Understanding concordance in patient-physician relationships: personal and ethnic dimensions of shared identity

Effect of surgeon-patient sex discordance on ventral hernia repair outcomes

PURPOSE

Concordance is an important dimension of the physician-patient relationship that may be linked to health care disparities. The purpose of this study was to determine if sex discordance between surgeon and patient impacts surgical outcomes.

METHODS

A retrospective review of prospectively collected data obtained from the Abdominal Core Health Quality Collaborative (ACHQC) registry was performed on all patients who underwent ventral hernia repair. Surgical site occurrences (SSO), surgical site infections (SSI), surgical site occurrence requiring procedural intervention (SSOPI) and 30-day readmission rates were recorded.

RESULTS

Female patients operated on by male surgeons have increased odds of having an SSI/SSO (OR 1.099, 95% CI 1.022-1.181), SSOPI (OR 1.156, 95% CI 1.031-1.297), and readmission (OR 1.259, 95% CI 1.128-1.406) when compared to male patients operated on by male surgeons. There was no significant difference in adverse outcomes between patient groups when operated on by female surgeons.

CONCLUSION

Sex discordance between surgeon and patient is associated with increased odds adverse outcomes when male surgeons operate on female patients.

The Influence of Racial/Ethnic and Gender Concordance on Care Among Non-Pregnant Women of Childbearing Age with Diabetes Mellitus: an Analysis of the Medical Expenditure Panel Survey, 2010-2019

INTRODUCTION

This study examined associations between patient-provider race/ethnicity concordance and gender concordance on overall healthcare ratings, self-efficacy, and diabetes care monitoring in non-pregnant women of childbearing age with diabetes mellitus before and after adjusting for sociodemographic factors.

METHODS

We analyzed longitudinal data from the 2010-2019 Medical Expenditure Panel Survey. The sample was limited to non-pregnant women of childbearing age (18-45 years) diagnosed with diabetes (unweighted n = 327; weighted n = 566,504). Bivariate analysis, logistic regression, and latent variable modeling were performed.

RESULTS

Few racially minoritized women reported racial/ethnic and gender concordance with their healthcare provider. Only 2.9% of Hispanic women reported having a Hispanic provider and 12.1% of non-Hispanic Black women reported seeing a non-Hispanic Black provider compared to 81.1% of non-Hispanic White women who reported seeing a non-Hispanic White provider (p < .0001). Among Hispanic women, 15.3% reported seeing a female provider compared to 25.2% of non-Hispanic Black and 53.5% of non-Hispanic White women. Patient-provider race/ethnicity and gender concordance were not statistically significantly associated with overall healthcare ratings, self-efficacy, or diabetes care monitoring.

CONCLUSIONS

This study revealed a large disparity in race/ethnicity and gender concordance among minority women of reproductive age with diabetes compared to their non-Hispanic White counterparts. There is a need for larger, more robust studies to examine the influence of provider and other healthcare characteristics on diabetes-related outcomes in this understudied population.

A Representative Profile of MSW Graduates in the United States

As the United States faces burgeoning behavioral health needs and a growing recognition of the inextricable link between social conditions and health outcomes and quality-of-life indicators, a current representative profile of the MSW workforce with respect to sociodemographic and employment characteristics can provide a reference point for ongoing assessments of that workforce. The profile also can establish a baseline by which efforts to bolster the diversity and strength of the MSW workforce can be grounded. The core aim of the current study was to generate a nationally representative, descriptive profile of MSW graduates in the United States using a sample of 1,028 MSW graduates (representing a subpopulation of 691,061 individuals) from the 2021 National Survey of College Graduates. Weighted univariate and bivariate analyses were conducted to generate a descriptive profile of MSW graduates with respect to sociodemographic, education, and employment characteristics. Study findings can help employers, health services researchers, policymakers, and practitioners understand the context of the MSW workforce as it relates to diversity, labor workforce projection data, and student loan and salary considerations. This information can guide future policy and training goals to support the future vitality of the social work profession.

Increasing Underrepresented Minority Representation in a General Surgery Residency Program Utilizing a 3-Phase Strategy

BACKGROUND

Underrepresented minority groups (URMs) in surgery are not significantly increasing despite evidence suggesting that diversity in health care providers leads to excellent patient outcomes and care. Efforts to increase URM representation in surgical residency programs are essential for addressing disparities and improving health care delivery.

METHODS

This retrospective study outlines a three-phase strategy implemented at a large academic-affiliated hospital to increase URM representation in its general surgery residency program. The strategy encompassed interview selection with a holistic review and implicit bias training for interviewers, modification of the interview scoring rubric, and post-interview recruitment efforts, including a virtual second look event for URM applicants.

RESULTS

Following the implementation of these strategies, the URM match rate improved from 0 to 33.3% in the first year and was sustained at 33.3% in the subsequent year. Consequently, the representation of URMs in the residency program rose from 6.7% before our intervention to 13.3% afterwards.

DISCUSSION

This structured approach successfully increased URM representation in a surgical residency program, affirming the success of targeted recruitment strategies. By promoting a diverse and inclusive environment, the program better reflects the community it serves, with aims at improved patient care and patient satisfaction.

Diversity, Equity, and Inclusion in US Anesthesiology Residency Matching

BACKGROUND

Patient outcomes are improved with physician-patient gender, racial, and ethnic concordance. However, female, Black, Hispanic or Latino, Native Hawaiian-Pacific Islander (NH-PI), and American Indian-Native Alaskan (AI-AN) physicians are underrepresented in anesthesiology. The American Association of Medical Colleges 2018 Diversity in Medicine Report revealed that women comprise only 35% of anesthesiologists yet nearly half of medical school graduates are women. More than 77% of anesthesiologists are White or Asian. Anesthesiology applicant and match trends may provide insights needed to address underrepresentation within anesthesiology. We hypothesized that proportionally fewer women and racially and ethnically minoritized applicants apply and match into anesthesiology.

METHODS

This retrospective observational study identified 47,117 anesthesiology applicants among the 546,298 residency applicants in the Electronic Residency Application Service (ERAS) system between 2011 and 2022 and stratified applicants by self-reported gender, race, and ethnicity. The demographics of anesthesiology trainees reported in the 2014 to 2015, 2018 to 2019, and 2022 to 2023 Accreditation Counsel of Graduate Medical Education (ACGME) Data Resource Books were used as surrogates for matched applicants as demographics are not reported by the National Residency Match Program. To facilitate comparisons, ERAS applicants were grouped into 4-year epochs to align with consolidated ACGME reports corresponding to the application years. Odds ratios (OR); 95% confidence interval of applying to and matching into anesthesiology were analyzed.

RESULTS

Women had lower odds of applying to anesthesiology compared to men overall (OR, 0.55; 95% CI, 0.54-0.56, P < .0001) and maintained significantly lowered odds of applying within each epoch. Women had similar odds of matching into anesthesiology residency compared to men (OR, 1.10; 95% CI, 1.06-1.14, P < .0001). Black, Hispanic or Latino, Asian and NH-PI, and AI-AN applicants had similar odds to White applicants of applying to anesthesiology but odds of matching were significantly lower overall ( P < .0001) for Asian and NH-PI (OR, 0.66; 95% CI, 0.63-0.70), Black (OR, 0.49; 95% CI, 0.45-0.53), Hispanic or Latino (OR, 0.50; 95% CI, 0.46-0.54), and AI-AN (OR, 0.20; 95% CI, 0.15-0.28) applicants. The odds of matching among some minoritized applicants increased in the ACGME 2022 to 2023 report year.

CONCLUSIONS

From 2011 to 2022, women had lower odds of applying to anesthesiology residency than men yet had similar odds of matching. Racial and ethnic minoritized groups had significantly lower odds of matching compared to White applicants despite similar odds of applying. These findings highlight disparities in the anesthesiology match and may help identify opportunities to promote workforce diversity within the field. More detailed reporting of gender, race, and ethnicity in annual match data may better define barriers to entry and identify opportunities for improvement.

Intersectional Discrimination in Mental Health Care: A Systematic Review With Qualitative Evidence Synthesis

OBJECTIVE

Discriminatory practices in mental health care undermine the right to health of marginalized service users. Intersectional approaches enable consideration of multiple forms of discrimination that occur simultaneously and remain invisible in single-axis analyses. The authors reviewed intersectionality-informed qualitative literature on discriminatory practices in mental health care to better understand the experiences of marginalized service users and their evaluation and navigation of mental health care.

METHODS

The authors searched EBSCO, PubMed, MEDLINE, and JSTOR for studies published January 1, 1989-December 14, 2022. Qualitative and mixed-methods studies were eligible if they used an intersectional approach to examine discrimination (experiences, mechanisms, and coping strategies) in mental health care settings from the perspective of service users and providers. A qualitative evidence synthesis with thematic analysis was performed.

RESULTS

Fifteen studies were included in the qualitative evidence synthesis. These studies represented the experiences of 383 service users and 114 providers. Most studies considered the intersections of mental illness with race, sexual and gender diversity, or both and were performed in the United States or Canada. Four themes were identified: the relevance of social identity in mental health care settings, knowledge-related concerns in mental health care, microaggressions in clinical practice, and service users' responses to discriminatory practices.

CONCLUSIONS

Discriminatory practices in mental health care lead to specific barriers to care for multiply marginalized service users. Universities and hospitals may improve care by building competencies in recognizing and preventing discrimination through institutionalized training.

Underrepresentation of Black Men in Physician Assistant and Associate Training

Importance

The underrepresentation of Black men in the health care workforce, particularly among physician assistants and associates (PAs), represents a missed opportunity to alleviate shortages of health care professionals and enhance workforce diversity. Increasing the number of Black men in the training pipeline could significantly benefit education, patient care, and overall health outcomes.

Objective

To analyze patterns from 2013 to 2021 among Black men applying to and matriculating into PA programs and compare these figures with the age-specific US population of Black men.

Design, Setting, and Participants

This cohort study assessed deidentified application and matriculation data from the Central Application Service for Physician Assistants (CASPA) for PA training programs in the US, alongside US Census data. CASPA applicants reporting race and gender identities as Black male were included. Data were obtained March 10, 2023, from the 2012-2013 to the 2020-2021 application cycles; data were analyzed from June 2023 to May 2024.

Exposures

Black male applicants and matriculation.

Main Outcomes and Measures

Patterns and proportion of Black male applicants and matriculants to PA programs relative to total rates and expected numbers.

Results

From 2013 to 2021, PA programs grew 64.3%, with an increase in applicants from 19 761 to 30 196 and matriculants from 6192 to 11 115. Despite this growth, the representation of Black men among applicants (from 435 to 732) and matriculants (from 73 to 156) remained stagnant, averaging 2.2% and 1.2%, respectively, significantly lower than their 8.7% (3 920 231 individuals aged 20-29 years) representation in the US Census. In 2021, the matriculation rate for Black men (156 of 732 [21.3%]) was notably lower than the matriculation rate for all applicants (11 115 of 30 196 [36.8%]). Based on the expected proportion of Black men in the PA applicant age range, there should have been 2641 applicants (actual: 732) and 972 matriculants (actual: 156) across 308 PA programs in 2021; these numbers indicate that, per program, approximately 9 applicants would have to have been evaluated and 3 matriculated to achieve parity, in contrast to the mean of 2 applicants and 1 matriculant per 2 programs.

Conclusions and Relevance

In this cohort study of PA applicants and matriculants, Black men remained substantially underrepresented despite overall growth of PA training programs. The low representation among matriculants was due in part to the low numbers of applicants but also to substantially lower matriculation success. This persistent underrepresentation highlights systemic barriers and underscores the need for targeted interventions to achieve a more representative health care workforce. To achieve equitable admissions, each PA program should aim to evaluate 9 Black male applicants and matriculate 3 Black men annually.

The Hydronephrosis Severity Index guides paediatric antenatal hydronephrosis management based on artificial intelligence applied to ultrasound images alone

Antenatal hydronephrosis (HN) impacts up to 5% of pregnancies and requires close, frequent follow-up monitoring to determine who may benefit from surgical intervention. To create an automated HN Severity Index (HSI) that helps guide clinical decision-making directly from renal ultrasound images. We applied a deep learning model to paediatric renal ultrasound images to predict the need for surgical intervention based on the HSI. The model was developed and studied at four large quaternary free-standing paediatric hospitals in North America. We evaluated the degree to which HSI corresponded with surgical intervention at each hospital using area under the receiver-operator curve, area under the precision-recall curve, sensitivity, and specificity. HSI predicted subsequent surgical intervention with > 90% AUROC, > 90% sensitivity, and > 70% specificity in a test set of 202 patients from the same institution. At three external institutions, HSI corresponded with AUROCs ≥ 90%, sensitivities ≥ 80%, and specificities > 50%. It is possible to automatically and reliably assess HN severity directly from a single ultrasound. The HSI stratifies low- and high-risk HN patients thus helping to triage low-risk patients while maintaining very high sensitivity to surgical cases. HN severity can be predicted from a single patient ultrasound using a novel image-based artificial intelligence system.

The Relationship Between Provider and Patient Racial Concordance and Receipt of Postpartum Care

Access to postpartum care (PPC) varies in the US and little data exists about whether patient factors may influence receipt of care. Our study aimed to assess the effect of provider-patient racial concordance on Black patients' receipt of PPC. We conducted a cross-sectional study analyzing over 24,000 electronic health records of childbirth hospitalizations at a large academic medical center  in Alabama from January 2014 to March 2020. The primary outcome variable was whether a Black patient with a childbirth hospitalization had any type of PPC visit within 12 weeks after childbirth. We used a generalized estimating equation (GEE) logistic regression model to assess the relationship between provider-patient racial concordance and receipt of PPC. Black patients with Black main providers of prenatal or childbirth care had significantly higher adjusted odds of receiving PPC (adj. OR 2.26, 95% CI 1.65-3.09, p < .001) compared to Black patients with non-Black providers. White patients who had White providers did not have statistically significantly different odds of receiving PPC compared to those with non-White providers after adjustment (adj. OR 0.88, 95% CI 0.68-1.14). Although these results should be interpreted with caution given the low number of Black providers in this sample, our findings suggest that in one hospital system in Alabama, Black birthing people with a racially concordant main prenatal and delivery care provider may have an increased likelihood of getting critical PPC follow-up.

Assessing inclusion and representativeness on digital platforms for health education: Evidence from YouTube

BACKGROUND

Studies confirm that significant biases exist in online recommendation platforms, exacerbating pre-existing disparities and leading to less-than-optimal outcomes for underrepresented demographics. We study issues of bias in inclusion and representativeness in the context of healthcare information disseminated via videos on the YouTube social media platform, a widely used online channel for multi-media rich information. With one in three US adults using the Internet to learn about a health concern, it is critical to assess inclusivity and representativeness regarding how health information is disseminated by digital platforms such as YouTube.

METHODS

Leveraging methods from fair machine learning (ML), natural language processing and voice and facial recognition methods, we examine inclusivity and representativeness of video content presenters using a large corpus of videos and their metadata on a chronic condition (diabetes) extracted from the YouTube platform. Regression models are used to determine whether presenter demographics impact video popularity, measured by the video's average daily view count. A video that generates a higher view count is considered to be more popular.

RESULTS

The voice and facial recognition methods predicted the gender and race of the presenter with reasonable success. Gender is predicted through voice recognition (accuracy = 78%, AUC = 76%), while the gender and race predictions use facial recognition (accuracy = 93%, AUC = 92% and accuracy = 82%, AUC = 80%, respectively). The gender of the presenter is more significant for video views only when the face of the presenter is not visible while videos with male presenters with no face visibility have a positive relationship with view counts. Furthermore, videos with white and male presenters have a positive influence on view counts while videos with female and non - white group have high view counts.

CONCLUSION

Presenters' demographics do have an influence on average daily view count of videos viewed on social media platforms as shown by advanced voice and facial recognition algorithms used for assessing inclusion and representativeness of the video content. Future research can explore short videos and those at the channel level because popularity of the channel name and the number of videos associated with that channel do have an influence on view counts.

The Effects of Safe Zone Badges in Physicians' Online Biographies: Evidence from an Experimental Study

Earning digital badges to showcase a person's expertise or knowledge are becoming increasingly popular. A healthcare provider's displaying of a Safe Zone badge within their online profile may offer prospective patients a cue as to the kind of care they might receive if they selected that particular provider. Prior research indicates LGBTQ+ individuals are looking for these types of cues within providers' biographies to make their selections. A between subjects, 2 (Safe Zone badge present/absent) x 2 (male/female doctor) online experiment was conducted (n = 658). Results revealed a main effect for the presence of the Safe Zone badge. Participants had greater anticipated satisfaction, liking, were more likely to view the provider as approachable, and were more willing to schedule an appointment with the provider displaying a Safe Zone badge.

The Heart of the Matter: A Path to Building Diversity in Pediatric Cardiology

Our essay discusses the impact of underrepresentation in medical training, with a focus on pediatric cardiology. We use the perspective of a physician who is underrepresented in medicine (URiM), and has chosen to pursue a career in pediatric cardiology, to initiate an analysis of the current path toward pediatric cardiology and the factors in undergraduate and graduate medical education which could currently be optimized to improve diversity in training. We argue that a lack of diversity among physicians leads to worse patient outcomes, and we describe steps to improve representation in the field. In order to improve representation in pediatric cardiology, we must reflect upon our current practices and implement systemic changes within cardiology training program recruitment and retention practices. These changes should include continuous mentorship of URiM trainees interested in cardiology and prioritization of research that investigates social determinants of health which may disproportionally affect minority patients.

The weaponization of professionalism against physicians of color

Though we have made ample advances in the field of medicine in recent years, our idea of professionalism continues to be based on the standard of how white men dressed in the nineteenth century. Such a standard of professionalism not only perpetuates gender bias, but also aims to remove the culture, traditions, and behaviors of minority groups with the goal of molding these individuals to resemble the majority, preventing 'Afro' heritage from entering medicine. By contextualizing our own experiences in the medical setting as physicians of color in the context of a variety of supporting literature, we provide an overview of professionalism, its role in medicine, the double standard faced by women, and how it continues to be weaponized against physicians of racial, ethnic, and religious minorities. We advocate for minority physicians to embrace their authenticity and for institutions to develop policies that openly, firmly, and enthusiastically welcome physicians of all ethnicities, religions, and genders. Positionality Statement: In the editorial you are about to read, we, the authors, collectively bring a rich tapestry of backgrounds and experiences to our discussion on healthcare disparities. Our team consists of two Hispanic/Latina oncologists, one Middle Eastern oncologist, one Black/Caribbean-American hematologist, and one White pre-medical student with Middle Eastern heritage. Our diverse backgrounds inform our perspectives and enhance our understanding of the complex and multifaceted nature of healthcare. We are united by a shared commitment to justice, equity, and the belief that every patient deserves high-quality care, regardless of their background. This editorial is informed by our professional expertise, personal experiences, and the diverse communities we serve, aiming to highlight the critical need for inclusivity and representation in healthcare. By acknowledging our positionality, we hope to provide a comprehensive and empathetic analysis that not only identifies the challenges but also offers actionable solutions to improve healthcare outcomes for all. We recognize the power of diversity in fostering innovation and driving positive change, and we are dedicated to using our voices and positions to advocate for a more equitable healthcare system.

A Comparison of Demographic Diversity Between Orthopaedic Surgery Residents and ACGME Foot and Ankle Fellows From 2007 to 2022

Background

Academic medicine emphasizes the need to recruit a diverse workforce in graduate medical education. Orthopaedic surgery residency has demonstrated efforts to model program compositions with evolving US demographics. However, it remains unclear whether orthopaedic fellowships, particularly foot and ankle, also reflect these efforts.

Methods

Using the publicly available Accreditation Council for Graduate Medical Education (ACGME) Data Resource Book, a census of the gender and racial/ethnic identities of orthopaedic foot and ankle fellows, as well as active orthopaedic surgery residents, were compiled from 2007 to 2022. Linear trend analysis was conducted to evaluate the trends of orthopaedic residents and foot and ankle fellows, with a Pearson correlation for comparison.

Results

Prior analysis demonstrated no significant change in sex and ethnic diversity of fellows from 2006 to 2015. The majority of foot and ankle fellows were White (31%-69%) and male (63%-88%). Linear analysis demonstrated growing diversity in female and non-White active orthopaedic surgery residents. Similarly, there was an increasing number of female foot and ankle fellows (0%-38%) reflective of the trend in orthopaedic residency (12%-20%); however, there was no significant change among racial/ethnic identities. Pearson correlation analysis between the trend of orthopaedic residency residents and foot and ankle fellows suggests moderate correlation among female, Asian, and "Unknown" racial/ethnic categories.

Conclusion

The proportion of foot and ankle female fellows in ACGME-accredited fellowships has matched or exceeded the percentage of female orthopaedic residents. Despite increased diversity of orthopaedic surgery residents over the past 2 decades, ACGME-accredited foot and ankle fellowships do not yet reflect similar trends among racial/ethnic minorities.

Level of Evidence

Level III, retrospective cohort study.

Second opinions: Do otolaryngologist demographics matter?

OBJECTIVE

Pediatric patients and their caregivers may receive information from their primary care physician (PCP) that does not match current American Academy of Otolaryngology (AAO) guidelines. The purpose of this study is to evaluate the frequency of parents deciding to seek a second opinion based on the demographics of pediatric otolaryngologists who deliver guideline supported advice, contrary to advice from their child's PCP.

METHODS

A survey was distributed to parents in a pediatric otolaryngology clinic between June 2021 and July 2023. Demographics included parent age category, gender, race, and age of youngest child. The survey included a scenario depicting recurrent otitis media with clear ears and a suggestion to defer tympanostomy tube insertion per AAO guidelines after their child's PCP recommended tubes. Thirteen variations of otolaryngologist photos were used in the case, including a control case with no picture.

RESULTS

Of the 658 participants, 460 (69.9 %) were female. 551 (83.7 %) were aged 30-49 years, 70 (10.7 %) were younger, and 37 (5.6 %) were older. 545 (82.8 %) were White, 30 (4.6 %) were Black, 20 (3.0 %) were Asian, and 31 (4.7 %) were Hispanic. 39.9 % of parents would seek a second opinion if an otolaryngologist recommended watchful waiting following evaluation of their child's otitis media. Participants given the control case were 2.23 times more likely to listen to the otolaryngologist's advice (p = .025). If a picture was provided, respondents were more likely to follow advice given if the pictured otolaryngologist was female (p = .025, OR = 1.47) or Asian (p = .042, OR = 1.53).

CONCLUSION

In this group, there is evidence that physician race and gender may influence decision making when considering action versus monitoring in the context of recurrent otitis media.

Health Care Discrimination and Care Avoidance Due to Patient-Clinician Identity Discordance Among Sexual and Gender Minority Adults

Sexual and gender minority (SGM) adults experience poor health outcomes, in part due to frequent avoidance of necessary health care. Little is known, however, about factors contributing to patterns of health care utilization in this population. Using national data from the All of Us Research Program, this study evaluated the prevalence of care avoidance due to patient-clinician identity discordance (PCID) and its association with health care discrimination among SGM adults. Sexual minority (20.0% vs 9.4%; adjusted rate ratio [aRR] = 1.58; 95% CI, 1.49-1.67, P <0.001) and gender minority adults (34.4% vs 10.3%; aRR = 2.00; 95% CI, 1.79-2.21, P <0.001) were significantly more likely than their non-SGM counterparts to report care avoidance due to PCID. Exposure to health care discrimination was also more prevalent in this population and was dose-dependently associated with significantly higher rates of PCID-based care avoidance. Study findings highlight the importance of diversifying the health care workforce, expanding SGM-related clinical training, and preventing health care discrimination against SGM patients.

The Relationship of Race/Ethnicity Concordance to Physician-Patient Communication: A Mixed-Methods Systematic Review

The concept of race or ethnic concordance between health care provider and patient has emerged as a dimension of the patient-physician relationship that could influence health outcomes for patients from minoritized groups, particularly through differences in the way physicians communicate with patients based on race or ethnicity. However, two decades of study on concordance and physician-patient communication have produced contradictory results. Given the heightened societal awareness of racism and the persistence of health disparities, there is a need for a comprehensive review of the current state of knowledge. This review sets out to determine how communication patterns differ in race/ethnicity concordant versus discordant patient-physician medical encounters. Thirty-three studies employing a range of methodologies were identified. In most analyses, after accounting for covariates, no relationship was found between race/ethnicity concordance and communication variables. Race/ethnicity concordance with their physician does not appear to influence the quality of communication for most patients from minoritized groups. A number of methodological weaknesses were identified in existing research, among them: few studies investigated potential explanatory variables, the heterogeneity of ethnic and cultural experience was over-simplified, there was little consistency in operationalization of communication variables, and the physician-patient dynamic was inadequately conceptualized.

More Than Skin Deep: Patient-Provider Racial and Ethnic Concordance and Discordance in Collegiate Athletics and Concussion Management

CONTEXT

There is strong evidence that racial and ethnic disparities exist in multiple arenas of health and wellness. The causes of racial and ethnic differences in health care are multidimensional; one factor that may affect injury/illness communication, interactions, and outcomes is patient-provider racial and ethnic concordance. At present, it is unclear what role patient-provider racial and ethnic concordance and discordance plays in facilitating concussion care for collegiate athletes.

OBJECTIVE

To investigate the presence of athlete-athletic trainer (AT) racial and ethnic concordance and discordance among diagnosed concussion cases and examine if racial and ethnic concordance and discordance influences time (in days) until diagnosis, symptom resolution, or return-to-sport clinical milestones in collegiate athletes.

DESIGN

Retrospective cohort study.

SETTING

Collegiate athletics.

PATIENTS OR OTHER PARTICIPANTS

A total of 694 concussion cases (38.6% [n = 268] sustained by women, 61.4% [n = 426] sustained by men) that occurred within the 2015-2016 through 2019-2020 sport seasons at 9 institutions.

MAIN OUTCOME MEASURE(S)

The number of days from the date of injury to diagnosis, symptom resolution, and return to sport and from the date of diagnosis to symptom resolution and return to sport.

RESULTS

Overall, 68.4% (n = 475) of concussion cases had patient-provider racial and ethnic concordance, and 31.6% (n = 219) were discordant. All concordant pairs included a White athlete and White AT. Time to diagnosis differed between the concordant and discordant groups (median [interquartile range] = 1 [0-2] versus 0 [0-1], respectively) only in the model adjusted for sex, sport type, and availability of an AT (odds ratio [95% CI] = 1.46 [1.07-1.85]). There were no other group differences.

CONCLUSIONS

One-third of concussion cases had athlete-AT racial and ethnic discordance. Although this group was diagnosed with a concussion 1 day sooner than the concordant group, no differences were observed for any concussion recovery milestones. These findings suggest that patient-provider racial and ethnic concordance may play a minor role in concussion recognition or reporting but not necessarily in the management and recovery thereafter.

Relevance and ethical issues of diversity equity and inclusion programs, circa 2024-2025

A recent resolution with approximately 100 signatories entitled "Sunsetting All Diversity, Equity, and Inclusion (DEI) Programs" administered by the American Academy of Dermatology (AAD) sparked controversial debate within the field. Despite the AAD voting against the proposal to eliminate DEI initiatives, many underrepresented medical groups wondered how to move forward and create safe spaces for everyone. We discuss the relevance of DEI programs in today's society and the ethical challenges that may arise. We conclude with actionable recommendations on how organizations can improve their current DEI strategies to ensure they are more inclusive and not perceived as discriminatory.

The patient perspective on diversity-sensitive care: a systematic review

BACKGROUND

The provision of diversity-sensitive care is a promising approach towards reducing health disparities. Recent criticism and a scientific gap demonstrate the need for the patient perspective on diversity-sensitive care. This systematic review aims to describe the patient perspective, including patient experiences, expectations, and satisfaction with diversity-sensitive care provided by healthcare providers.

METHODS

In December 2022 the Medline ALL, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO and additionally Google Scholar were searched for original studies that described or measured patient expectations, experiences, and/or satisfaction, specifically focusing on cultural or diversity competence of healthcare providers. Analysis of the collected data was performed using a convergent mixed-methods design based on thematic synthesis.

RESULTS

From initially 5,387 articles, 117 were selected for full-text screening, and ultimately, 34 articles were included in this study. The concept of diversity-sensitive care was observed to comprise three components. The first component is focused on patient-centered care and includes competencies such as clear and direct communication, shared decision-making, individualized care, empathy, and consideration. The second component centers on providing culturally tailored information, adjusting care to cultural needs, working with interpreters, allyship, community partnerships, self-awareness, and cultural knowledge, and builds upon the first component. Across the first two components of diversity-sensitive care, patients have reported experiencing dissatisfaction and encountering shortcomings in their healthcare providers, sometimes resulting in the third and final component pertaining to provider care. This component underscores the importance of linguistic, ethnic, cultural, and gender concordance in delivering quality care.

CONCLUSION

In conclusion, the patient perspective on diversity-sensitive care encompasses multiple components, from patient-centered care to concordant care. The components incorporate various competencies as communication skills, empathy, self-awareness and adjusting care to cultural needs. Patients reported experiencing dissatisfaction and shortcomings across all components of diversity-sensitive care provided by healthcare providers.

Racial and Ethnic Diversity of Athletic Trainers in National Collegiate Athletic Association Institutions, 2008-2018: A Retrospective Study

CONTEXT

Athletic trainers (ATs) are the most visible members of the sports medicine team and are responsible for the health and well-being of student-athletes. However, the representation of Black, Indigenous, and people of color (BIPOC) ATs in National Collegiate Athletic Association (NCAA) member institutions has not been studied.

OBJECTIVE

To quantify the representation of BIPOC ATs in National Collegiate Athletic Association (NCAA) member institutions.

DESIGN

Cross-sectional study.

SETTING

National Collegiate Athletic Association's Demographic Database.

PATIENTS OR OTHER PARTICIPANTS

Team athletic personnel at NCAA member institutions.

MAIN OUTCOME MEASURE(S)

Chi-square tests were used to assess differences in racial and ethnic frequencies across division, calendar year, and gender. Linear regression models were calculated to examine changes in racial and ethnic distributions of head and assistant ATs over time.

RESULTS

Most NCAA ATs were categorized as White (88%), which was reflected in both head (90.8%) and assistant (87.2%) AT positions. Black ATs made up the largest proportion of a specific racial or ethnicity group within BIPOC ATs (3.4% of head ATs, 4.6% of assistant ATs), with the next most prevalent being Hispanic (2.8% of head ATs, 3.9% of assistant ATs). Historically Black Colleges and Universities showed higher proportions of BIPOC ATs in both the head and assistant categories than non-historically Black institutions. Division I schools had the greatest AT racial or ethnicity diversity in comparison with Divisions II and III (P < .0001). In our linear regression models, we found increases in many of the racial or ethnic categories for both head and assistant ATs.

CONCLUSIONS

We demonstrated that BIPOC ATs represented a small proportion of the ATs currently working at NCAA member institutions. Although BIPOC ATs have increased over the past 10 years, a large racial and ethnic discordance gap still exists between student-athletes and the ATs caring for them.

Ophthalmic care may not align with patient need: An analysis on state-wide patient needs and provider density between 2008 and 2022

PURPOSE

This study aims to assess the extent to which the demand for ophthalmologic care among patients at the state level is reflected in Google Trends data, serving as an indicator of patient desire in ophthalmology.

METHODS

For each state, patient interest in ophthalmologic care was estimated using the Google Trends resource measuring web search and YouTube search rates for multiple ophthalmologic terms. We compared the change in search for ophthalmologic terms over time and used ordinary least squares regression to evaluate whether search interest for ophthalmologic terms was able to predict the rate of practicing ophthalmologists in each state. We also compare the changing rates of searches across the web and YouTube to evaluate the resources patients are most likely to utilize.

RESULTS

From 2008 to 2022, web search rates for general ophthalmology related terms increased by 43.98%, while search interest for retinal specific terms increased by 19.51%. YouTube specific results for general ophthalmology terms increased by 55.83% while search for retinal terms fell by 58.48%. Ophthalmologic and retinal specific search interest was not significantly associated with either outcome.

CONCLUSIONS

Our findings suggest that patient information needs, demographic elements, and the educational backgrounds of residents and fellows - those important factors - are surprisingly poorly correlated with ophthalmology provider density. Furthermore, we observed no noteworthy correlation between the search interest in ophthalmology and the overall density of ophthalmologists or retinal specialists. This implies that there is a pressing need to explore and implement strategies aimed at better aligning these influencing factors the choices made by ophthalmologists in selecting their practice locations to bridge the gap between healthcare availability and public interest.

Limitations in Faculty Advancement for Underrepresented Groups in Academic Otolaryngology

OBJECTIVE

Despite the increasing racial diversity of the United States, representation in academic medicine faculty does not reach concordance with the general population and worsens with higher rank. Few studies have examined this within academic Otolaryngology and surgical subspecialties. This project aims to compare rank equity in academic Otolaryngology on self-reported gender and race/ethnicity between the years 2000 and 2020.

METHODS

Publicly available data were obtained from the Association of American Medical Colleges under the "Data & Reports" section for the years 2000 and 2020. The report comprised of full-time faculty from all U.S. medical schools. To determine parity between faculty ranks across gender and race/ethnicity, rank equity index (REI) was calculated for associate/assistant, professor/associate, and professor/assistant professor comparisons.

RESULTS

The percentage of women faculty in Otolaryngology has increased from 21% in 2000 to 37% in 2020; however, they did not achieve parity at all rank comparisons for both years. On the contrary, men were above parity at all rank comparisons. Improvements in rank equity occurred for Black/African American (Black) and Hispanic Latino/Spanish Origin (Latine) faculty between the years 2000 and 2020; however, when accounting for gender, benefits were concentrated among men.

CONCLUSION

Advancement along the academic ladder is limited for women of all racial groups in academic Otolaryngology. While improved rank equity was seen for Black and Latine faculty, these improvements were largely among men. Future directions should aim to identify barriers to recruitment, retention, and promotion for women and underrepresented in medicine (URiM) academic otolaryngologists and create interventions that diversify Otolaryngology faculty at all ranks.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:1625-1632, 2024.

Social concordance and patient reported experiences in countries with different gender equality: a multinational survey

BACKGROUND

Patient reported experiences (PREMs) are important indices of quality of care. Similarities in demography between patient and doctor, known as social concordance, can facilitate patient-doctor interaction and may be associated with more positive patient experiences. The aim of this research is to study associations between gender concordance, age concordance and PREMs (doctor-patient communication, involvement in decision making, comprehensiveness of care and satisfaction) and to investigate whether these associations are dependent on a countries' Gender Equality Index (GEI).

METHODS

Secondary analysis on a multinational survey (62.478 patients, 7.438 GPs from 34 mostly European countries) containing information on general practices and the patient experiences regarding their consultation. Multi-level analysis is used to calculate associations of both gender and age concordance with four PREMs.

RESULTS

The female/female dyad was associated with better experienced doctor-patient communication and patient involvement in decision making but not with patient satisfaction and experienced comprehensiveness of care. The male/male dyad was not associated with more positive patient experiences. Age concordance was associated with more involvement in decision making, more experienced comprehensiveness, less satisfaction but not with communication. No association was found between a country's level of GEI and the effect of gender concordance.

CONCLUSION

Consultations in which both patient and GP are female are associated with higher ratings of communication and involvement in decision making, irrespective of the GEI of the countries concerned. Age concordance was associated with all PREMs except communication. Although effect sizes are small, social concordance could create a suggestion of shared identity, diminish professional uncertainty and changes communication patterns, thereby enhancing health care outcomes.

Knowledge and Attitude Towards the Elderly Among Doctors and Medical Students: A Questionnaire-Based Study

INTRODUCTION

 There is a continuous rise in the total number and percentage of elders globally, and as such, they are expected to utilize healthcare services more often. Therefore, this study aimed to determine doctors' and students' current knowledge and attitudes toward elders and compare those findings with other studies worldwide. The specific objectives of this study were to determine and compare the differences in attitudes between medical students and doctors regarding geriatrics. This comparison will focus on the following four key domains: social values, resource distribution, compassion, and medical care. Another objective was to assess the knowledge of medical students and doctors regarding geriatric topics. This assessment will help determine the necessity for interventions such as educational programs and workshops on geriatrics.

METHODS

This cross-sectional questionnaire-based study was conducted by disseminating a Google Forms survey to medical students and doctors. The survey included the University of California, Los Angeles (UCLA) Geriatrics Attitudes Scale and the UCLA Geriatrics Knowledge Test. Data was analyzed using SPSS version 29.0.2.0 (Armonk, NY: IBM Corp.).

RESULTS

 A total number of 126 medical students and 72 doctors filled out the survey. Both medical students and doctors demonstrated moderate scores on the attitudes scale, with overall average scores of 2.92 out of 5 and 2.93 out of 5, respectively. As for knowledge, medical students achieved an average score of 41%, while doctors attained an average score of 43%.

CONCLUSION

 This study provides significant insights regarding the knowledge and attitudes of students and doctors and attitudes towards geriatrics. The moderate attitudes score and poor knowledge score across both groups indicate the need for medical educators in Oman to further emphasize and teach about geriatrics in medical curricula.

Obstetric Racism, Education, and Racial Concordance

ABSTRACT

The United States holds the distinction of being the developed country with the worst perinatal outcomes despite spending the most per capita on health care. Black women are three to four times more likely than White women to experience adverse birth outcomes. These outcomes persist despite access to prenatal care, insurance, and college education. A long overdue racial reckoning has arrived, beginning with acknowledging the fallacy of race-based medicine and the role of enduring systemic racism as foundational to obstetric racism in the reproductive lives of Black women. Centering voices of Black women and honoring their lived experiences are essential to providing respectful maternity care. Naming micro- and macroaggressions experienced by Black women allows for dismantling of systemic barriers which perpetuate inequitable outcomes and enable substandard care. Racial concordance (shared racial identity) is one tool to consider in creating safe health care spaces for Black women. Improving diversity of the nursing workforce specifically, and the health care workforce in general, is necessary to affect racial concordance. Application of skills in cultural humility can mitigate challenges associated with adverse patient encounters for Black women as diversity pipeline strategies are explored. Histories of foundational fallacy, their impact on care and outcomes, and patient-driven indicators for improving pregnancy care experiences for women of color are explored through the lens of a Black physician and the collective reproductive health workforce.

Youth preferences for healthcare providers and healthcare interactions: a qualitative study

BACKGROUND

Patient-physician relationships in healthcare can influence healthcare provision, patient engagement, and health outcomes. Little is known about youth preferences on types and characteristics of their healthcare providers. The aim of this study was to assess youth perspectives on preferences for and interactions with their healthcare providers.

METHODS

We posed 5 open-ended questions to 1,163 MyVoice participants, a nationwide text message cohort of United States youth aged 14-24, on April 10, 2020 related to youth preferences for healthcare providers. Content analysis was used to develop a codebook. Responses were independently coded by two reviewers with discrepancies discussed to reach consensus. Descriptive statistics were calculated for demographics and frequency of codes.

RESULTS

944 (81%) participants responded to at least one question. Respondents had a mean age of 18.9 years (SD: 2.8) and were a majority female (53.6%) and White (56.3%). Youth reported "kindness" or other personality traits (31%) and education (30%) as important in choosing their doctor. Patient-physician concordance was not important to many youths (44%) and among those who reported concordance as important (55%), having the same gender was the most noted (68%). Youth suggested respect, open conversation, and addressing issues directly to help alleviate uncomfortable situations, though some would simply switch providers.

CONCLUSION

Personality and empathy are important provider characteristics valued by youth. Female respondents preferred gender concordant providers, particularly for sexual health-related issues, and non-white respondents were more likely to prefer racial concordance. Strengthening professional and interpersonal skills among youth-serving providers may improve healthcare engagement and satisfaction among youth.

Validating computer-generated measures of linguistic style matching and accommodation in patient-clinician communication

OBJECTIVE

To explore the validity of computer-analyzed linguistic style matching (LSM) in patient-clinician communication.

METHODS

Using 330 transcribed HIV patient encounters, we quantified word use with Linguistic Inquiry and Word Count (LIWC), a dictionary-based text analysis software. We measured LSM by calculating the degree to which clinicians matched patients in the use of LIWC "function words" (e.g., articles, pronouns). We tested associations of different LSM metrics with patients' perceptions that their clinicians spoke similiarly to them.

RESULTS

We developed 3 measures of LSM: 1) at the whole-visit level; (2) at the turn-by-turn level; and (3) using a "rolling-window" approach, measuring matching between clusters of 8 turns per conversant. None of these measures was associated with patient-rated speech similarity. However, we found that increasing trajectories of LSM, from beginning to end of the visit, were associated with higher patient-rated speech similarity (β 0.35, CI 0.06, 0.64), compared to unchanging trajectories.

CONCLUSIONS

Our findings point to the potential value of clinicians' adapting their communication style to match their patients, over the course of the visit.

PRACTICE IMPLICATIONS

With further validation, computer-based linguistic analyses may prove an efficient tool for generating data on communication patterns and providing feedback to clinicians in real time.

Experimental Evidence on the Effectiveness of Nonexperts for Improving Vaccine Demand

We experimentally vary signals and senders to identify which combination will increase vaccine demand among a disadvantaged population in the United States-Black and White men without a college education. Our main finding is that laypeople (nonexpert concordant senders) are most effective at promoting vaccination, particularly among those least willing to become vaccinated. This finding points to a trade-off between the higher qualifications of experts on the one hand and the lower social proximity to low-socioeconomic-status populations on the other hand, which may undermine credibility in settings of low trust.

Rapport between nurses and adult patients with cancer in ambulatory oncology care settings: A scoping review

BACKGROUND

Although the importance of the nurse-patient relationship in oncology is established, a consolidated body of research describing nurse-patient rapport, especially in ambulatory care, is lacking.

OBJECTIVES

This scoping review aimed to explore knowledge about rapport between adult patients with cancer and their nurses in ambulatory oncology care, including nurse, patient, nurse-patient dyad, and system-level factors that influence rapport.

METHODS

A scoping review was conducted to explore sources of evidence and gaps in knowledge pertinent to future research. The Joanna Briggs Institute methodology for Systematic Reviews was used with searches in MEDLINE, CINAHL, and ProQuest Dissertations and Theses Global databases. Experimental, descriptive observational, and qualitative study designs that focused on patients with cancer and their nurses within an ambulatory care setting were included. Results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.

RESULTS

The search strategy collected 4538 studies of which 10 met study criteria after screening. Forward and backward citation tracking of included articles resulted in 4 additional studies. In total, 14 studies were extracted and analyzed. Synthesis of results from the individual sources resulted in three key observations: (a) there is an absence of studies that focus directly on nurse-patient rapport; (b) the majority of extracted data on rapport-related factors described aspects of nurses' attitudes; and (c) there was minimal information on patient, nurse-patient dyad, and system-level factors reported in these studies.

CONCLUSIONS

The lack of studies focused specifically on nurse-patient rapport in oncology ambulatory care indicates a notable gap in our empirical understanding of relationship-based care, a hallmark of cancer care provision.

TWEETABLE ABSTRACT

Nurse-patient rapport in oncology ambulatory care requires additional research @paula_koppel.

Email-Based Recruitment Into the Health eHeart Study: Cohort Analysis of Invited Eligible Patients

BACKGROUND

Web- or app-based digital health studies allow for more efficient collection of health data for research. However, remote recruitment into digital health studies can enroll nonrepresentative study samples, hindering the robustness and generalizability of findings. Through the comprehensive evaluation of an email-based campaign on recruitment into the Health eHeart Study, we aim to uncover key sociodemographic and clinical factors that contribute to enrollment.

OBJECTIVE

This study sought to understand the factors related to participation, specifically regarding enrollment, in the Health eHeart Study as a result of a large-scale remote email recruitment campaign.

METHODS

We conducted a cohort analysis on all invited University of California, San Francisco (UCSF) patients to identify sociodemographic and clinical predictors of enrollment into the Health eHeart Study. The primary outcome was enrollment, defined by account registration and consent into the Health eHeart Study. The email recruitment campaign was carried out from August 2015 to February 2016, with electronic health record data extracted between September 2019 and December 2019.

RESULTS

The email recruitment campaign delivered at least 1 email invitation to 93.5% (193,606/206,983) of all invited patients and yielded a 3.6% (7012/193,606) registration rate among contacted patients and an 84.1% (5899/7012) consent rate among registered patients. Adjusted multivariate logistic regression models analyzed independent sociodemographic and clinical predictors of (1) registration among contacted participants and (2) consent among registered participants. Odds of registration were higher among patients who are older, women, non-Hispanic White, active patients with commercial insurance or Medicare, with a higher comorbidity burden, with congestive heart failure, and randomized to receive up to 2 recruitment emails. The odds of registration were lower among those with medical conditions such as dementia, chronic pulmonary disease, moderate or severe liver disease, paraplegia or hemiplegia, renal disease, or cancer. Odds of subsequent consent after initial registration were different, with an inverse trend of being lower among patients who are older and women. The odds of consent were also lower among those with peripheral vascular disease. However, the odds of consent remained higher among patients who were non-Hispanic White and those with commercial insurance.

CONCLUSIONS

This study provides important insights into the potential returns on participant enrollment when digital health study teams invest resources in using email for recruitment. The findings show that participant enrollment was driven more strongly by sociodemographic factors than clinical factors. Overall, email is an extremely efficient means of recruiting participants from a large list into the Health eHeart Study. Despite some improvements in representation, the formulation of truly diverse studies will require additional resources and strategies to overcome persistent participation barriers.

The Intersection between Pharmacogenomics and Health Equity: A Case Example

Pharmacogenomics (PGx) and the study of precision medicine has substantial power to either uplift health equity efforts or further widen the gap of our already existing health disparities. In either occurrence, the medication experience plays an integral role within this intersection on an individual and population level. Examples of this intertwined web are highlighted through a case discussion. With these perspectives in mind, several recommendations for the research and clinical communities are highlighted to promote equitable healthcare with PGx integrated.

Racism During Pregnancy and Birthing: Experiences from Asian and Pacific Islander, Black, Latina, and Middle Eastern Women

BACKGROUND

Despite persistent racial disparities in maternal health in the USA, there is limited qualitative research on women's experiences of discrimination during pregnancy and childbirth that focuses on similarities and differences across multiple racial groups.

METHODS

Eleven focus groups with Asian American and Pacific Islander (AAPI), Black, Latina, and Middle Eastern women (N = 52) in the USA were conducted to discuss the extent to which racism and discrimination impact pregnancy and birthing experiences.

RESULTS

Participants across groups talked about the role of unequal power dynamics, discrimination, and vulnerability in patient-provider relationships. Black participants noted the influence of prior mistreatment by providers in their healthcare decisions. Latinas expressed fears of differential care because of immigration status. Middle Eastern women stated that the Muslim ban bolstered stereotypes. Vietnamese participants discussed how the effect of racism on mothers' mental health could impact their children, while Black and Latina participants expressed constant racism-related stress for themselves and their children. Participants recalled better treatment with White partners and suggested a gradient of treatment based on skin complexion. Participants across groups expressed the value of racial diversity in healthcare providers and pregnancy/birthing-related support but warned that racial concordance alone may not prevent racism and emphasized the need to go beyond "band-aid solutions."

CONCLUSION

Women's discussions of pregnancy and birthing revealed common and distinct experiences that varied by race, skin complexion, language, immigration status, and political context. These findings highlight the importance of qualitative research for informing maternal healthcare practices that reduce racial inequities.

Problematic Integration: Racial Discordance in End-of-Life Decision Making

We describe racially discordant oncology encounters involving EOL decision-making. Fifty-eight provider interviews were content analyzed using the tenets of problematic integration theory. We found EOL discussions between non-Black providers and their Black patients were often complex and anxiety-inducing. That anxiety consisted of (1) ontological uncertainty in which providers characterized the nature of Black patients as distrustful, especially in the context of clinical trials; (2) ontological and epistemological uncertainty in which provider intercultural incompetency and perceived lack of patient health literacy were normalized and intertwined with provider assumptions about patients' religion and support systems; (3) epistemological uncertainty as ambivalence in which providers' feelings conflicted when deciding whether to speak with family members they perceived as lacking health literacy; (4) divergence in which the provider advised palliative care while the family desired surgery or cancer-directed medical treatment; and (5) impossibility when an ontological uncertainty stance of Black distrust was seen as natural by providers and therefore impossible to change. Some communication strategies used were indirect stereotyping, negotiating, asking a series of value questions, blame-guilt framing, and avoidance. We concluded that provider perceptions of Black distrust, religion, and social support influenced their ability to communicate effectively with patients.

Social Determinants of Health and Perceived Barriers to Care in Diabetic Retinopathy Screening

Importance

Regular screening for diabetic retinopathy often is crucial for the health of patients with diabetes. However, many factors may be barriers to regular screening and associated with disparities in screening rates.

Objective

To evaluate the associations between visiting an eye care practitioner for diabetic retinopathy screening and factors related to overall health and social determinants of health, including socioeconomic status and health care access and utilization.

Design, Setting, and Participants

This retrospective cross-sectional study included adults aged 18 years or older with type 2 diabetes who answered survey questions in the All of Us Research Program, a national multicenter cohort of patients contributing electronic health records and survey data, who were enrolled from May 1, 2018, to July 1, 2022.

Exposures

The associations between visiting an eye care practitioner and (1) demographic and socioeconomic factors and (2) responses to the Health Care Access and Utilization, Social Determinants of Health, and Overall Health surveys were investigated using univariable and multivariable logistic regressions.

Main Outcome and Measures

The primary outcome was whether patients self-reported visiting an eye care practitioner in the past 12 months. The associations between visiting an eye care practitioner and demographic and socioeconomic factors and responses to the Health Care Access and Utilization, Social Determinants of Health, and Overall Health surveys in All of Us were investigated using univariable and multivariable logistic regression.

Results

Of the 11 551 included participants (54.55% cisgender women; mean [SD] age, 64.71 [11.82] years), 7983 (69.11%) self-reported visiting an eye care practitioner in the past year. Individuals who thought practitioner concordance was somewhat or very important were less likely to have seen an eye care practitioner (somewhat important: adjusted odds ratio [AOR], 0.83 [95% CI, 0.74-0.93]; very important: AOR, 0.85 [95% CI, 0.76-0.95]). Compared with financially stable participants, individuals with food or housing insecurity were less likely to visit an eye care practitioner (food insecurity: AOR, 0.75 [95% CI, 0.61-0.91]; housing insecurity: AOR, 0.86 [95% CI, 0.75-0.98]). Individuals who reported fair mental health were less likely to visit an eye care practitioner than were those who reported good mental health (AOR, 0.84; 95% CI, 0.74-0.96).

Conclusions and Relevance

This study found that food insecurity, housing insecurity, mental health concerns, and the perceived importance of practitioner concordance were associated with a lower likelihood of receiving eye care. Such findings highlight the self-reported barriers to seeking care and the importance of taking steps to promote health equity.

Breaking Down Barriers: Advancing Toward Health Equity in Fertility Care for Black and Hispanic Patients

Infertility can affect all people, regardless of race, ethnicity, or socioeconomic status. Barriers to quality fertility care include access, financial limitations, education, and social stigmas. Although racial disparities in outcomes of assisted reproductive technology can be largely attributed to the influences of systemic racism (not race), we can make changes to improve equity of care. We propose strategies in the areas of advocacy, clinical setting, community, and outcomes to address the racial disparities.

Provider prescription of hydroxyurea in youth and adults with sickle cell disease: A review of prescription barriers and facilitators

Sickle cell disease (SCD) is an inherited red blood cell disorder associated with frequent painful events and organ damage. Hydroxyurea (HU) is the recommended evidence-based treatment of SCD. However, among patients eligible for HU, prescription rates are low. Utilizing a scoping review approach, we summarized and synthesized relevant findings regarding provider barriers and facilitators to the prescription of HU in youth and adults with SCD and provided suggestions for future implementation strategies to improve prescription rates. Relevant databases were searched using specified search terms. Articles reporting provider barriers and/or facilitators to prescribing HU were included. A total of 10 studies met the inclusion criteria. Common barriers to the prescription of HU identified by providers included: doubts around patients' adherence to HU and their engaging in required testing, concerns about side effects, lack of knowledge, cost and patient concerns about side effects. Facilitators to the prescription of HU included beliefs in the effectiveness of HU, provider demographics and knowledge. Findings suggest significant provider biases exist, particularly in the form of negative perceptions towards patients' ability to adhere to taking HU and engaging in the required follow-up. Improving provider knowledge and attitudes towards HU and SCD may help improve low prescription rates.

Racial and ethnic disparities in surgery for kidney cancer: a SEER analysis, 2007-2014

BACKGROUND AND OBJECTIVES

Compared with White patients, Black and American Indian/Alaskan Native (AI/AN) patients experience higher rates of kidney cancer incidence, and Black, AI/AN, and Hispanic patients face later stages of disease at diagnosis, poorer survival rates, and greater risk of mortality. Despite the importance that appropriate treatment has in ensuring positive outcomes, little is known about the association between race and ethnicity and receipt of treatment for kidney cancer. Accordingly, the aim of this study was to explore differences in receipt of treatment and patterns of refusal of recommended treatment by race and ethnicity.

DESIGN

96,745 patients ages 45-84 with kidney cancer were identified in the Surveillance, Epidemiology, and End Results (SEER) program between 2007 and 2014. Logistic regression models were used to examine the association of race and ethnicity with treatment and with patient refusal of recommended treatment. Outcomes of interest were (1) receiving any surgical procedure, and (2) refusing recommended surgery.

RESULTS

Relative to White patients, Black and AI/AN patients had lower odds of undergoing any surgical procedure (OR = 0.76; 95% CI: 0.72-0.81; p < 0.001, and OR = 0.92; 95% CI: 0.76-1.10; p = 0.36, respectively) after adjusting for gender, age, insurance status, stage at diagnosis, unemployment status, education status, and income as additive effects. Black and AI/AN patients also had higher odds of refusing recommended surgery (OR = 1.93; 95% CI: 1.56-2.39; p < 0.001, and OR = 1.99; 95% CI: 1.05-3.76; p = 0.035, respectively). Hispanic patients had slightly higher odds of undergoing any surgical procedure (OR = 1.10; 95% CI: 1.04-1.17; p = 0.001) and lower odds of refusal (OR = 0.67; 95% CI: 0.50-0.90; p = 0.007, respectively).

CONCLUSIONS

Compared with White patients, Black patients were less likely to receive potentially life-saving surgery, and both Black and AI/AN patients were more likely to refuse recommended surgery.

Personal Agency and Social Supports to Manage Health Among Non-Hispanic Black and Hispanic Men With Diabetes

The prevalence of type 2 diabetes (T2D) is increasing among non-Hispanic Black and Hispanic communities, especially among men who develop this chronic condition at earlier ages. Personal agency and social support are vital aspects to diabetes management. However, less is known about the relationship between these variables among men living with diabetes. The purposes of this study were to identify (1) levels of personal agency to manage health, (2) sources of social supports to manage health based on personal agency levels, and (3) factors associated with lower personal agency to manage health. Cross-sectional data from non-Hispanic Black (n = 381) and Hispanic (n = 292) men aged 40 years or older with T2D were collected using an internet-delivered questionnaire. Three binary logistic regression models were fitted to assess sociodemographics, health indicators, and support sources associated with weaker personal agency to manage health. About 68% of participants reported having the strongest personal agency relative to 32.1% reporting weaker personal agency. Men who relied more on their spouse/partner (odds ratio [OR] = 1.22, p = .025), coworkers (OR = 1.59, p = .008), or faith-based organizations (OR = 1.29, p = .029) for ongoing help/support to improve their health and manage health problems were more likely to have weaker personal agency. Conversely, men who relied more on their health care providers for ongoing help/support to improve their health and manage health problems were less likely to have weaker personal agency to manage health (OR = 0.74, p < .001). Findings suggest personal agency may influence men's support needs to manage T2D, which may also be influenced by cultural, socioeconomics, and the composition of social networks.

Native American Community Perspectives on Oral Health Access: Understanding the Impact of Rurality

PURPOSE

Oral health disparities related to access persist for American Indian/Alaska Native (AI/AN) communities compared to the general population, especially in rural areas of the United States. The objective of this study was to better understand community perspectives of oral health, how rurality impacts access to care, and attitudes towards the implementation of dental therapists in Oklahoma, particularly among the AI/AN population.

METHODS

A descriptive, observational study design was utilized. An exploratory survey was conducted online and comprised of qualitative and quantitative data. The total frequencies and percentages were evaluated for the quantitative questions. The qualitative data was analyzed using thematic analysis. Utilizing descriptive and qualitative research methods, the focus was to describe the experiences of the respondents and their characteristics related to oral health in Oklahoma.

RESULTS

A total of 201 responses were obtained, where 65% (n = 131) identified as an enrolled member or employee of a tribe represented in Oklahoma. Key qualitative themes included community access to care, community concerns, and community motivated solutions.

CONCLUSIONS

AI/AN communities are an underserved group in healthcare. Although communities in rural areas face major barriers to oral health services, evidence-based solutions can be implemented.

Physician weight influences responses to a public health message about the genetics of obesity

OBJECTIVE

Many patients prefer lean physicians to physicians with obesity and place higher credence in their weight management advice. Because genetic information about weight can be viewed as self-serving for individuals with overweight or obesity, physicians with obesity may be discounted when sharing such information. As provision of genetic information regarding weight becomes increasingly common in public health messaging, could a physician's own weight influence how these messages are received by the public?

METHODS

In an online survey, 967 participants were randomly assigned a physician profile (lean v. has obesity) with a media interview transcript discussing genetic factors of a common health condition (obesity v. osteoporosis).

RESULTS

Participants perceived the physician with obesity who discussed genetic factors in obesity as less trustworthy and less credible. Participants were also less likely to anticipate following her advice on weight-related issues. Participants with higher BMI had less negative perceptions of this physician.

CONCLUSION

Physicians with obesity, when providing public health messaging regarding genetic information about obesity, may be met with distrust and negative attitudes toward the physician.

PRACTICAL IMPLICATIONS

Future research should investigate health communication strategies that address this form of weight stigma while accurately conveying genetic factors that contribute to weight.

The Relationship of Ethnic, Racial, and Cultural Concordance to Physician-Patient Communication: A Mixed-Methods Systematic Review Protocol

The concept of racial, ethnic, or cultural concordance between a healthcare provider and a patient has emerged as a dimension of the patient-physician relationship that could influence health outcomes for minoritized patients, particularly through differences in the way physicians communicate with patients of various races and ethnicities. However, two decades of study on concordance and physician-patient communication have produced contradictory results. Although existing systematic reviews have addressed race, ethnicity, and culture as influences on medical encounters, only one review, published in 2006, has examined the effects of this concordance across multiple ethnicities, specifically focusing on physician-patient communication. Given the heightened societal awareness of racism and health disparities in recent years, there is a need for a comprehensive review of the current state of knowledge. This review, therefore, will seek to determine how communication patterns differ in ethnically, racially, and culturally concordant versus discordant patient-provider medical encounters, in the process identifying explanatory and outcome variables associated with those differences.

The Effects of Holistic Admissions on Diversity in Nursing: A Literature Review

BACKGROUND

The nursing profession does not reflect the diversity of the population they serve. Many health professions, including nursing, have altered their admissions practices to consider a holistic assessment of individuals. Quantitative data from students are not sufficient to develop a diverse student body.

METHOD

A literature review was conducted using MEDLINE, CINAHL, ERC, ERIC, and Google Scholar. Original research articles on holistic admission (HA) processes and the effects on diversity in nursing were included in the review. Search terms were "holistic admission," "holistic review," and "nursing."

RESULTS

There is a paucity of research regarding HA in nursing. The available literature suggests HA increases the odds of developing a more diverse student population.

CONCLUSION

HA should be considered to increase diversity of students. Further research is needed regarding the effects of HA on diversity among nursing students. [J Nurs Educ. 2023;62(10):556-562.].

Abortion Provision Among Family Physicians Underrepresented in Medicine

BACKGROUND AND OBJECTIVES

Workforce diversity in primary care is critical for improved health outcomes and mitigation of inequities. However, little is known about the racial and ethnic identities, training histories, and practice patterns of family physicians who provide abortions.

METHODS

Family physicians who graduated from residency programs with routine abortion training from 2015 through 2018 completed an anonymous electronic cross-sectional survey. We measured abortion training, intentions to provide abortion, and practice patterns, and examined differences between underrepresented in medicine (URM) and non-URM physicians using χ2 tests and binary logistic regression.

RESULTS

Two hundred ninety-eight respondents completed the survey (39% response rate), 17% of whom were URM. Similar percentages of URM and non-URM respondents had abortion training and had intended to provide abortions. However, fewer URMs reported providing procedural abortion in their postresidency practice (6% vs 19%, P=.03) and providing abortion in the past year (6% vs 20%, P=.023). In adjusted analyses, URMs were less likely to have provided abortions after residency (OR=.383, P=.03) and in the past year (OR=.217, P=.02) compared to non-URMs. Of the 16 noted barriers to provision, few differences were evident between groups on the indicators measured.

CONCLUSIONS

Differences in postresidency abortion provision existed between URM and non-URM family physicians despite similar training and intentions to provide. Examined barriers do not explain these differences. Further research on the unique experiences of URM physicians in abortion care is needed to then consider which strategies for building a more diverse workforce should be employed.

Factors Influencing Patient Satisfaction and Loyalty as Perceived by Dentists and Their Patients

OBJECTIVE

This study aimed to identify the key aspects of patients' dental care experience that influenced their self-perceived satisfaction and loyalty. Also examined was the agreement between patients and dentists regarding these factors.

METHODS

Questionnaires were administered to 1121 patients and 77 dentists, focusing on demographic information and 15 selected items related to the patients' last dental visit. Descriptive and linear regression analyses were conducted.

RESULTS

The study included participants from 41 practices. Factors significantly influencing satisfaction and loyalty included location convenience, treatment quality, trust in dentists' decisions, visit frequency satisfaction, clear treatment explanations, dentist's interest in symptoms, patient-dental personnel attachment, and dentist's knowledge of the patient and their medical records. While overall agreement between patients and dentists was high, some areas exhibited notable disagreement.

CONCLUSIONS

The findings mostly align with existing literature, underscoring the importance of communication, trust, and a personal patient-dentist relationship in promoting satisfaction and loyalty. However, they also show that local, generally not reported factors might be at play, which necessitates dentists' awareness and consideration of the local context for optimal outcomes.