Equitable Health Care Delivery Research Articles

Exploring the Feasibility and Acceptability of a Telehealth Platform for Older Adults with Noncommunicable Diseases and Chronic Viral Hepatitis.

Background: Telehealth improves access to health care and potentially leads to better clinical outcomes. However, digital competence could be an essential factor in ensuring its adoption, particularly among older adults. This study evaluated the acceptability and perception of a mobile application platform among Thai older patients with chronic diseases according to their demographics and digital skills. Methods: The demographic information and internet usage profiles of patients with nonmalignant chronic diseases, including chronic viral hepatitis, were collected. Participants were grouped based on their self-perceived digital familiarity. The chi-square test was used to evaluate the associations between the parameters. Results: Among 710 participants (61.7% women, mean age: 66.2 years), digital familiarity was significantly higher among individuals aged <70 years, men, those with a bachelor's degree or higher, those with higher incomes, and Bangkok residents (p < 0.001). In this study, regular use of smartphones and the internet, but not messaging applications, was associated with self-perceived digital familiarity. Of these, 100 participants completed a survey evaluating their satisfaction with and perceptions of telehealth. Participants with greater digital familiarity demonstrated significantly higher satisfaction with telemedicine compared with those with limited ability or relied on caretakers (χ2 = 70.145, p < 0.001). Conclusion: Our data indicated that a user-friendly mobile application is feasible and acceptable for the management of chronic diseases in older patients. Digital familiarity is an important factor associated with satisfaction with the platform, underscoring the need to bridge digital skill gaps and ensure equitable health care delivery.

Gender differences in spine surgery for degenerative lumbar disease: prospective cohort study.

Despite efforts toward achieving gender-based equality in clinical trial enrollment, females are frequently underrepresented and gender-specific data analysis is lacking. Identifying and addressing gender bias in medical decision-making and outcome reporting may facilitate more equitable healthcare delivery. This study aimed to determine if gender differences exist in the clinical evaluation and surgical management of patients with degenerative lumbar conditions. Consecutive adult patients undergoing spinal surgery for degenerative lumbar conditions (disc herniation [DH], spinal canal stenosis [SCS], and degenerative spondylolisthesis [DS]) were prospectively enrolled across 16 tertiary academic centers. Outcome domains included pain, disability, health-related quality of life (HRQOL), expectations of surgery, and satisfaction with surgical outcome. Covariates pertaining to the preoperative use of healthcare resources, diagnostic testing, and visits to healthcare providers were compared between genders before and after propensity score matching for 13 baseline demographic and procedural variables. Data were analyzed for 5038 patients (2396 female, 2642 male) with degenerative spinal pathologies including SCS (40.2%), DS (33.2%), and DH (26.6%). Surgical treatment effect was similar for both genders. For all conditions, female patients had worse pre- and postoperative pain, disability, and HRQOL. Significant gender differences were identified for marital status, education, employment status, exercise activities, and disability claims. Female patients were more likely to use select medications, diagnostic imaging tests, and nonsurgical therapeutic interventions, and access various healthcare providers. Findings were similar following post hoc propensity score matching. In this multicenter, prospective, observational cohort study, male and female patients benefitted similarly from surgery for degenerative lumbar spine disease. However, female patients had worse preoperative clinical assessment scores and were more likely to use select healthcare resources.

A Real-World Analysis on Access to Triplet and Quadruplet Therapy in Newly Diagnosed Multiple Myeloma Patients in the United States

BackgroundDisparities in access to triplet and quadruplet therapy for multiple myeloma (MM) patients remain a challenge in the United States. We aimed to investigate demographic and socioeconomic factors influencing treatment access using NCDB data. Patients and MethodsWe analyzed 101,867 MM patients diagnosed between 2004 and 2020. Multinomial logistic regression and multivariable cox regression were employed to assess factors influencing treatment access and survival, respectively. ResultsBlack patients exhibited significantly lower odds of receiving triplet and quadruplet therapy compared to White patients. Socioeconomic factors such as insurance status and household income also influenced treatment access. However, Black and Hispanic patients demonstrated better survival outcomes despite disparities in access. ConclusionRacial, socioeconomic, and insurance-related disparities persist in access to optimal MM therapy in the USA. Addressing these barriers is essential for ensuring equitable healthcare delivery and improving patient outcomes.

Racial Differences in Medications for Opioid Use Disorder Initiation in a Carceral Setting.

The opioid overdose crisis significantly affects marginalized communities, with people of color experiencing higher rates of overdose and barriers to treatment. The syndemic of opioid use disorder and mass incarceration exacerbates racial health disparities. Some carceral facilities offer medication for addiction treatment, though no significant research explores differences in type of treatment uptake by race in these settings. This study focuses on the racial differences in medications for opioid use disorder (MOUD) preferences among incarcerated individuals. A retrospective cohort study was conducted at the Rhode Island Department of Corrections (RIDOC), examining MOUD-type preferences (buprenorphine or methadone) among incarcerated individuals. The study utilized RIDOC electronic medical records from January 1, 2017 to December 31, 2022, involving 3533 unique incarceration events. Participants were categorized by race (White vs non-White) and MOUD status (new initiation vs community continuation), with logistic regression models. The study found no direct racial disparity in preferences for MOUD type. However, an interaction between race and MOUD initiation status significantly influenced MOUD-type preference. Among those initiating MOUD during incarceration, non-White individuals were more likely to choose buprenorphine compared to their White counterparts. This research provides new insights into the intersection of race, incarceration, and MOUD preferences. While direct racial disparities in MOUD type were not observed, the analysis uncovered a notable interaction effect: race influences the relationship between MOUD initiation status and the selected MOUD treatment during incarceration. Specifically, data demonstrate that the likelihood of choosing buprenorphine varies significantly based on both racial background and whether the treatment was initiated during incarceration or in the community. Further research is needed in different geographic settings to understand the broader implications to help guide equitable healthcare delivery in jails and prisons.

A Review-Based Study on the Importance of Doctor-Patient Communication in Healthcare

Effective doctor-patient communication is crucial for delivering quality healthcare, as it directly influences patient satisfaction, treatment adherence, and the incidence of medical errors. This review critically analyzes secondary data from various studies, surveys, and meta-analyses to examine the impact of communication on health outcomes, particularly focusing on vulnerable populations such as those with language barriers and low health literacy. The findings reveal that effective communication enhances patient satisfaction, improves adherence to treatment plans, and reduces medical errors, while poor communication leads to adverse health outcomes, including non-compliance and misdiagnosis. Additionally, improving communication practices lowers malpractice claims and mitigates physician burnout. These insights emphasize the need for targeted interventions to overcome communication barriers and foster equitable healthcare delivery.

Patient Management System Using Fuzzy Multiple Attribute Decision Making Method with SAW at Noura Aesthetic Clinic

This study presents the development and implementation of a Patient Management System (PMS) at Noura Aesthetic Clinic using the Fuzzy Multiple Attribute Decision Making (FMADM) method with Simple Additive Weighting (SAW). The aim is to enhance the decision-making process for patient treatment prioritization and management. The PMS integrates various patient attributes, including medical history, treatment urgency, and resource availability, into a comprehensive decision-making framework. By employing the FMADM method, the system addresses the inherent uncertainties and subjectivities in patient data, ensuring more accurate and reliable prioritization. The SAW technique further refines this process by assigning weighted scores to each attribute, facilitating a straightforward and effective comparison. This combination allows for a balanced assessment of multiple factors, promoting optimal resource allocation and improving overall patient care. The implementation at Noura Aesthetic Clinic demonstrated significant improvements in operational efficiency and patient satisfaction. The system's adaptability to diverse clinical settings and its user-friendly interface make it a valuable tool for healthcare providers. This study underscores the potential of advanced decision-making methodologies in transforming patient management practices, paving the way for more informed and equitable healthcare delivery.

Advancing Digital Health Equity: An Interdisciplinary Educational Approach to Digital Health Access and Inclusivity.

The innovatively structured BCIT Digital Health program is designed to build digital-care capacity within the healthcare workforce to improve outcomes across healthcare communities and optimize clinical transformation. An equity-oriented focus and an active commitment to reducing health disparities puts the patient voice at the centre of the program. To improve accessibility in digital health, the program focuses on inclusivity strategies such as capacity building, Indigenous perspectives, equity-oriented care and providing training to build an effective digital healthcare system. By combining clinical expertise with technological competencies and anchoring it all in a commitment to equity, this program will help reshape the future of innovative and equitable healthcare delivery.

Post-COVID conditions response: a collaborative approach to -establishing multidisciplinary clinics in Ecuador.

Worldwide, 3.7% (144.7 million) of people diagnosed with COVID-19 developed Post-COVID Conditions (PCC). Therefore, creating and implementing multidisciplinary rehabilitation clinics is important to address the needs of patients and improve overall recovery. This study was made possible with support from the United States Agency for International Development funded RISE program, under the terms of the cooperative agreement 7200AA19CA00003. This case study was conducted in Ecuador and describes the creation and implementation of 21 PCC rehabilitation clinics in primary healthcare centers and secondary level hospitals in 7 provinces across the country. Data was gathered for the identification of partnering health facilities and needs, for the evaluation of knowledge enhancement in health professionals after a specific training program, and for the measurement of key performance indicators. This article emphasizes the organization, educational strategies, and implementation of rehabilitation programs tailored specifically for the management of Post-COVID Conditions in Ecuador. The implementation of PCC rehabilitation clinics involved a collaborative effort between the Ministry of Public Health (MOPH), the private sector and a non-governmental organization (Jhpiego). Twenty-one health facilities from the primary and secondary level of care were selected, and PCC rehabilitation implemented in 7 provinces of Ecuador. Additionally, 133 health providers were trained and a total of 13,846 patients treated, among whom 859 had a diagnosis of PCC. Medical doctors outperformed nurses in both pre- and post-tests scores. However, all healthcare professionals demonstrated comparable improvement in knowledge acquisition. Rehabilitation manuals were developed and adopted by the MOPH, rehabilitation equipment was donated and a mobile application, "RESPIRA", was developed and disseminated free of charge. The establishment of PCC rehabilitation clinics in Ecuador was successful in identifying patients in need of early rehabilitation. The insights of this study can serve as a guide for the development of similar initiatives in other countries. Tailored courses are essential to address disparities and ensure comprehensive skill development and promote equitable healthcare delivery.

Increased disease severity during COVID-19 related hospitalization in black non-hispanic, hispanic and medicaid-insured young children.

The COVID-19 pandemic has disproportionately affected marginalized groups in the United States. Although most children have mild or asymptomatic COVID-19, some experience severe disease and long-term complications. However, few studies have examined health disparities in severe COVID-19 outcomes among US children. To examine disparities in the clinical outcomes of infants and children aged <5 years hospitalized with COVID-19 by race/ethnicity and payer status. Children aged <5 years hospitalized with an admission diagnosis of COVID-19 (April 2021-February 2023) were selected from the PINC AI™ Healthcare Database. Hospital outcomes included length of stay (LOS), intensive care unit (ICU) admission, oxygen supplementation, invasive mechanical ventilation (IMV), and prolonged duration of each outcome. Multivariable logistic regression models compared hospitalization outcomes by race/ethnicity and payer status. Among 10,190 children (mean age: 0.9 years, 56.5% male, 66.7% Medicaid-insured), race/ethnicity was distributed as follows: White non-Hispanic (35.1%), Hispanic (any or Unknown race; 28.3%), Black non-Hispanic (15.2%), Other race/ethnicity (8.9%) and Unknown (12.5%). Payer status varied by race/ethnicity. White non-Hispanic children had the highest proportion with commercial insurance (42.9%) while other racial/ethnic groups ranged between 13.8% to 26.1%. Black non-Hispanic children had the highest proportion with Medicaid (82.3%) followed by Hispanic children (76.9%). Black non-Hispanic children had higher odds of prolonged outcomes: LOS (adjusted odds ratio [aOR] = 1.20, 95% confidence interval [CI]:1.05-1.38), ICU days (aOR = 1.44, 95% CI: 1.07-1.93), and IMV days (aOR = 1.80, 95% CI: 1.09-2.97) compared to White non-Hispanic children. Similar patterns were observed for Hispanic and children of Other race/ethnicity. Medicaid-insured and children with other insurance had higher odds of prolonged LOS and oxygen days than commercially insured patients. There were disparities in clinical outcomes of COVID-19 by race/ethnicity and insurance type, particularly for prolonged-duration outcomes. Further research is required to fully comprehend the causes and consequences of these disparities and develop strategies to reduce them while ensuring equitable healthcare delivery.

Performance of ChatGPT and Google Translate for Pediatric Discharge Instruction Translation

BACKGROUND AND OBJECTIVES Patients who speak languages other than English face barriers to equitable healthcare delivery. Machine translation systems, including emerging large language models, have the potential to expand access to translation services, but their merits and limitations in clinical practice remain poorly defined. We aimed to assess the performance of Google Translate and ChatGPT for multilingual translation of pediatric discharge instructions. METHODS Twenty standardized discharge instructions for pediatric conditions were translated into Spanish, Brazilian Portuguese, and Haitian Creole by professional translation services, Google Translate and ChatGPT-4.0, and evaluated for adequacy (preserved information), fluency (grammatical correctness), meaning (preserved connotation), and severity (clinical harm), along with assessment of overall preference. Domain-level ratings and preferred translation source were summarized with descriptive statistics and compared with professional translations. RESULTS Google Translate and ChatGPT demonstrated similar domain-level ratings to professional translations for Spanish and Portuguese. For Haitian Creole, compared with both Google Translate and ChatGPT, professional translations demonstrated significantly greater adequacy, fluency meaning, and severity scores. ChatGPT (33.3%, P &amp;lt; .001) and Google Translate (23.3%, P = .024) contained more potentially clinically significant errors (severity score ≤3) for Haitian Creole than professional translations (8.3%). Professional Haitian Creole (48.3%) and Portuguese (43.3%), but not Spanish (15%), translations were most frequently preferred among translation sources. CONCLUSIONS Machine translation platforms have comparable performance to professional translations for Spanish and Portuguese but shortcomings in quality, accuracy, and preference persist for Haitian Creole. Diverse multilingual training data are needed, along with regulations ensuring safe and equitable applications of machine translation in clinical practice.

“Trying to write a story together”: general practitioners’ perspectives on culturally sensitive care

BackgroundCulturally sensitive care is integral to effective and equitable healthcare delivery, necessitating an understanding and acknowledgment of patients’ cultural needs, preferences, and expectations. This study investigates the perceptions of cultural sensitivity among general practitioners (GPs), focusing on their intentions, willingness and perceived responsibilities in providing care tailored to cultural needs.MethodsIn-depth interviews were conducted with 21 Flemish GPs to explore their perspectives on culturally sensitive care. Data analysis followed a conventional qualitative content analysis approach within a constructivist framework. A coding scheme was developed to identify recurring themes and patterns in the GPs’ responses.ResultsFindings reveal that culturally sensitive care provision is perceived as a multifaceted process, initiated by an exploration phase where GPs inquire about patients’ cultural needs and preferences. Two pivotal factors shaping culturally sensitive care emerged: patients’ specific cultural expectations and GPs’ perceived responsibilities. These factors guided the process of culturally sensitive care towards three distinct outcomes, ranging from complete adaptation to patients’ cultural requirements driven by a high sense of responsibility, through negotiation and compromise, to a paternalistic approach where GPs expect patients to conform to GPs’ values and expectations. Three typologies of GPs in providing culturally sensitive care were identified: genuinely culturally sensitive, surface-level culturally sensitive, and those perceiving diversity as a threat. Stereotyping and othering persist in healthcare, underscoring the importance of critical consciousness and cultural reflexivity in providing patient-centered and equitable care.ConclusionsThis study emphasizes the significance of empathy and underscores the necessity for GPs to embrace the exploration and acknowledgement of patients’ preferences and cultural needs as integral aspects of their professional role. It highlights the importance of shared decision-making, critical consciousness, cultural desire and empathy. Understanding these nuances is essential for enhancing culturally sensitive care and mitigating healthcare disparities.

Pharmacogenomic diversity of clinically significant cancer treatment biomarkers in ancestrally diverse US population.

e15099 Background: Cancer Health Disparities (CHD), in the US is well documented. The is significant evidence of CHD treatment related outcomes along ancestry lines. Africans and Hispanics generally have higher rates of adverse drug reactions (ADR), and poorer survival and response rates when compared to Europeans and Asians. The causes of CHD treatment related outcomes are poorly understood but it is plausible to believe that CHD has a genetic basis, given that human genomic variations underlie both disease susceptibility and treatment outcomes. Our goal is to determine the genetic basis of CHD treatment related outcome, with a particular focus on under-represented and underserved populations. Methods: We will deploy pharmacogenomic (PGx) differentiation analyses using a comprehensive patient database and correlative banked tissue (~ 2,000 patients) from MCW, together with 3 international cohorts as comparators (Africans = 372, Asians = 1,250 and Europeans = 958) to: Interrogate clinically significant cancer treatment PGx biomarkers and characterize the variation across different populations. Assess the implications of genetic admixture on CHD treatment related outcomes. Evaluate the intersection of genetic diversity with pharmacogenomic diversity. Explore the distribution of age, gender, diagnosis, treatments, response, ADRs, survival, comorbidities, and concomitant medication. Results: Our initial results point to a significant genetic contribution to CHD treatment related outcomes. The enrichment of genetic risk factors for therapeutic failure, ADRs or poorer survival in patients of African vs European descent, explains the increased sensitivity to ADRs, poorer response rates, and decreased survival in patients of African vs European descent. We will extend this analysis to a multi-ethnic US cohort including Africans, Hispanics, Europeans, Asians, and First Nations. Conclusions: There is extensive PGx diversity within the US population, hence, coupling preemptive PGx testing with genetic testing is imperative for a truly equitable delivery of healthcare. There is a need for diversified representation of all population in cancer research to level the gaps in CHD. The identification of the genetic basis of CHD treatment related outcomes is imperative for predicting outcomes, and the implementation of preemptive PGx and precision medicine. [Table: see text]

Socioeconomic deprivation is associated with worse patient and graft survival following adult liver transplantation.

The impact of social determinants of health (SDOH) on adult liver transplant recipient outcomes is not clear at a national level. Further understanding of the impact of SDOH on patient outcomes can inform effective equitable healthcare delivery. Unadjusted and multivariable models were used to analyze the Scientific Registry of Transplant Recipients to evaluate the association between the Social Deprivation Index (SDI) based on liver transplant recipient's residential location and patient and graft survival. We included adult recipients between 1/1/2008-12/1/2021. Patient and graft survival were lower in adults living in areas with deprivation scores above the median. Five-year patient and graft survival were 78.7% and 76.5% respectively in the cohort above median SDI compared to 80.5% and 78.3% below median SDI. Compared to the recipients in low deprivation residential areas, recipients residing in highest deprivation (SDI quintile=5) cohort had 6% higher adjusted risk of mortality (Adjusted Hazard Ratio [AHR]=1.06,95%C.I. 1.01-1.13) and 6% higher risk of graft failure (AHR=1.06,95% C.I. 1.001-1.11). The increased risks for recipients residing in more vulnerable residential areas were higher (AHR=1.11,95% CI 1.03-1.20 for both death and graft loss) following the first-year post-transplantation. Importantly, overall risk for graft loss associated with SDI was not linear but instead accelerated above the median level of deprivation. In the United States, SDOH, as reflected by residential distress, significantly impact 5-year patient and graft survival. The overall effect of residential deprivation are modest, but importantly, results illustrate they are more strongly associated with longer-term follow up and accelerate at higher deprivation levels. Further research is needed to evaluate effective interventions and policies to attenuate disparities in outcomes among recipients in highly disadvantaged areas.

Barriers to access and utilization of health services among marginalized communities in sub-Saharan African countries: Scoping review

Purpose: This scoping review aimed to investigate the barriers encountered by marginalized communities in sub-Saharan African countries when accessing and utilizing healthcare services. Methodology: The scoping review was evaluated through online databases like the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and SCOPUS review according to the barriers to accessing and utilizing health services among marginalized communities in sub-Saharan African countries. The scoping review identifies the articles from the topic through the online databases using the including and excluding criteria. Findings: The findings identified the barriers to healthcare access, lack of communication and language, and not sharing the proper health details with the healthcare professional. The findings also demonstrated the implications and consequences such as health disparities, economic burden, social and human rights implications, loss of productivity and development, public health implications, and reinforcing social exclusion. Unique contribution to theory, practice and policy: This scoping review illuminates the intricate nexus of socio-economic factors, cultural dynamics, and human rights awareness as barriers to healthcare access in sub-Saharan Africa. The findings offer actionable insights for healthcare practitioners to customize services for marginalized communities, addressing communication gaps and information-sharing reluctance. Moreover, policymakers can utilize these insights to advocate evidence-based policies aimed at promoting equitable healthcare access and enhancing health literacy. Thus, this research serves as a vital conduit between theoretical understanding, practical application, and policy formulation, facilitating the advancement of inclusive and equitable healthcare delivery in the region.

Racial disparities among mild stroke survivors: predictors of home discharge from a retrospective analysis

ABSTRACT Background Half of all strokes are classified as mild, and most mild stroke survivors are discharged home after their initial hospitalization without any post-acute rehabilitation despite experiencing cognitive, psychosocial, motor, and mobility impairments. Objectives To investigate the demographic and clinical characteristics of mild stroke survivors and their association with discharge location. Methods This is a retrospective analysis of mild stroke survivors from 2015–2023 in an academic medical center. Demographic characteristics, clinical measures, and discharge locations were obtained from the electronic health record. The Social Vulnerability Index was used to measure the community vulnerability. Associations between variables and discharge location were examined using bivariate logistic regression analysis. Results There were 2,953 mild stroke survivors included in this study. The majority of participants were White (65.46%), followed by Black (19.40%). Black stroke survivors and individuals with higher social vulnerability had a higher proportion of discharges to skilled nursing facilities (p = 0.001). Black patients and patients with high vulnerability in housing type and transportation were less likely to be discharged home. Conclusions Mild stroke survivors have a high rate of home discharge, potentially because less severe stroke symptoms have a reduced need for intensive care. Racial disparities in discharge location were evident, with Black stroke survivors experiencing higher rates of institutionalized care and lower likelihood of being discharged home compared to White counterparts, emphasizing the importance of addressing these disparities for equitable healthcare delivery and optimal outcomes.

Women’s experiences of seeking healthcare for abdominal pain in Ireland: a qualitative study

BackgroundEvidence suggests that women’s abdominal pain is more likely to be minimised or dismissed by healthcare professionals than men’s. This can have a detrimental impact on health-related outcomes as well as quality of life. The aim of this study was to explore women’s experiences of seeking healthcare for abdominal pain in Ireland.MethodA qualitative design and opportunity sampling approach were employed in this study. Fourteen women living in Ireland with experience of seeking healthcare for abdominal pain took part in one-to-one semi-structured interviews via video-conferencing software. Data were analysed using reflexive thematic analysis.ResultsFour themes were constructed from the data: [1] “Just Get on with It” – Normalisation and Invalidation; [2] “Bad Enough”? Costs of (Not) Seeking Help; [3] “Fight Your Case,” Fight for Care; and [4] “Out of the Loop” – Systemic Barriers to Care. Perceived invalidation of pain by healthcare professionals was common, as was internalised normalisation of pain. This created challenges when negotiating pain management solutions. Despite functional interference, participants felt their pain needed to reach an extreme level of severity before seeking help. Costs of private healthcare were implicated in delayed help-seeking. Participants felt the onus was on them to fight for care. Social support and information-seeking facilitated participants in this fight while systemic issues were identified as barriers to adequate care. Despite their frustrations, participants expressed empathy for healthcare professionals operating in a flawed system.ConclusionsParticipants described mostly negative experiences of seeking healthcare for abdominal pain, characterised by dismissal of symptoms and internalisation of normative views of women’s pain as less worthy of care. These experiences reinforced participants’ views that self-advocacy is essential to access care for their pain. There are systemic issues at play within the Irish healthcare system that limit women’s ability to access abdominal pain management support. Education and training for healthcare professionals on the Gender Pain Gap and its implications for patient care, as well as clear referral pathways for women presenting with abdominal pain, may help to ensure more equitable healthcare delivery for individuals with abdominal pain in Ireland.

Unlocking the potential of telehealth in Africa for HIV: opportunities, challenges, and pathways to equitable healthcare delivery.

Unlocking the potential of telehealth in Africa for HIV: opportunities, challenges, and pathways to equitable healthcare delivery.

The Impact of Social Determinants of Health on the Treatment of Distal Radius Fracture.

Disparities in social determinants of health (SDH) have been shown to play an increasingly important role in the equitable delivery of health care. Distal radius fractures (DRFs) are among the most common upper-extremity injuries encountered. This study aims to examine the influence of economic, educational, social, environmental, and healthcare disparities on management of these injuries. PearlDiver Mariner insurance claims database was analyzed for treatment patterns of DRF in patients aged 18 to 65 years based on the presence or absence of social determinants of health disparities (SDHDs). Outcome variables included the primary mode of management of DRF, including operative versus non-operative, as well as concomitant procedures. Multivariate logistic regression was used to compare fracture management modality in patients with and without SDHDs. Of 161 704 patients identified with DRF, 38.3% had at least 1 reported SDHD. The majority of SDHDs were economic. Patients identified with 1 or more SDHDs had a higher medical comorbidity index. Patients with environmental SDHD were more likely to receive non-operative management. Within any SDHD and economic subgroups, odds of operative management were higher. No relationship was identified between SDHD and concomitant procedures. The presence of environmental disparities in SDH may predispose patients disproportionately to non-operative management. The presence of SDHDs may influence medical decision-making in favor of open reduction and internal fixation in patients with DRF treated operatively. In treating at-risk populations, providers should be aware of the potential for implicit bias associated with SDHDs and prioritize shared decision-making between patients and physicians.

Emergency department visits in the United States by adults with a complaint of diarrhea (2016-2021).

For adults with a complaint of diarrhea presenting to United States emergency departments (EDs) from 2016 to 2021, we examined the: (1) occurrence and temporal trends in these ED visits, (2) frequency with which services were provided (laboratory testing, radiologic imaging, and intravenous fluids (IV fluids) administration) and patients were admitted; and (3) factors associated with service provision and admission. Data from the National Hospital Ambulatory Medical Care Survey (2016-2021) were analyzed. Multivariable logistic regression modeling was employed to examine factors associated with service provision and admission, according to patient demographic characteristics, healthcare insurance status, and associated clinical symptoms; ED geographic location; and type of ED medical staff who evaluated the patient. From 2016 to 2017, there were 3.3-3.7 million ED visits/year by adults with a complaint of diarrhea (3.1% [95% CI 2.9-3.3] of all adult US ED visits). Services were provided and patients were admitted per these frequencies: complete blood count (80%; 95% CI 76-83); blood culture (8%; 95% CI 6-9); metabolic panel (94%; 95% CI 86-97); ultrasound (8%; 95% CI 7-10); abdominal/pelvic CT (33%; 95% CI 29-35); IV fluids (63%; 95% CI 50-66); and admission (16%; 95% CI 14-18). Factors associated with receipt of these services and admission included other presenting symptoms (abdominal pain, vomiting, and nausea), ED geographic location, ED medical staff member evaluating the patient, race, Hispanic ethnicity, and type of health insurance. For adult patients presenting to US EDs with a complaint of diarrhea, US EDs highly utilized selected laboratory tests and radiologic imaging. Differences in utilization raise concerns about equitable healthcare delivery and call for further investigation into the underlying reasons, as well as the development and adoption of standardized care pathways.

Healthcare Quality from the Perspective of Patients in Gulf Cooperation Council Countries: A Systematic Literature Review

With the increased focus on patient-centered care, consensus on healthcare outcomes of importance to patients becomes crucial. Based on a systematic review of the literature, this study confirms the perspectives of patients on healthcare quality in GCC countries. Online databases were searched for relevant peer-reviewed articles published from 2012 to 2023. Twenty-two articles retrieved from the search were qualitatively analyzed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Most articles (90%) reported studies conducted in Saudi Arabia. Patients in GCC countries face common problems in the care delivery process, which contribute to negative perceptions of quality. These problems include diagnostic and medication errors, provider–patient communication problems, missed appointments with physicians, problems in emergency care access due to geographical distance and transportation barriers, long waiting times, and physical environments. Notably, healthcare quality is perceived to be an outcome of multiple factors dependent on the location and category of healthcare service providers; for instance, disparities in perceptions of quality were observed between patients attending Primary Health Care (PHC) centers in rural and urban areas. Issues such as lack of equitable healthcare delivery and deficiencies in Emergency Medical Services (EMS) effectiveness were disparately recognized as quality concerns by different patient populations. The findings provide insights into healthcare quality and area of weakness needing strategies and policies to ensure patient-centered, safe, equitable, timely, and effective healthcare. Healthcare providers and policymakers in GCC countries can use the results to plan, assess, and improve care delivery. Trial registration: PROSPERO ID: CRD42022326842.