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Struyf N, Vanwing T, Jacquet W, Ho-A-Tham N, Dankaerts W. What do we know about Indigenous Peoples with low back pain around the world? A topical review. Scand J Pain 2024; 24:sjpain-2023-0114. [PMID: 38497253 DOI: 10.1515/sjpain-2023-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/21/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Low back pain (LBP) represents a worldwide burden with rising disability, especially in low- and middle-income countries. Indigenous Peoples are exposed to many risk factors for LBP and seem to have overall worse health and higher mortality compared to non-Indigenous. This article aims to provide a topical overview of LBP in Indigenous Peoples. METHODS A comprehensive search was done using the keywords "Indigenous" and "back pain." Secondly, a cross-reference search of the citations list of the included articles was conducted. RESULTS LBP is a prevalent, disabling health condition among Indigenous Peoples that impacts activities of daily living, emotional well-being, and cultural identity. Indigenous Peoples face numerous and unique barriers to obtain Western health care. LBP in Indigenous Peoples is partly iatrogenic and available health care lacks a culturally secure setting. In combination with racism and discrimination by health care providers, this leads to miscommunication, frustration, and poor outcome in Indigenous patients around the world. CONCLUSION Contextual considerations and interpretation of findings within the appropriate cultural context are needed in future research and treatment of LBP in Indigenous Peoples. However, our literature analysis exhibits disproportionate representation with the scarcity of studies of Indigenous Peoples of Asia and Africa. Addressing this gap in the literature could provide significant scientific value. Indigenous Peoples should not be forgotten in reducing the global burden for LBP.
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Affiliation(s)
- Niels Struyf
- Department of Rehabilitation Sciences, Research Group for Musculoskeletal Rehabilitation, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Physiotherapy, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
- Onderzoeksgroep Musculoskeletale Revalidatie, Tervuursevest 101 - Bus 1501, 3001 Leuven Belgium
| | - Tom Vanwing
- Department of Educational Sciences EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Wolfgang Jacquet
- Department of Educational Sciences EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Oral Health Sciences ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nancy Ho-A-Tham
- Department of Physiotherapy, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Wim Dankaerts
- Department of Rehabilitation Sciences, Research Group for Musculoskeletal Rehabilitation, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Khosravi Pour A, Hejazi S, Kameli A, Hoseini Azizi T, Armat MR, Eshghi M. Cooling spray or lidocaine spray and needle insertion pain in hemodialysis patients: an open-label cross-over randomized clinical trial. BMC Anesthesiol 2023; 23:69. [PMID: 36882711 PMCID: PMC9990356 DOI: 10.1186/s12871-023-02028-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 02/24/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The needle insertion pain to perform hemodialysis is the main challenge and a common problem that requires pain management techniques for patients' comfort. AIM This study aimed to compare the effects of cooling and lidocaine sprays on needle insertion pain in hemodialysis patients. METHODS In this randomized cross-over clinical trial study, the hemodialysis patients were selected through convenience sampling according to inclusion criteria and randomly assigned to three intervention groups using the block randomization method. Each patient received three interventions in a cross-over design: Cooling spray or 10% lidocaine spray or placebo spray. There was a 2-week wash-out time between each intervention. The pain score was measured four times for each patient by the Numerical Rating Scale. RESULTS Forty-one hemodialysis patients were included. The results showed a significant interaction between time and group (p < 0.05), so only observations of time 1 with adjustment for baseline values were used to evaluate the effect of the intervention. Patients receiving cooling spray reported 2.29 less pain score on average compared to placebo (B=-2.29, 95% CI: -4.17 to -0.43; p < 0.05); Also, patients receiving cooling spray reported a 1.61 lower pain score than those receiving lidocaine spray, but this difference was not statistically significant (95% CI: -0.26 to 3.48; p > 0.05). CONCLUSION The cooling spray was effective in reducing the needle insertion pain. Although it was impossible to compare the pain scores at different times and following different interventions, the present study results can help supplement the existing knowledge regarding cooling and lidocaine sprays.
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Affiliation(s)
- Armin Khosravi Pour
- Student Research Committee, Bojnurd Faculty of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Sima Hejazi
- Department of Nursing, Bojnurd Faculty of Nursing, North Khorasan University of Medical Sciences, Shahriar Street, Bojnurd, Iran.
| | - Ahmad Kameli
- Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Tooba Hoseini Azizi
- Department of Nursing, Bojnurd Faculty of Nursing, North Khorasan University of Medical Sciences, Shahriar Street, Bojnurd, Iran
| | - Mohammad Reza Armat
- Department of Nursing, Bojnurd Faculty of Nursing, North Khorasan University of Medical Sciences, Shahriar Street, Bojnurd, Iran
| | - Maesoomeh Eshghi
- Student Research Committee, Bojnurd Faculty of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran
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Karris MY, Danilovich M. Editorial: Chronic Pain and Health Disparities in Older Adults With Complex Needs. FRONTIERS IN PAIN RESEARCH 2022; 3:941476. [PMID: 35836738 PMCID: PMC9274255 DOI: 10.3389/fpain.2022.941476] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maile Young Karris
- Department of Medicine, University of California, San Diego, San Diego, CA, United States
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Ovrom E, Hagedorn JM, Bhandarkar A, Bydon M. Racial disparities in the cost of inpatient spinal cord stimulator surgery among patients in the 2016-2018 National Inpatient Sample. J Clin Neurosci 2022; 98:189-193. [PMID: 35189543 DOI: 10.1016/j.jocn.2022.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/28/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Spinal cord stimulation is a promising therapy for patients with treatment refractory pain syndromes, and a viable alternative to chronic opioid therapy. Racial disparities are well-documented in the field of pain medicine. This study seeks to determine whether racial disparities are present in spinal cord stimulator (SCS) surgery involving inpatient hospital stays in the United States. OBJECTIVE The objective of this study was to analyze the effects of race on health care cost and utilization for patients receiving inpatient SCS surgery. We used total charges incurred by the patient to measure cost and length of stay (LOS) to measures hospital utilization for patients undergoing inpatient SCS surgery. We examined cost and utilization for inpatient surgeries involving SCS insertion, removal, and revision across different race demographics. METHODS This retrospective cohort study used ICD-10 procedure codes to query for all patients in the 2016-2018 National Inpatient Sample (NIS) who received SCS insertion, removal, and revision surgeries. Univariate analysis was performed in R-studio to assess the relationship between race, LOS, and total charge. Multivariate analysis was also performed in R-studio to adjust for possible confounders. RESULTS Hispanic race was associated with higher total charge for inpatient SCS surgery (β=+0.29, p = 3.92e-07). Hospital region was also associated with total charge. The South (β=+0.12, p = 3.7e-03) and the West (β=+0.28, p = 3.8e-09) were associated with higher total charge. The linear model also showed that patients with more comorbidities and complex cases paid higher total charges (β=+0.014, p = 6.2e-04). There was no statistically significant difference in LOS between race demographics. CONCLUSION After adjusting for age, gender, type of surgical approach (percutaneous vs. open), household income, insurance coverage, hospital region, and hospital location (urban vs. rural vs. teaching), and comorbidity scores, Hispanic patients had higher total charges for inpatient SCS surgery, but there was no disparity in total charge between white and black patients. White patients were older than minority patients at the time of inpatient SCS surgery.
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Affiliation(s)
- Erik Ovrom
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA.
| | | | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
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Wilson M, De Luca E. Equitable Integrative Pain Care: Are We There Yet? Pain Manag Nurs 2021; 22:681-683. [PMID: 34756522 DOI: 10.1016/j.pmn.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Marian Wilson
- From the Washington State University College of Nursing, Spokane, Washington, USA.
| | - Enrico De Luca
- University 'Sapienza' of Rome, Department of Psychology, Rome, Italy
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Christensen J, Beveridge JK, Wang M, Orr SL, Noel M, Mychasiuk R. A Pilot Study Investigating the Role of Gender in the Intergenerational Relationships between Gene Expression, Chronic Pain, and Adverse Childhood Experiences in a Clinical Sample of Youth with Chronic Pain. EPIGENOMES 2021; 5:epigenomes5020009. [PMID: 34968296 PMCID: PMC8594698 DOI: 10.3390/epigenomes5020009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/24/2021] [Accepted: 04/13/2021] [Indexed: 12/20/2022] Open
Abstract
Chronic pain is a highly prevalent and costly issue that often emerges during childhood or adolescence and persists into adulthood. Adverse childhood experiences (ACEs) increase risk for several adverse health conditions, including chronic pain. Recent evidence suggests that parental trauma (ACEs, post-traumatic stress disorder (PTSD) symptoms) confers risk of poor health outcomes in their children. Intergenerational relationships between parental trauma and child chronic pain may be mediated by epigenetic mechanisms. A clinical sample of youth with chronic pain and their parents completed psychometrically sound questionnaires assessing ACEs, PTSD symptoms, and chronic pain, and provided a saliva sample. These were used to investigate the intergenerational relationships between four epigenetic biomarkers (COMT, DRD2, GR, and SERT), trauma, and chronic pain. The results indicated that the significant biomarkers were dependent upon the gender of the child, wherein parental ACEs significantly correlated with changes in DRD2 expression in female children and altered COMT expression in the parents of male children. Additionally, the nature of the ACE (maltreatment vs. household dysfunction) was associated with the specific epigenetic changes. There may be different pathways through which parental ACEs confer risk for poor outcomes for males and females, highlighting the importance of child gender in future investigations.
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Affiliation(s)
- Jennaya Christensen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia;
| | - Jaimie K. Beveridge
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (J.K.B.); (M.N.)
| | - Melinda Wang
- Hotchkiss Brain Institute, Calgary, AB T2N 4N1, Canada;
- Alberta Children’s Hospital Research Institute, Calgary, AB T2N 4N1, Canada
| | - Serena L. Orr
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (J.K.B.); (M.N.)
- Hotchkiss Brain Institute, Calgary, AB T2N 4N1, Canada;
- Alberta Children’s Hospital Research Institute, Calgary, AB T2N 4N1, Canada
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia;
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (J.K.B.); (M.N.)
- Hotchkiss Brain Institute, Calgary, AB T2N 4N1, Canada;
- Alberta Children’s Hospital Research Institute, Calgary, AB T2N 4N1, Canada
- Correspondence:
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Kazimi M, Terndrup T, Tait R, Frey JA, Strassels S, Emerson G, Todd KH. Cultivating emergency physician behavioral empathy to improve emergency department care for pain and prescription opioid misuse. J Am Coll Emerg Physicians Open 2020; 1:1480-1485. [PMID: 33392553 PMCID: PMC7771829 DOI: 10.1002/emp2.12086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 12/30/2022] Open
Abstract
Clinical empathy is the ability to understand the patient's experience, communicate that understanding, and act on it. There is evidence that patient and physician benefits are associated with more empathic communications. These include higher patient and physician satisfaction, improved quality of life, and decreased professional burnout for physicians, as well as increased patient compliance with care plans. Empathy appears to decline during medical school, residency training, and early professional emergency medicine practice; however, brief training has the potential to improve behavioral measures of empathy. Improvements in emergency department physician empathy seems especially important in managing patients at elevated risk for opioid-related harm. We describe our conceptual approach to identifying and designing a practice improvement curriculum aimed to cultivate and improve behavioral empathy among practicing emergency physicians. Emergent themes from our preliminary study of interviews, focus groups, and workshops were identified and analyzed for feasibility, sensitivity to change, and potential impact. A conceptual intervention will address the following key categories: patient stigmatization, identification of problematic pain-subtypes, empathic communication skills, interactions with family and friends, and techniques to manage inappropriate patient requests. The primary outcomes will be the changes in behavioral empathy associated with training. An assessment battery was chosen to measure physician psychosocial beliefs, attitudes and behavior, communication skills, and burnout magnitude. Additional outcomes will include opioid prescribing practice, naloxone prescribing, and referrals to addiction treatment. A pilot study will allow an estimation of the intervention impact to help finalize a curriculum suitable for web-based national implementation.
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Affiliation(s)
- Maher Kazimi
- Department of Emergency MedicineOhio State UniversityColumbusOhioUSA
| | - Thomas Terndrup
- Department of Emergency MedicineOhio State UniversityColumbusOhioUSA
| | - Raymond Tait
- Department of PsychiatrySt. Louis UniversitySt. LouisMissouriUSA
| | - Jennifer A. Frey
- Department of Emergency MedicineOhio State UniversityColumbusOhioUSA
| | | | - Geremiah Emerson
- Department of Emergency MedicineOhio State UniversityColumbusOhioUSA
| | - Knox H. Todd
- Department of Emergency MedicineOhio State UniversityColumbusOhioUSA
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Lin IB, Ryder K, Coffin J, Green C, Dalgety E, Scott B, Straker LM, Smith AJ, O'Sullivan PB. Addressing Disparities in Low Back Pain Care by Developing Culturally Appropriate Information for Aboriginal Australians: "My Back on Track, My Future". PAIN MEDICINE 2018; 18:2070-2080. [PMID: 28087847 DOI: 10.1093/pm/pnw314] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives Addressing disparities in low back pain care (LBP) is an important yet largely unaddressed issue. One avenue to addressing disparities, recommended by clinical guidelines, is to ensure that LBP information is culturally appropriate. Our objectives were, first, to develop LBP information that was culturally appropriate for Aboriginal Australians living in a rural area and, second, to compare this to traditional information. Methods The overall information development process was guided by a "cultural security" framework and included partnerships between Aboriginal/non-Aboriginal investigators, a synthesis of research evidence, and participation of a project steering group consisting of local Aboriginal people. LBP information (entitled My Back on Track, My Future [MBOT]) was developed as five short audio-visual scenarios, filmed using Aboriginal community actors. A qualitative randomized crossover design compared MBOT with an evidence-based standard (the Back Book [BB]). Twenty Aboriginal adults participated. Qualitatively we ascertained which information participants' preferred and why, perceptions about each resource, and LBP management. Results Thirteen participants preferred MBOT, four the BB, two both, and one neither. Participants valued seeing "Aboriginal faces," language that was understandable, the visual format, and seeing Aboriginal people undertaking positive changes in MBOT. In contrast, many participants found the language and format of the BB a barrier. Participants who preferred the BB were more comfortable with written information and appreciated the detailed content. Conclusions The MBOT information was more preferred and addressed important barriers to care, providing support for use in practice. Similar processes are needed to develop pain information for other cultural groups, particularly those underserved by existing approaches to care.
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Affiliation(s)
- Ivan B Lin
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Western Australia
| | - Kim Ryder
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Western Australia
| | - Juli Coffin
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia.,Geraldton Regional Aboriginal Medical Service, Geraldton, Western Australia.,Notre Dame University, Broome, Western Australia
| | - Charmaine Green
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Western Australia.,Geraldton Regional Aboriginal Medical Service, Geraldton, Western Australia
| | - Eric Dalgety
- Geraldton Regional Aboriginal Medical Service, Geraldton, Western Australia
| | - Brian Scott
- Geraldton Regional Aboriginal Medical Service, Geraldton, Western Australia
| | - Leon M Straker
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Anne J Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Peter B O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
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Andreae MH, Nair S, Gabry JS, Goodrich B, Hall C, Shaparin N. A pragmatic trial to improve adherence with scheduled appointments in an inner-city pain clinic by human phone calls in the patient's preferred language. J Clin Anesth 2017; 42:77-83. [PMID: 28841451 DOI: 10.1016/j.jclinane.2017.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE We investigated if human reminder phone calls in the patient's preferred language increase adherence with scheduled appointments in an inner-city chronic pain clinic. We hypothesized that language and cultural incongruence is the underlying mechanism to explain poor attendance at clinic appointments in underserved Hispanic populations. DESIGN Pragmatic randomized controlled clinical trial SETTING: Innercity academic chronic pain clinic with a diverse, predominantly African-American and Hispanic population PATIENTS: All (n=963) adult patients with a scheduled first appointment between October 2014 and October 2015 at the Montefiore Pain Center in the Bronx, New York were enrolled. INTERVENTIONS Patients were randomized to receive a human reminder call in their preferred language before their appointment, or no contact. MEASUREMENTS We recorded patients' demographic characteristics and as primary outcome attendance as scheduled, failure to attend and/or cancellation calls. We fit Bayesian and classical multinomial logistic regression models to test if the intervention improved adherence with scheduled appointments. MAIN RESULTS Among the 953 predominantly African American and Hispanic/Latino patients, 475 patients were randomly selected to receive a language-congruent, human reminder call, while 478 were assigned to receive no prior contact, (after we excluded 10 patients, scheduled for repeat appointments). In the experimental group, 275 patients adhered to their scheduled appointment, while 84 cancelled and 116 failed to attend. In the control group, 249 patients adhered to their scheduled appointment, 31 cancelled and 198 failed to attend. Human phone reminders in the preferred language increased adherence (RR 1.89, CI95% [1.42, 1.42], (p<0.01). The intervention seemed particularly effective in Hispanic patients, supporting our hypothesis of cultural congruence as possible underlying mechanism. CONCLUSIONS Human reminder phone calls prior in the patient's preferred language increased adherence with scheduled appointments. The intervention facilitated access to much needed care in an ethnically diverse, resource poor population, presumably by overcoming language barriers.
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Affiliation(s)
- Michael H Andreae
- Department of Anesthesiology, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, Hershey PA 17033, United States.
| | - Singh Nair
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467 Bronx, NY, United States
| | - Jonah S Gabry
- Institute for Social and Economic Research and Policy (ISERP), Columbia University of the City of New York, International Affairs Building, 420 West 118th St, New York, NY 10027, United States
| | - Ben Goodrich
- Department of Political Science, Columbia University in the City of New York, International Affairs Building, 420 West 118th Street, New York, NY 10027, United States
| | - Charles Hall
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, United States
| | - Naum Shaparin
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467 Bronx, NY, United States
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Analgesic Access for Acute Abdominal Pain in the Emergency Department Among Racial/Ethnic Minority Patients. Med Care 2015; 53:1000-9. [DOI: 10.1097/mlr.0000000000000444] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Katende G, Mugabi B. Comforting strategies and perceived barriers to pediatric pain management during IV line insertion procedure in Uganda's national referral hospital: A descriptive study. BMC Pediatr 2015; 15:122. [PMID: 26377665 PMCID: PMC4572629 DOI: 10.1186/s12887-015-0438-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 08/28/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Venipuncture and intravenous (IV) cannula insertions are the two common sources of pain in hospitalized children and health care today. The WHO asserts that, pain relief is a basic fundamental right and requires a multidisciplinary approach. Nonpharmacological comforting strategies when implemented are important to relive pain related distress in children during peripheral IV line insertion. However, evidence to date that suggests implementation of such strategies and their barriers in Uganda remains very limited. This study aimed at establishing the current practices in regard to the use of comforting strategies and the perceived barriers faced by health care providers to implement pediatric pain management during IV line insertion procedure in Uganda's national referral hospital, Mulago. METHOD A cross sectional and descriptive study was conducted between December 1, 2012 and February 28, 2013 involving doctors, nurses and interns in six pediatric wards of Mulago Hospital in Uganda. A pre-tested self- administered and semi- structured questionnaire was used to collect the data. Data was entered into SPSS and descriptive statistics run on all the variables. RESULTS Of the 120 questionnaires distributed, 105 (RR = 87.5%) were returned and completed. The evidence based comforting strategies used for pain management during IV line insertion by the majority of health care professionals were; skin to skin (51%) and appropriate upright positioning of the child on mother's lap (69%). The least used comforting strategies were; allowing the child to suck his thumb or hand (70%), use of distraction (69%) and directing the child to suck one of his fingers into his mouth (90%). The identified barriers to implementing comforting strategies were; lack of time (42%), having emergency situations (18%), and not knowing the right method to use (11%). Of 105, 100 (95%) reported that there is need for continuous professional development on comforting strategies. CONCLUSIONS Findings demonstrated that fewer health care providers used some evidence based comforting strategies of pain relief during pediatric peripheral IV line insertion. Distraction and other evidence based strategies for pain and distress relieve are less often used by the majority of the health care providers. Incorporating pediatric pain management content in all health professionals training curricula could improve the current practices for better health outcomes.
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Affiliation(s)
- Godfrey Katende
- Sultan Qaboos University, College of Nursing, 123, Muscat, Oman.
| | - Benedicto Mugabi
- Department of Nursing, Makerere University,College of Health Sciences, 256, Kampala, Uganda.
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Ringwalt C, Roberts AW, Gugelmann H, Skinner AC. Racial disparities across provider specialties in opioid prescriptions dispensed to medicaid beneficiaries with chronic noncancer pain. PAIN MEDICINE (MALDEN, MASS.) 2015; 16:633-40. [PMID: 25287703 PMCID: PMC5012901 DOI: 10.1111/pme.12555] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Chronic pain affects both psychological and physical functioning, and is responsible for more than $60 billion in lost productivity annually in the United States. Although previous studies have demonstrated racial disparities in opioid treatment, there is little evidence regarding disparities in treatment of chronic noncancer pain (CNCP) and the role played by physician specialty in these disparities. DESIGN A retrospective cohort study. SETTING We analyzed North Carolina Medicaid claims data, from July 1, 2009 to May 31, 2010, to examine disparities by different provider specialties in beneficiaries' dispensed prescriptions for opioids. SUBJECTS The population included white and black North Carolina Medicaid beneficiaries with CNCP (N = 75,458). METHODS We used bivariate statistics and logistic regression analysis to examine race-based discrepancies in opioid prescribing by physician specialty. RESULTS Compared with white beneficiaries with CNCP (N = 49,197), black beneficiaries (N = 26,261) were less likely (odds ratio [OR] 0.91 [confidence interval {CI}: 0.88-0.94]) to fill an opioid prescription. Our hypothesis was partially supported: we found that race-based differences in beneficiaries' dispensed opioid prescriptions were more prominent in certain specialties. In particular, these differences were most salient among patients of specialists in obstetrics and gynecology (OR 0.78 [CI: 0.67-0.89]) and internal medicine (OR 0.86 [CI: 0.79-0.92]), as well as general practitioners/family medicine physicians (OR 0.91 [CI: 0.85-0.97]). CONCLUSIONS Our findings suggest that, in our study population, black beneficiaries with CNCP are less likely than whites to fill prescriptions for opioid analgesics as a function of their provider's specialty. Although race-based differences in patients filling opioid prescriptions have been noted in previous studies, this is the first study that clearly demonstrates these disparities by provider specialty.
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Affiliation(s)
- Chris Ringwalt
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Andrew W. Roberts
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Hallam Gugelmann
- California Poison Control System, San Francisco Division, University of California at San Francisco and Veterans Affairs Medical Center, San Francisco
| | - Asheley Cockrell Skinner
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics in the School of Medicine, University of North Carolina at Chapel Hill
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American Society for Pain Management nursing position statement: pain management in patients with substance use disorders. J Addict Nurs 2014; 23:210-22. [PMID: 24335741 DOI: 10.1097/jan.0b013e318271c123] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high-quality pain assessment and management. Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders. Topics addressed in this position statement include the scope of substance use and related disorders, conceptual models of addiction, ethical considerations, addiction risk stratification, and clinical recommendations.
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Im ES, Kim JS. Distraction Techniques for Children Undergoing Procedures: A Critical Review of Korean Intervention Research. CHILD HEALTH NURSING RESEARCH 2014. [DOI: 10.4094/chnr.2014.20.4.340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Eun Seon Im
- Doctoral Student, Department of Nursing, Graduate School of Chosun University, Gwangju, Korea
| | - Jin Sun Kim
- Department of Nursing, Chosun University, Gwangju, Korea
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Grubert E, Baker TA, McGeever K, Shaw BA. The role of pain in understanding racial/ethnic differences in the frequency of physical activity among older adults. J Aging Health 2013; 25:405-21. [PMID: 23271728 PMCID: PMC3855288 DOI: 10.1177/0898264312469404] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate racial/ethnic differences in physical activity among white, black, and Hispanic adults aged 65 years and older, and to assess the potential role of pain as a mediator. METHODS Analyses were based on data from the 2008 Health and Retirement Study. Logistic regression was used to evaluate associations between race/ethnicity and pain and the odds of regular physical activity. RESULTS Compared to Whites, the odds of both light physical activity and moderate/vigorous physical activity were lower among Blacks, but not Hispanics. A graded inverse association between levels of pain severity and the odds of physical activity was found, but pain did not mediate racial/ethnic differences in physical activity. DISCUSSION When compared to Whites, older Blacks appear to have relatively low rates of physical activity even without comparatively high levels of pain, while older Hispanics experience relatively high rates of pain, but are perhaps more resilient to the effects of pain on physical activity.
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Affiliation(s)
- Elizabeth Grubert
- School of Public Health, University at Albany, SUNY, Rensselaer, NY 12144, USA.
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16
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Evans BC, Ume E. Psychosocial, cultural, and spiritual health disparities in end-of-life and palliative care: where we are and where we need to go. Nurs Outlook 2013; 60:370-5. [PMID: 23141196 DOI: 10.1016/j.outlook.2012.08.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/18/2012] [Accepted: 08/20/2012] [Indexed: 12/13/2022]
Abstract
Although health disparities are well documented, the extent to which they affect end-of-life care is unknown. Limited research funding leads to sparse and often contradictory palliative care literature, with few studies on causal mechanisms. This article explores the psychosocial, cultural, and spiritual health disparities existing in palliative and end-of-life care with the goal of identifying future research needs. This article reports efforts to determine knowledge gaps related to health disparities in psychosocial, cultural, and spiritual aspects of end-of-life care in which the authors draw upon recent literature from multiple databases. Although few data are available, studies show that minorities make little use of hospice, often because of lack of knowledge about hospice or palliative care, family-centered cultures, and preferences for more aggressive end-of-life care than hospice allows. The authors conclude that future research should include a search for theoretical and causal mechanisms; prospective longitudinal investigations; diverse patients, conditions, contexts, and settings; methodological diversity and rigor; and interdisciplinary, culturally sensitive interventions.
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Affiliation(s)
- Bronwynne C Evans
- Arizona State University College of Nursing & Health Innovation, Phoenix, AZ 85004, USA.
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17
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Oliver J, Coggins C, Compton P, Hagan S, Matteliano D, Stanton M, St Marie B, Strobbe S, Turner HN. American Society for Pain Management nursing position statement: pain management in patients with substance use disorders. Pain Manag Nurs 2013; 13:169-83. [PMID: 22929604 DOI: 10.1016/j.pmn.2012.07.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 07/01/2012] [Indexed: 01/17/2023]
Abstract
The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high-quality pain assessment and management. Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders. Topics addressed in this position statement include the scope of substance use and related disorders, conceptual models of addiction, ethical considerations, addiction risk stratification, and clinical recommendations.
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Lebovits A. Maintaining Professionalism in Today's Business Environment: Ethical Challenges for the Pain Medicine Specialist. PAIN MEDICINE 2012; 13:1152-61. [DOI: 10.1111/j.1526-4637.2012.01465.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Davitt JK. Racial/Ethnic Disparities in Home Health Care: Charting a Course for Future Research. Home Health Care Serv Q 2012; 31:1-40. [DOI: 10.1080/01621424.2011.641919] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Czarnecki ML, Turner HN, Collins PM, Doellman D, Wrona S, Reynolds J. Procedural pain management: a position statement with clinical practice recommendations. Pain Manag Nurs 2011; 12:95-111. [PMID: 21620311 DOI: 10.1016/j.pmn.2011.02.003] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 02/23/2011] [Accepted: 02/24/2011] [Indexed: 12/18/2022]
Abstract
The American Society for Pain Management Nursing (ASPMN) has developed a position statement and clinical practice recommendations related to procedural preparation and comfort management. Procedures potentially produce pain and anxiety, both of which should be assessed and addressed before the procedure begins. This position statement refers to "comfort management" as incorporating the management of pain, anxiety, and any other discomforts that may occur with procedures. It is the position of ASPMN that nurses and other health care professionals advocate and intervene based on the needs of the patient, setting, and situation, to provide optimal comfort management before, during, and after procedures. Furthermore, ASPMN does not condone procedures being performed without the implementation of planned comfort assessment and management. In addition to outlining this position with supporting evidence, this paper reviews the ethical considerations regarding procedural comfort management and provides recommendations for nonpharmacologic and pharmacologic management during all phases of the procedure. An appendix provides a summary of this position statement and clinical practice recommendations.
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Affiliation(s)
- Michelle L Czarnecki
- Jane B. Pettit Pain and Palliative Care Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53201, USA.
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22
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Fan L, Thomas M, Deitrick GE, Polomano RC. Awareness and action for eliminating health care disparities in pain care: Web-based resources. J Pain Palliat Care Pharmacother 2008; 22:243-50. [PMID: 19042858 DOI: 10.1080/15360280802251306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Evidence shows that disparities in pain care exist, and this problem spans across all health care settings. Health care disparities are complex, and stem from the health system climate, limitations imposed by laws and regulations, and discriminatory practices that are deep seated in biases, stereotypes, and uncertainties surrounding communication and decision-making processes. A search of the Internet identified thousands of Web sites, documents, reports, and educational materials pertaining to health and pain disparities. Web sites for federal agencies, private foundations, and professional and consumer-oriented organizations provide useful information on disparities related to age, race, ethnicity, geography, socioeconomic status, and specific populations. The contents of 10 Web sites are examined for resources to assist health professionals and consumers in better understanding health and pain disparities and ways to overcome them in practice.
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Affiliation(s)
- Ling Fan
- Hospital of the University of Pennsylvania, USA
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23
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Bieber CM, Fernandez K, Borsook D, Brennan MJ, Butler SF, Jamison R, Osgood E, Sharpe-Potter J, Thomson HN, Weiss RD, Katz NP. Retrospective accounts of initial subjective effects of opioids in patients treated for pain who do or do not develop opioid addiction: a pilot case-control study. Exp Clin Psychopharmacol 2008; 16:429-34. [PMID: 18837639 PMCID: PMC3153468 DOI: 10.1037/1064-1297.16.5.429] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This pilot case-control study retrospectively assessed between-groups differences in subjective opioid effects in patients treated for the first time with opioids for chronic pain. Cases were individuals in an inpatient substance abuse treatment center for primary prescription opioid addiction whose initial exposure to prescription opioids was reported for chronic pain. Controls had not developed prescription opioid addiction as measured in part by close monitoring on long-term opioid therapy at a pain management center. Twenty subjects in each group completed a battery of measures to capture data related to the individual's first exposure to prescription opioids. The Morphine Benzedrine Group subscale of an adapted 49-item Addiction Center Research Inventory (ARCI), designed to measure euphoria and other drug effects, showed an average score of 8.70 (+/-4.18) in cases versus 2.55 (+/-3.36) in controls (p<0.001), indicating a significantly greater "euphoric" effect of opioids in the cases compared to the controls. Differences in the subjective response to opioids suggest that: (1) a subgroup of patients does develop euphoria when taking opioids for pain, which may be a risk factor for eventual development of prescription opioid addiction; and (2) subjective effects predictive of eventual addiction may include stimulation and other experiences not typically associated with opioids.
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Affiliation(s)
- Corey M. Bieber
- Inflexxion, Inc. 320 Needham St. Suite 100, Newton, MA 02464
| | | | - David Borsook
- McLean Hospital 115 Mill St., Belmont, MA 02478 and Department of Psychiatry, Harvard Medical School, Boston, MA
| | | | | | - Robert Jamison
- Pain Management Center, Brigham and Women’s Hospital, 850 Boylston St., Chestnut Hill, MA 02467
| | - Eric Osgood
- Tufts University School of Medicine, Boston, MA
| | - Jennifer Sharpe-Potter
- McLean Hospital 115 Mill St., Belmont, MA 02478 and Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Heather N. Thomson
- Tufts University School of Medicine, Boston, MA,Endo Pharmaceuticals, 15 Pine Ledge Way, Norfolk, CT 06058
| | - Roger D. Weiss
- McLean Hospital 115 Mill St., Belmont, MA 02478 and Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Nathaniel P. Katz
- Inflexxion, Inc. 320 Needham St. Suite 100, Newton, MA 02464,Tufts University School of Medicine, Boston, MA,Analgesic Research, 109 Highland Ave, Needham, MA 02494
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Horgas AL, Yoon SL, Nichols AL, Marsiske M. The relationship between pain and functional disability in Black and White older adults. Res Nurs Health 2008; 31:341-54. [PMID: 18231972 DOI: 10.1002/nur.20270] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this study we examined pain and disability in 115 community-dwelling, urban, older adults (mean age = 74 years; 52% Black, 48% White). Participants completed a survey of pain (pain presence, intensity, locations, and duration) and disability (Sickness Impact Profile). Sixty percent of the sample reported pain; Black and White adults did not differ on any pain variable. In structural equation models controlling for socioeconomic factors and health, pain did not mediate the relationship between race and disability. Race moderated the pain-disability relationship; pain was more associated with disability among Whites than Blacks. This study highlights the need for greater understanding of health disparities between Black and White older adults as they relate to pain and disability.
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Affiliation(s)
- Ann L Horgas
- Department of Adult and Elderly Nursing, College of Nursing, University of Florida, HPNP Complex, P.O. Box 100197, Gainesville, FL 32610-0197
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King RK, Green AR, Tan-McGrory A, Donahue EJ, Kimbrough-Sugick J, Betancourt JR. A plan for action: key perspectives from the racial/ethnic disparities strategy forum. Milbank Q 2008; 86:241-72. [PMID: 18522613 PMCID: PMC2690363 DOI: 10.1111/j.1468-0009.2008.00521.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
CONTEXT Racial and ethnic disparities in health care in the United States have been well documented, with research largely focusing on describing the problem rather than identifying the best practices or proven strategies to address it. METHODS In 2006, the Disparities Solutions Center convened a one-and-a-half-day Strategy Forum composed of twenty experts from the fields of racial/ethnic disparities in health care, quality improvement, implementation research, and organizational excellence, with the goal of deciding on innovative action items and adoption strategies to address disparities. The forum used the Results Based Facilitation model, and several key recommendations emerged. FINDINGS The forum's participants concluded that to identify and effectively address racial/ethnic disparities in health care, health care organizations should: (1) collect race and ethnicity data on patients or enrollees in a routine and standardized fashion; (2) implement tools to measure and monitor for disparities in care; (3) develop quality improvement strategies to address disparities; (4) secure the support of leadership; (5) use incentives to address disparities; and (6) create a message and communication strategy for these efforts. This article also discusses these recommendations in the context of both current efforts to address racial and ethnic disparities in health care and barriers to progress. CONCLUSIONS The Strategy Forum's participants concluded that health care organizations needed a multifaceted plan of action to address racial and ethnic disparities in health care. Although the ideas offered are not necessarily new, the discussion of their practical development and implementation should make them more useful.
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Affiliation(s)
- Roderick K King
- The Disparities Solutions Center, Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA.
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