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Job C, Adenipekun B, Cleves A, Gill P, Samuriwo R. Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review. BMJ Open 2024; 14:e081723. [PMID: 38960454 PMCID: PMC11227794 DOI: 10.1136/bmjopen-2023-081723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/12/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVES Research indicates that people with lower socioeconomic status (SES) receive inferior healthcare and experience poorer health outcomes compared with those with higher SES, in part due to health professional (HP) bias. We conducted a scoping review of the impact of HP bias about SES on clinical decision-making and its effect on the care of adults with lower SES. DESIGN JBI scoping review methods were used to perform a systematic comprehensive search for literature. The scoping review protocol has been published in BMJ Open. DATA SOURCES Medline, Embase, ASSIA, Scopus and CINAHL were searched, from the first available start date of the individual database to March 2023. Two independent reviewers filtered and screened papers. ELIGIBILITY CRITERIA Studies of all designs were included in this review to provide a comprehensive map of the existing evidence of the impact of HP bias of SES on clinical decision-making and its effect on the care for people with lower SES. DATA EXTRACTION AND SYNTHESIS Data were gathered using an adapted JBI data extraction tool for systematic scoping reviews. RESULTS Sixty-seven papers were included from 1975 to 2023. 35 (73%) of the included primary research studies reported an association between HP SES bias and decision-making. Thirteen (27%) of the included primary research studies did not find an association between HP SES bias and decision-making. Stereotyping and bias can adversely affect decision-making when the HP is fatigued or has a high cognitive load. There is evidence of intersectionality which can have a powerful cumulative effect on HP assessment and subsequent decision-making. HP implicit bias may be mitigated through the assertiveness of the patient with low SES. CONCLUSION HP decision-making is at times influenced by non-medical factors for people of low SES, and assumptions are made based on implicit bias and stereotyping, which compound or exacerbate health inequalities. Research that focuses on decision-making when the HP has a high cognitive load, would help the health community to better understand this potential influence.
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Affiliation(s)
- Claire Job
- Cardiff University, Cardiff, UK
- Cardiff University, Cardiff, UK
| | | | | | - Paul Gill
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Ray Samuriwo
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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Elafros MA, Callaghan BC, Skolarus LE, Vileikyte L, Lawrenson JG, Feldman EL. Patient and health care provider knowledge of diabetes and diabetic microvascular complications: a comprehensive literature review. Rev Endocr Metab Disord 2023; 24:221-239. [PMID: 36322296 PMCID: PMC10202021 DOI: 10.1007/s11154-022-09754-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/05/2022]
Abstract
Diabetic retinopathy, neuropathy, and nephropathy occur in more than 50% of people with diabetes, contributing substantially to morbidity and mortality. Patient understanding of these microvascular complications is essential to ensure early recognition and treatment of these sequalae as well as associated symptoms, yet little is known about patient knowledge of microvascular sequalae. In this comprehensive literature review, we provide an overview of existing knowledge regarding patient knowledge of diabetes, retinopathy, neuropathy, and nephropathy. We also discuss health care provider's knowledge of these sequalae given that patients and providers must work together to achieve optimal care. We evaluated 281 articles on patient and provider knowledge of diabetic retinopathy, neuropathy, and nephropathy as well as predictors of improved knowledge and screening practices. Results demonstrated that patient and provider knowledge of microvascular sequalae varied widely between studies, which may reflect sociocultural or methodologic differences. Knowledge assessment instruments varied between studies with limited validation data and few studies controlled for confounding. Generally, improved patient knowledge was associated with greater formal education, longer diabetes duration, and higher socioeconomic status. Fewer studies examined provider knowledge of sequalae, yet these studies identified multiple misconceptions regarding appropriate screening practices for microvascular complications and the need to screen patients who are asymptomatic. Further investigations are needed that use well validated measures, control for confounding, and include diverse populations. Such studies will allow identification of patients and providers who would benefit from interventions to improve knowledge of microvascular complications and, ultimately, improve patient outcomes.
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Affiliation(s)
| | | | - Lesli E Skolarus
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Loretta Vileikyte
- Division of Diabetes, Endocrinology, and Gastroenterology, University of Manchester, Manchester, UK
- Department of Endocrinology and Dermatology, University of Miami, Miami, FL, USA
| | - John G Lawrenson
- School of Health and Psychological Sciences, City, University of London, London, UK
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
- Department of Neurology, Michigan Medicine, University of Michigan, 48109, Ann Arbor, MI, USA.
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Peters GA, Cash RE, Goldberg SA, Ordoobadi AJ, Camargo CA. Out-of-Hospital Presentation and Management of Asthma and Chronic Obstructive Pulmonary Disease Exacerbations in the United States: A Nationwide Retrospective Cohort Study. Ann Emerg Med 2023; 81:679-690. [PMID: 36669918 DOI: 10.1016/j.annemergmed.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/21/2022] [Accepted: 10/10/2022] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVE To describe the demographic, clinical, and emergency medical service (EMS) response characteristics associated with EMS activations for asthma and chronic obstructive pulmonary disease (COPD) exacerbations in the US. METHODS Using a nationwide set of out-of-hospital patient care report data from 2018 to 2019, we analyzed 9-1-1 EMS activations where asthma/COPD exacerbation was indicated by symptom, impression, or treatment provided. We excluded patients with ages less than 2 years or unknown, nonemergency transports, and encounters with any indication of anaphylaxis. Demographic, clinical, and EMS response characteristics were described for pediatric and adult patients with asthma/COPD exacerbations. RESULTS A total of 1,336,988 asthma/COPD exacerbations were included, comprising 5% of qualifying 9-1-1 scene activations from 2018 to 2019. Most patients were adults (96%). Most adult patients were female (55%), whereas most pediatric patients were male (58%). Most activations occurred in urban settings (82%), particularly in pediatric patients (90%). Most asthma/COPD exacerbations were managed by advanced life support units (94%). Inhaled bronchodilators and systemic corticosteroid therapy were administered to 75% and 14% of all patients, respectively. Adults more often had oxygen saturation <92% (43% vs 20% of pediatric patients) and were more often treated with assisted ventilation (9% vs 1%). CONCLUSION In this large nationwide sample of 9-1-1 activations treated and transported by EMS, 5% were for asthma/COPD exacerbation. Future work should focus on evidence-based standardization of EMS protocols and practice for asthma/COPD exacerbations to improve the quality of EMS care.
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Affiliation(s)
- Gregory A Peters
- Harvard Medical School, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Rebecca E Cash
- Harvard Medical School, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Scott A Goldberg
- Harvard Medical School, Boston, MA; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Alexander J Ordoobadi
- Harvard Medical School, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Carlos A Camargo
- Harvard Medical School, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
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Assessing Provider Bias in General Practitioners' Assessment and Referral of Depressive Patients with Different Migration Backgrounds: Methodological Insights on the Use of a Video-Vignette Study. Community Ment Health J 2020; 56:1457-1472. [PMID: 32133547 DOI: 10.1007/s10597-020-00590-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
Although the prevalence of common mental health conditions such as depression and anxiety, is higher among people with a migration background, these groups are generally underrepresented in all forms of institutionalized mental health care. At the root of this striking discrepancy might be unequal referral by health care practitioners. In this article we describe the development of a quasi-experimental video vignette methodology to assess potential forms of unequal diagnosing, treatment and referral patterns, based on clients' migration background and asylum status. The presented methodology also allows to explore whether potential differences are related to provider bias, i.e. underlying attitudes and expectations held by general practitioners. Potential assets and drawbacks of this methodology are discussed in detail.
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Dusendang JR, Reeves AN, Karvonen-Gutierrez CA, Herman WH, Ylitalo KR, Harlow SD. The association between perceived discrimination in midlife and peripheral neuropathy in a population-based cohort of women: the Study of Women's Health Across the Nation. Ann Epidemiol 2019; 37:10-16. [PMID: 31447292 PMCID: PMC6755046 DOI: 10.1016/j.annepidem.2019.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/01/2019] [Accepted: 07/11/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Peripheral neuropathy (PN) is a highly prevalent condition with serious sequelae. Many studies of the condition have been restricted to populations with diabetes, limiting evidence of potential contributing risk factors including salient psychosocial risk factors such as discrimination. METHODS The longitudinal Study of Women's Health Across the Nation was used to assess the relationship between perceived discrimination and prevalent PN in 1718 ethnically diverse midlife women. We used multivariable logistic regression to determine the association between perceived discrimination (Detroit Area Study Everyday Discrimination Scale) and PN (symptom questionnaire and monofilament testing) and conducted an assessment of the mediating effects of body mass index (BMI). RESULTS The prevalence of PN was 26.1% in the total sample and 40.9% among women with diabetes. Women who reported perceived discrimination had 29% higher odds of PN compared with women who did not report perceived discrimination (95% confidence interval, 1.01-1.66). Approximately 30% of the total effect of discrimination on PN was mediated indirectly by BMI. CONCLUSIONS More research is needed to determine the contributing factors to nondiabetic PN. Our findings reaffirm the impact of financial strain, BMI, and diabetes as significant correlates of PN and highlight discrimination as an important risk factor.
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Affiliation(s)
- Jennifer R Dusendang
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Alexis N Reeves
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | | | - William H Herman
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor; Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor
| | | | - Siobán D Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor.
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Lee D, Ahn KO, Suh J, Jung SY. Factors associated with the provision of targeted temperature management: A balanced factorial experiment. Am J Emerg Med 2019; 37:1917-1921. [PMID: 30711387 DOI: 10.1016/j.ajem.2019.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 10/27/2022] Open
Abstract
AIM This study examined the influence of patient attributes and provider or organizational factors on the decision to apply targeted temperature management (TTM) to resuscitated out-of-hospital cardiac arrest (OHCA) patients. METHODS A balanced factorial experiment was conducted among emergency medicine physicians (EMPs). Sixteen OHCA patient scenarios with balanced factors were presented. The balancing factors were dichotomous categories of patient age (45 ± 2 vs. 70 ± 2 years), patient sex (men vs. women), socioeconomic status (SES; higher vs. lower), and guardian attitudes (positive vs. reluctant) regarding TTM. Information on participant and organizational characteristics was collected. The outcome variable was a score (0-100) based on responses to questions that indicated how likely the participants were to apply TTM. RESULTS Seventy-five EMPs completed the experiment. The median score for the likelihood of TTM application was 85 (interquartile range, 70-95). Scores differed significantly for patient age (90% vs. 80%, p = 0.001), SES (90% vs. 80%, p = 0.001), and guardian attitude regarding TTM (90% vs. 70%, p = 0.001). The likelihood of TTM application was associated with EMP experience with TTM (more or <50 times) (90% vs. 80%, p = 0.001). EMPs working in hospitals with commercial TTM devices or operating protocols were more likely to use TTM than those working in hospitals without TTM devices or protocols (88 vs. 80 and 90 vs. 80; p = 0.001, respectively). CONCLUSION Patient demographics and provider and organizational factors significantly affected the decision to apply TTM.
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Affiliation(s)
- DongHyun Lee
- Department of Emergency Medicine, Myongji Hospital, Goyang-si, Republic of Korea
| | - Ki Ok Ahn
- Department of Emergency Medicine, Myongji Hospital, Hanyang University, College of Medicine, Goyang-si, Republic of Korea.
| | - Joohyun Suh
- Department of Emergency Medicine, Myongji Hospital, Hanyang University, College of Medicine, Goyang-si, Republic of Korea.
| | - Si Young Jung
- Department of Emergency Medicine, Myongji Hospital, Hanyang University, College of Medicine, Goyang-si, Republic of Korea
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Brown JJ, Pribesh SL, Baskette KG, Vinik AI, Colberg SR. A Comparison of Screening Tools for the Early Detection of Peripheral Neuropathy in Adults with and without Type 2 Diabetes. J Diabetes Res 2017; 2017:1467213. [PMID: 29250555 PMCID: PMC5698816 DOI: 10.1155/2017/1467213] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/31/2017] [Accepted: 09/13/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Examine the effectiveness of the 128 Hz tuning fork, two monofilaments, and Norfolk Quality of Life Diabetic Neuropathy (QOL-DN) questionnaire as tools for the early detection of diabetic peripheral neuropathy (DPN) in overweight, obese, and inactive (OOI) adults or those who have prediabetes (PD) or type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Thirty-four adults (mean age 58.4 years ± 12.1) were divided by glycemia (10 OOI normoglycemic, 13 PD, and 11 T2D). Sural nerves were tested bilaterally with the NC-stat DPNCheck to determine sural nerve amplitude potential (SNAP) and sural nerve conduction velocity (SNCV). All other testing results were compared to SNAP and SNCV. RESULTS Total 1 g monofilament scores significantly correlated with SNAP values and yielded the highest sensitivity and specificity combinations of tested measures. Total QOL-DN scores negatively correlated with SNAP values, as did QOL-DN symptoms. QOL-DN activities of daily living correlated with the right SNAP, and the QOL-DN small fiber subscore correlated with SNCV. CONCLUSIONS The 1 g monofilament and total QOL-DN are effective, low-cost tools for the early detection of DPN in OOI, PD, and T2D adults. The 128 Hz tuning fork and 10 g monofilament may assist DPN screening as a tandem, but not primary, early DPN detection screening tools.
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Affiliation(s)
- Jennifer J. Brown
- Elizabeth City State University, Elizabeth City, NC, USA
- Old Dominion University, Norfolk, VA, USA
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Sellers SL, Moss ME, Calzone K, Abdallah KE, Jenkins JF, Bonham VL. Nurses' Use of Race in Clinical Decision Making. J Nurs Scholarsh 2016; 48:577-586. [PMID: 27676232 DOI: 10.1111/jnu.12251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine nurses' self-reported use of race in clinical evaluation. DESIGN This cross-sectional study analyzed data collected from three separate studies using the Genetics and Genomics in Nursing Practice Survey, which includes items about use of race and genomic information in nursing practice. The Racial Attributes in Clinical Evaluation (RACE) scale was used to measure explicit clinical use of race among nurses from across the United States. METHODS Multivariate regression analysis was used to examine associations between RACE score and individual-level characteristics and beliefs in 5,733 registered nurses. FINDINGS Analysis revealed significant relationships between RACE score and nurses' race and ethnicity, educational level, and views on the clinical importance of patient demographic characteristics. Asian nurses reported RACE scores 1.41 points higher than White nurses (p < .001), and Black nurses reported RACE scores 0.55 points higher than White nurses (p < .05). Compared to diploma-level nurses, the baccalaureate-level nurses reported 0.69 points higher RACE scores (p < .05), master's-level nurses reported 1.63 points higher RACE scores (p < .001), and doctorate-level nurses reported 1.77 points higher RACE scores (p < .01). In terms of clinical importance of patient characteristics, patient race and ethnicity corresponded to a 0.54-point increase in RACE score (p < .001), patient genes to a 0.21-point increase in RACE score (p < .001), patient family history to a 0.15-point increase in RACE score (p < .01), and patient age to a 0.19-point increase in RACE score (p < .001). CONCLUSIONS Higher reported use of race among minority nurses may be due, in part, to differential levels of racial self-awareness. A relatively linear positive relationship between level of nursing degree nursing education and use of race suggests that a stronger foundation of knowledge about genetic ancestry, population genetics and the concept "race" and genetic ancestry may increase in clinical decision making could allow nurses to more appropriately use of race in clinical care. Integrating patient demographic characteristics into clinical decisions is an important component of nursing practice. CLINICAL RELEVANCE Registered nurses provide care for diverse racial and ethnic patient populations and stand on the front line of clinical care, making them essential for reducing racial and ethnic disparities in healthcare delivery. Exploring registered nurses' individual-level characteristics and clinical use of race may provide a more comprehensive understanding of specific training needs and inform nursing education and practice.
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Affiliation(s)
- Sherrill L Sellers
- *Associate Dean for Undergraduate Education and Professor, Department of Family Studies and Social Work, Miami University, Oxford, OH, USA.
| | - Melissa E Moss
- *Postbaccalaureate Intramural Research Training Award (IRTA) Fellow, Health Disparities Unit, Social and Behavioral Research Branch, Division of Intramural Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kathleen Calzone
- Senior Nurse Specialist, Research, National Cancer Institute, Center for Cancer Research, Genetics Branch, National Institutes of Health, Bethesda, MD, USA
| | - Khadijah E Abdallah
- Research Analyst, Health Disparities Unit, Social and Behavioral Research Branch, Division of Intramural Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jean F Jenkins
- Clinical Advisor, Office of the Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Vence L Bonham
- Associate Investigator, Health Disparities Unit, Social and Behavioral Research Branch, Division of Intramural Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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Shearer JE, Jenkins CH, Magwood GS, Pope CA. Contested Ownership of Disease and Ambulatory-Sensitive Emergency Department Visits for Type 2 Diabetes. Am J Med Sci 2016; 351:400-6. [PMID: 27079346 DOI: 10.1016/j.amjms.2016.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Approximately 21 million persons have diabetes and account for 11.9% of all emergency department (ED) visits for a total cost of $14.1 billion. Nonemergent visits for ambulatory-sensitive conditions that could be managed by the primary care provider make up almost one-third of the ED visits. African Americans comprise approximately 30% of South Carolina's population but make up approximately 50% of the ED visits for diabetes. The purpose of the research was to explore the experiences of 20 African-American adults with diabetes with ambulatory-sensitive ED use. RESEARCH DESIGN AND METHODS The research design for this study is grounded theory with dimensional analysis methods. Following ethics approval and informed consent, interviews were conducted, recorded and transcribed verbatim, and themes were analyzed to form the explanatory framework or matrix for ED use. The framework of context, conditions, processes and consequences provides a key for understanding the themes of the story embedded in the descriptive narratives. RESULTS The contested ownership of diabetes was the overarching perspective--"doing what I got to do," "it's always on mind… wishing not to be a diabetic" and "it's a constant burden." And handling diabetes involved taking decisions "into your hands." The context of perceived urgency of symptoms included all the reasons that precipitated ED visit--personal experience, primary care access and services and social network support for decisions--influenced ownership of these decisions.
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Affiliation(s)
- Jennifer E Shearer
- College of Nursing, Charleston Southern University, Charleston, South Carolina
| | - Carolyn H Jenkins
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina.
| | - Gayenell S Magwood
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Charlene A Pope
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina; Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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Stevens CD, Schriger DL, Raffetto B, Davis AC, Zingmond D, Roby DH. Geographic clustering of diabetic lower-extremity amputations in low-income regions of California. Health Aff (Millwood) 2016; 33:1383-90. [PMID: 25092840 DOI: 10.1377/hlthaff.2014.0148] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
For patients suffering from diabetes and other chronic conditions, a large body of work demonstrates income-related disparities in access to coordinated preventive care. Much less is known about associations between poverty and consequential negative health outcomes. Few studies have assessed geographic patterns that link household incomes to major preventable complications of chronic diseases. Using statewide facility discharge data for California in 2009, we identified 7,973 lower-extremity amputations in 6,828 adults with diabetes. We mapped amputations based on residential ZIP codes and used data from the Census Bureau to produce corresponding maps of poverty rates. Comparisons of the maps show amputation "hot spots" in lower-income urban and rural regions of California. Prevalence-adjusted amputation rates varied tenfold between high-income and low-income regions. Our analysis does not support detailed causal inferences. However, our method for mapping complication hot spots using public data sources may help target interventions to the communities most in need.
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Affiliation(s)
- Carl D Stevens
- Carl D. Stevens is a clinical professor in health sciences, David Geffen School of Medicine at the University of California, Los Angeles (UCLA)
| | - David L Schriger
- David L. Schriger is a professor at the Center for Emergency Medicine, UCLA
| | - Brian Raffetto
- Brian Raffetto is a physician resident in the Department of Emergency Medicine, Keck School of Medicine, University of Southern California, in Los Angeles
| | - Anna C Davis
- Anna C. Davis is a PhD student in the Department of Health Policy and Management, Fielding School of Public Health, UCLA
| | - David Zingmond
- David Zingmond is an associate professor of medicine in the Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA
| | - Dylan H Roby
- Dylan H. Roby is an assistant professor in the Department of Health Policy and Management, Fielding School of Public Health, and director of health economics and evaluation research, UCLA Center for Health Policy Research
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The influence of patients' immigration background and residence permit status on treatment decisions in health care. Results of a factorial survey among general practitioners in Switzerland. Soc Sci Med 2016; 161:64-73. [PMID: 27258017 DOI: 10.1016/j.socscimed.2016.05.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 11/23/2022]
Abstract
This study examines the influence of patients' immigration background and residence permit status on physicians' willingness to treat patients in due time. A factorial survey was conducted among 352 general practitioners with a background in internal medicine in a German-speaking region in Switzerland. Participants expressed their self-rating (SR) as well as the expected colleague-rating (CR) to provide immediate treatment to 12 fictive vignette patients. The effects of the vignette variables were analysed using random-effects models. The results show that SR as well as CR was not only influenced by the medical condition or the physicians' time pressure, but also by social factors such as the ethnicity and migration history, the residence permit status, and the economic condition of the patients. Our findings can be useful for the development of adequate, practically relevant teaching and training materials with the ultimate aim to reduce unjustified discrimination or social rationing in health care.
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Chevalier L, Goldfarb E, Miller J, Hoeppner B, Gorrindo T, Birnbaum RJ. Gaps in preparedness of clergy and healthcare providers to address mental health needs of returning service members. JOURNAL OF RELIGION AND HEALTH 2015; 54:327-338. [PMID: 25112409 DOI: 10.1007/s10943-014-9917-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
To elucidate gaps in the preparedness of clergy and healthcare providers to care for service members (SM) with deployment-related mental health needs. Participants identified clinically relevant symptoms in a standardized video role play of a veteran with deployment-related mental health needs and discussed their preparedness to deal with SM. Clergy members identified suicide and depression most often, while providers identified difficulty sleeping, low energy, nightmares and irritability. Neither clergy nor providers felt prepared to minister to or treat SM with traumatic brain injury. Through a mixed methods approach, we identified gaps in preparedness of clergy and healthcare providers in dealing with the mental health needs of SM.
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Affiliation(s)
- Lydia Chevalier
- Department of Psychiatry, Massachusetts General Hospital (MGH), 1 Bowdoin Sq, Ste 744, Boston, MA, 02114, USA,
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