April 25, 2007
Equal Access Reduces Racial Disparities
From Reuters:
In an equal access health care system, such as Veterans Affairs (VA) hospitals, the outcomes for African-American patients treated for heart disease are similar to, or better than, those of white patients, new research suggests.
In a setting where differences in access and treatment are minimized, "so are racial differences in functional outcome," Dr. Nancy R. Kressin from the VA Medical Center in Bedford, Massachusetts, colleagues report in the American Heart Journal.
More information at the American Heart Journal
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Posted by: David Porter on April 25, 2007
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Category: Health Disparities; Health Disparities
April 24, 2007
Health Disparities in HIV/AIDS Diagnosis
From the current issues of JAMA:
During 2001-2005, HIV/AIDS diagnoses, diagnosis rates, and RRs were higher among black males and females than among any other racial/ethnic population in the United States. In 2005, the annual rates of HIV/AIDS diagnosis among black men and women were seven and 21 times higher than rates among white men and women, respectively. For black men, sexual contact with men was the primary mode of HIV infection; for black women, high-risk heterosexual contact was the primary mode. In a recent study of MSM in five cities, 46% of blacks were infected with HIV, compared with 21% of whites and 17% of Hispanics. In 2004, HIV/AIDS was the fourth-leading cause of death among blacks aged 25-44 years in the United States.
During 2001-2004, HIV diagnosis rates among black males and females declined by 4.4% and 6.8%, respectively. A 2007 study reported similar declines among blacks in Florida. These declines were observed among black heterosexuals and injection-drug users but not among MSM. Although these declines in rates of new HIV diagnoses are encouraging, they might not directly reflect trends in HIV incidence because they are also affected by changes in testing behavior and surveillance practices. Regardless of the trends, blacks remain disproportionately affected by high rates of HIV/AIDS. Several factors might contribute to these higher rates (e.g., higher overall prevalence of infection and undiagnosed infection among MSM or greater likelihood among females of high-risk heterosexual contact).
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Posted by: David Porter on April 24, 2007
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Category: Health Disparities; Health Disparities
April 23, 2007
Women Weighed Down by Health Care
As Cover the Uninsured Week approaches, a new Commonwealth Fund report by researchers at the National Women's Law Center finds that even women with health insurance coverage are more likely than insured men to go without needed health care because of costs. Also, a higher percentage of women than men struggle with medical bills.
The report, Women and Health Coverage: The Affordability Gap, by Elizabeth M. Patchias and Judith G. Waxman of the National Women's Law Center finds that women are at a disadvantage because they have greater health care needs and lower incomes than men. More specifically, the report finds that 38% of women are struggling with medical bills compared with 29% of men. And, the high cost of health care services and premiums is forcing many women, even women with health insurance, to go without needed care. In fact, 33% of insured women and 68% of uninsured women don't get the health care they need because they can't afford it. In contrast, 23% of insured and 49% of uninsured men are avoiding care because of cost. Further, 16% of women are underinsured, meaning they have high out-of-pocket costs compared to their income, while only 9% of men are underinsured.
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Posted by: David Porter on April 23, 2007
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Category: Health Disparities; Health Disparities
April 19, 2007
Genetics
First, Calvin on genetics and behavior.
Now Sally Lehrman writing in the Boston Globe on genetics and health:
As science begins to intertwine genetics, medicine, and race, the results already are affecting our lives in important ways. We may be offered different tests, drugs, even vitamins, depending on our skin color. In 2005, regulators approved the first race-based drug, BiDil, for treating heart failure in black patients. Some pharmacologists have wondered whether race should affect prescription dosage, based on possible differences in drug metabolism.
It's hard to talk about race in this country, but with a new medical enterprise focused on biological difference, we are forced to confront it. The onus is on us. Lay people don't have to become experts prepared to decide whether genetics will help solve race-based health inequities. But we do need to understand the nature of the conversation.
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Posted by: David Porter on April 19, 2007
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Category: Health Disparities; Health Disparities
April 18, 2007
Cover the Uninsured
The Healthcare Leadership Council is holding a Cover the Uninsured event.
The event will take place next week at the Children's Museum of Cleveland.
Details below.
What:
The Children's Museum of Cleveland will host an enrollment event with information on low-cost or free health care coverage available in Ohio. For more information contact Tom Maher at (603) 228-3342.
When:
April 21, 2007
10:00am
Where:
The Children's Museum of Cleveland
10730 Euclid Avenue
Cleveland, OH
Sponsoring Organization:
Health Access America
Contact:
Cover the Uninsured
info@covertheuninsured.org
Future events can be found at covertheuninsured.org.
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Posted by: David Porter on April 18, 2007
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Category: Health Disparities; Health Disparities
April 17, 2007
Reducing Costs - Improving Quality via Self Managment
From PLoS Medicine:
We propose that the time has come for health systems to support appropriate and appropriately timed shifts from practitioner-based care to patient self-management. The use of toolkits in other fields has demonstrated an improvement in quality, lowering of costs, and more efficient completion of tasks. This trend holds even in very complex fields. We believe that this trend will also be evident in the management of patients with chronic illness.
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Posted by: David Porter on April 17, 2007
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Category: Health Care; Health Disparities
April 16, 2007
Genetic Link to Disparities
From Reuters:
Racial disparity in cancer rates and outcomes may be driven by genetics as well as socioeconomic factors, U.S. researchers said on Sunday.
Minorities are much more likely to develop and die from cancer than the general U.S. population, with previous research pointing to lack of health insurance, poverty, cultural barriers, and limited access to good medical care as causes.
"What is emerging now is a science of health disparities -- biological factors, genetic factors that can enhance the aggressiveness of cancer are being documented," said Carlos Casiano, a professor in microbiology and molecular genetics at Loma Linda University in California.
Full report at the American Association for Cancer Research.
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Posted by: David Porter on April 16, 2007
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Category: Health Disparities; Health Disparities
April 11, 2007
Talk About the Cost
In the November 2006 issue of the American Journal of Managed Care, one study reports:
For one third of newly prescribed medications, physicians discussed an aspect of acquisition, including cost and insurance coverage for 12%, logistics of obtaining medications for 18%, and medication supply for 9%. Patients initiated cost or insurance concerns for fewer than 2% of the new medications prescribed.
This low number of patients that ask about cost is alarming.
The FTC encourages patients to ask doctors about generic drugs.
Talk with your doctor or pharmacist. Explain that you want the most effective drug at the best price. Ask your doctor to write prescriptions for generic drugs when possible.
The FDA encourages patients and doctors to discuss the generic option.
[P]hysicians and their patients should discuss and decide whether a brand-name or generic is the best therapy.
Consumer groups have called for the use of generic drugs over brand name drugs.
Lipitor is among the most widely prescribed drugs to lower cholesterol, but Consumer Reports says doctors should consider its price before writing a prescription.
The consumer group says generic statins are as effective as high-priced brands for most people who need a statin drug, and can help consumers save more than $1,000 a year.
Yet, many doctors still prescribe expensive brand name drugs although cheaper options are available.
Why?
The March 28, 2007 issue of Nature Medicine says aggressive drug marketing may be to blame.
Critics say the sales reps' spiels hype new drugs when older, cheaper medications would suffice. And a growing number of studies have shown that even small gifts can create a sense of obligation, conscious or not, in the receiver. "Very small actions, even a gift worth a dollar or less, can affect prescribing behavior, and not necessarily in a way that's consistent with best practices," says says Margaret K. Cho, associate director of Stanford University's Center for Biomedical Ethics.
The Independent Drug Information Service is trying to circumvent the influence of aggressive drug marketing by providing "an accurate, up-to-date synthesis of relevant drug information in a non-biased format."
Their website explains how it works:
A team of physicians and drug researchers at Harvard Medical School comprehensively evaluate medical journals and other data sources to pull together the best available information about drugs used commonly in primary care practice. They then synthesize it into concise, clinically relevant summaries. These materials are presented to practitioners in their offices by a team of specially trained Independent Drug Information Service pharmacists, nurses, and other healthcare professionals.
Once doctors receive unbiased information regarding drugs the issue of cost needs to be discussed with the patient. One study reported that nearly 40% of seniors did not discuss cost related nonadherence with their doctors.
First, 27% of seniors who skipped doses or stopped taking a medicine because of side effects or poor perceived efficacy did not tell their physician. Second, 39% of seniors who reported cost-related nonadherence had not talked with their physicians about it. Third, physician–patient dialogue about medication costs was associated with patients’ being switched to lower cost medications.
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Posted by: David Porter on April 11, 2007
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Category: Health Disparities; Health Disparities
April 10, 2007
What Makes a Difference
Perry A. Klaassen, MD, writes in JAMA that insurance makes a difference.
The difference in the outcome of these two similar situations is obvious. I had good health insurance, received optimal care, and 5-1/2 years later I not only have survived, but lead a fairly normal life even though I still have cancer and have to have regular treatment. My patient had no health insurance, delayed her evaluation and treatment, and died less that two years following diagnosis of a preventable and treatable disease.
More at CNN.com.
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Posted by: David Porter on April 10, 2007
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Category: Health Disparities; Health Disparities
April 09, 2007
Treating the Poor: A Gap in Doctor Training
From LaTimes.com:
A FEW WEEKS back, a 48-year-old man arrived at a local free clinic where I sometimes work. He'd lost his health insurance two years ago and recently enrolled in Medi-Cal, the state health insurance program for the poor. Now he receives care for his diabetes, high blood pressure, heart failure and depression at our clinic, primarily staffed by resident physicians like me.
"Every time I come here, I meet a new doctor. Don't make me tell you everything about me all over again," he said. But the rotating staff wasn't his main concern. After his last visit, he hadn't been able to get all his medicine. Medi-Cal caps the number of prescriptions that can be filled at six per month, so he got only a portion of the drugs he needed.
Read the entire article over at LaTimes.com.
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Posted by: David Porter on April 09, 2007
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Category: Health Disparities
April 05, 2007
Assessing the Relationship between Cultural Competence and Health Literacy
The Case Center for Reducing Health Disparities will hold the next lecture in our Works in Progress Series.
"Assessing the Relationship between Cultural Competence and Health Literacy: Implications for Practice" will be presented by Lucinda M. Deason, Ph.D., Associate Professor and Coordinator of the M.A. in Urban Studies at the University of Akron.
Date - Friday, April 13, 2007.
Time - 3:00 - 4:00 p.m.
Location - Case Western Reserve University - Medical School - T503 - 2109 Albert Avenue.
Please RSVP your attendance to Sharon Lowstetter at slowstetter@metrohealth.org or by calling 216-778-8479.
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Posted by: David Porter on April 05, 2007
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Category: Works in Progress
Problems Finding a Doctor in Canada
From Canada.com:
The number of family doctors accepting new patients in Ontario has continued to decline so much that only one in 10 general practitioners is taking on additional work, according to new data released yesterday by the College of Physicians and Surgeons of Ontario.
That report can be found at the College's website.
Again from Canada.com:
In 2000, 38.4% of physicians responding to the college's annual survey indicated they could accommodate new patients.
"We've always assumed that the disparity was a rural-urban one or a north-south thing, but for the first time, we're seeing northern communities have actually improved access to family physicians," college president Dr. Jeff Turnbull said.
The training of international students seems to be one issue.
Dr. Turnbull noted that 2006 was the third year in a row where more licences were issued to international medical graduates than to Ontario graduates. Forty-two per cent, or 1,247 licences, were granted to foreign trained physicians; 37%, or 1,102, were issued to Ontario-trained doctors; 18%, or 538 licences, went to physicians from other provinces; and 3%, or 74, went to doctors who came here from the United States.
Of the 1,247 certifications for foreign-trained physicians, 470 went to doctors who will actually be practising, with the balance being issued to doctors in post-graduate training, some of whom will return to their own countries.
Physicians licensed last year by the college came from 96 countries.
To add perspective, the CDC reported that in 2003-2004 up to 94% of U.S. doctors were accepting new patients.
Although 94.2% of primary-care physicians reported in 2003--2004 that they were accepting new patients, acceptance varied by the patient's expected payment source. Among the physicians, 43.0% did not accept new charity cases, 29.3% did not accept new Medicaid patients, and 20.3% did not accept new Medicare patients. Only 7.0% did not accept new patients who self-paid.
In 2006, the Boston Globe painted a less accepting picture of the Boston area.
Massachusetts General Hospital's physician referral line says all, or almost all, of the hospital's 178 primary care physicians are not accepting new patients. The 42 internists at Boston Medical Center have had full patients lists for four months, and 108 of Brigham and Women's Hospital's 120 primary care doctors have closed their practices to new patients.
The Globe and Mail has a personal account of the search for a doctor in Canada.
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Posted by: David Porter on April 05, 2007
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Category: Health Disparities; Health Disparities
April 04, 2007
WHO Reports on Shortage of Health Care Workers in Developing World
From Reuters:
Thousands of doctors, nurses, and pharmacists from developing countries have emigrated to wealthier western nations with ageing populations in search of better-paid jobs -- a trend that many health experts consider a crippling brain drain for their home countries.
Warning about a growing rich-poor gap in terms of health services, Chan said that the health-care needs of poorer nations are also being overlooked by medical research and development (R&D), which is geared towards the rich.
"Huge gaps in health outcomes are growing wider, and these gaps divide rather precisely along the lines of poverty and wealth," [WHO's Margaret Chan] said.
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Posted by: David Porter on April 04, 2007
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Category: Health Disparities; Health Disparities
April 02, 2007
Health Disparities and Aging in Connecticut
From Wilton Villager Online:
According to a study by the [Connecticut] Department of Health, more blacks are having their lower extremities amputated than their Caucasian and Hispanic counterparts due to the toll the disease ravages on their bodies.
and later in the story:
In its 2006 report, "The Burden of Diabetes in Connecticut," the Department of Health contends that blacks have 3.8 times the rate of diabetes hospitalizations and 3.6 times the rate of lower extremity amputations than other ethnic groups.
Blacks in Connecticut also have 2.6 times the risk of death due to diabetes and 2.1 times the risk of dying from diabetes-related causes than Caucasians.
The numbers for Hispanics are 2.5 times and 3.2 times respectively as compared with Caucasians.
And more 367 per 100,000 blacks are hospitalized for diabetes as compared to 243 for Hispanics and nearly 97 for Caucasians.
The Burden of Diabetes report asserts "access to health care is key to the prevention, treatment, and management of diabetes."
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Posted by: David Porter on April 02, 2007
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Category: Health Disparities; Health Disparities