Determining satisfaction with access and financial aspects of care for persons exposed to Libby amphibole asbestos: rural and national environmental policy implications

Our plain-English summary of Determining satisfaction with access and financial aspects of care for persons exposed to Libby amphibole asbestos: rural and national environmental policy implications, by C.A. Winters, W. Hill, S.W. Kuntz, et al (Journal of Environmental and Public Health, 2011).

The study

• Authors: C.A. Winters, W. Hill, S.W. Kuntz, C. Weinert, K. Rowse, T. Hernandez, B. Black
• Journal: Journal of Environmental and Public Health
• Published: 2011;2011:789514
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Libby, Montana is a Superfund site and epicenter of one of the worst environmental disasters in the USA history in terms of asbestos-related mortality and morbidity. Perceptions of access and financial aspects of care were explored among a national cohort of persons postasbestos exposure and prior to a 2009 Public Health Emergency Declaration. Our findings indicated the Libby cohort was significantly less satisfied with access and financial aspects of care as measured by two PSQ-III scales when compared to an adult, chronically ill patient sample. Participants with higher levels of respiratory morbidity and depression had significantly lower satisfaction scores.

In plain English

This descriptive cross-sectional study surveyed 426 of 1,500 patients of the Center for Asbestos Related Disease (CARD) clinic in Libby, Montana, all exposed to Libby amphibole asbestos. Of these, 286 lived locally and 140 elsewhere in the USA. Data were collected in 2007, before a 2009 Public Health Emergency Declaration. On two patient satisfaction scales, the Libby group scored lower than a published sample of adults with chronic conditions: 42.54 versus 46.03 for access to care, and 22.75 versus 29.10 for financial aspects. Participants under 65 were less satisfied with access than those 65 and older. The lowest financial scores went with exposure through a family or household member, younger age, and insurance through the mining company's voluntary plan or the Libby Asbestos Medical Plan. Participants scoring high on depression, alone or with high respiratory scores, were less satisfied than those scoring low on both. The authors concluded the Libby cohort was significantly less satisfied than people with other chronic illnesses. They noted their tool did not separate specialty from primary care.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Descriptive cross-sectional questionnaire study
• Who was studied: 426 of a total of 1500 patients of the CARD clinic in Libby, Montana. 286 (67.1%) were local residents of the Libby area and 140 (32.9%) lived elsewhere in the USA. There were 242 men and 184 women, aged 20 to 65 and over. Data were collected February to September 2007.
• Exposure: History of exposure to Libby amphibole asbestos. Route of exposure, taken from clinic records, was grouped as worker, family/household contact, or other. No doses were measured.
• Main results:
  • Across all 426 participants, the mean satisfaction score was 42.5 (SD 7.0) for access to care and 22.8 (SD 7.2) for financial aspects of care.
  • The Libby group scored significantly lower on both scales than a published sample of adult patients with one or more of four chronic conditions. The article prints the size of that sample as "n = 2, 197". Access: Libby mean 42.54 versus comparison mean 46.03 (t = −10.63). Financial: Libby mean 22.75 versus comparison mean 29.10 (t = −19.04).
  • Within the Libby group, participants in the two younger age groups were significantly less satisfied with access to care than those 65 and older. Access means were 40.3 (ages 20–49), 41.7 (50–64) and 44.2 (65+).
  • For financial aspects of care, three factors went with the lowest satisfaction scores. By exposure route, family/household contact scored 21.3 versus 23.5 for other routes. By age, younger participants scored lowest: 18.8 for ages 20–49 versus 25.9 for 65+. By insurance, HNA/LAMP coverage scored 21.3, versus 23.3 for public and 25.0 for private insurance.
  • Participants were grouped by whether they scored above or below the 50th percentile on a respiratory questionnaire (SGRQ) and a depression scale (CES-D). Those low on both (reference, n=191; access 44.6, financial 24.7) scored significantly higher than two groups: those high on depression only (n=26; access 37.7, financial 21.0) and those high on both (n=110; access 39.7, financial 20.3).
  • For access to care, participants high on respiratory morbidity only (n=99; access mean 43.0) were more satisfied than those high on both respiratory morbidity and depression (n=110; 39.7).
• The authors' conclusion: The authors concluded that, compared with persons with other chronic illnesses, the Libby cohort was significantly less satisfied with access and financial aspects of care. They presented the study as a baseline for comparison with studies done after the 2009 emergency declaration.
• Limitations the authors state:
  • The satisfaction tool did not distinguish between specialty care and primary care.

Mines named here

Asbestos mines this study is about. Each mine's page says who ran it, when it worked, and what it produced.

• Libby vermiculite mine, Montana

All asbestos mines

Topics

Medical terms in this study, explained in our Lexicon: Libby amphiboles, Superfund, Public Health Emergency Declaration.

Related studies

• Rural public health policy models to address an evolving environmental asbestos disaster — S.W. Kuntz, C.A. Winters, et al. (2009)
• Social Support Functions During a Slowly-Evolving Environmental Disaster: The Case of Amphibole Asbestos Exposure in Libby, Montana — R.J. Cline, H. Orom, et al. (2015)
• Childhood exposure to Libby amphibole asbestos and respiratory health in young adults — P.H. Ryan, C.H. Rice, et al. (2017)
• Influence of exposure assessment and parameterization on exposure response. Aspects of epidemiologic cohort analysis using the Libby Amphibole asbestos worker cohort — T.F. Bateson, L. Kopylev (2015)
• Exposure to airborne amphibole structures and health risks: Libby, Montana — B. Price (2008)
• A review of scientific literature examining the mining history, geology, mineralogy, and amphibole asbestos health effects of the Rainy Creek igneous complex, Libby, Montana, USA — B.R. Bandli, M.E. Gunter (2006)

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