Missed opportunities by health care providers to reduce racial/ethnic disparities in the use of alcohol treatment services

Abstract Background In Canada, there is longstanding evidence of health inequities for racialized groups. The purpose of this study is to understand the effect of current health care policies and practices on racial/ethnic groups and in particular racialized groups at the level of the individual in Toronto’s health care system. Methods This study used a semi-qualitative study design: concept mapping. A purposive sampling strategy was used to recruit participants. Health care users and health care providers from Toronto and the Greater Toronto Area participated in all four concept mapping activities. The sample sizes varied according to the activity. For the rating activity, 41 racialized health care users, 23 non-racialized health care users and 11 health care providers completed this activity. The data analysis was completed using the concept systems software. Results Participants generated 35 unique statements of ways in which patients feel disrespect or mistreatment when receiving health care. These statements were grouped into five clusters: ‘Racial/ethnic and class discrimination’, ‘Dehumanizing the patient’, ‘Negligent communication’, ‘Professional misconduct’, and ‘Unequal access to health and health services’. Two distinct conceptual regions were identified: ‘Viewed as inferior’ and ‘Unequal medical access’. From the rating activity, racialized health care users reported ‘race’/ethnic based discrimination or everyday racism as largely contributing to the challenges experienced when receiving health care; statements rated high for action/change include ‘when the health care provider does not complete a proper assessment’, ‘when the patient’s symptoms are ignored or not taken seriously’, ‘and ‘when the health care provider belittles or talks down to the patient’. Conclusions Our study identifies how racialized health care users experience everyday racism when receiving health care and this is important to consider in the development of future research and interventions aimed at addressing institutional racism in the health care setting. To support the elimination of institutional racism, anti-racist policies are needed to move beyond cultural competence polices and towards addressing the centrality of unequal power social relations and everyday racism in the health care system.

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Ethnicity as a Factor

10.1093/oxfordhb/9780199974412.013.20 ◽

2015 ◽

Author(s):

Kimberly S. Johnson ◽

Ramona L. Rhodes

Keyword(s):

Health Care ◽

Palliative Care ◽

African Americans ◽

Health Care Providers ◽

Cultural Beliefs ◽

Ethnic Disparities ◽

Care Providers ◽

Care Services ◽

Palliative Care Services ◽

Advance Care

This chapter examines how race or ethnicity affects access to, and the quality of, palliative care by focusing on the experience of African Americans and Hispanics. More specifically, it considers how cultural beliefs, values, and preferences may influence care. It begins by looking at racial and ethnic disparities that exist throughout the health-care continuum, from disease prevention, early diagnosis, and curative treatment, to communication and pain management, lower rates of advance care planning, and lower utilization of hospice and palliative care services. It then explores the preferences of African Americans and Hispanics when it comes to end-of-life care, as well as the role of spirituality and faith in how they cope with illness. The chapter concludes by suggesting strategies and future directions for health-care providers, organizations, policymakers, and researchers on how to improve care for patients of diverse racial and ethnic backgrounds.

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Improving Behavioral Health Equity through Cultural Competence Training of Health Care Providers

Ethnicity & Disease ◽

10.18865/ed.29.s2.359 ◽

2019 ◽

Vol 29 (Supp2) ◽

pp. 359-364 ◽

Cited By ~ 3

Author(s):

Brian McGregor ◽

Allyson Belton ◽

Tracey L. Henry ◽

Glenda Wrenn ◽

Kisha B. Holden

Keyword(s):

Health Care ◽

Cultural Competence ◽

Integrated Care ◽

Health Care Providers ◽

Health Care Professionals ◽

Care Delivery ◽

Ethnic Disparities ◽

The United States ◽

Care Providers ◽

Care Needs

Racial/ethnic disparities have long persisted in the United States despite concerted health system efforts to improve access and quality of care among African Americans and Latinos. Cultural competence in the health care setting has been recognized as an important feature of high-quality health care delivery for decades and will continue to be paramount as the society in which we live becomes increasingly culturally diverse. Unfortunately, there is limited empirical evidence of patient health benefits of a culturally competent health care workforce in integrated care, its feasibility of implementation, and sustainability strategies. This article reviews the status of cultural competence education in health care, the merits of continued commitment to training health care providers in integrated care settings, and policy and practice strategies to ensure emerging health care professionals and those already in the field are prepared to meet the health care needs of racially and ethnically diverse populations. Ethn Dis. 2019;29(Supp 2):359-364. doi:10.18865/ed.29.S2.359

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Family Conference in Palliative Care

Hospice and Palliative Medicine and Supportive Care Flashcards ◽

10.1093/med/9780190633066.003.0024 ◽

2018 ◽

Author(s):

Margaret L. Isaac ◽

J. Randall Curtis

Keyword(s):

Health Care ◽

Palliative Care ◽

Health Care Providers ◽

Care Providers ◽

Therapeutic Communication ◽

Missed Opportunities ◽

Patient Navigators ◽

Family Conference ◽

Advance Care ◽

End Of Life Decision

Patients receiving palliative care often experience severe psychosocial distress, which may due to the perception of the situation, the community resources and support, educational level, comorbidities, coping skills, and socioeconomic status. However, the distress can be reduced by communication between patients, caregivers, and health care providers. Studies have shown that family conferences can be a safe and well-accepted means for communication between patients, caregivers, and health care providers in the palliative care setting. This chapter highlights key topics regarding the family conference and facilitation of patient–clinician communication in palliative care. The topics covered in this chapter include (a) key components of a family conference (e.g., the importance of listening, therapeutic communication, and missed opportunities), (b) proactive communication strategies in the intensive care unit, (c) use of patient navigators and communication facilitators to reduce family distress, and (d) the impact of advance care planning on end-of-life decision-making regarding resuscitation.

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RACIAL-ETHNIC DISPARITIES IN ATTITUDES TOWARD PASSIVE AND ACTIVE EUTHANASIA

Innovation in Aging ◽

10.1093/geroni/igz038.1590 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S426-S426

Author(s):

Sara M Moorman

Keyword(s):

Health Care Providers ◽

Assisted Suicide ◽

Ethnic Disparities ◽

Recent Experience ◽

Care Providers ◽

Physician Assisted Suicide ◽

Policy And Practice ◽

Loved One ◽

Life Project ◽

Racial Ethnic

Abstract This paper examined racial/ethnic differences in opinions about passive euthanasia (withdrawing or withholding treatment), suicide, and physician-assisted suicide. Data came from 1,832 participants in the 2013 Pew Religion and Public Life Project. Respondents from all racial/ethnic backgrounds were most likely to favor multiple forms of euthanasia. However, persons of color had a wider variety of opinions about euthanasia than did non-Hispanic whites. In multivariate multinomial logistic regressions, non-Hispanic whites had a 63% chance of approving broadly of euthanasia, while non-Hispanic blacks had a 40% chance, and Hispanics, a 49% chance. Opposition to euthanasia was most common among people with multiple disadvantages (e.g., educational attainment, immigrant status). Neither trust in health care providers nor recent experience with the death of a loved one explained these group differences. Results highlight large differences of opinion between the people who set policy and practice guidelines and those who lack this power and access.

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Engaging Informal Private Health Care Providers for TB Case Detection: Experiences from RIPEND Project in India

Tuberculosis Research and Treatment ◽

10.1155/2021/9579167 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Santosha Kelamane ◽

Srinath Satyanarayana ◽

Sharath Burugina Nagaraja ◽

Vikas Panibatla ◽

Ramesh Dasari ◽

...

Keyword(s):

Health Care ◽

Medical Care ◽

Health Care Providers ◽

Financial Incentives ◽

Sputum Smear ◽

Care Providers ◽

Project Staff ◽

Treatment Services ◽

Informal Providers ◽

The Government

Background. Informal (unqualified) health care providers are an important source of medical care for persons with presumptive TB (PPTB) in India. A project (titled RIPEND) was implemented to engage informal providers for the identification of PPTBs and TB patients in 4 districts of Telangana State, India, during October 2018-December 2019 project period. Engagement involved sensitizing the informal providers about TB, providing them financial incentives to identify PPTBs, and linking these PPTBs to diagnostic and treatment services provided by the Government of India’s National TB Elimination Programme. Objectives. To describe (a) the characteristics of the informal providers, along with their self-reported practices on TB diagnosis, treatment, and challenges encountered by the RIPEND project staff in engaging them in the project and (b) the outputs and outcomes of this engagement. Methods. We used a combination of one-on-one interviews with informal providers, group interviews with RIPEND project staff, and secondary analysis of data available within the project’s recording and reporting systems. Results. A total of 555 informal providers were actively engaged under the project. The majority (87%) had a nonmedicine-related graduate degree and had been providing medical care for more than 10 years. Most (95%) were aware that a cough for 2 weeks or more is a symptom of pulmonary TB and that such patients should be referred for sputum-smear microscopy at a government health facility. Challenges in engaging the informal providers included motivating them to participate in the study, suboptimal mobile usage for referral services, and delays in providing financial incentives to them for referring PPTBs. During the project period (October 2018-December 2019), 8342 PPTBs were identified of which 1003 TB patients were detected and linked to TB treatment services. Conclusion. This project showed that engaging informal providers is feasible and that a large number of PPTB and TB patients can be identified through this effort. The Government of India should consider engaging informal providers for the early diagnosis of TB to reduce the missing TB cases in the country.

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Health Care Providers' Missed Opportunities for Preventing Femicide

Preventive Medicine ◽

10.1006/pmed.2001.0902 ◽

2001 ◽

Vol 33 (5) ◽

pp. 373-380 ◽

Cited By ~ 88

Author(s):

Phyllis W. Sharps ◽

Jane Koziol-McLain ◽

Jacquelyn Campbell ◽

Judith McFarlane ◽

Carolyn Sachs ◽

...

Keyword(s):

Health Care ◽

Health Care Providers ◽

Care Providers ◽

Missed Opportunities

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Missed opportunities: are residents prepared to care for transgender patients? A study of family medicine, psychiatry, endocrinology, and urology residents

Canadian Medical Education Journal ◽

10.36834/cmej.42906 ◽

2018 ◽

Vol 9 (3) ◽

pp. e41-55 ◽

Cited By ~ 10

Author(s):

Alexandre Coutin ◽

Sarah Wright ◽

Christine Li ◽

Raymond Fung

Keyword(s):

Health Care ◽

Family Medicine ◽

Health Care Providers ◽

Health Care Professionals ◽

Clinical Care ◽

Care Providers ◽

Care Needs ◽

Missed Opportunities ◽

Clinical Exposure ◽

Care Education

Background: The transgender (trans) population faces multiple barriers in accessing health care, with knowledge deficits of health care providers contributing substantially. Trans patients report having to teach health care professionals about their own health needs.We compared perceptions of trans-care education and training across family medicine, psychiatry, endocrinology, and urology residency training programs at the University of Toronto. Methods: We surveyed residents to assess their perceptions of and attitudes towards trans-care, exposure to trans patients, knowledge of trans-specific clinical care, and the state of trans-care education within their training. We used Likert scale data to identify patterns across residency programs. We collected open-ended responses to further explain quantitative findings where appropriate.Results: Of 556 residents approached, 319 participated (response rate = 57.4%). Nearly all endocrinology and psychiatry residents agreed that trans-care falls within their scope of practice, while only 71% and 50% of family medicine and urology residents did, respectively. Though participants were at different stages of their postgraduate training when surveyed, only 17% of all participants predicted they would feel competent to provide specialty-specific trans-care by the end of their residency and only 12% felt that their training was adequate to care for this population.Conclusion: Though the study revealed a willingness to serve this population, there was a lack of clinical exposure and trans-related teaching within postgraduate curricula resulting in feelings of unpreparedness to meet the health care needs of this underserved population.

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Racial/Ethnic Disparities in Maternal Vaccine Knowledge, Attitudes, and Intentions

Public Health Reports ◽

10.1177/0033354920974660 ◽

2021 ◽

pp. 003335492097466

Author(s):

Matthew Z. Dudley ◽

Rupali J. Limaye ◽

Daniel A. Salmon ◽

Saad B. Omer ◽

Sean T. O’Leary ◽

...

Keyword(s):

Black Women ◽

Health Care Providers ◽

White Women ◽

Ethnic Disparities ◽

Vaccine Safety ◽

Care Providers ◽

Vaccine Acceptance ◽

Race Ethnicity ◽

Perceive Risk ◽

Racial Ethnic

Objectives Although disparities in maternal vaccine acceptance among racial/ethnic groups are well documented, the reasons for these disparities are unclear. The objective of this study was to describe differences in pregnant women’s knowledge, attitudes, beliefs, intentions, and trust regarding maternal and infant vaccines by race/ethnicity. Methods We collected survey data from 1862 pregnant women from diverse prenatal care practices in Georgia and Colorado from June 2017 through July 2018. We performed multiple logistic regressions to determine differences in intentions, knowledge, attitudes, beliefs, and trust by race/ethnicity and calculated odds ratios (ORs) and 95% CIs. Results Compared with White women, Black and Hispanic women were less confident in vaccine safety and efficacy and less likely to perceive risk of acquiring vaccine-preventable diseases, report provaccine social norms, indicate having enough vaccine knowledge, and trust vaccine information from health care providers and public health authorities. Black women were the least confident in the safety of the maternal influenza vaccine (OR = 0.37; 95% CI, 0.27-0.49); maternal tetanus, diphtheria, and acellular pertussis vaccine (OR = 0.37; 95% CI, 0.27-0.52); and infant vaccines overall (OR = 0.40; 95% CI, 0.28-0.58), and were least likely to intend to receive both maternal vaccines (OR = 0.35; 95% CI, 0.27-0.47) or all infant vaccines on time (OR = 0.45; 95% CI, 0.34-0.61) as compared with White women. Conclusions Understanding differences in behavioral constructs integral to vaccine decision making among women of different races/ethnicities can lead to tailored interventions to improve vaccine acceptance.

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