COLLEGE DRINKING: STAGGERING TO THE ED
Tens of thousands of American college students visit the emergency department (ED) after bouts of drinking. This study found that 10% of all ED visits in a large university health system involved alcohol intoxication. Two thirds of these alcohol-related ED visits had an additional diagnosis, with injuries (24%) the most common condition. The rate of alcohol intoxication as a proportion of all ED visits rose more than 50% from 2009–10 to 2014–15. The increase was greater among female students, students below 20 years of age, Asian students, and student athletes.
NAVIGATING THE HEALTH CARE SEA
Patient navigators (aka case managers, care coordinators, community health workers, health coaches) are persons with or without a healthcare-related background who engage patients on an individual basis to help them access care, follow treatment guidelines, and pursue self-care. This review of 67 papers across chronic diseases looked primarily for improvements in processes of care. Most navigators are lay people and most communication is done by phone. Two thirds of studies reported improvement in primary outcomes such as disease screening and adherence to follow-up appointments. Few studies of navigators have assessed patient experiences, clinical outcomes, or costs.
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LIMITED HEALTH FUNDING FOR AIANs
American Indians and Alaskan Natives (AIANs) can receive free health care from facilities managed by the Indian Health Service, federally recognized Tribes, and urban Indian health programs. All receive money from the funds allocated by Congress to the Indian Health Service. The funding is limited, however, and if more is required, some services may be prioritized over others or rationed.
The image above depicts the findings of a recent report on AIAN health. In 2017, Congress provided $4.8 billion to all AIAN health care services, and $1.3 billion came from third-party sources like Medicaid, Medicare, private insurance, and the Veterans Administration. Urban Indian health programs only received 1%, or about $40 million, of this funding. AIANs who do not live on federal reservations and are not members of federally recognized Tribes are unable to receive care from the Indian Health Service or Tribe-operated programs, and may turn to the urban Indian health programs for services.
The uneven distribution and disproportionately small amount of funding that these programs receive in comparison to other services indicates that some AIAN health needs remain unmet. Those who rely entirely on the Indian Health Service may not have access to primary care. Unlike Indian Health Service and Tribe-operated facilities, urban Indian health organizations cannot contract with the Purchased/Referred Care program, which fills gaps in care with private providers. To improve access to care, urban Indian health programs must receive similar or greater support in comparison to other AIAN health care services, and funding mechanisms for such broad programs must improve.
—Sampada Nandyala, PHP Fellow
Graphic: Kaiser Family Foundation, "Medicaid and American Indians and Alaska Natives," Samantha Artiga, Petry Ubri, and Julia Foutz Published: Sep 07, 2017
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