Patient Health Care Disparities Research Articles

A scoping review of disparities in health and health-care service provisions experienced by adults with autism spectrum disorder

PurposeAdults with autism spectrum disorder (ASD) are more likely to have a poor health status because of being diagnosed with a range of physical and mental health conditions and experience disparities in health care. The purpose of this study is to find barriers to health care experienced by adults with ASD and find gaps in health care which health-care providers can work to fill.Design/methodology/approachThis scoping review aimed to identify studies that report on disparities in health and health-care service provisions experienced by adults with ASD. The authors included articles that described health-care disparities for patients with ASD and were published in peer-reviewed journals between January 2010 and April 2022. The authors searched the following databases and medical journals to search for eligible studies: Google Scholar, Pubmed, Elsevier, Sage Publications and Embase. The authors comprehensively searched key terms related to ASD, health care and disparities.FindingsThe core defining features of ASD, which include communication and social impairments and deficits in sensory processing, were found to be barriers in the health-care experience of adults with ASD. Continued research and changes in health care, such as developing interventions to empower patients, adequately training providers and increasing the accessibility of the health-care system, are necessary to ensure adults with ASD receive adequate medical care.Research limitations/implicationsAdditionally, clarifying the current literature on this topic can guide future research efforts to explore the influence of factors such as gender and the spectrum of autism itself leading to various levels of abilities and their influence on the health-care experience of adults with ASD.Practical implicationsOverall, the findings from this scoping review underline the importance of providing readily accessible evidence-based, age-appropriate primary and hospital health care for adults with ASD.Social implicationsFurther interventions are needed to empower patients, adequately train providers, increase the accessibility of the health-care system, increase support for ASD patients and decrease discrimination.Originality/valueThis paper is a scoping literature review of the original work done by researchers in the field of developmental disorders and health care.

Characteristics of chronic intestinal failure in the USA based on analysis of claims data.

This study investigated the prevalence, characteristics, and management of patients with chronic intestinal failure (CIF) in the United States in 2012-2020, based on parenteral support (PS) prescription claims and healthcare utilization. Patients with CIF were identified from the Integrated DataVerse® claims database if they had at least two PS prescriptions within 6 months and a relevant diagnosis. Analysis included prevalence and characteristics of patients with CIF, their travel distance to receive PS prescriptions, and the distribution of PS providers and their prescribing history. Up to 24,048 patients with CIF were identified, equivalent to 75 patients per million. CIF affected people of all ages, being more prevalent in women than in men. Many providers signed PS orders for small patient groups over short time periods, whereas few providers signed PS orders for large patient groups long term, indicating a lack of centralization. The distribution of PS providers suggested a disparity in healthcare coverage in rural vs urban areas, leading to patients traveling considerable distances to receive PS prescriptions. This may be exacerbated by a decline of providers with expertise in CIF and nutrition. Healthcare disparities for patients with CIF have likely been obscured by the lack of CIF-specific diagnostic and procedure codes, obliging providers to code for their patients under other codes. Effective policy changes, including centralized care, revision of reimbursement models, and expansion of nutrition-focused education in addition to the newly introduced International Classification of Diseases codes, are needed to provide the best care for patients.

Health Care Disparities Among Latina Patients Presenting With Pelvic Organ Prolapse.

This study identifies barriers, including language and insurance status, Latina patients may face in accessing urogynecology care. The aim of the study was to determine differences in objective prolapse severity at the time of presentation between Latina and non-Latina patients and the effect socioeconomic disparities may have on these differences. This is a retrospective cohort study of patients visiting urogynecology clinics at 2 academic institutions (1 private, 1 public). Patients with symptomatic > stage II prolapse were included. Initial Pelvic Organ Prolapse Quantification examinations, leading edge of prolapse, and demographic data were extracted. We evaluated several socioeconomic factors for associations with prolapse severity in a multivariable analysis. Three hundred forty-two patients were included (36% Latina). Twenty-eight percent were non-English speaking and 54% had public or no insurance. Using leading edge as the outcome, there was no objective difference in prolapse severity between the Latina and non-Latina patients. A higher proportion of patients with public insurance had more advanced prolapse compared with those with private insurance (odds ratio, 2.78; 95% confidence interval, 1.40-5.55; P < 0.01) and a higher proportion of non-English speaking had more advanced prolapse compared with English speakers (odds ratio, 2.44; 95% confidence interval, 1.12-5.34; P = 0.03). Latina ethnicity was not a risk factor for more advanced prolapse at the time of initial evaluation in a urogynecology clinic. Rather, patients who were non-English speaking and had public insurance were more likely to present with more advanced prolapse. Our data suggest that language barriers and lower socioeconomic status are health care disparities for patients seeking care for prolapse.

An Economic Framework to Measure Value of Pediatric Telehealth.

Background: Health care is experiencing significant disruptive innovation with the use of technology, including telemedicine and virtual modalities to deliver care. These new models can dramatically improve access to care and reduce health care disparities for patients, especially in underserved and vulnerable populations like children. Problem: To assure diffusions and retention of new approaches they must be assessed for economic value. However, measuring telehealth programs using only an institutional financial viewpoint fails to convey all the societal value of such interventions, so economic studies of telehealth are needed but complex to design. Methods: We reviewed economic study guidelines, details from telehealth study research protocols, IRB submission questions, and telehealth study design literature. We then used an iterative consensus process to develop a framework for measuring value of virtual care at the societal level. Results: The work produced a set of tools that are useful for designing studies for measuring value of virtual care at the societal level. The framework and tools are presented in this report. Conclusions: The conceptual framework for economic evaluation was feasible for use when applied to measure pediatric telehealth value.

A Scoping Review of Behavior Change Interventions to Decrease Health Care Disparities for Patients With Disabilities in a Primary Care Setting: Can Social Marketing Play a Role?

Background: One in four Americans have a disability but remain an overlooked minority population at risk for health care disparities. Adults with disabilities can be high users of primary care but often face unmet needs and poor-quality care. Providers lack training, knowledge and have biased practices and behaviors toward people with disabilities (PWD); which ultimately undermines their quality of care. Focus of the Article: The aim is to identify behavior change interventions for decreasing health care disparities for people with disabilities in a healthcare setting, determine whether those interventions used key features of social marketing and identify gaps in research and practice. Research Question: To what extent has the social marketing framework been used to improve health care for PWD by influencing the behavior of health care providers in a primary health care setting? Program Design/Approach: Scoping Review. Importance to the Social Marketing Field: Social marketing has a long and robust history in health education and public health promotion, yet limited work has been done in the disabilities sector. The social marketing framework encompasses the appropriate features to aligned with the core principles of the social model of disability, which espouses that the barriers for PWD lie within society and not within the individual. Incorporating elements of the social model of disability into the social marketing framework could foster a better understanding of the separation of impairment and disability in the healthcare sector and open a new area of research for the field. Results: Four articles were found that target primary care providers. Overall, the studies aimed to increase knowledge, mostly for clinically practices and processes, not clinical behavior change. None were designed to capture if initial knowledge gains led to changes in behavior toward PWD. Recommendations: The lack of published research provides an opportunity to investigate both the applicability and efficacy of social marketing in reducing health care disparities for PWD in a primary care setting. Integrating the social model of disability into the social marketing framework may be an avenue to inform future interventions aimed to increase health equity and inclusiveness through behavior change interventions at a systems level.

The Prevalence of Disability Health Training and Residents With Disabilities in Emergency Medicine Residency Programs.

Individuals with disabilities experience significant health care disparities due to a multitude of barriers to effective care, which include a lack of adequate physician training on this topic and negative attitudes of physicians. This results in disparities through inadequate physical examination and diagnostic testing, withholding or inferior treatment, and neglecting preventative care. While much has been published about disability education in undergraduate medical education, little is known about the current state of disability education in emergency medicine (EM) residency programs. In 2019, a total of 237 EM residency program directors (PDs) in the United States were surveyed about the actual and desired number of hours of disability health instruction, perceived barriers to disability health education, prevalence of residents and faculty with disabilities, and confidence in providing accommodations to residents with disabilities. A total of 104 surveys were completed (104/237, 43.9% response rate); 43% of respondents included disability-specific content in their residency curricula for an average of 1.5 total hours annually, in contrast to average desired hours of 4.16 hours. Reported barriers to disability health education included lack of time and lack of faculty expertise. A minority of residency programs have faculty members (13.5%) or residents (26%) with disabilities. The prevalence of EM residents with disabilities was 4.02%. Programs with residents with disabilities reported more hours devoted to disability curricula (5 hours vs 1.54hours, p=0.017) and increased confidence in providing workplace accommodations for certain disabilities including mobility disability (p=0.002), chronic health conditions (p=0.022), and psychological disabilities (p=0.018). A minority of EM PDs in our study included disability health content in their residency curricula. The presence of faculty and residents with disabilities is associated with positive effects on training programs, including a greater number of hours devoted to disability health education and greater confidence in accommodating learners with disabilities. To reduce health care disparities for patients with disabilities, we recommend that a dedicated disability health curriculum be integrated into all aspects of the EM residency curriculum, including lectures, journal clubs, and simulations and include direct interaction with individuals with disabilities. We further recommend that disability be recognized as an aspect of diversity when hiring faculty and recruiting residents to EM programs, to address this training gap and to promote a diverse and inclusive learning environment.

Surgical Residents as Certified Bilingual Speakers: A Quality Improvement Initiative

The objective of this quality improvement initiative was to identify general surgery residents proficient in a non-English language and have each attempt the Clinician Cultural and Linguistic Assessment (CCLA) to become qualified bilingual staff speakers. General surgery house staff were asked to self-identify as proficient in a language other than English. Fees for the certification examination were waived, and each resident was excused from clinical duties to complete the exam. McNemar's test was used for statistical analysis. All residents responded to the initial survey, with 18/65 reporting a non-English language proficiency. Of the 12 residents who sat for the CCLA exam, 9 (75.0%) passed, with 5 certifying in the most commonly spoken non-English languages at this institution. The number of certified residents increased from 1 to 10 (1.5 % to 15.4%, p = 0.004). Language barriers result in health care disparities for patients with limited English proficiency. This reproducible quality improvement initiative significantly increased the number of qualified bilingual speakers, while 25.0% of self-described proficient speakers did not demonstrate adequate language proficiency. These newly certified providers allow for increased language concordant care, which may be associated with improved outcomes.

DDHE Director Speaks About the Importance of Diversity in Psychiatry

Back to table of contents Previous article Next article Association NewsFull AccessDDHE Director Speaks About the Importance of Diversity in PsychiatryVabren WattsVabren WattsSearch for more papers by this authorPublished Online:1 Jul 2015https://doi.org/10.1176/appi.pn.2015.7a17AbstractThe mission of APA’s Division of Diversity and Health Equity is to meet the professional needs of psychiatrists from minority and underrepresented groups and improve the quality of care for minority and underserved populations.July is APA’s Diversity Mental Health Month, a month during which the mental health needs of diverse populations are spotlighted, as well as the importance of continued training in cultural competence by the health care professionals who serve them. Last year APA launched Diversity Mental Health Month, which is spearheaded by the Division of Diversity Health Equity (DDHE), formally known as the Office of Minority and National Affairs. Since July 2014, the division has undergone some change, including the appointment of Ranna Parekh, M.D., M.P.H., as DDHE director. In an interview with Psychiatric News, Parekh discusses the purpose of APA Diversity Mental Health Month and the future of DDHE.Ranna Parekh, M.D., M.P.H., believes that as patient demographics continue to change and as more diverse groups access mental health care, the way in which health care professionals approach diversity has to broaden.Aaron LevinPN: What is APA Diversity Mental Health Month?RP: Diversity Mental Health Month was created two years after Steve Koh, M.D., M.P.H., M.B.A., Barton Blinder, M.D., Ph.D., and Joseph Mawhinney, M.D., wrote an action paper calling for APA to designate a month to spotlight diversity initiatives—looking at patient health care disparities, workforce diversity, and cultural competency issues. They thought it was important to designate a month that really focused on the importance of the diversity of our members, the patients we serve, and the science that informs our work as psychiatrists.PN: Why do psychiatrists need to be sensitive to diversity issues?RP: It is important that people recognize that disparities exist in access to mental health care. The U.S. Department of Health and Human Services reports that Hispanics and African Americans are, respectively, 30 percent and 40 percent less likely to receive any mental health care services than whites. Asians are 50 percent less likely to access mental health care than whites. One of the hopes for Diversity Mental Health Month is to provide a platform that makes health care disparities more visible.Whenever a psychiatrist interfaces with a patient with a background different from his or her own, there is going to be a huge range of differences in how they view the world around them. Psychiatrists need to be aware of how their cultural, racial, and ethnic background differs from those of their patients so they are able to provide their patients with the best care possible.PN: How do you define “diversity?”RP Diversity is a broad term that continues to evolve. Our division was created in 1974 as the Office of Minority and National Affairs. Its purview expanded through the years until it became clear that we needed a new name for the department that reflected the broader mission we have today.APA has long been committed to racial and ethnic groups who have a long history of health disparities and have been underrepresented in the field of psychiatry, including Asians, American Indian, Hispanics, and African Americans. At the same time, we want to evolve with the definition of diversity to include other groups, such as women; members of the lesbian, gay, bisexual, and transgender (LGBT) community; religious minorities; internationals; and those who are underrepresented geographically.PN: You’ve been DDHE director since January. How do you like your position?RP: I feel really fortunate. I get to think about ways to improve diversity in psychiatry every day—this is a dream job come true. Prior to coming here, I worked as a practicing psychiatrist at Massachusetts General Hospital for 15 years. I loved being a practicing physician, but having the opportunity to work with 36,000 members, seven minority/underrepresented caucus groups, an incredible council on minority mental health and health disparities, and a great DDHE team has been absolutely amazing. Locations of meetings, community outreach, and “On Tour” programs where DDHE has gathered physicians, patients, and advocates of mental health care to address mental health disparities of minority populations.It has also been exciting to be a part of the APA administration and work with our elected leaders who have made diversity issues a top priority for the organization.[Note: The seven minority/underrepresented caucuses represent American Indian, Alaska Native and Native Hawaiian psychiatrists; Asian-American psychiatrists; black psychiatrists; Hispanic psychiatrists; international medical graduates; lesbian, gay and bisexual psychiatrists; and women psychiatrists.]PN: What is your vision for DDHE?RP: Part of my goal is to continue to develop the great work that APA is already doing. This work includes continuing to grow the minority fellowship programs, which at their core is about increasing workforce diversity—a platform of one of my predecessors, Jeanne Spurlock, M.D. We are also looking to expand in the areas of education, research, as well as partnerships with APA district branches, governmental agencies, and community and other mental health advocacy organizations.At this year’s annual meeting, we had the first “conversation” in a series on diversity and health equity. Through this candid dialogue with members, DDHE now has a better idea about what programs need to be continued, improved upon, or discontinued and what new programs members would like to see added. The “conversations” event was the first step in APA reimagining what the DDHE can mean for our members and the patients we serve. We plan to make these conversations with members a regular part of future annual meetings and the IPS: The Mental Health Services Conference.PN: What events does DDHE have planned for later this year?RP: We will have a “DDHE on Tour” program at this year’s IPS: The Mental Health Services Conference in New York City in October on domestic violence (see page 10). This will be a very unifying event where the seven minority caucuses will be able to participate because domestic violence affects all ethnic racial, geographical, cultural, and socioeconomic groups. Psychiatrists should be leaders in mental health issues surrounding domestic violence, especially as it relates to destigmatizing help for victims. We should also be trained to provide better services to this population. PN: What do you want APA members to know about DDHE? RP: My hope is that APA members know that DDHE represents them. Also, they should be aware that we offer a valuable resource to which they can turn when faced with questions about how best to work with patients of different backgrounds. Our plan is to build a robust website with more resources for our members that will ultimately help them provide better care for all patients seeking mental health services. ■The DDHE toolkit for APA Diversity Mental Health Month can be accessed here. ISSUES NewArchived

The Effects of Race and Socioeconomic Status on Immunomodulator and Anti-Tumor Necrosis Factor Use among Ambulatory Patients With Inflammatory Bowel Disease in the United States

Health-care disparities exist for patients of minority race and low socioeconomic status (SES) in many chronic disease states, but little is known regarding health-care disparities for patients with inflammatory bowel disease (IBD). Using nationally representative data, we sought to determine whether use of immunomodulators and anti-tumor necrosis factor (TNF) agents differed by race/ethnicity and SES among ambulatory patients with IBD. We used data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from 1998 to 2010. We identified visits associated with IBD and the medications associated with those visits. Race/ethnicity and SES were characterized. The frequency of immunomodulator and anti-TNF use over time was assessed. We performed analyses accounting for the survey's complex multistage probability sampling design. Associations between race/ethnicity, SES and IBD medication use were identified. A total of 26,400,000 visits for patients with IBD occurred in the United States from 1998 to 2010. Seventy-six per cent of visits were for whites, 9% were for blacks, 7% were for Hispanics, and 2% were for Asians. Sixty-one per cent of visits were privately insured, whereas 7% had Medicaid coverage. From 1998 to 2010, the proportion of visits associated with immunomodulators increased from 6 to 13%, whereas the proportion associated with anti-TNF agents increased from <1 to 14%. In adjusted analyses, visits with Medicaid were three times more likely to be associated with immunomodulators than visits with private insurance, but there were no race/ethnicity-based differences in immunomodulator use. There were no race/ethnicity- or SES-based differences in anti-TNF therapy. Using nationally representative data over a 13-year time period, we found no evidence of disparities in medical therapy for IBD among visits with minority race/ethnicity or low SES.