Factors Associated With, and Mitigation Strategies for, Healthcare Disparities Faced by Patients With Headache Disorders

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012261
Author(s):  
Jessica Kiarashi ◽  
Juliana VanderPluym ◽  
Christina L. Szperka ◽  
Scott Turner ◽  
Mia T. Minen ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Cultural Sensitivity ◽  
Healthcare Disparities ◽  
Community Outreach ◽  
Primary Care Providers ◽  
Mitigation Strategies ◽  
Care Providers ◽  
Headache Disorders ◽  
Pubmed Search ◽  
Underserved Groups

ObjectiveTo review the contemporary issues of healthcare disparities in Headache Medicine with regard to race/ethnicity, socioeconomic status and geography and propose solutions for addressing these disparities.MethodsAn internet and PubMed search was performed and literature was reviewed for key concepts underpinning disparities in Headache Medicine. Content was refined to areas most salient to our goal of informing the provision of equitable care in headache treatment through discussions with this group of 16 experts from a range of headache subspecialties.ResultsTaken together, a multitude of factors including racism, socioeconomic status and insurance status and geographical disparities contribute to the inequities that exist within the healthcare system when treating headache disorders. Interventions such as improving public education, advocacy, optimizing telemedicine, engaging in community outreach to educate primary care providers, training providers in cultural sensitivity and competence and implicit bias, addressing health literacy and developing recruitment strategies to increase representation of underserved groups within headache research are proposed as solutions to ameliorate disparities.ConclusionNeurologists have a responsibility to provide and deliver equitable care to all. It is important that disparities in the management of headache disorders are identified and addressed.

scholarly journals Promoting Healthy Aging of Individuals With Developmental Disabilities

2016 ◽  
Vol 39 (2) ◽  
pp. 234-251
Author(s):  
Anne E. Roll ◽  
Barbara J. Bowers
Keyword(s):  
Developmental Disabilities ◽  
Healthy Aging ◽  
Community Outreach ◽  
Primary Care Providers ◽  
Nursing Program ◽  
Care Providers ◽  
Daily Work ◽  
Home Support ◽  
Community Based Programs

This qualitative case study sought to examine an innovative community outreach nursing program designed to promote healthy aging for more than 250 individuals with intellectual or developmental disabilities living in the community. We analyzed 10 in-depth interviews, one focus group, and various documents using thematic analysis. We researched why the program emerged and found the reasons to be improving the communication with primary care providers, providing person-centered health care, and building on and contributing to existing community-based programs. Findings on what the daily work of community outreach nurses with individuals with intellectual or developmental disabilities entailed, included person-centered health education, advocacy for the safe return home, support for staff to understand that health issues can lead to behavior changes, and enabling social participation. This case study may inspire further research or help others develop similar programs.

scholarly journals Clinical and Socioeconomic Predictors of Palliative Care Utilization

2021 ◽  
Author(s):  
Rohan Tummala ◽  
Andrew de Jesus ◽  
Natasha Tillett ◽  
Jeffrey Nelson ◽  
Christine Lamey
Keyword(s):  
Primary Care ◽  
Socioeconomic Status ◽  
Palliative Care ◽  
Primary Care Providers ◽  
Care Utilization ◽  
Care Providers ◽  
Lower Systolic Blood Pressure ◽  
Care Clinic ◽  
Hospital Referral ◽  
Primary Care Patients

INTRODUCTION: Palliative care continues to gain recognition among primary care providers, as patients suffering from chronic conditions may benefit from use of this growing service. OBJECTIVES: This single-institution quality improvement study investigates the clinical characteristics and socioeconomic status (SES) of palliative care patients and identifies predictors of palliative care utilization. METHODS: Retrospective chart review was used to compare clinical and SES parameters for three groups of patients: (1) palliative care patients who attended at least one visit since the inception of the University Clinical Health Palliative Care Clinic in Memphis, TN in October 2018 (n = 61), (2) palliative care patients who did not attend any appointments (n = 19), and (3) a randomized group of age-matched primary care patients seen by one provider from May 2018 to May 2019 (n = 36). A Poisson regression model with backward conditional variable selection was used to determine predictors of palliative care utilization. RESULTS: Patients across the three care groups did not differ in demographic parameters. Compared to palliative care-referred non-users and primary care patients, palliative care patients tended to have lower health risk (p < 0.001). Palliative care patients did not differ from primary care patients in socioeconomic status but did differ in comorbidity distribution, having a higher prevalence of cancer (𝜒2 = 14.648, df = 7, p = 0.041). Chance of 10-year survival did not differ across risk categories for palliative care patients but was significantly lower for very high-risk compared to moderate-risk primary care patients (30% vs. 78%, p = 0.019). Significant predictors of palliative care use and their corresponding incidence rate ratios (IRR) were hospital referral (IRR = 1.471; p = 0.039), higher number of prescribed medications (IRR = 1.045; p = 0.003), lower Charlson Comorbidity Index (IRR = 0.907; p = 0.003), and lower systolic blood pressure (IRR = 0.989; p = 0.004). CONCLUSIONS: Patients who are expected to benefit from and of being high utilizers of palliative care may experience greater clinical benefit from earlier referral to this service.

scholarly journals Comprehensive Obesity Education for Family Medicine Residents

PRiMER ◽  
2020 ◽  
Vol 4 ◽  
Author(s):  
Birgit Khandalavala ◽  
Jessica Koran-Scholl ◽  
Jenenne Geske
Keyword(s):  
Family Medicine ◽  
Implicit Bias ◽  
Primary Care Providers ◽  
Mitigation Strategies ◽  
Care Providers ◽  
Patient Centered ◽  
Obesity Bias ◽  
Health Expert ◽  
Centered Care ◽  
Family Medicine Residents

Background: Family medicine residents receive limited education on obesity management and obesity bias. Weight stigmatization is prevalent in primary care providers and trainees, and early mitigation is critical to optimize patient-centered care. Recent Provider Competencies for the Prevention and Management of Obesity include obesity bias. This report is intended to fill a current gap in obesity education for family medicine residents. Methods: An interprofessional obesity teaching half day for family medicine residents incorporated the Provider Competencies and focused on five modules that addressed complexities of obesity and its clinical management. The obesity bias module focused on both explicit and implicit bias, assessment of implicit bias, preferential language usage, and mitigation strategies. An obesity-simulation empathy suit was available, and a public health expert described successful obesity care in a patient-centered medical home. Family medicine residents were surveyed prior to, immediately after the half-day of obesity teaching, and 15 months later. Results: Survey results indicated 39.3% of residents had no previous biopsychosocial obesity education. Residents believed the content moderately (68.8%) or mostly (12.5%) impacted their approach to working with patients with obesity. Residents’ comfort in working with patients with obesity as well as their perceived understanding of their own biases increased immediately after the intervention and was sustained 15 months later. Conclusions: Our results suggest that a half day of obesity teaching can have a positive and sustained impact on family medicine residents. Additionally, this educational experience allowed for greater individual awareness building and insight regarding implicit bias. Such education for family medicine residents fills an identified gap in obesity education.

scholarly journals Exploring the Provider Preferences of Multiracial Patients

2019 ◽  
Vol 7 (4) ◽  
pp. 479-483
Author(s):  
Cyndy R Snyder ◽  
Anjali R Truitt
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Cultural Sensitivity ◽  
Health Care Professionals ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Primary Care Providers ◽  
Care Providers ◽  
Patient Provider Communication ◽  
Race Concordance

Background: Patient–provider race concordance has been argued as one way to improve patient–provider communication, patient satisfaction, and even patient outcomes. However, much of this literature focuses on or assumes that both patients and providers identify with only one race. Objective: The purpose of this study was to understand multiracial patients’ preferences in choosing a health-care provider. Methods: We conducted 15 interviews and 3 focus groups. We performed a directed content analysis to understand participants’ expressed preferences. Results: Thirty-one participants shared their health-care preferences. Participants described proximity to their homes or work, convenience in terms of availability, and health insurance coverage as reasons for selecting a provider. The majority articulated preferences related to provider gender and race. However, participants noted key barriers to receiving care from their preferred providers. Conclusion: This study highlights the preferences for health-care providers and the factors influencing those preferences and decisions among multiracial individuals. Findings illustrate the need to increase health workforce diversity, especially among primary care providers. Findings also show the need for increased empathy and cultural sensitivity among health-care professionals.

scholarly journals Priming primary care providers to engage in evidence-based discussions about cannabis with patients

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Devan Kansagara ◽  
William C. Becker ◽  
Chelsea Ayers ◽  
Jeanette M. Tetrault
Keyword(s):  
Risk Mitigation ◽  
Primary Care Providers ◽  
Cannabis Use ◽  
Mitigation Strategies ◽  
Current Evidence ◽  
Evidence Based ◽  
Care Providers ◽  
Risk Mitigation Strategies ◽  
Practical Guidance ◽  
Withdrawal Syndromes

AbstractCannabis use has become increasingly common in the U.S. in recent years, with legalization for medical and recreational purposes expanding to more states. With this increase in use and access, providers should be prepared to have more conversations with patients about use. This review provides an overview of cannabis terminology, pharmacology, benefits, harms, and risk mitigation strategies to help providers engage in these discussions with their patients. Current evidence for the medical use of cannabis, cannabis-related diagnoses including cannabis use disorder (CUD) and withdrawal syndromes, and the co-use of opioids and cannabis are discussed. It is crucial that providers have the tools and information they need to deliver consistent, evidence-based assessment, treatment, prevention and harm-reduction, and we offer practical guidance in these areas.

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

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