1
|
Lauwers EDL, Vandecasteele R, McMahon M, De Maesschalck S, Willems S. The patient perspective on diversity-sensitive care: a systematic review. Int J Equity Health 2024; 23:117. [PMID: 38840119 PMCID: PMC11155005 DOI: 10.1186/s12939-024-02189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/30/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The provision of diversity-sensitive care is a promising approach towards reducing health disparities. Recent criticism and a scientific gap demonstrate the need for the patient perspective on diversity-sensitive care. This systematic review aims to describe the patient perspective, including patient experiences, expectations, and satisfaction with diversity-sensitive care provided by healthcare providers. METHODS In December 2022 the Medline ALL, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO and additionally Google Scholar were searched for original studies that described or measured patient expectations, experiences, and/or satisfaction, specifically focusing on cultural or diversity competence of healthcare providers. Analysis of the collected data was performed using a convergent mixed-methods design based on thematic synthesis. RESULTS From initially 5,387 articles, 117 were selected for full-text screening, and ultimately, 34 articles were included in this study. The concept of diversity-sensitive care was observed to comprise three components. The first component is focused on patient-centered care and includes competencies such as clear and direct communication, shared decision-making, individualized care, empathy, and consideration. The second component centers on providing culturally tailored information, adjusting care to cultural needs, working with interpreters, allyship, community partnerships, self-awareness, and cultural knowledge, and builds upon the first component. Across the first two components of diversity-sensitive care, patients have reported experiencing dissatisfaction and encountering shortcomings in their healthcare providers, sometimes resulting in the third and final component pertaining to provider care. This component underscores the importance of linguistic, ethnic, cultural, and gender concordance in delivering quality care. CONCLUSION In conclusion, the patient perspective on diversity-sensitive care encompasses multiple components, from patient-centered care to concordant care. The components incorporate various competencies as communication skills, empathy, self-awareness and adjusting care to cultural needs. Patients reported experiencing dissatisfaction and shortcomings across all components of diversity-sensitive care provided by healthcare providers.
Collapse
Affiliation(s)
- Ewout Daniël Lieven Lauwers
- Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, South Holland, 3015 GD, The Netherlands.
| | - Robin Vandecasteele
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital, Campus Entrance 42, C. Heymanslaan 10, Ghent, 9000, Belgium
| | - Michael McMahon
- Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, Ghent, 9000, Belgium
| | - Stéphanie De Maesschalck
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital, Campus Entrance 42, C. Heymanslaan 10, Ghent, 9000, Belgium
| | - Sara Willems
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital, Campus Entrance 42, C. Heymanslaan 10, Ghent, 9000, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Quality & Safety Ghent, Ghent University, University Hospital, Campus Entrance 42, C. Heymanslaan 10, Ghent, 9000, Belgium
- Centre for the Social Study of Migration and Refugees, Ghent University, H. Dunantlaan 2, Ghent, 9000, Belgium
| |
Collapse
|
2
|
Vallée A. The impact of the COVID-19 pandemic on the socioeconomic gradient of hypertension. J Public Health Policy 2024:10.1057/s41271-024-00491-4. [PMID: 38831023 DOI: 10.1057/s41271-024-00491-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 06/05/2024]
Abstract
The COVID-19 pandemic has brought into sharp focus the impact of socioeconomic factors on hypertension outcomes. This review examines the implications of the pandemic on the socioeconomic gradient of hypertension and explores the physiological and pathophysiological processes underlying this relationship. Changes in socioeconomic factors have disproportionately affected individuals with lower socioeconomic status, leading to adverse hypertension outcomes. The pandemic-related stressors, coupled with social isolation and disrupted daily routines, have contributed to elevated stress levels among individuals, particularly those with lower socioeconomic status. Equitable access to healthcare, enhancing health literacy and patient empowerment, and addressing social determinants of health are essential components of hypertension management strategies. By recognizing the specific challenges faced by individuals with lower socioeconomic status and implementing targeted interventions, public health efforts can help reduce the socioeconomic gradient of hypertension.
Collapse
Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, 92150, Suresnes, France.
| |
Collapse
|
3
|
Wei H, Jiang K, Zhao Y, Pu C. Equity of health resource allocation in Chongqing, China, in 2021: a cross-sectional study. BMJ Open 2024; 14:e078987. [PMID: 38238051 PMCID: PMC10806633 DOI: 10.1136/bmjopen-2023-078987] [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] [Received: 09/07/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Chongqing, the most populous city in Southwest China. This study aims to examine the equity of health resource allocation in Chongqing using the latest statistics, analyse possible shortcomings and propose strategies to address these issues. METHODS This cross-sectional study used healthcare resource, population, area and gross domestic product data from the Seventh National Census Bulletin of Chongqing, the National County Statistical Yearbook, the Chongqing Municipal Bureau of Statistics and the Chongqing Health Statistical Yearbook 2022. We also studied the equity of health resource allocation in Chongqing by using the Gini coefficient, Lorenz curve and Theil index, and used the Analytical Hierarchy Process and Technique for Order of Preference by Similarity to Ideal Solution (AHP-TOPSIS) method to comprehensively evaluate the health resources in the four major regions of Chongqing. RESULTS The Gini coefficient of health resources in Chongqing in 2021 was the highest when allocated according to geographical area, between 0.4285 and 0.6081, both of which exceeded 0.4, and the Gini coefficient of medical equipment was the highest and exceeded 0.6. The inter-regional Theil index of each resource was greater than the intraregional Theil index, and the contribution of inter-regional differences ranged from 64.83% to 80.21%. The results of the AHP-TOPSIS method showed that the relative proximity between health resources and ideal solutions in four regions of Chongqing ranged from 0.0753 to 0.9277. CONCLUSION The allocation of health resources in Chongqing exhibits pronounced inequities, particularly in the distribution of medical equipment according to geographical area. Moreover, there exists a substantial gap in the equity of health resource allocation among the four regions of Chongqing. As such, this study emphasises the need for Chongqing, China, to prioritise the equitable allocation of health resources and increase consideration of geographic factors. Implementing measures to promote equitable allocation of health resources, particularly in geographic terms, is critical.
Collapse
Affiliation(s)
- Hao Wei
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Collaborative Innovation Center for early warning of health-related major social risks Chongqing Medical University sub center, Chongqing, China
| | - Ke Jiang
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Yong Zhao
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Child Nutrition and Health, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chuan Pu
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Collaborative Innovation Center for early warning of health-related major social risks Chongqing Medical University sub center, Chongqing, China
| |
Collapse
|
4
|
Gao Y, Guo Y, Deng J. Effects of and Prospects for the Hierarchical Medical Policy in Beijing, China. Healthcare (Basel) 2023; 11:healthcare11081067. [PMID: 37107901 PMCID: PMC10137581 DOI: 10.3390/healthcare11081067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/23/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Hierarchical medical policies are widely used worldwide to reduce healthcare costs, rationalize the use of healthcare resources, and improve accessibility and fairness of healthcare services. However, few case studies have evaluated the effects and prospects of such policies. Medical reform efforts in China have distinct goals and characteristics. Therefore, we investigated the effects of a hierarchical medical policy in Beijing and assessed the future potential of the policy to yield insights for other countries, especially developing countries. Different methods were used to analyze multidimensional data from official statistics, a questionnaire survey of 595 healthcare workers from 8 representative public hospitals in Beijing, a questionnaire survey of 536 patients, and 8 semi-structured interview records. The hierarchical medical policy had strong positive effects on improving access to healthcare services, balancing the workload of healthcare workers in various levels of public hospitals, and improving the management of public hospitals. The remaining obstacles include severe job stress among healthcare workers, the high cost of some healthcare services, and the need for improvement in the development level and service capacity of primary hospitals. This study provides useful policy recommendations regarding the implementation and extension of the hierarchical medical policy, including the need for governments to improve the hospital assessment system and for hospitals to actively participate in developing medical partnerships.
Collapse
Affiliation(s)
- Yongchuang Gao
- School of Labor and Human Resources, Renmin University of China, 59 Zhongguancun Street, Beijing 100872, China
| | - Yuangeng Guo
- School of Economics and Management, Tsinghua University, 30 Shuangqing Street, Beijing 100084, China
| | - Jianwei Deng
- School of Management and Economics, Beijing Institute of Technology, 5 Zhongguancun South Street, Beijing 100081, China
- Sustainable Development Research Institute for Economy and Society of Beijing, 5 Zhongguancun South Street, Beijing 100081, China
| |
Collapse
|
5
|
Yang C, Cui D, Yin S, Wu R, Ke X, Liu X, Yang Y, Sun Y, Xu L, Teng C. Fiscal autonomy of subnational governments and equity in healthcare resource allocation: Evidence from China. Front Public Health 2022; 10:989625. [PMID: 36249207 PMCID: PMC9561467 DOI: 10.3389/fpubh.2022.989625] [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: 07/08/2022] [Accepted: 09/08/2022] [Indexed: 01/26/2023] Open
Abstract
Objectives Promoting equity in healthcare resource allocation (EHRA) has become a critical political agenda of governments at all levels since the ambitious Universal Health Coverage was launched in China in 2009, while the role of an important institutional variable-fiscal autonomy of subnational governments-is often overlooked. The present study was designed to determine the effect of FASG on EHRA and its potential mechanism of action and heterogeneity characteristics to provide empirical support for the research field expansion and relative policies making of EHRA. Methods From the start, we utilized the Theil index and the entropy method to calculate the EHRA index of 22 provinces (2011-2020) based on the medical resource data of 287 prefecture-level cities. Furthermore, we used the two-way fixed effects model (FE) to identify and analyze the impact of FASG on EHRA and then used three robustness test strategies and two-stage least squares (2SLS) regression to verify the reliability of the conclusions and deal with potential endogeneity problems, respectively. At last, we extend the baseline regression model and obtain the two-way FE threshold model for conducting heterogeneity analysis, which makes us verify whether the baseline model has nonlinear characteristics. Results The static value and the trend of interannual changes in the EHRA values in different provinces are both very different. The regression results of the two-way FE model show that FASG has a significant positive impact on EHRA, and the corresponding estimated coefficient is - 0.0849 (P < 0.01). Moreover, this promotion effect can be reflected through two channels: enhancing the intensity of government health expenditure (IGHE) and optimizing the allocation of human resources for health (AHRH). At last, under the different economic and demographic constraints, the impact of FASG on EHRA has nonlinear characteristics, i.e., after crossing a specific threshold of per capita DGP (PGDP) and population density (PD), the promotion effect is reduced until it is not statistically significant, while after crossing a particular threshold of dependency ratio (DR), the promotion effect is further strengthened and still statistically significant. Conclusions FASG plays an essential role in promoting EHRA, which shows that subnational governments need to attach great importance to the construction of fiscal capability in the allocation of health care resources, effectively improve the equity of medical and health fiscal expenditures, and promote the sustainable improvement of the level of EHRA.
Collapse
Affiliation(s)
- Ciran Yang
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China,Global Health Institute, Wuhan University, Wuhan, China
| | - Dan Cui
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China,Global Health Institute, Wuhan University, Wuhan, China,*Correspondence: Dan Cui
| | - Shicheng Yin
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China,Global Health Institute, Wuhan University, Wuhan, China
| | - Ruonan Wu
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China,Global Health Institute, Wuhan University, Wuhan, China
| | - Xinfeng Ke
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China,Global Health Institute, Wuhan University, Wuhan, China
| | - Xiaojun Liu
- Public Health School, Fujian Medical University, Fuzhou, China
| | - Ying Yang
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China,Global Health Institute, Wuhan University, Wuhan, China
| | - Yixuan Sun
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China,Global Health Institute, Wuhan University, Wuhan, China
| | - Luxinyi Xu
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China,Global Health Institute, Wuhan University, Wuhan, China
| | - Caixia Teng
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China,Global Health Institute, Wuhan University, Wuhan, China
| |
Collapse
|
6
|
Purtell R, Tam RP, Avondet E, Gradick K. We are part of the problem: the role of children's hospitals in addressing health inequity. Hosp Pract (1995) 2021; 49:445-455. [PMID: 35061953 DOI: 10.1080/21548331.2022.2032072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
Racism is an ongoing public health crisis that undermines health equity for all children in hospitals across our nation. The presence and impact of institutionalized racism contributes to health inequity and is under described in the medical literature. In this review, we focus on key interdependent areas to foster inclusion, diversity, and equity in Children's Hospitals, including 1) promotion of workforce diversity 2) provision of anti-racist, equitable hospital patient care, and 3) prioritization of academic scholarship focused on health equity research, quality improvement, medical education, and advocacy. We discuss the implications for clinical and academic practice.Plain Language Summary: Racism in Children's Hospitals harms children. We as health-care providers and hospital systems are part of the problem. We reviewed the literature for the best ways to foster inclusion, diversity, and equity in hospitals. Hospitals can be leaders in improving child health equity by supporting a more diverse workforce, providing anti-racist patient care, and prioritizing health equity scholarship.
Collapse
Affiliation(s)
- Rebecca Purtell
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Reena P Tam
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Erin Avondet
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Katie Gradick
- Assistant Professor of Pediatrics, Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| |
Collapse
|
7
|
Gender Inequalities in Health and Their Effect on the Economic Prosperity Represented by the GDP of Selected Developed Countries-Empirical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103555. [PMID: 32438655 PMCID: PMC7277572 DOI: 10.3390/ijerph17103555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 12/16/2022]
Abstract
The objective is to evaluate the relations between gender health inequalities and economic prosperity in the Organisation for Economic Co-operation and Development (OECD) countries. The groups included health indicators in the specification of men, women and gender inequalities: life expectancy, causes of mortality and avoidable mortality. The variable determining the economic prosperity was represented by the Gross Domestic Product (GDP). The analytical processing included descriptive analysis, analysis of differences and analysis of relationships. The regression analysis was presented as the main output of the research. Most of the significant gender differences in health showed a more positive outcome for women. It is possible to identify a certain relation between gender health inequalities and economic prosperity. If there is some reduction in gender inequalities in health, the economic prosperity will increase. The reduction seems to be more effective on the part of men than women. The output of the cluster analysis showed the relations of indicators evaluating the inequalities and the prosperity. The countries such as Luxembourg, Norway or Switzerland showed very positive outputs, on the other hand, the countries with a potential for the improvement are Lithuania, Latvia or Estonia. Overall, the policies should focus on reducing the inequalities in avoidable mortality as well as reducing the frequent diseases in younger people.
Collapse
|