Equitable Health Care System Research Articles

Harnessing fast and slow thinking to ensure sustainability of general practice and functional universal health coverage in Australia.

Harnessing fast and slow thinking to ensure sustainability of general practice and functional universal health coverage in Australia.

Training to Build Antiracist, Equitable Health Care Systems

All clinicians should provide high-quality, safe, and equitable care to every patient and community. Yet, in practice, health care delivery systems are designed and organized to exacerbate inequity in access and outcomes, and clinicians are incentivized to deliver unequal and inequitable care in deeply segregated academic health centers that are structured to reify white supremacy. This article investigates the nature and scope of health professions educators' obligations to acknowledge harms of segregation in health care as widespread, unjust, iatrogenic, and preventable.

Artificial Intelligence in Addressing Cost, Efficiency, and Access Challenges in Healthcare

Objective: The healthcare industry is undergoing a transformative phase marked by rising costs and a shortage of healthcare professionals, necessitating the adoption of information technology-based solutions (Shaheen, 2021). Methods: This study explores the integration of artificial intelligence (AI) in addressing these challenges and enhancing healthcare systems. Using a systematic literature review, we examined the role of AI in overcoming issues such as limited access, high costs, inefficiencies, and an aging population (Greenberg et al., 2020; Maphumulo & Bhengu, 2019). Our analysis focused on applications of AI in drug discovery, clinical trials, and patient care, including intelligent care systems and healthcare robotics (Chan et al., 2019; Vaishya et al., 2020). Results: The findings suggest that AI significantly accelerates drug discovery, streamlines clinical trials, and improves patient outcomes through advanced diagnostics and treatment support (Díaz et al., 2019; Woo, 2019). AI has proven particularly effective during the COVID-19 pandemic, where it aided in diagnosis, contact tracing, and treatment decision-making, highlighting its potential to address existing vulnerabilities in healthcare systems (Pavli et al., 2021). Conclusion: AI offers a paradigm shift in healthcare by providing clinicians with real-time access to robust clinical evidence and best practices, reducing reliance on anecdotal experience and cognitive biases (McNeill & Walton, 2002; Shaheen, 2021a). By harnessing the power of AI, healthcare systems can improve efficiency, reduce costs, and enhance patient outcomes, marking a significant step towards a more efficient, effective, and equitable healthcare system (Mayorga-Ruiz et al., 2019; Luengo-Oroz et al., 2020).

Strengthening health care in Canada post-COVID-19 pandemic

The purpose of this policy briefing is to examine our health care systems through the lens of the COVID-19 pandemic and identify how we can strengthen health care in Canada post-pandemic. The COVID-19 pandemic has provided compelling evidence that substantive changes to our health care systems are needed. Specifically, the pandemic has emphasized structural inequities on a broad scale within Canadian society. These include systemic racial and socioeconomic inequities that must be addressed broadly, including in the delivery of health care. We make recommendations about what we can do to emerge stronger from the pandemic. While these recommendations are not novel, how they are framed and contextualized differs because of the problems in our health care system that have been highlighted and exacerbated by the pandemic.The evidence is clear that socioeconomic circumstances, intergenerational trauma, adverse early life experiences, and educational opportunities are critical factors when it comes to health over the life course. Given the problems in the delivery of health care that the pandemic has revealed, we need a different approach. How health care was organized prior to the COVID-19 pandemic did not produce what people wanted and needed in terms of health care and outcomes. How do we emerge from COVID-19 with an effective, equitable, and resilient health care system for all Canadians? To address health inequities and emerge from the pandemic with strengthened health care in Canada, we must consider how Amartya Sen's capabilities framework on social well-being can be operationalized to achieve better health care and health outcomes. Specifically, we address the need to: strengthen primary care and improve access to primary care; utilize a community-embedded approach to care; and implement better integration across the care continuum, including integration between primary care and public health. Coherent governance and leadership that are charged with realizing benefits through collaboration will maximize outcomes and promote sustainability. Only when we provide access to high-quality culturally competent care that is centered around the individual and their needs will we be able to make true headway in addressing these long-standing health inequities.

Culturally responsive psychological assessment with racially and ethnically diverse older adults.

The older adult population in the United States (U.S.) is becoming more racially and ethnically diverse, whereas most practicing neuropsychologists are white. Psychologists hold social privilege of which they may not be aware and work in health care systems that benefit the racial majority. System-level change is necessary to create a more equitable and accessible health care system for racially and ethnically diverse older adults. It is vital for the field of psychology to understand how oppression, power, and privilege impact the accessibility, reliability, and effectiveness of psychological assessment. The aim of this article is to address how historical medical injustices, poor education quality, barriers to communication, biases, and intersectionality influence psychological evaluations. Via a selective literature review, we illustrate how these issues apply to working with racially and ethnically diverse older adults. We discuss the historical context of the multicultural approach to assessment; system- and interpersonal-level manifestations of oppression; and age-cohort-related considerations. A clinical vignette illustrates how oppression, power, and privilege can manifest in the context of an evaluation. We issue a commentary and call to action, charging psychologists to implement individual- and system-level change. We provide recommendations for culturally responsive psychological assessments. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Social Deprivation and Post-TAVR Outcomes in Ontario, Canada: A Population-Based Study.

Background Transcatheter aortic valve replacement (TAVR)/intervention has become the standard of care for treatment of severe aortic stenosis across the spectrum of risk. There are socioeconomic disparities in access to TAVR. The impact of these disparities on postprocedural outcomes remains unknown. Our objective was to examine the association between neighborhood-level social deprivation and post-TAVR mortality and hospital readmission. Methods and Results We conducted a population-based retrospective cohort study of all 4145 patients in Ontario, Canada, who received TAVR from April 1, 2017, to March 31, 2020. Our co-primary outcomes were 1-year postprocedure mortality and 1-year postprocedure readmission. Using Cox proportional hazards models for mortality and cause-specific competing risk hazard models for readmission, we evaluated the relationship between neighborhood-level measures of residential instability, material deprivation, and concentration of racial and ethnic groups with post-TAVR outcomes. After multivariable adjustment, we found a statistically significant relationship between residential instability and postprocedural 1-year mortality, ranging from a hazard ratio of 1.64 to a hazard ratio of 2.05. There was a significant association between the highest degree of residential instability and 1-year readmission (hazard ratio, 1.23 [95% CI, 1.01-1.49]). There was no association between material deprivation and concentration of racial and ethnic groups with post-TAVR outcomes. Conclusions Residential instability was associated with increased risk for post-TAVR mortality, and the highest quintile of residential instability was associated with increased post-TAVR readmission. To reduce health disparities and promote an equitable health care system, further research and policy interventions will be required to identify and support economically and socially minoritized patients undergoing TAVR.

System-Level Changes to Better Support Women Survivors of Intimate Partner Violence and Traumatic Brain Injury

<h3>Research Objectives</h3> Traumatic brain injury (TBI) occurring during intimate partner violence (IPV) is a largely unrecognized but significant public health crisis. One in 3 women will experience IPV in their lifetime, up to 75% of whom will sustain a TBI as a result. Our main objectives were to: (1) Identify key needs, facilitators, and barriers to care for women survivors of IPV presenting with TBI (2) Cocreate ideas for resources and principles for identification, clinical care, and support for healthcare practitioners who treat women exposed to IPV and TBI. <h3>Design</h3> Data were gathered through small group breakout sessions using semi-structured discussion guides. Sessions were recorded, transcribed verbatim, and analyzed using thematic analysis techniques. Stakeholders contributed to the analysis and knowledge translation through member-checking activities. <h3>Setting</h3> The study took place in the community using a community-based participatory research approach, and was conducted through 2 half-day virtual meetings. <h3>Participants</h3> We engaged 30 stakeholders drawn from a national IPV-TBI Knowledge-to-Practice (K2P) Network including diverse women survivors, service providers, researchers, and decision makers. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> N/A. <h3>Results</h3> Three main systems-level themes arose during these discussions: (1) the need for trauma-informed, anti-racist, and equitable health and social care systems; (2) the need for cross-pollination of knowledge between disciplines; and (3) the need for systems-level support for integrated and coordinated care. This presentation will explore these needs and will provide recommendations and suggestions for paths forward. <h3>Conclusions</h3> The findings of this project enhance understanding of system-level needs among women survivors and provide a template for a national agenda for IPV-TBI research and practice. <h3>Author(s) Disclosures</h3> The authors declare no conflicts of interest.

Strategies to strengthen non-governmental organizations' participation in the Iranian health system.

Non-governmental organizations (NGOs) added a new dimension to intersectoral action for health. Involving the NGOs in health system strengthening could lead to a more efficient, equitable, and better-governed healthcare system. This qualitative study explored effective strategies for NGO participation in the Iranian health system to achieve broader health system goals. We conducted 33 semi-structured interviews with health policymakers and planners, NGO actors at the national and provincial levels, and other key informants. The qualitative data were analyzed through a thematic analysis approach. Trustworthiness in the study was observed at all stages of the study. Four main themes- were identified: empowerment for learning leadership and management skills, creating active participation in policy-making, capacity building for participation, clarifying participation process, falling into 17 sub-themes. Along with the government and health sector policymakers, NGOs may have a significant role in improving health system goals and increasing equity, social responsiveness, financial risk protection, and efficiency. The participation of NGOs in the Iranian health system is a complex process. All elements and dimensions of this process need to be considered when developing a platform for the appropriate participation of NGOs in the health system functions. Evidence-informed strategies for strengthening the participation of NGOs in the health system should be used to utilize NGOs potential to the fullest.

Charting the Course Toward More Equitable Health Care Systems.

Departments of Health Policy, Epidemiology and Population Health, and (by courtesy) Pediatrics, Stanford School of Medicine, Stanford, CA Adams receives funding from the Diabetes Research for Equity through Advanced Multilevel Science Center for Diabetes Translational Research (DREAMS-CDTR) (P30 DK092924) and the Stanford Cancer Institute (P30 CA124435). She is also supported by an endowment through the Stanford Cancer Institute as the Stanford Medicine Innovation Professor. The author declares no conflict of interest. Correspondence to: Alyce S. Adams, PhD, 300 Pasteur Drive, Room M121K, Stanford, CA 94305. E-mail: [email protected].

How vulnerable are high-income countries to the covid-19 pandemic? An MCDM approach

This paper tries to determine the most vulnerable points of high–income countries during the Covid-19 pandemic in an MCDM setting. For this aim, we use the entropy method to obtain criteria weights and the PIV method for the comparisons. We employ a wide range of criteria that account for political, demographic, capacity, and Covid-19 indicators including vaccination. Our sample consists of 40 HICs. The results reveal that countries with less equitable healthcare systems and with more vaccine hesitancy are more vulnerable to Covid-19. Hospital bed capacity, a strict government policy, and a lower percentage of the population who smoke add to the success of countries in this combat. We compare our findings with SAW and MAUT techniques as well and obtain very similar rankings. Therefore, we conclude that the PIV method can be used for national performance evaluations with a reduced rank reversal problem and computational simplicity.

Healthcare in Her Shoes

Subjects within the realm of a woman’s reproductive health have been greatly debated for decades and the controversy that surrounds them does not appear to be dissipating any time soon. Thousands of articles are published annually on the topics of abortion, female sterilization, their associated ethical dilemmas, and the disparities that women face in the healthcare system. Although we have made great strides in creating an equitable healthcare system, there are still changes to be made. I would argue that women face a disproportional degree of stigmatization, bias, and unethical policy when it comes to their reproductive healthcare, and my aim is to highlight some realistic examples of what this may look like. Broadcasting these issues and encouraging others to think about them allows disparities to be more greatly recognized and thus better able to be dismantled.

The Medical and Health Humanities in the Middle East: Report on the Meeting of the 2nd International Conference on the Medical Humanities in the Middle East (online) in Doha, Qatar

The Medical and Health Humanities in the Middle East: Report on the Meeting of the 2nd International Conference on the Medical Humanities in the Middle East (online) in Doha, Qatar

Improving Access and Health Outcomes in Palliative Care through Cultural Competence: An exploration of opportunities and challenges in India.

People who belong to ethnic, racial and cultural minorities often have less access to healthcare and have poorer health outcomes when compared to the majority population. In the COVID pandemic, too, health disparities have been observed. Similar disparities have been noted in patients with advanced disease and suffering from pain, with minority patients having less access to or making less use of palliative care. In the US, a range of solutions has been proposed to address the issue of inequality in access to healthcare, with cultural competence figuring prominently among them. This study explores whether and how cultural competence may be applied to palliative care in India to improve access and health outcomes. In the literature, it is argued that, in diverse societies, cultural competence is an essential part of the solution towards equitable healthcare systems. Solutions to problems of healthcare disparities must go beyond an increase in financial resources as more financial resources will not necessarily make the healthcare system more equitable. A culturally competent system recognises and integrates at all levels the culture as a significant component of care, which is particularly relevant at the end of life. If efficiently implemented, cultural competence will lead to higher patient satisfaction, better follow-up and patient compliance and an improved reputation of palliative care among minorities. This may help to reduce inequalities in access and health outcomes in palliative care.

Access to health care perceived by parents caring for their child at home supported by eHealth—a directed approach introducing aperture

BackgroundIn recent years a variety of eHealth solutions has been introduced to enhance efficiency and to empower patients, leading to a more accessible and equitable health care system. Within pediatric care eHealth has been advocated to reduce emergency and hospital outpatient visits, with many parents preferring eHealth to physical visits following the transition from hospital to home. Still, not many studies have focused on access from the parental perspective. Therefore, the aim of the study was to analyze access to health care as perceived by parents when caring for their child at home, with conventional care supported by eHealth following pediatric surgery or preterm birth.MethodsTwenty-five parents who went home with their child following hospitalization and received conventional care supported by eHealth (a tablet) were interviewed in this qualitative study. Directed content analysis was used, guided by a framework for dimensions of access previously described as: approachability, acceptability, affordability, appropriateness, and availability.ResultsAll dimensions of access were present in the material with the dimensions of approachability, appropriateness and acceptability most frequently emphasized. The dimensions highlighted a strong acceptance of eHealth, which was perceived by the parents as beneficial, particularly access to communication with health care personnel familiar to them. The chat function of the tablet was often mentioned as positive. A new dimension was also identified: “aperture.” It is defined by the pathways by which communication is transmitted in cyberspace, and these pathways are not easily visualized for parents submitting information, therefore generating concerns.ConclusionsParents generally experienced good access to the eHealth-supported health care. Describing access through its dimensions complemented previous descriptions of eHealth in pediatric care and gave new insights. As such, the new dimension of “aperture”, the indeterminate opening of pathways of communication reflecting the uncertainty of not comprehending cyberspace, could be further evaluated. The dimensional framework of access is recommended when evaluating eHealth in the future.Trial registrationClinicalTrials.gov identifier: NCT04150120.

Healthcare disparity and its associations with cytomegalovirus disease in pediatric liver transplant recipients in South Africa.

Cytomegalovirus (CMV) infection and disease are preventable complications following pediatric liver transplantation (PLT), despite the use of prophylaxis to minimize the risk of CMV disease. We evaluated the incidence and complications of CMV disease in PLT recipients in South Africa (SA), with particular reference to potential differences in outcome between state and private sector patients. Medical records of patients younger than 16 years of age who received liver transplants between January 1, 2012, and August 31, 2018 were analyzed. Records of all 150 PLT patients were retrieved. The median age at transplant was 29.2 months (95% confidence interval 15.6-58.4) and follow-up was 46.3 months (interquartile range 27.6-63.1). Sixty-six (44%) patients were high risk, 79 (52.7%) were intermediate risk, and five (3.3%) were low risk for CMV infection. Forty-three (28.9%) patients had CMV DNAemia following transplantation, and 30 (20.1%) developed CMV disease. Receipt of care in the private sector was consistently associated with a lower hazard of CMV disease (adjusted hazard ratio [aHR] ranging from 0.36 to 0.43) and a consistently lower hazard of death among recipients at high risk for CMV disease and/or those who developed CMV disease (aHR ranging from 0.28 to 0.33). Receipt of care in the private health sector was associated with a consistently lower hazard of CMV disease and death in individuals with CMV disease and/or at high risk for CMV disease. Policies aimed at creating a more equitable healthcare system in SA may mitigate the differential burden of illness associated with CMV in PLT recipients.

Are Black Girls Exhibiting Puberty Earlier? Examining Implications of Race-Based Guidelines.

Are Black Girls Exhibiting Puberty Earlier? Examining Implications of Race-Based Guidelines.

Exploring the Equity Impact of Current Digital Health Design Practices: Protocol for a Scoping Review.

BackgroundThe field of digital health has grown rapidly in part due to digital health tools’ potential to reduce health inequities. However, such potential has not always been realized. The design approaches used in digital health are one of the known aspects that have an impact on health equity.ObjectiveThe aim of our scoping review will be to understand how design approaches in digital health have an impact on health equity.MethodsA scoping review of studies that describe how design practices for digital health have an impact on health equity will be carried out. The scoping review will follow the methodologies laid out by Arksey and O’Malley, the Joanna Briggs Institute, and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The PubMed, Embase, Web of Science, and ACM Digital Library databases will be searched for peer-reviewed papers. The ProQuest Dissertations and Theses and Global Index Medicus databases will be searched for gray literature. The results will be screened against our inclusion and exclusion criteria. Subsequently, the data extracted from the included studies will be analyzed.ResultsAs of March 2022, a preliminary search of the peer-reviewed databases has yielded over 4900 studies, and more are anticipated when gray literature databases are searched. We expect that after duplicates are removed and screening is completed, a much smaller number of studies will meet all of our inclusion criteria.ConclusionsAlthough there has been much discussion about the importance of design for lowering barriers to digital health participation, the evidence base demonstrating its impacts on health equity is less obvious. We hope that our findings will contribute to a better understanding of the impact that design in digital health has on health equity and that these findings will translate into action that leads to stronger, more equitable health care systems.

From Strategy to Implementation: Optimizing the Contribution of Health Services and Policy Research to Equitable Healthcare System Transformation.

The Canadian Institutes of Health Research - Institute of Health Services and Policy Research's (IHSPR) Strategic Plan 2021-2026 (CIHR IHSPR 2021) aims to accelerate healthcare system transformation to achieve the Quadruple Aim and health equity through research. This special issue features a collection of commentaries from academic and health system leaders who were invited to respond to IHSPR's strategic plan and share insights regarding the opportunities the plan presents and areas where more attention may be needed. The present paper features a response from the IHSPR team and outlines the next steps regarding implementation. IHSPR is deeply grateful to the commentary authors for their insight, advice and recommendations, which will help to inform the implementation of the plan.

The American Public Health Association Endorses Single-Payer Health System Reform.

Health care is a human right. Achieving universal health insurance coverage for all US residents requires significant system-wide reform. The most equitable and cost-effective health care system is a public, single-payer (SP) system. The rapid growth in national health expenditures can be addressed through a system that yields net savings over projected trends by eliminating profit and waste. With universal health insurance coverage through SP financing, providers can focus on optimizing delivery of services, rather than working within a system covered by payers who have incentives to limit costs regardless of benefit. Rather, with a SP, the people act as their own insurer through a partnership with provider organizations where tax dollars work for everyone. Consumer choice is then based on the best care to meet need with no out-of-pocket payments. SP financing is the best option to ensure equity, fairness, and public health priorities align with medical needs, providing incentives for wellness. Consumer choice will drive market forces, not provider network profits or insurer restrictions. This approach benefits public health, as everyone will have universal access to needed care, with treatment plans developed by providers based on what works best for the patient. In 2021, the American Public Health Association adopted a policy statement calling for comprehensive reforms to implement a SP system. The proposed action steps in this policy will help build a healthier nation, saving lives and reducing wasted health care expenditures while addressing inequities rooted in social, demographic, mental health, economic, and political determinants.

Cancer Prevention in a Postpandemic World: A One-Stop-Shop Approach

Cancer Prevention in a Postpandemic World: A One-Stop-Shop Approach