• The Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) in Georgia: Women Covered and Medicaid Costs in 2003

      Adams, E. Kathleen; Blake, Sarah C.; Raskind-Hood, Cheryl; Chien, Linien; Zhou, Mei; Liff, Jonathan; Eley, William; Georgia Health Policy Center; Emory University (Georgia Public Health Association, 2007)
      The Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) provided states with an optional Medicaid eligibility category for uninsured women with breast and/or cervical cancers. The BCCPTA is the first and only such effort to use a population-based public health screening program, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to provide a pathway to publicly funded health insurance for otherwise uninsured low-income women. Georgia was one of the first states to adopt the BCCPTA and was one of only twelve states that provided Medicaid eligibility to women screened by non-NBCCEDP providers. We use 2003 Georgia Medicaid claims and enrollment data to investigate the scope of the state’s BCCPTA enrollment and enrollees’ costs as well as demographic characteristics of breast and cervical cancer patients in Georgia’s BCCPTA and other Medicaid eligibility categories. Georgia’s Medicaid coverage of women with breast and/or cervical cancer under BCCPTA accounted for over one-third of all women with these cancers covered by the state in 2003 alone. Those newly eligible under BCCPTA were more likely to have breast, as opposed to cervical, cancer and to be older than those women with breast/cervical cancers enrolled in Georgia Medicaid due to low-income, pregnancy or disability status. Georgia’s Medicaid program spent over $29 million on BCCPTA enrollees in 2003 at a cost of over $12,000 per enrollee. BCCPTA enrollee costs were more similar to those for disabled women with these cancers, about $19,500, than to costs for low-income/pregnant women which equaled about $7,500. By expanding Medicaid coverage, BCCPTA can potentially bring women in at earlier stages of their cancer and provide needed coverage/treatment. Future research should examine the potential effect of BCCPTA on reduced morbidity and mortality among these low-income women.
    • Clinicians’ Perception of Inmates’ Satisfaction with Mental Health Services

      Daniel, Jerry B.; Korr, Wynne S.; Mercer University; University of Illinois at Urbana-Champaign (Georgia Public Health Association, 2007)
      A growing body of literature addresses the mental health needs of prison inmates; however, very little research has examined mental health services among this population. Based on the Behavioral Model of Health Services Use (Andersen Model), the current study examined clinicians’ perception of inmates’ satisfaction with mental health services. The study’s main objective was to identify the effect of three major groups of predictor variables (predisposing, enabling, and need) on clinicians’ perception with inmates’ satisfaction with mental health services. The study utilized an exploratory, survey methodology. Although only a few variables were found to be statistically significant in the multivariate analyses, the findings of the study are a significant step in beginning to understand satisfaction of mental health services by inmates. The link between satisfaction and treatment outcome has great significance in the correctional environment, where staff and inmates may tend to see each other as adversaries.
    • Modifying And Validating A Quality Of Life Measure to Fit Your Patient Population

      Johnson, Michelle R.; Maclean, J. Ross; Rogers, Rebecca L.; Fick, Donna M.; Kallab, Andre; Augusta State University; Medical College of Georgia; Augusta State University; Medical College of Georgia; Medical College of Georgia (Georgia Public Health Association, 2007)
      Introduction: A well-developed quality of life (QoL) instrument is valuable in identifying the burden of illness. We were interested in exploring whether existing QoL instruments were suitable for patients in our medical setting and, if not, whether this could be rectified by adapting an existing valid and reliable instrument to meet the specific needs of our patient population. For the purposes of this study, we chose to evaluate the quality of life of patients with breast cancer. Specifically, we were interested in two aspects of QoL in women with breast cancer. The first was whether existing instruments were pertinent to the women in our venue. The second research interest was dependent upon the first. If current instruments were found wanting, could this be rectified through the creation and validation of new domains of relevance to these patients? Method: First, five patients were interviewed to ascertain QoL issues pertinent to women in our medical setting. Second, to determine regional appropriateness of existing breast cancer QoL instruments, a search was conducted to identify and review existing breast cancer specific QoL instruments. Third, an addendum was created (to be used in conjunction with an existing instrument identified through the search) that contained three QoL domains not typically found: Financial, Spirituality and Satisfaction with Medical Care. The addendum was then tested along with an existing instrument (FACT-B). Results: Internal consistency for the new scales, Satisfaction with Medical Care, Spirituality, and Financial had alpha coefficients of 0.81, 0.80, and 0.63 respectively. The total score for FACT-B plus addendum was 0.69. Pearson’s correlation coefficients were 0.49 for Financial, 0.64 for Satisfaction with Medical Care, and 0.70 for Spirituality. Total test/retest was 0.71.
    • Multi-Level Evaluation of a Perinatal Health Program in Rural Southeast Georgia

      Raychowdhury, Swati; Tedders, Stuart H.; O'Steen, Greta; Jones, Sarah K.; Georgia Southern University; Southeast Health District (Georgia Public Health Association, 2007)
      Problem: Infant mortality has declined steadily in the past decade, however, significant disparities associate with lack of adequate perinatal health services and barriers to access disproportionately impact women residing in rural areas. In Georgia, data suggest significant challenges with respect to birth outcomes, and this problem seems to be exacerbated in rural regions of state. The objective of this presentation is to report on the impact of a regional perinatal health care collaborative implemented in rural southeast Georgia. Method: Analysis of pre-intervention and post-intervention birth outcomes (gestational age, birth weight and infant mortality) served as the focal point programmatic evaluation. Differences in mean gestational age and mean birth weight were analyzed using a t-test (α = 0.05). Proportional differences in low birth weight and infant mortality were assessed using the chi-square test (α = 0.05). Differences were investigated relative to race (white and nonwhite). Results: Analysis of white participants showed no significant difference in any birth outcomes investigated. Furthermore, analysis of non-white PHP participants suggested significant improvements in all birth weight (p < 0.001), gestational age (p = 0.007), low birth weight (p = 0.002), and infant mortality (p = 0.007). Conclusion: The perinatal health program in southeast Georgia demonstrated considerable effectiveness as measured through pre-intervention and post-intervention birth outcomes. The potential for improved health outcomes of high risk pregnant women and infants as a result of adequate perinatal care may also lead to the achievement of Healthy People 2010 within this region.
    • Relationship of Fruit and Vegetable Servings and Self-Reported Diabetics in the Southeast and Northeast

      Rimando, Marylen; Lopez, Faye; Battula, Haritha; Mercer University (Georgia Public Health Association, 2007)
      According to the American Diabetes Association, most diabetic patients are not consuming the recommended 3-5 servings of vegetables and 2-4 servings of fruits a day. This study examined fruit and vegetable servings of self-reported diabetics (N=35,407) in select southeastern and northeastern states using Behavioral Risk Factor Surveillance System (BRFSS) 2005 data. The estimate for both fruit and vegetable servings and self-reported diabetes was determined using multivariate logistic regression, adjusting for sociodemographics and geographic region. The results indicated a significant difference between fruit and vegetable servings for diabetics and non-diabetics (p<0.0001). A higher percentage of diabetics in the northeast consumed more than three servings of fruit and vegetables when compared to diabetics in the southeast. Respondents in the northeast were 21% more likely to consume five or more servings of fruit and vegetables and 16% less likely to be diabetic than those in the southeast after adjusting for age, race, sex, and geographic region. In conclusion, diabetics in the northeast consumed more servings of fruit and vegetables than did those in the southeast. Multiple factors influence fruit and vegetable consumption and diabetes and should be considered when developing targeted nutritional interventions. Diabetes educators, nurses, and physicians can encourage diabetic patients to consume more fruit and vegetables and motivate them to continue eating fruit and vegetables.