers to medication adherence and follow-up, providers often did not know about these problems and cited barriers to communication. Time restrictions on medical visits further limited communication. Conclusions: Perspectives reported here illustrate a gap in knowledge and understanding between patients and providers. The PA's unique relationship with patients and presence inside and outside of medical visits allowed them to learn contextual patient information unknown to providers. PAs and providers cited numerous ways PAs can help to improve patient–provider mutual understanding. [ABSTRACT FROM AUTHOR]

Objectives: Data documenting the scope of sexual health clinical services offered as public health in Canada are unavailable. This article provides first insights into the scope of STI and clinical sexual health services available nationally. Methods: Data were gathered using an online survey of 113 Canadian public health units. Results: Almost half of the clinics were not providing expedited partner therapy, one third were not providing point of care testing for HIV and one third were not using syndromic management of sexually transmitted infections (STIs). Low rates of physician support were evident. Conclusion: Given the ever-higher rates of STIs, findings from this study identify important challenges to providing comprehensive services. [ABSTRACT FROM AUTHOR]

Background: HIV/AIDS has had a significant impact on maternal and child health in South Africa. It is thus of vital importance to implement interventions to prevent mother-to-child transmission of HIV (PMTCT) as early as possible during pregnancy. Negative interactions between patients and health care providers (HCPs) can be an important barrier to antenatal care, PMTCT use and PMTCT adherence. Research about respectful maternity care has focused more on the patient perspective. We therefore compared the patient and HCP perspectives and reflected on how interactions between HCPs and patients can be improved. Objective: To obtain insights into the attitudes of HCPs in the context of HIV and PMTCT-related care, by studying patient and HCP perceptions of their interactions, in a peri-urban hospital setting in Gauteng province, South Africa. Methods: A qualitative study was conducted in a public tertiary-level hospital. Fourteen semi-structured in-depth interviews were conducted with nurses and doctors in the antenatal clinic and postnatal ward. Thirty-one semi-structured in-depth interviews and two focus group discussions were conducted with HIV positive and negative women on the postnatal ward. Results: HCPs experienced a difficult work environment due to a high workload. This was combined with frustrations when they felt that patients did not take responsibility for their own or their child's health. They were motivated by the need to help the child. Patients experienced judging comments by HCPs especially towards younger, older and foreign women. They expressed fear to ask questions and self-blame, which in some cases delayed health care seeking. No discrimination or isolation of HIV infected patients was reported by patients and HCPs. Conclusion: We hypothesize that more humane working conditions for obstetric HCPs and a caring, personalised approach to patient management can improve patient-provider interactions and access to respectful care. These are critical to preventing mother-to-child transmission of HIV. [ABSTRACT FROM AUTHOR]

Objective: As the first professional contact for most Australians with mental health concerns, general practitioners (GPs) are often considered the “gateway” to accessing psychologists. Understanding GPs’ views of psychologists is therefore of great importance to the profession. GPs serve a particularly important role in mental health in rural and remote areas given the lack of other services; however there has been limited research investigating the relationship between psychologists and GPs in rural areas. This study aimed to investigate rural GPs’ perceptions of rural psychologists. Method: Semi‐structured qualitative telephone and in‐person interviews were conducted with 13 GPs working in rural and remote South Australia. Data were analysed thematically. Results: Three main themes were identified: Psychologists are useful/helpful; working with psychologists can be challenging; and psychologists are not well understood. Rural GPs held mostly positive views about psychologists and their value in providing professional support and reducing GP workloads. However, GPs’ understanding of psychologists’ training and expertise varied considerably, with most reporting gaps in their knowledge. Challenges included limited access to psychologists and communication barriers. Communication was considered to be enhanced by co‐locating psychology services within the GP practice, which was also considered to be a valuable educational opportunity for GPs. Conclusion: While rural GPs held largely positive views of psychologists, they may require further support in understanding what psychologists can offer and promoting psychology to their patients. Results may assist in improving communication between rural psychologists and GPs and inform strategies to improve rural GPs’ understanding of psychologists’ skills and training. [ABSTRACT FROM AUTHOR]

People suffering from amyotrophic lateral sclerosis (ALS) have complex health and care needs. The purpose of this study was to gain insight into the gaps in the health and community service care provided to ALS patients. In order to ensure continuity of care, specialist centres have to build effective relationships with local primary health care services and community services, health managers, physicians, patients, families and the surrounding support networks. We undertook a qualitative study that examined the specialist centres in hospitals, communities and primary care services. In 2010 we carried out 47 semi-structured interviews and one group interview in Italy, targeting all those involved in ALS care, on all levels. We used purposive sampling to obtain maximum variation across professions, sectors and services. Participants reported gaps arising when local health managers have to assess patient eligibility for certain services. The need to set priorities when allocating resources means that professionals ‘categorize’ patients without considering the multidimensional nature of their needs. For instance, rehabilitation is generally guaranteed for people with temporary or non-progressive functional limitations, yet it is not granted to degenerative patients. Patients with similar physical conditions, with perceived differences of other kinds (i.e. curable vs. treatable), may experience differential access to care. [ABSTRACT FROM AUTHOR]

Research has shown persistent inequalities in access to health care between and within sociodemographic groups and geographic areas. Yet much of what we know about geographical disparities in access comes from studies of regional and urban/rural contrasts, or from studies of intra-urban, neighborhood-level variations. We know relatively little about variations in access to primary health care across different urban areas, and whether such variations translate into differences among residents' health. This study examines how health status and access to primary care vary across five of Canada's largest cities, paying particular attention to populations that may be particularly vulnerable based on age and income. Across all outcomes, there was a consistently strong relationship with individual socioeconomic status. We show that city of residence is important for access to health care but not for health status. Results are discussed in terms of their relevance for urban health-care policy and delivery, and impacts on health and access to care. [ABSTRACT FROM AUTHOR]

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Increasingly, migrants with precarious status (MPS) are recognized as being particularly vulnerable. This exploratory study assesses whether the health of MPS in Montreal, Canada, is similar to that reported in the international literature (see Health situation of migrants with precarious status: Review of the literature and implications for the Canadian context—Part A, Social Work in Public Health, 27 (4), 330–344). The results of this study show that, as in other parts of the world, MPS in Canada appear to be confronted by multiple obstacles to health, many of which are linked to their precarious migration status and its impact on living conditions and access to health care. To reduce health inequalities, therefore, it is crucial to better understand and address the specific needs of this highly vulnerable population. [ABSTRACT FROM PUBLISHER]

Older adults face many challenges to community living. The literature has not sufficiently explored the roles of care coordination in the maintenance of housing and access to health care among older adults, particularly from their own perspectives. This qualitative study analyzes the findings from 25 interviews and 6 focus group discussions (48 participants) with a multiethnic sample of older adults in the New York City area. Care coordination services appear to assist older adults access health care, and to a lesser extent, maintain affordable housing. Disparities in access to care coordination appear to remain for immigrant, minority and suburban populations. [ABSTRACT FROM PUBLISHER]

Background. Despite the National Asthma Education and Prevention Program (NAEPP) guidelines that specify the goals of asthma control and management strategies, the number of patients with uncontrolled asthma remains high, and factors associated with uncontrolled asthma are unknown. Objective. The aim was to examine the relationship between asthma control and socio-demographic characteristics, health-care access and use, asthma education, and medication use among adults with active asthma residing in New England. Methods. Data from the 2006-2007 Behavior Risk Factor Surveillance System Adult Asthma Call-Back Survey were analyzed using multinomial logistic regression. Asthma control was categorized as "well controlled," "not well controlled," or "very poorly controlled" according to the NAEPP guidelines. Results. Of the respondents (n = 3079), 30% met the criteria for well-controlled asthma, 46% for not well-controlled asthma, and 24% for very poorly controlled asthma. Being of Hispanic ethnicity (odds ratio [OR] = 4.0; 95% confidence interval [CI] = 1.2-13.7), unemployed or unable to work (OR = 17.9; 95% CI = 6.0-53.4), high school educated or less (OR = 2.8; 95% CI = 1.6-4.7), current smokers (OR = 2.5; 95% CI = 1.3-5.1), or being unable to see a doctor or specialist for asthma care or unable to buy medication for asthma because of cost (OR = 7.6; 95% CI = 3.4-17.1) were associated with very poorly controlled asthma. In addition, having Coronary Obstructive Pulmonary Disease (COPD) (OR = 2.6; 95% CI = 1.5-4.5), two or more routine checkups for asthma (OR = 4.5; 95% CI = 2.3-8.9), or an emergency department visit, urgent care facility visit, and hospitalization in the past year (OR = 3.9; 95% CI = 2.1-7.3) were also associated with having very poorly controlled asthma. Using controller medication in the past year (OR = 2.6; 95% CI = 1.6-4.2) and taking a course on how to manage asthma (OR = 3.0; 95% CI = 1.2-7.8) were significantly associated with poor asthma control. Conclusion. The high prevalence (70%) of not well-controlled asthma and poorly controlled asthma in this study emphasizes the need to identify factors associated with poor asthma control for development of targeted intervention. A health policy of increasing asthma education, health-care access, and smoking cessation may be effective and result in better asthma control and management. [ABSTRACT FROM AUTHOR]

Adults with childhood-onset neuromotor disabilities face problems accessing health care services. There are often challenges finding primary care providers or specialized providers, such as physical therapists, who are knowledgeable about neuromotor disabilities. The purpose of this study was to determine the perceptions of physical therapists regarding (a) barriers to providing therapy to adults with childhood-onset neuromotor disabilities and (b) resources that would be beneficial for improving and/or providing these services. An online questionnaire was sent to 1,250 therapists licensed in Oregon and Southwest Washington. One hundred fifty-two physical therapists responded resulting in a 12% response rate. The top three barriers to providing therapy were extra time for complex patients, lack of insurance coverage, and lack of experience. The three most frequently cited resource needs included information on equipment, continuing education, and written educational materials. These findings suggest that physical therapists may benefit from further education in working with adults with childhood-onset neuromotor disabilities. [ABSTRACT FROM AUTHOR]

Advocates can successfully improve access to health care for people without health insurance. This article demonstrates the success of what began as a local advocacy effort to improve access to health care on Long Island, which later grew to become a major statewide advocacy movement. It explores the process taken by local coalition members to successfully fight for monumental public health legislation—first locally then statewide—to improve access to hospital care for the medically indigent. Using New York State as a model, it includes several approaches that could facilitate the enactment of legislation in other states. The experiences of New York advocates suggest that with focused collaborative efforts it is feasible to promote significant changes to public health laws to benefit the uninsured and underinsured. [ABSTRACT FROM AUTHOR]

In developing countries like India, poor health and inability to access health care are an important part of the experience of ageing, particularly among people living in poverty: access to treatment is governed by public policy, as well as socio-economic characteristics of the elderly people. My research into morbidity among the elderly in an urban slum in South India demonstrates that the state should not dilute its commitment to health care, as it is the only source of access to health care, particularly for elderly women who have experienced multiple deprivations throughout their life course. [ABSTRACT FROM AUTHOR]

This article reviews the literature on medically underserved children's access to health care. It describes the populations of children most likely to be medically underserved and the social, financial, and systemic factors that compromise their ability to obtain the health services they need. It provides brief descriptions of selected model programs designed to improve access to health care and offers recommendations for practitioners and policy makers interested in working to improve access in their communities. [ABSTRACT FROM AUTHOR]

In 1996 the Tanzanian government initiated community health insurance schemes to improve access to health care and to protect people against the financial cost of illness in an environment with shrinking budgets for the health sector. This study aims to evaluate the role of the community-health funds (CHF) in lowering the barriers to assessing health care. Three important results emerge from this study: first, the results show that income is amongst the most important factors determining household participation in the schemes. This means that despite exemption mechanisms, the poorest of the poor within the society are not reached as they can not afford to pay regular insurance premiums. Secondly, though we find no significant differences between members and non-members in the overall amount of health expenditure and in the use of preventive measures, sick individuals in member households were 15 percentage points more likely to get treatment than non-member households. Hence, being insured leads to an increase in the effective utilization of health care. Third, the analysis reveals that members of the CHF are better financially protected against health shocks than non members. The result of this work provides further evidence of the important role that micro-insurance schemes can play in the risk management of people in developing countries. [ABSTRACT FROM AUTHOR]

Objectives. Hospitalization for ambulatory care sensitive conditions, also called preventable hospitalization, has been widely accepted as an indicator of access to primary health care, and of the overall success of the primary health care system. Our objective is to examine associations between preventable hospitalization and race and ethnicity in the USA, separately for six major chronic diseases: angina, asthma, chronic obstructive pulmonary disease, congestive heart failure, diabetes and hypertension. Design. We used the 1997 Nationwide Inpatient Sample, 1997 Current Population Survey and 1997 National Health Interview Survey, to calculate rates of preventable hospitalization, and the prevalence of ambulatory care sensitive conditions, for African Americans, Hispanics and non-Hispanic whites. Rates were calculated for ages 19–64, and 65 and over. Preventable hospitalization rates that accounted for underlying hospitalization patterns were also estimated. A final set of estimations adjusted the preventable hospitalization rates for disease prevalence. Results. Preventable hospitalization rates were notably higher for African Americans and Hispanics than for non-Hispanic whites for almost all of the conditions, both for women and men and for both age groups. Rates adjusted for underlying hospitalization patterns showed a similar pattern. Adjusted for disease prevalence, rate differences remained notably large for both women and men, and for both age groups. Particularly great, for both African Americans and Hispanics of both sexes, are the risks of preventable hospitalization for asthma, diabetes and hypertension. Conclusion. African Americans and Hispanics have high preventable hospitalization rates for major chronic conditions, even after disease prevalence and underlying hospital utilization patterns are considered. These rates are particularly high for asthma, diabetes and hypertension, which are amenable to prevention and management interventions. Our results suggest a need to improve access to quality primary health care for African Americans and Hispanics in the USA, and for enhanced support of targeted prevention efforts. [ABSTRACT FROM AUTHOR]

Keywords: Race, minority health, access to health care, socioeconomics, ethnicity. [ABSTRACT FROM AUTHOR]