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A Focused Ethnography of Healthcare Transition among Persistent Asthmatic/Chronic Obstructive Pulmonary Disease (COPD) Adult Pennsylvania Medicaid Beneficiaries
Başlık:
A Focused Ethnography of Healthcare Transition among Persistent Asthmatic/Chronic Obstructive Pulmonary Disease (COPD) Adult Pennsylvania Medicaid Beneficiaries
Yazar:
Cummings, Sister Agnes Marie, author.
ISBN:
9780438008090
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (261 pages)
Genel Not:
Source: Dissertation Abstracts International, Volume: 79-10(E), Section: B.
Advisors: Nalini Jairath; Patricia Connor-Ballard Committee members: Donna Gage.
Özet:
The Affordable Care Act (ACA) (2010) provided for the largest reform of Medicaid since its 1965 Centers for Medicare and Medicaid implementation, providing funding for both low-income and disabled citizens. The additional amount of Medicaid beneficiaries increased the complexity and effectiveness of an already struggling, massive and bureaucratic government program. From a beneficiary perspective (emic perspective), Medicaid as a federal agency, is far from "user-friendly." This problematic complexity remains despite ACA-induced Medicaid reform. Thus despite new eligibility for Medicaid services, a client may still face unresolved health concerns due to system-based or client-based obstacles to effective Medicaid utilization. Failure to establish a trusting, durable relationship between Medicaid beneficiary and healthcare provider (HCP) may result in delaying or avoidance of healthcare. Overwhelmed clients' dependence on former unhealthy healthcare seeking behaviors may prevail with a return to episodic emergency department care regardless of symptoms or acuity.
A multi-method, focused ethnographic study design was selected to gain deep insight into the transition experience of Pennsylvania Medicaid beneficiaries (PAMB) to Medicaid services. The inductive design of ethnography acutely elicited PAMB challenges and obstacles to positive healthy transition, and the measures taken to overcome them. Three main instruments of data collection (semi-structured interviews, sociodemographic data sheets, and a cultural cognitive domain analysis activity) ensured full capture of relevant transitional data. A pilot test assured cohesion/coherence between the interview guide questions and the study research questions. Thematic analysis of ethnographic findings presented the voice of the PAMB and the future direction of nursing practice, nursing education, nursing research, and health policy. Constant comparison in data sources centered on the PAMB role changes as it affected their health beliefs, health practices, and personal health responsibility. PAMB's meaning of transition was identified in the data by emerging patterns, explanations, causal flows, themes, and propositions. Triangulation of data sources assisted in learning how members of the culture of transitioning PAMB assign meaning to health beliefs and behaviors. Coding analysis occurred in two cycles---exploratory coding then domain and taxonomic coding. Common participant experiences were categorized and coded for convergence and divergence uniquely and collectively. Following reflection of participants' interviews, documentation of conclusions were written in summary notes for each interview.
Although the 2010 ACA-induced Medicaid reform increases the opportunity for Medicaid eligibility, it does not necessarily ensure access to quality healthcare for Medicaid beneficiaries. A significant disconnect remains following Pennsylvania Medicaid expansion between eligibility and access to Medicaid, effective utilization of Medicaid-funded healthcare, and positive health outcomes. The resolution of this disconnect in DSH may be resolved through establishing and maintaining a connection with PAMB once they are discharged to home in the community. PAMB's experience of internalized and externalized stigma related to Medicaid insurance negatively mediated their self-care integration and self-advocacy efforts. Some participants refrained from clinical decision-making and did not question the HCP-developed action plan. PAMB's experience of stigmatization reflected a sense of shame and inequality, and correlated to their reliance on a historically stigma-associated public health insurance program. The inability to procure private health insurance for oneself adversely affected PAMB sense of autonomy creating variance in the power distribution between HCP/case managers and PAMB. The social determinants of health (SDH) are likely to impact PAMB health outcomes greater than PAMB non-adherence to treatment plans, clinical appointments, or utilization of the appropriate level of healthcare. Society will benefit from aggressive strategies to improve and safeguard the health of highly vulnerable individuals (e.g. infection control, herd immunity). A place-based and physical determinant model of population health can more effectively guide appropriate nursing interventions to mitigate the effects of imbalanced social structures. Given the often-overwhelming prevalence of socioeconomic needs facing Medicaid populations (e.g. including housing, transportation, and adequate nutrition), aligning social services with healthcare is critical. Pennsylvania legislature recognized the connection between the SDH, healthcare utilization, and outcomes, but has yet to adopt a SDH/physical determinants of health model of health policy.
Medicaid has become a major point of contention in the US political arena, due to the intensive efforts by Republican leaders to repeal and replace the Affordable Care Act (Shankar et al., 2017). The findings of this dissertation study do not support Grogan and Park's conclusions that stigma related to Medicaid has been eliminated through PPACA-induced expansion of Medicaid eligibility. Many instances of residual internalized and externalized stigma are noted in Chapter 4. Given an opportunity to reflect on healthcare transition, the PAMB of Mercy Health System MFH provided an inner view of multiple factors which impact their health. (Abstract shortened by ProQuest.).
Notlar:
School code: 0043
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Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
---|---|---|---|
XX(680290.1) | 680290-1001 | Proquest E-Tez Koleksiyonu | Arıyor... |
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