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Zima BT, Edgcomb JB, Fortuna LR. Identifying Precise Targets to Improve Child Mental Health Care Equity: Leveraging Advances in Clinical Research Informatics and Lived Experience. Child Adolesc Psychiatr Clin N Am 2024; 33:471-483. [PMID: 38823818 DOI: 10.1016/j.chc.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
To reduce child mental health disparities, it is imperative to improve the precision of targets and to expand our vision of social determinants of health as modifiable. Advancements in clinical research informatics and please state accurate measurement of child mental health service use and quality. Participatory action research promotes representation of underserved groups in informatics research and practice and may improve the effectiveness of interventions by informing research across all stages, including the identification of key variables, risk and protective factors, and data interpretation.
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Affiliation(s)
- Bonnie T Zima
- UCLA Mental Health Informatics and Data Science (MINDS) Hub, Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, 37-384B, Los Angeles, CA 90024, USA.
| | - Juliet B Edgcomb
- UCLA Mental Health Informatics and Data Science (MINDS) Hub, Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, 37-372A, Los Angeles, CA 90024, USA
| | - Lisa R Fortuna
- Department of Psychiatry and Neuroscience, University of California Riverside, School of Medicine, 900 University Avenue, Riverside, CA 92521, USA
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Shibre G, Mekonnen W, Haile Mariam D. Explaining changes in educational disparities in competent maternal health care services in urban and rural areas in Ethiopia. Front Public Health 2024; 12:1332801. [PMID: 38680926 PMCID: PMC11045905 DOI: 10.3389/fpubh.2024.1332801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/19/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Aggregate statistics of maternal health care services have improved in Ethiopia. Nevertheless, the country has one of the lowest Universal Health Coverage (UHC) service coverage indices, with slight improvement between 2000 and 2019. There are disparity studies that focus on a single dimension of inequality. However, studies that combine multiple dimensions of inequality simultaneously may have important policy implications for closing inequalities. In this study, we investigated education inequalities in the receipt of maternal health care services in rural and urban areas separately, and we examined whether these inequalities decreased, increased, or remained unchanged. Methods The data for the study came from the 2011 and 2016 Ethiopia Demographic and Health Surveys. Using women's education as a dimension of inequality, we separately analyzed inequalities in maternal health care services in urban and rural settings. Inequalities were measured through the Erreygers concentration index, second differences, and Relative Index of Inequality (RII). Whether inequalities changed over time was analyzed by relative and absolute measures. An Oaxaca-type decomposition approach was applied to explain changes in absolute disparities over time. Results There were glaring educational disparities in maternal health care services in urban and rural areas, where the services were more concentrated among women with better schooling. The disparities were more severe in urban than in rural areas. In urban areas, skilled birth service was the most unequal in both periods. Disparities in rural places were roughly similar for all services except that in 2011, postnatal care was the least unequal, and in 2016, skilled birth was the most unequal services. Trend analyses revealed that disparities significantly dropped in urban by absolute and relative measures. Conversely, in rural regions, the disparities grew by the concentration index measure for most services. The RII and second differences presented conflicting results regarding whether the gaps were increasing, shrinking, or remaining the same. Conclusion Substantial disparities in maternal health care services remained and even increased, as in rural areas. Different and targeted strategies are needed for urban and rural places to close the observed educational inequalities in these areas.
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Affiliation(s)
- Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wubegzier Mekonnen
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Damen Haile Mariam
- Department of Health Systems Management and Health Policy, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Balagopalan A, Baldini I, Celi LA, Gichoya J, McCoy LG, Naumann T, Shalit U, van der Schaar M, Wagstaff KL. Machine learning for healthcare that matters: Reorienting from technical novelty to equitable impact. PLOS DIGITAL HEALTH 2024; 3:e0000474. [PMID: 38620047 PMCID: PMC11018283 DOI: 10.1371/journal.pdig.0000474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/18/2024] [Indexed: 04/17/2024]
Abstract
Despite significant technical advances in machine learning (ML) over the past several years, the tangible impact of this technology in healthcare has been limited. This is due not only to the particular complexities of healthcare, but also due to structural issues in the machine learning for healthcare (MLHC) community which broadly reward technical novelty over tangible, equitable impact. We structure our work as a healthcare-focused echo of the 2012 paper "Machine Learning that Matters", which highlighted such structural issues in the ML community at large, and offered a series of clearly defined "Impact Challenges" to which the field should orient itself. Drawing on the expertise of a diverse and international group of authors, we engage in a narrative review and examine issues in the research background environment, training processes, evaluation metrics, and deployment protocols which act to limit the real-world applicability of MLHC. Broadly, we seek to distinguish between machine learning ON healthcare data and machine learning FOR healthcare-the former of which sees healthcare as merely a source of interesting technical challenges, and the latter of which regards ML as a tool in service of meeting tangible clinical needs. We offer specific recommendations for a series of stakeholders in the field, from ML researchers and clinicians, to the institutions in which they work, and the governments which regulate their data access.
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Affiliation(s)
- Aparna Balagopalan
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology; Cambridge, Massachusetts, United States of America
| | - Ioana Baldini
- IBM Research; Yorktown Heights, New York, United States of America
| | - Leo Anthony Celi
- Laboratory for Computational Physiology, Massachusetts Institute of Technology; Cambridge, Massachusetts, United States of America
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center; Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard T.H. Chan School of Public Health; Boston, Massachusetts, United States of America
| | - Judy Gichoya
- Department of Radiology and Imaging Sciences, School of Medicine, Emory University; Atlanta, Georgia, United States of America
| | - Liam G. McCoy
- Division of Neurology, Department of Medicine, University of Alberta; Edmonton, Alberta, Canada
| | - Tristan Naumann
- Microsoft Research; Redmond, Washington, United States of America
| | - Uri Shalit
- The Faculty of Data and Decision Sciences, Technion; Haifa, Israel
| | - Mihaela van der Schaar
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge; Cambridge, United Kingdom
- The Alan Turing Institute; London, United Kingdom
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Jones N, Tong L, Pagdon S, Ebuenyi ID, Harrow M, Sharma RP, Rosen C. Using latent class analysis to investigate enduring effects of intersectional social disadvantage on long-term vocational and financial outcomes in the 20-year prospective Chicago Longitudinal Study. Psychol Med 2024:1-13. [PMID: 38523254 DOI: 10.1017/s0033291724000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND Class and social disadvantage have long been identified as significant factors in the etiology and epidemiology of psychosis. Few studies have explicitly examined the impact of intersecting social disadvantage on long-term employment and financial independence. METHODS We applied latent class analysis (LCA) to 20-year longitudinal data from participants with affective and non-affective psychosis (n = 256) within the Chicago Longitudinal Research. LCA groups were modeled using multiple indicators of pre-morbid disadvantage (parental social class, educational attainment, race, gender, and work and social functioning prior to psychosis onset). The comparative longitudinal work and financial functioning of LCA groups were then examined. RESULTS We identified three distinct latent classes: one comprised entirely of White participants, with the highest parental class and highest levels of educational attainment; a second predominantly working-class group, with equal numbers of Black and White participants; and a third with the lowest parental social class, lowest levels of education and a mix of Black and White participants. The latter, our highest social disadvantage group experienced significantly poorer employment and financial outcomes at all time-points, controlling for diagnosis, symptoms, and hospitalizations prior to baseline. Contrary to our hypotheses, on most measures, the two less disadvantaged groups did not significantly differ from each other. CONCLUSIONS Our analyses add to a growing literature on the impact of multiple forms of social disadvantage on long-term functional trajectories, underscoring the importance of proactive attention to sociostructural disadvantage early in treatment, and the development and evaluation of interventions designed to mitigate ongoing social stratification.
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Affiliation(s)
- Nev Jones
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
| | - Liping Tong
- Advocate Aurora Health, Downers Grove, IL, USA
| | - Shannon Pagdon
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ikenna D Ebuenyi
- School of Health & Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Martin Harrow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Rajiv P Sharma
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
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Peters CMM, Evers YJ, Kampman CJG, Theunissen-Lamers MJ, Van Den Elshout MAM, Dukers-Muijrers NHTM, Hoebe CJPA. Differences in STI/HIV Burden and Sexual Health Care-Seeking Behavior Among First- and Second-Generation Migrant and Western-Born Male Sex Workers Who Have Sex With Men in the Netherlands: A Retrospective Cohort Study. Sex Transm Dis 2024; 51:105-111. [PMID: 38290155 DOI: 10.1097/olq.0000000000001902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Globally, migrant sex workers have a higher burden of sexually transmitted infections (STI)/human immunodeficiency virus (HIV). This large study aimed to assess demographics, STI/HIV burden, and sexual health care-seeking behavior of first-generation migrant and second-generation migrant male sex workers who have sex with men (MSW-MSM) versus Western-born MSW-MSM. METHODS Coded STI clinic consultations (n = 6970) from 3116 individual MSW-MSM attending any Dutch STI clinic between 2016 and 2021 were included. First-generation migrant: born outside of northern/central/southern/western Europe/North America/Oceania. Second-generation migrant: ≥1parent born outside of northern/central/southern/western Europe/North America/Oceania. Multivariable logistic regression analysis assessed associations between MSW-MSM groups and STI in first consultation in the data. A Cox proportional hazard regression compared the incidence of a first repeat consultation between migration groups, stratified by STI in first consultation. All analyses were adjusted for age and urbanity of STI clinic region. RESULTS First-generation migrant MSW-MSM (n = 1085) were mostly born in Latin America (50%), whereas second-generation migrant MSW-MSM (n = 368) mostly originated from North Africa (30.4%). The proportion of STI diagnoses differed (33.2%, 29.3%, 23.3%; P < 0.001) between the first-generation migrant, second-generation migrant, and Western-born MSW-MSM. First-generation migrant MSW-MSM versus Western-born had an adjusted odds ratio of 1.6 (95% confidence interval, 1.3-1.9) of STI diagnosis in the first consultation. First-generation migrant MSW-MSM versus Western-born had an adjusted hazard ratio of 1.5 (95% confidence interval, 1.3-1.8) of having a first repeat consultation at any time, when stratified for no STI in the first consultation. CONCLUSIONS The STI/HIV burden is high among all 3 MSW-MSM groups. First-generation migrants have higher odds of STI, but retention in care seems similar. Results highlight the importance of low-threshold STI testing and care for (migrant) MSW-MSM.
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Richie C. Environmental sustainability and the paradox of prevention. JOURNAL OF MEDICAL ETHICS 2023:jme-2023-109437. [PMID: 38124200 DOI: 10.1136/jme-2023-109437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/24/2023] [Indexed: 12/23/2023]
Abstract
The carbon emissions of global healthcare activities make up 4%-5% of total world emissions, with the majority coming from industrialised countries. The solution to healthcare carbon reduction in these countries, ostensibly, would be preventive healthcare, which is less resource intensive than corrective healthcare in itself and, as a double benefit, reduces carbon by preventing diseases which may require higher healthcare carbon to treat. This leads to a paradox: preventive healthcare is designed to give humans longer, healthier lives. But, by extending life spans, the carbon emissions of a person increase both over a lifetime and in the medical industry overall. At the same time, the need for higher carbon end-of-life care does not disappear, particularly in resource intensive countries. This article will first identify sources of healthcare carbon, focusing on the industrialised world, and explain various efforts towards healthcare carbon reduction, which include preventive healthcare. Second, it will develop the 'paradox of prevention'-that preventive healthcare may save healthcare carbon by proximally reducing the need for medical treatments, but also, paradoxically, result in more healthcare carbon both in an individual's life and in the medical industry. The third section will offer ethical principles for approaching the paradox of prevention. The conclusion will emphasise the need for institutional approaches to healthcare carbon reduction in the industrialised world, which will relieve some of the tensions of healthcare industry decarbonisation and individual healthcare carbon use.
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Zhang X, Jaswal A, Quint J. Experience in Accessing Healthcare in Ethnic Minority Patients with Chronic Respiratory Diseases: A Qualitative Meta-Synthesis. Healthcare (Basel) 2023; 11:3170. [PMID: 38132060 PMCID: PMC10743025 DOI: 10.3390/healthcare11243170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Access to healthcare is part of every individual's human rights; however, many studies have illustrated that ethnic minority patients seem to be confronted with barriers when using healthcare services. Understanding how healthcare utilities are accessed from the perspective of patients and why healthcare disparities occur with patients from a minority background has the potential to improve health equality and care quality. This qualitative systematic review aims to gain insights into the experiences of people with chronic respiratory diseases (CRDs) from a minority background and explore factors contributing to their experiences in accessing healthcare to inform related health policy makers and healthcare providers. METHODS This systematic review complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, where the Joanna Briggs Institute meta-aggregative instrument facilitated the qualitative synthesis. The study protocol was registered with PROSPERO (CRD42022346055). PubMed, Scopus, Web of Science, and CINAHL were the databases explored. RESULTS From the papers selected, 47 findings were derived from 10 included studies, and four synthesised findings were generated: (1) the relationship between patients and healthcare professionals affects the usage of healthcare services; (2) patients' perceptions and cultural beliefs affect their compliance with disease management; (3) personal behaviours affect the usage of healthcare services; and (4) health resource inequalities have an impact on accessing healthcare services. CONCLUSIONS This systematic review demonstrates that ethnic minorities with CRDs face inequalities when engaging in healthcare. The relationship between patients and clinicians impacting the use of healthcare is the most pivotal discovery, where not speaking the same language and being of a different race alongside the accompanying criticism and faith in facilities are key contributors to this effect. In addition, the thinking patterns of these marginalised groups may reflect their cultural upbringing and diminish their engagement with therapies. This paper has uncovered ways to attenuate inequalities amongst ethnic minorities in engaging with healthcare providers and provides insight into building effective equity-promoting interventions in healthcare systems. To overcome these disparities, coaching doctors to communicate better with minority cohorts could help such patients to be more comfortable in connecting with medical facilities.
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Affiliation(s)
| | | | - Jennifer Quint
- School of Public Health, Imperial College London, London W12 0BZ, UK; (X.Z.); (A.J.)
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Azap L, Woldesenbet S, Lima H, Munir MM, Diaz A, Endo Y, Yang J, Mokadam NA, Ganapathi A, Pawlik TM. The Association of Persistent Poverty and Outcomes Among Patients Undergoing Cardiac Surgery. J Surg Res 2023; 292:30-37. [PMID: 37572411 DOI: 10.1016/j.jss.2023.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION We sought to evaluate the association of county-level poverty duration and cardiac surgical outcomes. METHODS Patients who underwent coronary artery bypass graft, surgical aortic valve replacement, and mitral valve repair and replacement between 2016 and 2020 were identified using the Medicare Standard Analytical Files Database. County-level poverty data were acquired from the American Community Survey and US Department of Agriculture (1980-2015). High poverty was defined as ≥19.5% of residents in poverty. Patients were stratified into never-high poverty (NHP), intermittent low poverty, intermittent high poverty, and persistent poverty (PP). A mixed-effect hierarchical generalized linear model and Cox regression models that adjusted for patient-level covariates were used to evaluate outcomes. RESULTS Among 237,230 patients, 190,659 lived in NHP counties, while 10,273 resided in PP counties. Compared with NHP patients, PP patients were more likely to present at a younger median age (NHP: 75 y versus PP: 74 y), be non-Hispanic Black (5388, 2.9% versus PP: 1030, 10.1%), and live in the south (NHP: 66,012, 34.6% versus PP: 87,815, 76.1%) (all P < 0.001). PP patients also had more nonelective surgical operations (NHP: 58,490, 30.8% versus 3645, 35.6%, P < 0.001). Notably, PP patients had increased odds of 30-d mortality (odds ratio 1.13, 95% confidence interval [CI] 1.02-1.26), 90-d mortality (odds ratio 1.14, 95% CI 1.05-1.24), and risk of long-term mortality (hazard ratio 1.13, 95% CI 1.09-1.19) compared with patients in NHP counties (all P < 0.05). CONCLUSIONS County-level poverty was associated with a greater risk of short- and long-term mortality among cardiac surgical patients.
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Affiliation(s)
- Lovette Azap
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio; Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Selamawit Woldesenbet
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio
| | - Henrique Lima
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio
| | - Muhammad Musaab Munir
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio
| | - Adrian Diaz
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio
| | - Yutaka Endo
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio
| | - Jason Yang
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio
| | - Nahush A Mokadam
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Asvin Ganapathi
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio.
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Gandara E, Harvey IS, McKyer L, Luo W, Burdine J. Qualitative Inquiry of African American Female Church Leaders on Facilitators and Barriers of Conducting Adult Health Programs Within African American Churches: A Pilot Study Using a Socioecological Perspective Within the United States. JOURNAL OF RELIGION AND HEALTH 2023; 62:3430-3452. [PMID: 37314599 DOI: 10.1007/s10943-023-01852-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 06/15/2023]
Abstract
Despite the success of health programs conducted within African American (AA) churches, research has been limited in understanding the facilitators and barriers of conducting adult health programs in churches led by female AA pastors/leaders. In addition, research has yet to analyze the effect of policy on these church-based health programs. Thus, this pilot study's objective is to use the socio-ecological model (SEM) as a framework to explore female AA pastors' and church leaders' perspectives, in the U.S., on facilitators and barriers that exist when conducting adult health programs within their congregations. Using snowball sampling to recruit AA female church leaders and pastors (n = 6), semi-structured interviews were conducted with study participants. Data were then transcribed and analyzed using First and Second Cycle coding to identify themes. Nine themes emerged from the data, and after stratifying the themes according to the SEM, this study found that facilitators and barriers exist at the intrapersonal, organizational, community, and policy levels of the SEM. It is important for these factors to be considered to ensure that health programs led by AA women pastors/leaders are successful within AA churches. Study limitations and the need for further research are also noted.
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Affiliation(s)
- Eduardo Gandara
- Department of Public Health, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, USA.
| | | | - Lisako McKyer
- Alice L. Walton School of Medicine, Bentonville, AR, USA
| | - Wen Luo
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA
| | - Jim Burdine
- Department of Health Behavior, Texas A&M School of Public Health, College Station, TX, USA
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Kim C, Kabbani S, Dube WC, Neuhauser M, Tsay S, Hersh A, Marcelin JR, Hicks LA. Health Equity and Antibiotic Prescribing in the United States: A Systematic Scoping Review. Open Forum Infect Dis 2023; 10:ofad440. [PMID: 37671088 PMCID: PMC10475752 DOI: 10.1093/ofid/ofad440] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/17/2023] [Indexed: 09/07/2023] Open
Abstract
We performed a scoping review of articles published from 1 January 2000 to 4 January 2022 to characterize inequities in antibiotic prescribing and use across healthcare settings in the United States to inform antibiotic stewardship interventions and research. We included 34 observational studies, 21 cross-sectional survey studies, 4 intervention studies, and 2 systematic reviews. Most studies (55 of 61 [90%]) described the outpatient setting, 3 articles were from dentistry, 2 were from long-term care, and 1 was from acute care. Differences in antibiotic prescribing were found by patient's race and ethnicity, sex, age, socioeconomic factors, geography, clinician's age and specialty, and healthcare setting, with an emphasis on outpatient settings. Few studies assessed stewardship interventions. Clinicians, antibiotic stewardship experts, and health systems should be aware that prescribing behavior varies according to both clinician- and patient-level markers. Prescribing differences likely represent structural inequities; however, no studies reported underlying drivers of inequities in antibiotic prescribing.
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Affiliation(s)
- Christine Kim
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Kabbani
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William C Dube
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melinda Neuhauser
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon Tsay
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adam Hersh
- University of Utah, Salt Lake City, Utah, USA
| | | | - Lauri A Hicks
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Schletzbaum M, Sweet N, Astor B, Yu A, Powell WR, Gilmore-Bykovskyi A, Kaiksow F, Sheehy A, Kind AJ, Bartels CM. Associations of Postdischarge Follow-Up With Acute Care and Mortality in Lupus: A Medicare Cohort Study. Arthritis Care Res (Hoboken) 2023; 75:1886-1896. [PMID: 36752354 PMCID: PMC10406973 DOI: 10.1002/acr.25097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 12/06/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Patients with systemic lupus erythematosus experience the sixth highest rate of 30-day readmissions among chronic diseases. Timely postdischarge follow-up is a marker of ambulatory care quality that can reduce readmissions in other chronic conditions. Our objective was to test the hypotheses that 1) beneficiaries from populations experiencing health disparities, including patients from disadvantaged neighborhoods, will have lower odds of completed follow-up, and that 2) follow-up will predict longer time without acute care use (readmission, observation stay, or emergency department visit) or mortality. METHODS This observational cohort study included hospitalizations in January-November 2014 from a 20% random sample of Medicare adults. Included hospitalizations had a lupus code, discharge to home without hospice, and continuous Medicare A/B coverage for 1 year before and 1 month after hospitalization. Timely follow-up included visits with primary care or rheumatology within 30 days. Thirty-day survival outcomes were acute care use and mortality adjusted for sociodemographic information and comorbidities. RESULTS Over one-third (35%) of lupus hospitalizations lacked 30-day follow-up. Younger age, living in disadvantaged neighborhoods, and rurality were associated with lower odds of follow-up. Follow-up was not associated with subsequent acute care or mortality in beneficiaries age <65 years. In contrast, follow-up was associated with a 27% higher hazard for acute care use (adjusted hazard ratio [HR] 1.27 [95% confidence interval (95% CI) 1.09-1.47]) and 65% lower mortality (adjusted HR 0.35 [95% CI 0.19-0.67]) among beneficiaries age ≥65 years. CONCLUSION One-third of lupus hospitalizations lacked follow-up, with significant disparities in rural and disadvantaged neighborhoods. Follow-up was associated with increased acute care, but 65% lower mortality in older systemic lupus erythematosus patients. Further development of lupus-specific postdischarge strategies is needed.
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Affiliation(s)
- Maria Schletzbaum
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Nadia Sweet
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Brad Astor
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Ang Yu
- Department of Sociology, University of Wisconsin – Madison, Madison, WI, US
- Center for Demography and Ecology, University of Wisconsin – Madison, Madison, WI, US
| | - W. Ryan Powell
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Andrea Gilmore-Bykovskyi
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- School of Nursing, University of Wisconsin – Madison, Madison, WI, US
| | - Farah Kaiksow
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Ann Sheehy
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Amy J Kind
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Christie M Bartels
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
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Lewis CL, Yan A, Williams MY, Apen LV, Crawford CL, Morse L, Valdez AM, Alexander GR, Grant E, Valderama-Wallace C, Beatty D. Health equity: A concept analysis. Nurs Outlook 2023; 71:102032. [PMID: 37683597 DOI: 10.1016/j.outlook.2023.102032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Although health equity is critically important for healthcare delivery, there are inconsistencies in its definitions or lack of definitions. PURPOSE Develop a comprehensive understanding of health equity to guide nursing practice and healthcare policy. METHOD Walker and Avant's concept analysis method was used to establish defining attributes, antecedents, consequences, and empirical referents of health equity. FINDINGS Health equity defining attributes are grounded in ethical principles, the absence of unfair and avoidable differences, and fair and just opportunities to attain a person's full health potential. Health equity antecedents are categorized into environmental; financial or economic; law, politics, and policy; societal and structural; research; and digital and technology. DISCUSSION Health equity's antecedents are useful to distinguish health disparities from health outcomes resulting from individual preferences. To achieve health equity, organizations need to focus on addressing the antecedents.
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Affiliation(s)
- Chrystal L Lewis
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA.
| | - Alice Yan
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Michelle Y Williams
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA; Division of Primary Care and Population Health and Nursing Research Section, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Lynette V Apen
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Cecelia L Crawford
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Lisa Morse
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Anna M Valdez
- Department of Nursing, Sonoma State University, Rohnert Park, CA
| | - G Rumay Alexander
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Dale Beatty
- Executive Administration, Stanford Health Care, Palo Alto, CA
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Behinaein P, Treffalls J, Hutchings H, Okereke IC. The Role of Sublobar Resection for the Surgical Treatment of Non-Small Cell Lung Cancer. Curr Oncol 2023; 30:7019-7030. [PMID: 37504369 PMCID: PMC10378348 DOI: 10.3390/curroncol30070509] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
Lung cancer is the most common cancer killer in the world. The standard of care for surgical treatment of non-small cell lung cancer has been lobectomy. Recent studies have identified that sublobar resection has non-inferior survival rates compared to lobectomy, however. Sublobar resection may increase the number of patients who can tolerate surgery and reduce postoperative pulmonary decline. Sublobar resection appears to have equivalent results to surgery in patients with small, peripheral tumors and no lymph node disease. As the utilization of segmentectomy increases, there may be some centers that perform this operation more than other centers. Care must be taken to ensure that all patients have access to this modality. Future investigations should focus on examining the outcomes from segmentectomy as it is applied more widely. When employed on a broad scale, morbidity and survival rates should be monitored. As segmentectomy is performed more frequently, patients may experience improved postoperative quality of life while maintaining the same oncologic benefit.
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Affiliation(s)
- Parnia Behinaein
- School of Medicine, Wayne State University, Detroit, MI 48202, USA
| | - John Treffalls
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Hollis Hutchings
- Department of Surgery, Henry Ford Health, Detroit, MI 48202, USA
| | - Ikenna C Okereke
- Department of Surgery, Henry Ford Health, Detroit, MI 48202, USA
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Yousefi Nooraie R, Dadgostar P, Roman G, Cullen JP, Bennett NM. Mapping the distribution of health equity research and practice across a university: a network analysis. J Clin Transl Sci 2023; 7:e142. [PMID: 37396810 PMCID: PMC10308423 DOI: 10.1017/cts.2023.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Health equity research spans various disciplines, crossing formal organizational and departmental barriers and forming invisible communities. This study aimed to map the nomination network of scholars at the University of Rochester Medical Center who were active in racial and ethnic health equity research, education, and social/administrative activities, to identify the predictors of peer recognition. Methods We conducted a snowball survey of faculty members with experience and/or interest in racial and ethnic health equity, nominating peers with relevant expertise. Results Data from a total of 121 individuals (64% doing research on extent and outcomes of racial/ethnic disparities and racism, 48% research on interventions, 55% education, and 50% social/administrative activities) were gathered in six rounds of survey. The overlap between expertise categories was small with coincidence observed between education and social/administrative activities (kappa: 0.27; p < 0.001). Respondents were more likely to nominate someone if both were involved in research (OR: 3.1), if both were involved in education (OR: 1.7), and if both were affiliated with the same department (OR: 3.7). Being involved in health equity research significantly predicted the centrality of an individual in the nomination network, and the most central actors were involved in multiple expertise categories. Conclusions Compared with equity researchers, those involved in racial equity social/administrative activities were less likely to be recognized by peers as equity experts.
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Affiliation(s)
- Reza Yousefi Nooraie
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
- Clinical and Translational Science Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Porooshat Dadgostar
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Gretchen Roman
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
- Department of Family Medicine, University of Rochester, Rochester, NY, USA
| | - John P. Cullen
- Clinical and Translational Science Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Susan B. Anthony Center, University of Rochester, Rochester, NY, USA
| | - Nancy M. Bennett
- Clinical and Translational Science Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, NY, USA
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15
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Strand E, Murta F, Tupetz A, Barcenas L, Phillips AJ, Farias AS, Santos AC, Rocha GDS, Staton CA, Ramos FR, Machado VA, Wen FH, Vissoci JR, Sachett J, Monteiro W, Gerardo CJ. Perspectives on snakebite envenoming care needs across different sociocultural contexts and health systems: A comparative qualitative analysis among US and Brazilian health providers. Toxicon X 2023; 17:100143. [PMID: 36578905 PMCID: PMC9791583 DOI: 10.1016/j.toxcx.2022.100143] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
With the advancements in therapeutics and available treatment options, almost all deaths and permanent disabilities from snakebite envenoming (SBE) are preventable. The challenge lies in implementing these evidence-based treatments and practices across different settings and populations. This study aims to compare data on provider perceptions of SBE care across health systems and cultural contexts to inform potential implementation science approaches. We hypothesize different health systems and cultural contexts will influence specific perceived needs to provide adequate snakebite care within central tenets of care delivery (e.g., cost, access, human resources). We previously conducted exploratory descriptive studies in the US and Brazil in order to understand the experience, knowledge, and perceptions of health professionals treating SBE. In the US, in-depth interviews were performed with emergency physicians from January 2020 to March 2020. In BR, focus group discussions were conducted with health professionals from community health centers at the end of June 2021. The focus group discussions (BR) were originally analyzed through an inductive thematic analysis approach. We conducted a secondary qualitative analysis in which this codebook was then applied to the interviews (US) in a deductive content analysis. The analysis concluded in August 2022. Brazil participants were physicians (n=5) or nurses (n=20) from three municipalities in the State of Amazonas with an average of three years of professional experience. US participants were emergency physicians (n=16) with an average of 15 years of professional experience. Four main themes emerged: 1) barriers to adequate care on the patient and/or community side and 2) on the health system side, 3) perceived considerations for how to address SBE, and 4) identified needs for improving care. There were 25 subthemes within the four themes. These subthemes were largely the same across the Brazil and US data, but the rationale and content within each shared subtheme varied significantly. For example, the subtheme "role of health professionals in improving care" extended across Brazil and the US. Brazil emphasized the need for task-shifting and -sharing amongst health care disciplines, whereas the US suggested specialized approaches geared toward increasing access to toxicologists and other referral resources. Despite similar core barriers to adequate snakebite envenoming care and factors to consider when trying to improve care delivery, health professionals in different health systems and sociocultural contexts identified different needs. Accounting for, and understanding, these differences is crucial to the success of initiatives intended to strengthen snakebite envenoming care. Implementation science efforts, with explicit health professional input, should be applied to develop new and/or adapt existing evidence-based treatments and practices for SBE.
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Affiliation(s)
- Eleanor Strand
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Felipe Murta
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Anna Tupetz
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Loren Barcenas
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Ashley J. Phillips
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Altair Seabra Farias
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Alícia Cacau Santos
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Gisele dos Santos Rocha
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Catherine A. Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Flávia Regina Ramos
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Vinícius Azevedo Machado
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Fan Hui Wen
- Instituto Butantan, São Paulo, São Paulo, Brazil
| | - João R.N. Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Jacqueline Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Alfredo da Matta, Manaus, Brazil
| | - Wuelton Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Charles J. Gerardo
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
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Laksono AD, Wulandari RD, Rohmah N, Rukmini R, Tumaji T. Regional disparities in hospital utilisation in Indonesia: a cross-sectional analysis data from the 2018 Indonesian Basic Health Survey. BMJ Open 2023; 13:e064532. [PMID: 36596635 PMCID: PMC9815017 DOI: 10.1136/bmjopen-2022-064532] [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] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Policymakers must ensure that the entire population has equal access to health services, and efforts to minimise inequalities are needed. This study aimed to analyse the regional disparities in hospital utilisation in Indonesia. DESIGN A cross-sectional study analysing secondary data from the 2018 Indonesian Basic Health Survey. SETTING National-level survey data from Indonesia. PARTICIPANTS A total of 629 370 participants were included in the study.InterventionWe employed no interventionPrimary and secondary outcome measuresThe primary outcome was hospital utilisation. Aside from region, we utilise residence type, age, gender, marital status, educational level, occupation, wealth, insurance and travel time as control variables. We used binary logistic regression in the final analysis RESULTS: The respondents in Sumatra were 1.079 times (95% CI 1.073 to 1.085) more likely than those in Papua to use the hospital. Furthermore, compared with the respondents in Papua, those in the Java-Bali region (1.075 times, 95% CI 1.069 to 1.081), Nusa Tenggara (1.106 times, 95% CI 1.099 to 1.113), Sulawesi (1.008 times, 95% CI 1.002 to 1.014) and Kalimantan (1.212 times, 95% CI 1.205 to 1.219) were more likely to use the hospital. However, those in Maluku were less likely than those in Papua to use the hospital (0.827 times, 95% CI 0.820 to 0.835). Six demographic variables (age, gender, marital status, educational level, occupation and wealth) and three other control variables (residence type, insurance and travel time to the hospital) were found to be associated with hospital utilisation. CONCLUSIONS Our findings highlight the existence of regional disparities in hospital utilisation in Indonesia.
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Affiliation(s)
- Agung Dwi Laksono
- Research Center for Public Health and Nutrition, National Research and Innovation Agency Republic of Indonesia, Central Jakarta, Indonesia
| | | | - Nikmatur Rohmah
- Faculty of Health Science, University of Muhammadiyah Jember, Jember, Indonesia
| | - Rukmini Rukmini
- Research Center for Public Health and Nutrition, National Research and Innovation Agency Republic of Indonesia, Central Jakarta, Indonesia
| | - Tumaji Tumaji
- Research Center for Public Health and Nutrition, National Research and Innovation Agency Republic of Indonesia, Central Jakarta, Indonesia
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Burdzy A, Dai M, Nagubandi V, Nguyen M, Marten C, Paul-Quinn J. Tackling Health Inequities: A Unique, Asynchronous Course Designed Through Peer-to-Peer Methods. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231203917. [PMID: 37822776 PMCID: PMC10563473 DOI: 10.1177/23821205231203917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES This study investigates the efficacy and feasibility of an asynchronous, peer-to-peer health disparities enrichment course on postbaccalaureate prehealth students' knowledge, behaviors, and reaction to course materials. INTRODUCTION Growing awareness of social inequities has prompted educators of prehealth and medical students to explore student education by addressing systemic healthcare issues. This cross-sectional study assessed reactions, learning, and self-reported behavior changes in students after taking the course "Social Determinants, Disparities, and Preparing for the Future of Healthcare" (SDDH). METHODS The curriculum was designed by prehealth postbaccalaureate students for their peers. Course goals were to educate participants on social determinants of health and to build cultural and structural competence in their roles as future healthcare professionals. SDDH is an asynchronous, noncredit-bearing, 5-h online course with 10 modules covering various topics. The Kirkpatrick Model was used to assess the effectiveness of the curriculum, alongside qualitative and quantitative analyses of student performance. RESULTS Out of the 102 active students in the prehealth program that accepted the invitation to join, 29 students successfully completed the course (rate of completion = 28%). On average, students expressed positive reactions and attitudes toward the course and experienced an observable increase in knowledge assessment scores upon curriculum completion (P-value = .0002). Students' self-reported observations demonstrated sustained behavioral change 3 months after course completion. CONCLUSION It is critical to educate prehealth students on health disparities, structural, and cultural competence. A course such as SDDH may help prehealth students build effective communication skills for advocacy and develop an empathetic, patient-centered approach earlier on in their career pursuit. Some barriers to students completing the entire course include its length, uncredited status, and voluntary self-enrollment.
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Affiliation(s)
- Alexander Burdzy
- Penn Pre-Health Programs, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michelle Dai
- Penn Pre-Health Programs, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA
| | - Veda Nagubandi
- Penn Pre-Health Programs, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - My Nguyen
- Penn Pre-Health Programs, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Sage Bionetworks, Seattle, Washington, USA
| | - Carly Marten
- Penn Pre-Health Programs, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Sage Bionetworks, Seattle, Washington, USA
| | - Jennifer Paul-Quinn
- Penn Pre-Health Programs, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
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18
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Maness SB, Low JH, Vu T. A Qualitative Analysis of Access to Healthcare Among African American Adults in South Carolina. J Prim Care Community Health 2023; 14:21501319231153593. [PMID: 36760101 PMCID: PMC9943950 DOI: 10.1177/21501319231153593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/08/2023] [Accepted: 01/11/2023] [Indexed: 02/11/2023] Open
Abstract
Access to healthcare is a Social Determinant of Health that is associated with public health outcomes and barriers to access disproportionately affect African American adults. This study used a health and financial literacy approach to qualitatively assess how African American adults access healthcare and potential barriers faced (n = 20). Results indicated a wide range of experiences generally split between positive and negative experiences in access to healthcare. Specific themes that emerged included scheduling issues and appointment availability, expense of care, lack of transparency in insurance coverage, the need for more primary care clinics and enhanced community outreach and education on how to access healthcare. This research identifies a need for increased education surrounding health insurance coverage and an identified need for more local physicians or ease of scheduling. All participants in this study stated they were covered by health insurance of some form. Future research should examine these issues in the context of socioeconomic and insurance status.
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Affiliation(s)
- Sarah B. Maness
- Department of Health and Human
Performance, College of Charleston, Charleston, SC, USA
| | - Jonathan H. Low
- Meharry Medical College, Nashville, TN,
USA
- College of Charleston School of
Business, Charleston, SC, USA
| | - Tony Vu
- College of Charleston School of
Business, Charleston, SC, USA
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Zimbile F, David S, Daemen M, Goossens A, Creemers J, Crutzen R. Introducing video consultations at public sexual health clinics in the Netherlands: a mixed-methods study. Health Promot Int 2022; 37:6730776. [PMID: 36173604 PMCID: PMC9521338 DOI: 10.1093/heapro/daac135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Video consultations (in combination with remote STI testing) can benefit both public sexual health clinics (SHCs) and their clients. The Dutch public SHCs explored the extent to which video consultations are accepted and appreciated—compared to face-to-face consultations—by both young clients (under 25 years) and nurses who normally carry out consultations. A mixed-methods study, using online questionnaires and telephone interviews with both young clients (aged under 25 years) and nurses (focus groups), was conducted to evaluate acceptance and appreciation of video and face-to-face consultations of the SHCs. Young clients evaluated 333 video consultations and 100 face-to-face consultations. Clients rated the VCs and F2F consultations as being of equal high level on five evaluation criteria (e.g. how it feels to talk about sex with a nurse, contact with the nurse). These positive results were confirmed in the interviews. Most important perceived advantages of VCs were time saving, ease, and feelings of comfort and safety. The nurses evaluated 422 VCs and 120 F2F consultations, rating the VCs and F2F consultations on an equal high level on three evaluation criteria (e.g., contact with the client, possibility to continue asking questions). Increasing accessibility of SHC consultations, getting faster to the point and saving time were mentioned as advantages of VCs during the focus group sessions with nurses. Video consultations are accepted and appreciated by young clients and nurses. They can be used for standard STI consultations that do not require a physical examination.
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Affiliation(s)
- Filippo Zimbile
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands.,National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Aidsfonds - Soa Aids Nederland, Amsterdam, The Netherlands
| | - Silke David
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Maud Daemen
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands
| | - Anne Goossens
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands
| | - Josien Creemers
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands
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20
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López AN, Mutis MJ, Morón EM, Beltrán-Aguilar ED, Borrell LN. Oral health inequities: Recommended public policies to achieve health equity. J Dent Educ 2022; 86:1242-1248. [PMID: 36165261 DOI: 10.1002/jdd.13071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/10/2022]
Abstract
In the United States (US), racial and ethnic minority populations experience poorer oral health than the general population. Social and commercial determinants of health embedded in structural and institutional racism and/or discrimination generate and exacerbate oral health inequities. We provide examples of oral health disparities (including oral health status and workforce issues) among selected racial and ethnic minority groups in the US. In addition, we compiled four priority areas based on research over the last two decades to guide actions to improve oral health equity. These four priority areas aim to improve health care models, interventions, and policies to help close gaps and reduce disparities in oral health and access to dental care.
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Affiliation(s)
- Ana N López
- School of Dental Medicine, University of Puerto Rico, San Juan, Puerto Rico, USA
| | - Martha J Mutis
- National Chair of Research Initiative, Hispanic Dental Association, New York, New York, USA
| | - Elías M Morón
- Nova Southeastern University College of Dental Medicine, Davie, Florida, USA
| | | | - Luisa N Borrell
- Department of Epidemiology and Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, New York, USA
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21
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Findings from the implementation of a novel needs assessment survey in children and youth with epilepsy; The impact of social determinants of health on utilization of medical services. BRAIN DISORDERS 2022. [DOI: 10.1016/j.dscb.2022.100043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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22
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Sumpter IJ, Phillips SM, Magwood GS. Approaches to reducing fragmented care in systemic lupus erythematosus (SLE) and other multimorbid conditions: A realist review. INTERNATIONAL JOURNAL OF CARE COORDINATION 2022. [DOI: 10.1177/20534345221121068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Fragmented care overwhelmingly affects populations with multimorbid chronic conditions, like systemic lupus erythematosus (SLE). However, strategies to mitigate care fragmentation typically focus on singular disease frameworks with insufficient evidence regarding approaches for individuals with two or more concurrent chronic conditions (multimorbidity). This review explores the literature to identify the (C)ontextual influences, underlying (M)echanisms, and associated (O)utcomes of fragmented care prevention in SLE and other multimorbid conditions. Methods A realist review was applied to systematically examine literature, including the search of >1300 published articles focused on SLE and multimorbidity, continuity of care, and approaches to mitigate fragmented care. The analysis was guided by care continuity elements and organized by fragmented care concepts explicated by the MacColl Institute for Healthcare Innovations Care Coordination Model and further grouped for context–mechanism–outcome (CMO) configurations. Results Fourteen articles met inclusion/exclusion criteria and were included in the sample to illustrate the relationship between C-M-O for approaches focused on fragmented care prevention. Favorable outcomes in mechanisms that produced positive responses to resources relevant to fragmented care prevention included 1) opportunities for exposure and negotiation within professional teams, 2) structured health education, role clarity, and access to adherence services for patients, and 3) awareness of workflow waste and use of clinical algorithms. Discussion Review findings suggest using a multidimensional approach to mitigate fragmented care in SLE and other multimorbid conditions. Multidimensional approaches should focus on shared decision-making, social support, social–cultural–economic factors, patient engagement, and technological infrastructure to support the complex care needs of the multimorbid patient.
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Affiliation(s)
- IJ Sumpter
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - SM Phillips
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - GS Magwood
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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23
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Racial and ethnic disparities in pediatric magnetic resonance imaging missed care opportunities. Pediatr Radiol 2022; 52:1765-1775. [PMID: 35930081 DOI: 10.1007/s00247-022-05460-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/04/2022] [Accepted: 07/18/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Imaging missed care opportunities (MCOs), previously referred to as "no shows," impact timely patient diagnosis and treatment and can exacerbate health care disparities. Understanding factors associated with imaging MCOs could help advance pediatric health equity. OBJECTIVE To assess racial/ethnic differences in pediatric MR imaging MCOs and whether health system and socioeconomic factors, represented by a geography-based Social Vulnerability Index (SVI), influence racial/ethnic differences. MATERIALS AND METHODS We conducted a retrospective analysis of MR imaging MCOs in patients younger than 21 years at a pediatric academic medical center (2015-2019). MR imaging MCOs were defined as: scheduled but appointment not attended, canceled within 24 h, and canceled but not rescheduled. Mixed effects multivariable logistic regression assessed the association between MCOs and race/ethnicity and community-level social factors, represented by the SVI. RESULTS Of 68,809 scheduled MRIs, 6,159 (9.0%) were MCOs. A higher proportion of MCOs were among Black/African-American and Hispanic/Latino children. Multivariable analysis demonstrated increased odds of MCOs among Black/African-American (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.7-2.3) and Hispanic/Latino (aOR 1.5, 95% CI 1.3-1.7) children compared to White children. The addition of SVI >90th percentile to the adjusted model had no effect on adjusted OR for Black/African-American (aOR 1.9, 95% CI 1.7-2.2) or Hispanic/Latino (aOR 1.5, 95% CI 1.3-1.6) children. Living in a community with SVI >90th percentile was independently associated with MCOs. CONCLUSION Black/African-American and Hispanic/Latino children were almost twice as likely to experience MCOs, even when controlling for factors associated with MCOs. Independent of race/ethnicity, higher SVI was significantly associated with MCOs. Our study supports that pediatric health care providers must continue to identify systemic barriers to health care access for Black/African-American and Hispanic/Latino children and those from socially vulnerable areas.
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Lumpkins CY, Goeckner R, Hale J, Lewis C, Gunville J, Gunville R, Daley CM, Daley SM. In Our Sacred Voice - An Exploration of Tribal and Community Leader Perceptions as Health Communicators of Disease Prevention among American Indians in the Plains. HEALTH COMMUNICATION 2022; 37:1180-1191. [PMID: 34949125 DOI: 10.1080/10410236.2021.2008108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
American Indians (AI) are disproportionately and significantly impacted by disease morbidity, mortalityand poor behavioral health outcomes. Health promotion and health communication programs exist to address these health disparities and health conditions; however, few programs fully integrate holistic approaches when targeting AI populations. The objective of this study was to explore how tribal and community leaders throughout the Central Plains (Kansas, Iowa, Missouri, and South Dakota) viewed themselves as health communicators and health promoters within their communities. Members of the Center for American Indian Community Health (CAICH) conducted 39 in-depth interviews with members of federally recognized tribes living in reservation communities as well as urban tribal communities across the region. Results from the sample show that these individuals do not necessarily see themselves as the "authority" health communicator or health promoter within their tribe or community. They did perceive themselves and others as gatekeepers of pertinent health information. Social and cultural authority within culturally centered messaging and collective delivery of this type of health information from trusted sources within tribes and communities is perceived to bolster health communication programs and positively impact health outcomes among AI populations.
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Affiliation(s)
- Crystal Y Lumpkins
- Department of Family Medicine and Community Health, University of Kansas Medical Center
- William Allen White School of Journalism and Mass Communications, University of Kansas-Lawrence
| | | | - Jason Hale
- Lehigh College of Health, Institute for Indigenous Studies
| | - Charley Lewis
- Lehigh College of Health, Institute for Indigenous Studies
| | | | - River Gunville
- Lehigh College of Health, Institute for Indigenous Studies
| | - Chris M Daley
- Lehigh College of Health, Institute for Indigenous Studies
| | - Sean M Daley
- Lehigh College of Health, Institute for Indigenous Studies
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Peltzman T, Rice K, Jones KT, Washington DL, Shiner B. Optimizing Data on Race and Ethnicity for Veterans Affairs Patients. Mil Med 2022; 187:e955-e962. [PMID: 35323934 DOI: 10.1093/milmed/usac066] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Maintaining accurate race and ethnicity data among patients of the Veterans Affairs (VA) healthcare system has historically been a challenge. This work expands on previous efforts to optimize race and ethnicity values by combining multiple VA data sources and exploring race- and ethnicity-specific collation algorithms. MATERIALS AND METHODS We linked VA patient data from 2000 to 2018 with race and ethnicity data from four administrative and electronic health record sources: VA Medical SAS files (MedSAS), Corporate Data Warehouse (CDW), VA Centers for Medicare extracts (CMS), and VA Defense Identity Repository Data (VADIR). To assess the accuracy of each data source, we compared race and ethnicity values to self-reported data from the Survey of Health Experiences of Patients (SHEP). We used Cohen's Kappa to assess overall (holistic) source agreement and positive predictive values (PPV) to determine the accuracy of sources for each race and ethnicity separately. RESULTS Holistic agreement with SHEP data was excellent (K > 0.80 for all sources), while race- and ethnicity-specific agreement varied. All sources were best at identifying White and Black users (average PPV = 0.94, 0.93, respectively). When applied to the full VA user population, both holistic and race-specific algorithms substantially reduced unknown values, as compared to single-source methods. CONCLUSIONS Combining multiple sources to generate race and ethnicity values improves data accuracy among VA patients. Based on the overall agreement with self-reported data, we recommend using non-missing values from sources in the following order to fill in race values-SHEP, CMS, CDW, MedSAS, and VADIR-and in the following order to fill in ethnicity values-SHEP, CDW, MedSAS, VADIR, and CMS.
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Affiliation(s)
- Talya Peltzman
- White River Junction VA Medical Center, White River Junction, VT 05009, USA
| | - Korie Rice
- White River Junction VA Medical Center, White River Junction, VT 05009, USA
| | | | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California Los Angeles Geffen School of Medicine, Los Angeles, CA 90024, USA
| | - Brian Shiner
- White River Junction VA Medical Center, White River Junction, VT 05009, USA
- Geisel School of Medicine at Dartmouth College, Hanover, NH 03755, USA
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Brignoni-Pérez E, Scala M, Feldman HM, Marchman VA, Travis KE. Disparities in Kangaroo Care for Premature Infants in the Neonatal Intensive Care Unit. J Dev Behav Pediatr 2022; 43:e304-e311. [PMID: 34723932 PMCID: PMC9046459 DOI: 10.1097/dbp.0000000000001029] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/02/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to investigate whether preterm infants whose families have lower socioeconomic status (SES) or communicate with clinical staff in a language other than English experience differences in the rate, frequency, and duration of kangaroo care (KC) in the neonatal intensive care unit (NICU) compared with preterm infants of higher SES or primarily English-speaking families. METHODS Participants were infants born <32 weeks' gestational age (GA), N = 116. We defined SES by the infants' health insurance (private/higher vs public/lower) and language by the language mothers used to communicate with clinical staff (English vs Other language). SES or language groups were compared on (1) rate of KC infants experienced during hospitalization per visitation days, (2) frequency of KC per visitation days, and (3) duration of KC events per day. RESULTS Infants in the lower SES and Other language groups experienced KC in reduced amounts, lower frequencies, and shorter durations than infants in either the higher SES or English language groups. SES and language group differences remained significant after controlling for family visitation and GA at birth. After controlling for SES, language group differences in KC duration remained significant. CONCLUSION Our findings revealed disparities in the rate, frequency, and duration of KC experienced in the NICU as a function of both SES and language. Such disparities reduced infants' access to this developmental care practice shown to stabilize clinical status and promote neurodevelopment. We recommend that hospital nurseries implement policies that minimize these disparities.
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Affiliation(s)
- Edith Brignoni-Pérez
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Melissa Scala
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, Stanford, CA, USA
| | - Heidi M. Feldman
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, USA
| | | | - Katherine E. Travis
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, USA
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The racial and cultural ecology of home and community-based services for diverse older adults. J Aging Stud 2022; 61:101023. [DOI: 10.1016/j.jaging.2022.101023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 11/19/2022]
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Fleming E, Raskin SE, Brody E. From describing disparities to understanding why disparities exist: Anti-racist methods to support dental public health research. J Public Health Dent 2022; 82 Suppl 1:73-78. [PMID: 35726470 PMCID: PMC9541958 DOI: 10.1111/jphd.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
Racism is understudied in the oral health literature at the same time that race is overutilized as an explanatory factor in study design. Social and behavioral methodologies offer conceptual models that can be used to include racism in dental public health questions. In addition, interdisciplinary and mixed methods approaches allow for understanding racism as an underlying cause of social and health disparities and exploring solutions that address historical, institutional, social, political, and economic drivers of oral health inequity, while recognizing the limits of measuring racism quantitatively. In a collective acknowledgement of the limitations of conventional methods, there are new opportunities to explore how qualitative and mixed methods research can serve as drivers for both social justice and health equity, while building and sustaining a diverse research workforce that can better close these disparities and offer antiracist solutions to oral health inequities.
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Affiliation(s)
- Eleanor Fleming
- Department of Dental Public health, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Sarah E Raskin
- iCubed Oral Health Core, L. Douglas Wilder School of Government and Public Affairs and Department of Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Erica Brody
- Health Sciences Library, Virginia Commonwealth University, Richmond, Virginia, USA
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Aysola J, Clapp JT, Sullivan P, Brennan PJ, Higginbotham EJ, Kearney MD, Xu C, Thomas R, Griggs S, Abdirisak M, Hilton A, Omole T, Foster S, Mamtani M. Understanding Contributors to Racial/Ethnic Disparities in Emergency Department Throughput Times: a Sequential Mixed Methods Analysis. J Gen Intern Med 2022; 37:341-350. [PMID: 34341916 PMCID: PMC8811086 DOI: 10.1007/s11606-021-07028-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 07/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ensuring equitable care remains a critical issue for healthcare systems. Nationwide evidence highlights the persistence of healthcare disparities and the need for research-informed approaches for reducing them at the local level. OBJECTIVE To characterize key contributors in racial/ethnic disparities in emergency department (ED) throughput times. DESIGN We conducted a sequential mixed methods analysis to understand variations in ED care throughput times for patients eventually admitted to an emergency department at a single academic medical center from November 2017 to May 2018 (n=3152). We detailed patient progression from ED arrival to decision to admit and compared racial/ethnic differences in time intervals from electronic medical record time-stamp data. We then estimated the relationships between race/ethnicity and ED throughput times, adjusting for several patient-level variables and ED-level covariates. These quantitative analyses informed our qualitative study design, which included observations and semi-structured interviews with patients and physicians. KEY RESULTS Non-Hispanic Black as compared to non-Hispanic White patients waited significantly longer during the time interval from arrival to the physician's decision to admit, even after adjustment for several ED-level and patient demographic, clinical, and socioeconomic variables (Beta (average minutes) (SE): 16.35 (5.8); p value=.005). Qualitative findings suggest that the manner in which providers communicate, advocate, and prioritize patients may contribute to such disparities. When the race/ethnicity of provider and patient differed, providers were more likely to interrupt patients, ignore their requests, and make less eye contact. Conversely, if the race/ethnicity of provider and patient were similar, providers exhibited a greater level of advocacy, such as tracking down patient labs or consultants. Physicians with no significant ED throughput disparities articulated objective criteria such as triage scores for prioritizing patients. CONCLUSIONS Our findings suggest the importance of (1) understanding how our communication style and care may differ by race/ethnicity; and (2) taking advantage of structured processes designed to equalize care.
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Affiliation(s)
- Jaya Aysola
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA. .,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. .,Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA.
| | - Justin T Clapp
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA.,Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Patricia Sullivan
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Patrick J Brennan
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Eve J Higginbotham
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Matthew D Kearney
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Chang Xu
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Rosemary Thomas
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Sarah Griggs
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Mohamed Abdirisak
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Alec Hilton
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Toluwa Omole
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Sean Foster
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mira Mamtani
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Frank L, Starzyk E, Hoxworth T, Canon M, McGuinness C, Watkins A, Deem T, Orozco-Pacheco G. HIV PrEP implementation: A multi-level systems approach. EVALUATION AND PROGRAM PLANNING 2022; 90:101966. [PMID: 34127271 DOI: 10.1016/j.evalprogplan.2021.101966] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/21/2021] [Accepted: 05/14/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE CO-PrIDE was a three-year Pre-Exposure Prophylaxis (PrEP) demonstration project to increase access to PrEP for men who have sex with men and transgender people in the Denver/Aurora Metropolitan Statistical Area. CO-PrIDE implemented a multi-level framework featuring collaboration between health systems and community organizations to link clients to PrEP prescribers and provide support services intended to help clients overcome socioeconomic barriers to PrEP uptake. These services included payment assistance, insurance navigation, and healthcare navigation. CO-PrIDE implemented a participatory mixed-methods evaluation to understand the services associated with PrEP uptake. RESULTS From January 2016 to December 2018, navigators screened 10,129 clients for PrEP and offered supportive services. The results indicated that clients who received payment assistance were more likely to accept a PrEP prescription (aPR = 3.52, p < .0001). Additionally, clients were more likely to receive a PrEP prescription through a co-located health system model, meaning the clinical provider is located with the PrEP Navigator (aPR = 3.78, p < .001). CONCLUSIONS The primary factors associated with increased PrEP uptake included co-location of navigation and clinical PrEP services and providing navigation to payment assistance programs. The evaluation results suggest that a multi-level framework that includes diverse support services is needed to implement a sustainable PrEP program.
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Affiliation(s)
- Leslie Frank
- Colorado Department of Public Health and Environment 4300 Cherry Creek South Drive, Denver, CO, 80246, United States.
| | - Erin Starzyk
- Colorado Department of Public Health and Environment 4300 Cherry Creek South Drive, Denver, CO, 80246, United States.
| | - Tamara Hoxworth
- Colorado Department of Public Health and Environment 4300 Cherry Creek South Drive, Denver, CO, 80246, United States.
| | - Megan Canon
- Colorado Department of Public Health and Environment 4300 Cherry Creek South Drive, Denver, CO, 80246, United States.
| | - Colleen McGuinness
- Colorado Department of Public Health and Environment 4300 Cherry Creek South Drive, Denver, CO, 80246, United States.
| | - Anita Watkins
- Colorado Department of Public Health and Environment 4300 Cherry Creek South Drive, Denver, CO, 80246, United States.
| | - Thomas Deem
- Vivent Health 5250 Leetsdale Drive, Suite #300, Denver, CO, 80246, United States.
| | - Gerardo Orozco-Pacheco
- Colorado Department of Public Health and Environment 4300 Cherry Creek South Drive, Denver, CO, 80246, United States.
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Aggarwal NK, Chen D, Lam P, Lewis-Fernández R. Implementing the Cultural Formulation Interview in a Community Clinic to Improve Appointment Retention: A Pilot Study. Psychiatr Serv 2022; 73:227-230. [PMID: 34157856 PMCID: PMC8695638 DOI: 10.1176/appi.ps.202000925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite consensus that clinicians should receive cultural competence training to reduce mental health disparities among racial-ethnic minority groups, few studies have evaluated training in community settings. This column delineates implementation of the DSM-5 Cultural Formulation Interview (CFI) at a community hospital. Participating clinicians were able to implement the CFI after a single training session and offer administrative support and instructions on customizing care with lower- and middle-income, racially and ethnically diverse patients.
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Affiliation(s)
- Neil Krishan Aggarwal
- Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City (Aggarwal, Lam, Lewis-Fernández); Columbia University Irving Medical Center, New York City (Aggarwal, Lewis-Fernández); Jamaica Hospital Medical Center, Flushing Hospital Medical Center, and Advanced Centers for Psychotherapy, New York City (Chen). Dr. Lewis-Fernández is editor of this column
| | - Daniel Chen
- Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City (Aggarwal, Lam, Lewis-Fernández); Columbia University Irving Medical Center, New York City (Aggarwal, Lewis-Fernández); Jamaica Hospital Medical Center, Flushing Hospital Medical Center, and Advanced Centers for Psychotherapy, New York City (Chen). Dr. Lewis-Fernández is editor of this column
| | - Peter Lam
- Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City (Aggarwal, Lam, Lewis-Fernández); Columbia University Irving Medical Center, New York City (Aggarwal, Lewis-Fernández); Jamaica Hospital Medical Center, Flushing Hospital Medical Center, and Advanced Centers for Psychotherapy, New York City (Chen). Dr. Lewis-Fernández is editor of this column
| | - Roberto Lewis-Fernández
- Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City (Aggarwal, Lam, Lewis-Fernández); Columbia University Irving Medical Center, New York City (Aggarwal, Lewis-Fernández); Jamaica Hospital Medical Center, Flushing Hospital Medical Center, and Advanced Centers for Psychotherapy, New York City (Chen). Dr. Lewis-Fernández is editor of this column
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Egede LE, Ozieh MN, Campbell JA, Williams JS, Walker RJ. Cross-Sector Collaborations Between Health Care Systems and Community Partners That Target Health Equity/Disparities in Diabetes Care. Diabetes Spectr 2022; 35:313-319. [PMID: 36082007 PMCID: PMC9396714 DOI: 10.2337/dsi22-0001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Evidence shows that social determinants of health (SDOH) are key drivers of diabetes outcomes and disparities in diabetes care. Targeting SDOH at the individual, organizational, and policy levels is an essential step in improving health equity for individuals living with diabetes. In addition, there is increasing recognition of the need to build collaboration across the health care system and the communities experiencing inequities to improve health equity. As a result, partnerships between health and nonhealth sectors have emerged as a crucial component for increasing health equity in diabetes care and achieving health equity. The purpose of this article is to discuss cross-sector collaborations between health care systems and nonhealth partners that target health equity in diabetes care.
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Affiliation(s)
- Leonard E. Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Corresponding author: Leonard E. Egede,
| | - Mukoso N. Ozieh
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI
- Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, WI
| | - Jennifer A. Campbell
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Joni S. Williams
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Rebekah J. Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
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Hicks PM, Siedlecki A, Haaland B, Owen LA, Au E, Feehan M, Murtaugh MA, Sieminski S, Reynolds A, Lillvis J, DeAngelis MM. A global genetic epidemiological review of pseudoexfoliation syndrome. EXPLORATION OF MEDICINE 2021. [DOI: 10.37349/emed.2021.00069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Pseudoexfoliation (PXF) syndrome is an important public health concern requiring individual population level analysis. Disease prevalence differs by geographic location and ethnicity, and has environmental, demographic, genetic, and molecular risk factors have been demonstrated. Epidemiological factors that have been associated with PXF include age, sex, environmental factors, and diet. Genetic and molecular components have also been identified that are associated with PXF. Underserved populations are often understudied within scientific research, including research about eye disease such as PXF, contributing to the persistence of health disparities within these populations. In each population, PXF needs may be different, and by having research that identifies individual population needs about PXF, the resources in that population can be more efficiently utilized. Otherwise, PXF intervention and care management based only on the broadest level of understanding may continue to exacerbate health disparities in populations disproportionally burdened by PXF.
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Affiliation(s)
- Patrice M. Hicks
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84108, USA;Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Adam Siedlecki
- Department of Ophthalmology, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14209, USA
| | - Benjamin Haaland
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84108, USA
| | - Leah A. Owen
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84108, USA;Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA;Department of Ophthalmology, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14209, USA
| | - Elizabeth Au
- Department of Ophthalmology, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14209, USA
| | - Michael Feehan
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84108, USA;Department of Ophthalmology, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14209, USA;Cerner Enviza, Kansas City, MO 64117, USA
| | - Maureen A. Murtaugh
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84108, USA;Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Sandra Sieminski
- Department of Ophthalmology, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14209, USA
| | - Andrew Reynolds
- Department of Ophthalmology, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14209, USA
| | - John Lillvis
- Department of Ophthalmology, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14209, USA;VA Western New York Healthcare System, Buffalo, NY 14215, USA
| | - Margaret M. DeAngelis
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84108, USA;Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA;Department of Ophthalmology, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14209, USA;VA Western New York Healthcare System, Buffalo, NY 14215, USA
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Abstract
Health and health care disparities in pediatric rheumatology are prevalent among socially disadvantaged and marginalized populations based on race/ethnicity, socioeconomic position, and geographic region. These groups are more likely to experience greater disease severity, morbidity, mortality, decreased quality of life, and poor mental health outcomes, which are in part due to persistent structural and institutional barriers, including decreased access to quality health care. Most of the research on health and health care disparities in pediatric rheumatology focuses on juvenile idiopathic arthritis and childhood-onset systemic lupus erythematosus; there are significant gaps in the literature assessing disparities associated with other pediatric rheumatic diseases. Understanding the underlying causes of health care disparities will ultimately inform the development and implementation of innovative policies and interventions on a federal, local, and individual level.
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Affiliation(s)
- Alisha M Akinsete
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA. https://twitter.com/@akinsetemd
| | - Jennifer M P Woo
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, 111 TW Alexander Drive, Research Triangle Park, NC 27709, USA. https://twitter.com/@jmpwoo
| | - Tamar B Rubinstein
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA.
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Ivey GD, Johnston FM. Barriers to Equitable Palliative Care Utilization Among Patients with Cancer. Surg Oncol Clin N Am 2021; 31:9-20. [PMID: 34776067 DOI: 10.1016/j.soc.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Over the past half century, palliative care has grown to become a pillar of clinical oncology. Its practice revolves around relieving suffering and optimizing quality of life, not just dealing with end-of-life decisions. Despite evidence that palliative care has the potential to reduce health care utilization and improve advance care planning without affecting mortality, palliative care remains inequitably accessible and underutilized. Furthermore, it is still too often introduced late in the care of patients receiving surgical intervention. This article summarizes the numerous and complex barriers to equitable palliative care utilization among patients with cancer. Potential strategies for dismantling these barriers are also discussed.
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Affiliation(s)
- Gabriel D Ivey
- Department of Surgery, Division of Surgical Oncology, The Johns Hopkins University, 600 North Wolfe Street, Blalock 611, Baltimore, MD 21287, USA
| | - Fabian M Johnston
- Department of Surgery, Division of Surgical Oncology, The Johns Hopkins University, 600 North Wolfe Street, Blalock 606, Baltimore, MD 21287, USA.
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Marshall C, Adams AS, Ma L, Altschuler A, Lin MW, Thompson NA, Young JD. Clinical Decision Support to Address Racial Disparities in Hypertension Control in an Integrated Delivery System: Evaluation of a Natural Experiment. Perm J 2021; 26:11-20. [PMID: 35609161 PMCID: PMC9126555 DOI: 10.7812/tpp/21.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Effective, equity-promoting interventions implemented by health care systems are needed to address health care disparities and population-level health disparities. We evaluated the impact of a clinical decision support tool to improve evidence-based thiazide diuretic prescribing among Black patients to address racial disparities in hypertension control. METHODS We employed an interrupted time series design and qualitative interviews to evaluate the implementation of the tool. Our primary outcome measure was the monthly rate of thiazide use among eligible patients before and after implementation of the tool (January 2013-December 2016). We modeled month-to-month changes in thiazide use for Black and White patients, overall, and by sex and medical center racial composition. We conducted key informant interviews to identify modifiable facilitators and barriers to implementation of the tool across medical centers. RESULTS Of the 318,720 patients, 15.5% were Black. We observed no change in thiazide use or blood pressure control following the implementation of the tool in either racial subgroup. There was a slight but statistically significant reduction (2.32 percentage points, p < 0.01) in thiazide use among Black patients following the removal the tool that was not observed among White patients. Factors affecting the tool's implementation included physician and pharmacist resistance to thiazide use and a lack of ongoing promotion of the tool. DISCUSSION The clinical decision support tool was insufficient to change prescribing practices and improve blood pressure control among Black patients. CONCLUSIONS Future interventions should consider physician attitudes about thiazide prescribing and the importance of multilevel approaches to address hypertension disparities.
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Affiliation(s)
- Cassondra Marshall
- School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Alyce S Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Lin Ma
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Mark W Lin
- Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA
| | - Nailah A Thompson
- Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA
| | - Joseph D Young
- Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA
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Ellis C, Jacobs M, Kendall D. The Impact of Racism, Power, Privilege, and Positionality on Communication Sciences and Disorders Research: Time to Reconceptualize and Seek a Pathway to Equity. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2032-2039. [PMID: 34019772 DOI: 10.1044/2021_ajslp-20-00346] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Purpose The purpose of this article is to explore how racism, privilege, power, and positionality negatively impact clinical research conducted in the discipline of communication sciences and disorders. Conclusions Evidence suggests solutions will not emerge from a minor revision or adjustment of current research approaches. Instead, to make deep and necessary changes, a complete restructuring of the research process is needed. This restructuring calls for a reconceptualization of how research questions and hypotheses are formed, how methods are selected, how data are analyzed and interpreted, and who is at the table throughout this process of knowledge generation. Such an overhaul of current research approaches will offer the field a solution-oriented roadmap for scientific investigation that facilitates greater equity in the research enterprise that translates into improved clinical outcomes for all clients served.
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Affiliation(s)
- Charles Ellis
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC
| | - Molly Jacobs
- Department of Health Services and Information Management, East Carolina University, Greenville, NC
| | - Diane Kendall
- Department of Speech and Hearing Sciences, University of Washington, Seattle
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Baumeister H, Ebert DD, Snoek F. Special issue on digital health interventions in chronic medical conditions: Editorial. Internet Interv 2021; 28:100457. [PMID: 35646604 PMCID: PMC9136333 DOI: 10.1016/j.invent.2021.100457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Chronic medical conditions are increasingly common and associated with a high burden for persons affected by them. Digital health interventions might be a viable way to support persons with a chronic illness in their coping and self-management. The present special issue's editorial on digital health interventions in chronic medical conditions summarizes core findings and discusses next steps needed to further the field while avoiding to reinvent the wheel, thereby elaborating on four topics extracted from the special issue's articles: 1) Needs assessment and digital intervention development, 2) Efficacy and (cost-)effectiveness, 3) Dissemination and implementation research: reach and engagement as well as 4) next generation of digital interventions.
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Affiliation(s)
- Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Germany,Correspondence: Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Straße 16, D-89081 Ulm, Germany.
| | - David D. Ebert
- Psychology and Digital Mental Health Care, Department of Sport and Health Sciences, Technical University of Munich, Germany
| | - Frank Snoek
- Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
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Park S, Park J. Identifying the Knowledge Structure and Trends of Outreach in Public Health Care: A Text Network Analysis and Topic Modeling. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179309. [PMID: 34501897 PMCID: PMC8431096 DOI: 10.3390/ijerph18179309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/01/2022]
Abstract
Outreach programs are considered a key strategy for providing services to underserved populations and play a central role in delivering health-care services. To address this challenge, knowledge relevant to global health outreach programs has recently been expanded. The aims of this study were to analyze the knowledge structure and understand the trends in aspects over time and across regions using text network analysis with NetMiner 4.0. Data analysis by frequency, time and region showed that the central keywords such as patient, care, service and community were found to be highly related to the area, target population, purpose and type of services within the knowledge structure of outreach. As a result of performing topic modeling, knowledge structure in this area consisted of five topics: patient-centered care, HIV care continuum, services related to a specific disease, community-based health-care services and research and education on health programs. Our results newly identified that patient-centered care, specific disease and population have been growing more crucial for all times and countries by the examination of major trends in health-care related outreach research. These findings help health professionals, researchers and policymakers in nursing and public health fields in understanding and developing health-care-related outreach practices and suggest future research direction.
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Affiliation(s)
- Sooyeon Park
- College of Nursing, Korea University, Seoul 02841, Korea;
| | - Jinkyung Park
- College of Nursing, Chonnam National University, Gwangju 61469, Korea
- Correspondence:
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40
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Cruz TM, Paine EA. Capturing patients, missing inequities: Data standardization on sexual orientation and gender identity across unequal clinical contexts. Soc Sci Med 2021; 285:114295. [PMID: 34428618 PMCID: PMC8765327 DOI: 10.1016/j.socscimed.2021.114295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/21/2021] [Accepted: 08/02/2021] [Indexed: 12/30/2022]
Abstract
In effort to address fundamental causes and reduce health disparities, public programs increasingly mandate sites of care to capture patient data on social and behavioral domains within Electronic Health Records (EHRs). Data reporting drawing from EHRs plays an essential role in public management of social problems, and data on social factors are commonly cited as foundational for eliminating health inequities. Yet one major shortcoming of these data-centered initiatives is their limited attention to social context, including the institutional conditions of biomedical stratification and variation of care provision across clinical settings. In this article, we leverage comparative fieldwork to examine provider and system responses to mandated data collection on patient sexual orientation and gender identity (SOGI), highlighting unequal clinical contexts as they appear across a large county safety-net institution and an LGBTQ-oriented health organization. Although point of care data collection is commonly justified for governance in the aggregate (e.g., disparity monitoring), we find standardized data on social domains presents a double-edged sword in clinical settings: formal categories promote visibility where certain issues remain hidden, yet constrain clinical utility in sites with greater knowledge and experience with related topics. We further illustrate how data standardization captures patient identities yet fundamentally misses these unequal contexts, resulting in limited attenuation of inequity despite broad expectations of clinical change. By revealing the often-invisible contexts of care that elude standard measurement, our findings underline the strengths of qualitative social science in accounting for the complex dynamics of enduring social problems. We call for deeper engagement with the unequal contexts of biomedical stratification, especially in light of increasing pressure to quantify the social amidst the rising tide of data-driven care.
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Affiliation(s)
- Taylor M Cruz
- California State University, Fullerton, Department of Sociology, 2600 Nutwood Avenue, College Park 900, Fullerton, CA 92831, United States.
| | - Emily Allen Paine
- Columbia University and New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, 722 W 168th Street, New York, NY 10032, United States.
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Shen J, Shi J, Cooper J, Chen C, Taylor HG, Xiang H. A Population-Based Study of the Incidence, Medical Care, and Medical Expenditures for Pediatric Traumatic Brain Injury. J Surg Res 2021; 268:87-96. [PMID: 34298211 DOI: 10.1016/j.jss.2021.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is one of the leading causes of pediatric trauma morbidity and mortality around the world. However, limited research exists regarding disparities in the incidence of TBI and medical care seeking behaviors and medical expenditures for TBI, particularly using population-based and nationally-representative data. MATERIALS AND METHODS The present study used the Medical Expenditure Panel Survey (MEPS) Panels 9-19 (2004-2015) to provide nationally-representative estimates for the civilian, non-institutionalized U.S. POPULATION We examined differences in TBI incidence and associated medical care seeking behaviors and expenditures in relation to individual and family sociodemographic characteristics. RESULTS From a total of 50,563 children in the MEPS Panels 9-19, we identified 449 children with TBI. For 82% of these children, medical treatment was sought. The estimated annual total expenditure associated with pediatric TBIs nationally was approximately $667 million, with mean expenditures per TBI being $1,532 and family out of pocket expenditures accounting for 8.3% of total expenditures. Race/ethnicity was the only significant factor associated with both medical care seeking behavior and total expenditures. CONCLUSIONS The present study is among the first to compare pediatric TBI-related medical expenditures among different sociodemographic groups in the U.S. Our findings can inform future intervention research and policy-making from the perspectives of both epidemiological and behavioral sciences.
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Affiliation(s)
- Jiabin Shen
- Department of Psychology, University of Massachusetts Lowell, Lowell, MA.
| | - Junxin Shi
- Center for Injury Research and Prevention, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH
| | - Jennifer Cooper
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH; The Ohio State University College of Medicine, Columbus, OH
| | - Cheng Chen
- Center for Injury Research and Prevention, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH
| | - H Gerry Taylor
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH; The Ohio State University College of Medicine, Columbus, OH
| | - Henry Xiang
- Center for Injury Research and Prevention, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH; The Ohio State University College of Medicine, Columbus, OH
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The Importance of Primary Care Research in Understanding Health Inequities in the United States. J Am Board Fam Med 2021; 34:849-852. [PMID: 34312278 PMCID: PMC8868495 DOI: 10.3122/jabfm.2021.04.210060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/08/2022] Open
Abstract
Eliminating health and health care inequities is a longstanding goal of multiple United States health agencies, but overwhelming scientific evidence suggests that health and health care inequities persist in the United States, despite decades of research and initiatives to alleviate them. Because of its comprehensiveness, studying health inequities in the context of primary care allows for the use of multiple paradigms and methodologic approaches to understanding almost any state of health, disease, social challenge, or societal circumstance a patient or group of patients might face. We argue in this special communication that the many features/advantages of primary care research have valuable contributions to make in reducing health inequity, and scientists, journals, and funders should increase the incorporation of primary care approaches and findings into their portfolios to better understand and end health inequity.
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Pittman CA, Roura R, Price C, Lin FR, Marrone N, Nieman CL. Racial/Ethnic and Sex Representation in US-Based Clinical Trials of Hearing Loss Management in Adults: A Systematic Review. JAMA Otolaryngol Head Neck Surg 2021; 147:656-662. [PMID: 33885733 DOI: 10.1001/jamaoto.2021.0550] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Although the National Institutes of Health (NIH) mandated the inclusion and reporting of women and racial or ethnic minority groups in NIH-funded research in 1993, little is known regarding the representation of women and racial or ethnic minority groups in trials that investigate hearing loss management. Objective To assess sex and racial/ethnic representation in US-based clinical trials of hearing loss management in an adult population. Data Sources Pertinent studies were identified using search strategies in PubMed, Embase, and ClinicalTrials.gov. Study Selection Our search strategy yielded 6196 studies. We included prospective studies that were written in English, performed in the US, and evaluated hearing loss management in adults, including amplification devices, such as hearing aids or assistive listening devices, cochlear implants, aural rehabilitation, and therapeutics. Given its prevalence, only studies that addressed bilateral sensorineural hearing loss were included. Data Extraction and Synthesis Data from 125 studies were extracted. The Preferred Reporting Items for Systematic Reviews and Meta-analyses diagram for systematic reviews was used for abstracting data. The guidelines were applied using independent extraction by multiple observers. Results Among 125 clinical studies performed from January 1990 to July 2020 regarding hearing loss management, only 16 (12.8%) reported race/ethnicity, and 88 (70.4%) reported sex. Of the 16 studies that reported race/ethnicity, only 5 included more than 30% non-White representation. Among the 88 articles that reported sex, 44 (35.2%) reported more than 45% female representation. While the mean number of participants included in the observed trials was 80 (range, 7-644), the median number of participants from racial or ethnic minority groups in studies that reported race/ethnicity was 9 (range, 1-77), and a median of 12 female participants were included in studies with a numerical breakdown by sex. A mean of 41% (range, 1.55%-77.5%) of participants were female among studies that reported sex, and a mean of 30% (range, 1.96%-100%) of participants were from racial or ethnic minority groups among the 16 studies that reported race/ethnicity. Reporting of race/ethnicity varied substantially by funding source and journal type, while reporting by sex differed only by journal type. Conclusions and Relevance Studies investigating hearing loss management do not adequately reflect the US population. A closer examination of the inclusion of diverse adults in clinical research associated with hearing health may work to ameliorate disparities and contribute to the development of tailored interventions that address the needs of an increasingly diverse US population.
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Affiliation(s)
- Corinne A Pittman
- Cochlear Center for Hearing & Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,Howard University College of Medicine, Washington, DC
| | - Raúl Roura
- Cochlear Center for Hearing & Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Carrie Price
- Albert S. Cook Library, Towson University, Towson, Maryland
| | - Frank R Lin
- Cochlear Center for Hearing & Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nicole Marrone
- Department of Speech, Language & Hearing Sciences, University of Arizona, Tucson
| | - Carrie L Nieman
- Cochlear Center for Hearing & Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, Maryland
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44
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Seewoodhary J. Black Lives Matter: tackling racial and ethnic inequalities in diabetes health care. PRACTICAL DIABETES 2021. [DOI: 10.1002/pdi.2338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Jason Seewoodhary
- BSc (Hons), MBBCh (Hons), MRCP (UK), MSc (Dist), MRCGP (UK), DRCOG (UK), General Practitioner with a Special Interest in Diabetes & Endocrinology, NHS England, UK
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45
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Louisias M, Matsui E. Disentangling the Root Causes of Racial Disparities in Asthma: The Role of Structural Racism in a 5-Year-Old Black Boy with Uncontrolled Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:1162-1164. [PMID: 32147134 DOI: 10.1016/j.jaip.2019.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/06/2019] [Accepted: 12/09/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Margee Louisias
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, Mass; Brigham and Women's Hospital, Division of Allergy and Clinical Immunology, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Elizabeth Matsui
- Dell Children's Medical Center, Austin, Texas; Dell Medical School, The University of Texas at Austin, Austin, Texas
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Cruz TM, Smith SA. Health Equity Beyond Data: Health Care Worker Perceptions of Race, Ethnicity, and Language Data Collection in Electronic Health Records. Med Care 2021; 59:379-385. [PMID: 33528233 DOI: 10.1097/mlr.0000000000001507] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent research and policy initiatives propose addressing the social determinants of health within clinical settings. One such strategy is the expansion of routine data collection on patient Race, Ethnicity, and Language (REAL) within electronic health records (EHRs). Although previous research has examined the general views of providers and patients on REAL data, few studies consider health care workers' perceptions of this data collection directly at the point of care, including how workers understand REAL data in relation to health equity. OBJECTIVE This qualitative study examines a large integrated delivery system's implementation of REAL data collection, focusing on health care workers' understanding of REAL and its impact on data's integration within EHRs. RESULTS Providers, staff, and administrators expressed apprehension over REAL data collection due to the following: (1) disagreement over data's significance, including the expected purpose of collecting REAL items; (2) perceived barriers to data retrieval, such as the lack of standardization across providers and national tensions over race and immigration; and (3) uncertainty regarding data's use (clinical decision making vs. system research) and dissemination (with whom the data may be shared; eg, public agencies, other providers, and insurers). CONCLUSION Emerging racial disparities associated with COVID-19 highlight the high stakes of REAL data collection. However, numerous barriers to health equity remain. Health care workers need greater institutional support for REAL data and related EHR initiatives. Despite data collection's central importance to policy objectives of disparity reduction, data mandates alone may be insufficient for achieving health equity.
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Affiliation(s)
- Taylor M Cruz
- Department of Sociology, California State University, Fullerton, CA
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Zhang C, Zhang J, Qiu X, Zhang Y, Lin Z, Huang P, Pan Y, Storch EA, Sun B, Li D. Deep Brain Stimulation for Parkinson's Disease During the COVID-19 Pandemic: Patient Perspective. Front Hum Neurosci 2021; 15:628105. [PMID: 33867957 PMCID: PMC8046912 DOI: 10.3389/fnhum.2021.628105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background Public health guidelines have recommended that elective medical procedures, including deep brain stimulation (DBS) surgery for Parkinson’s disease (PD), should not be scheduled during the coronavirus (COVID-19) pandemic to prevent further virus spread and overload on health care systems. However, delaying DBS surgery for PD may not be in the best interest of individual patients and is not called for in regions where virus spread is under control and inpatient facilities are not overloaded. Methods We administered a newly developed phone questionnaire to 20 consecutive patients with PD who received DBS surgery in Ruijin Hospital in Shanghai during the COVID-19 pandemic. The questionnaire was designed to gather the patients’ experiences and perceptions on the impact of COVID-19 on their everyday activities and access to medical care. Results Most of the patients felt confident about the preventive measures taken by the government and hospitals, and they have changed their daily living activities accordingly. Moreover, a large majority of patients felt confident obtaining access to regular and COVID-19-related health care services if needed. Routine clinical referral, sense of security in the hospital during the outbreak, and poor control of PD symptoms were the three main reasons given by patients for seeking DBS surgery during the COVID-19 pandemic. Conclusion The COVID-19 pandemic has considerably impacted medical care and patients’ lives but elective procedures, such as DBS surgery for PD, do not need to be rescheduled when the health care system is not overloaded and adequate public health regulations are in place.
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Affiliation(s)
- Chencheng Zhang
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai, China
| | - Jing Zhang
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xian Qiu
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yingying Zhang
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhengyu Lin
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Peng Huang
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yixin Pan
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Ostendorf SB, Kampman CJG, Hoebe CJPA, van der Velden J, Hautvast JLA, van Jaarsveld CHM. Consultation rate and chlamydia positivity among ethnic minority clients at STI clinics in the Netherlands. PLoS One 2021; 16:e0247130. [PMID: 33606805 PMCID: PMC7894949 DOI: 10.1371/journal.pone.0247130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/01/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives Although ethnic minority clients (EMs) from STI endemic countries have a higher risk for STI, little is known about their STI clinic consultation rate proportionality. The aim of this study was to assess consultation and chlamydia positivity rates among different EMs visiting STI clinics in the Netherlands. Methods We calculated consultation rates in EM groups by dividing the number of STI consultations by the total number of inhabitants in the region belonging to an EM, then compared the EM rates to native Dutch rates. Factors associated with chlamydia positivity were analysed using multivariate regression analysis. Results A total of 23,841 clients visiting an eastern Netherlands STI clinic between 2011 and 2013 were included in the analysis, of which 7% were EMs. The consultation rate of native Dutch clients was 22.5 per 1000, compared to 8.5 per 1000 among EMs. Consultation rates in all EMs were lower than in Dutch clients, except for Antillean or Aruban EMs and Latin American EMs. The chlamydia positivity rate among all clients was 15.5%, and Antillean or Aruban ethnicity (27.1%) EMs had the highest rates. Multivariate analysis identified the following factors associated with chlamydia positivity: Eastern or Northern European EM, African EM, Antillean or Aruban EM, STI related symptoms, heterosexual preference, partner in a risk group, receiving a partner notification, and having had three or more partners in the past six months. Conclusion On a population level, most EMs visit STI clinics less often than native Dutch clients, but they have a higher rate of positive chlamydia diagnoses. STI clinics should increase outreach activities for EM clients because they are insufficiently reached by current practices, but contribute substantially to chlamydia incidence rates.
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Affiliation(s)
- S. B. Ostendorf
- Public Health Service Gelderland Midden, Arnhem, The Netherlands
| | - C. J. G. Kampman
- Public Health Service Twente, Enschede, The Netherlands
- * E-mail:
| | - C. J. P. A. Hoebe
- Public Health Service South Limburg, Heerlen, The Netherlands
- Department of Social Medicine and Medical Microbiology, Maastricht University Medical Center (MUMC+), Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute Maastricht, Maastricht, The Netherlands
| | - J. van der Velden
- Department of Primary and Community Care, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - J. L. A. Hautvast
- Department of Primary and Community Care, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - C. H. M. van Jaarsveld
- Department of Primary and Community Care, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Abstract
It may seem unlikely that the field of radiology perpetuates disparities in health care, as most radiologists never interact directly with patients, and racial bias is not an obvious factor when interpreting images. However, a closer look reveals that imaging plays an important role in the propagation of disparities. For example, many advanced and resource-intensive imaging modalities, such as MRI and PET/CT, are generally less available in the hospitals frequented by people of color, and when they are available, access is impeded due to longer travel and wait times. Furthermore, their images may be of lower quality, and their interpretations may be more error prone. The aggregate effect of these imaging acquisition and interpretation disparities in conjunction with social factors is insufficiently recognized as part of the wide variation in disease outcomes seen between races in America. Understanding the nature of disparities in radiology is important to effectively deploy the resources and expertise necessary to mitigate disparities through diversity and inclusion efforts, research, and advocacy. In this article, the authors discuss disparities in access to imaging, examine their causes, and propose solutions aimed at addressing these disparities.
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Affiliation(s)
- Stephen Waite
- From the Department of Radiology, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203 (S.W., J.M.S.); and Department of Psychiatry, Weill Cornell Medical College, New York, NY (D.C.)
| | - Jinel Scott
- From the Department of Radiology, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203 (S.W., J.M.S.); and Department of Psychiatry, Weill Cornell Medical College, New York, NY (D.C.)
| | - Daria Colombo
- From the Department of Radiology, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203 (S.W., J.M.S.); and Department of Psychiatry, Weill Cornell Medical College, New York, NY (D.C.)
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50
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Structure of communities in semantic networks of biomedical research on disparities in health and sexism. ACTA ACUST UNITED AC 2020; 40:702-721. [PMID: 33275349 PMCID: PMC7808772 DOI: 10.7705/biomedica.5182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Indexed: 01/12/2023]
Abstract
Introducción. Como una iniciativa para mejorar la calidad de la atención sanitaria, en la investigación biomédica se ha incrementado la tendencia centrada en el estudio de las disparidades en salud y sexismo. Objetivo. Caracterizar la evidencia científica sobre la disparidad en salud definida como la brecha existente entre la distribución de la salud y el posible sesgo por sexo en el acceso a los servicios médicos. Materiales y métodos. Se hizo una búsqueda simultánea de la literatura científica en la base de datos Medline PubMed de dos descriptores fundamentales: Healthcare disparities y Sexism. Posteriormente, se construyó una red semántica principal y se determinaron algunas subunidades estructurales (comunidades) para el análisis de los patrones de organización de la información. Se utilizó el programa de código abierto Cytoscape para el analisis y la visualización de las redes y el MapEquation, para la detección de comunidades. Asimismo, se desarrolló código ex profeso disponible en un repositorio de acceso público. Resultados. El corpus de la red principal mostró que los términos sobre las enfermedades del corazón fueron los descriptores de condiciones médicas más concurrentes. A partir de las subunidades estructurales, se determinaron los patrones de información relacionada con las políticas públicas, los servicios de salud, los factores sociales determinantes y los factores de riesgo, pero con cierta tendencia a mantenerse indirectamente conectados con los nodos relacionados con condiciones médicas. Conclusiones. La evidencia científica indica que la disparidad por sexo sí importa para la calidad de la atención de muchas enfermedades, especialmente aquellas relacionadas con el sistema circulatorio. Sin embargo, aún se percibe un distanciamiento entre los factores médicos y los sociales que dan lugar a las posibles disparidades por sexo.
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