Cultural Competence And Health Care Disparities: Key Perspectives And Trends

Betancourt, Joseph R.; Green, Alexander R.; Carrillo, J. Emilio; Park, Elyse R.

doi:10.1377/hlthaff.24.2.499

Cited by 477 publications

(335 citation statements)

References 5 publications

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“…35,36 Indeed, many of the clinicians in our study endorsed the use of these strategies to improve health care for minority patients. This cultural competency training may involve a combination of small group discussions of these issues among clinicians, role playing, and instruction on working effectively with translators.…”

Section: Discussionmentioning

confidence: 84%

Primary-care Clinician Perceptions of Racial Disparities in Diabetes Care

et al. 2008

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BACKGROUND: Primary-care clinicians can play an important role in reducing racial disparities in diabetes care. OBJECTIVE:The objective of the study is to determine the views of primary-care clinicians regarding racial disparities in diabetes care. DESIGN:The design of the study is through a survey of primary-care clinicians (response rate=86%). PARTICIPANTS:The participants of the study were 115 physicians and 54 nurse practitioners and physician assistants within a multisite group practice in 2007. MEASUREMENTS AND MAIN RESULTS:We identified sociodemographic characteristics of each clinician's diabetic patient panel. We fit multivariable logistic regression models to identify predictors of supporting the collection of data on patients' race and acknowledging the existence of racial disparities among patients personally treated. Among respondents, 79% supported the collection of data on patients' race. Whereas 88% acknowledged the existence of racial disparities in diabetes care within the U.S. health system, only 40% reported their presence among patients personally treated. Clinicians caring for greater than or equal to 50% minority patients were more likely to support collection of patient race data (adjusted odds ratio [OR] 9.0; 95% confidence interval [CI] 1.2-65.0) and report the presence of racial disparities within their patient panel (adjusted OR 12.0; 95% CI 2.5-57.7). Clinicians were more likely to perceive patient factors than physician or health system factors as mediators of racial disparities; however, most supported interventions such as increasing clinician awareness (84%) and cultural competency training (88%). CONCLUSIONS:Most primary-care clinicians support the collection of data on patients' race, but increased awareness about racial disparities at the local level is needed as part of a targeted effort to improve health care for minority patients. INTRODUCTIONRacial disparities in the quality of diabetes care are persistent across all sectors of the U.S. health care system. Black patients with diabetes are less likely than white patients to receive appropriate hemoglobin A1c and lipid testing 1,2 and less likely to achieve treatment goals including glycemic, cholesterol, and blood pressure control. [3][4][5][6][7][8] Blacks also experience worse long-term diabetes-related outcomes than whites, including diabetic retinopathy, 9 lower extremity amputations, 2,10,11 and chronic kidney disease. 12 Hispanics and Native Americans have also been found to receive lower-quality diabetes care, with Native Americans experiencing disproportionately high rates of lower extremity amputations, chronic kidney disease, and diabetes-related mortality. 2,[13][14][15][16][17] The etiology of these racial disparities is multifactorial involving health system, provider, and patient factors, all within the context of broader social issues. 18 Physicians can play an important role in addressing racial disparities in care through their direct interface with patients and the health care system. For example, clinica...

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Section: Discussionmentioning

confidence: 84%

Primary-care Clinician Perceptions of Racial Disparities in Diabetes Care

et al. 2008

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“…In general, AIAN parents reported that their child's health care providers were sensitive to their family's values and customs; however, this sentiment was reported less often among caregivers of AIAN children compared to those of NHW children. The advancement of cultural competence and diversity as key components in public health and clinical service delivery in the past two decades has perhaps had a positive impact on the sensitivity of health care providers [23,24]. Continued efforts in the area may be worthwhile.…”

Section: Discussionmentioning

confidence: 99%

Medical Home Access Among American Indian and Alaska Native Children in 7 States: National Survey of Children’s Health

Barradas

Kroelinger

Kogan

2012

Matern Child Health J

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To describe the prevalence of medical home among American Indian and Alaska Native children (AIAN) compared to non-Hispanic white (NHW) children and identify areas for improvement in the provision of care within a medical home. Prevalence of medical home, defined as familycentered, comprehensive, coordinated, compassionate, culturally effective care, including a personal doctor or nurse and usual care location, was estimated using 2007 National Survey of Children's Health data. Analyses included 1-17 year-olds in states reporting AIAN race as a distinct category (Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, and South Dakota, n = 9,764). Associations between medical home and demographic (child's age, household education and income, and state) and health-related [child's insurance status, special health care need status, and past year Indian Health Service (IHS) utilization] characteristics were assessed among AIAN children. Overall, the prevalence of medical home was 27 % lower among AIAN children (42.6, 95 % CI = 34.4-50.8) than NHW children (58.3, 95 % CI = 56.2-60.4). Child's age (adjusted OR [aOR] = 2.7, 95 % CI = 1.3-5.6) was significantly associated with medical home. IHS utilization was associated with medical home among AIAN children with private insurance (aOR = 0.2, 95 % CI = 0.1-0.4), but not among uninsured or publicly insured children. Care coordination and family-centered care were noted areas for improvement among AIAN children. Less than half of AIAN children had a medical home. Future studies should further examine the intersection between insurance and IHS to determine if enhanced coordination is Correspondence to: Danielle T. Barradas, dbarradas@cdc.gov. Electronic supplementary material The online version of this article

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“…Encouraging training programs for cultural competency have been launched by the ACGME and AAMC (47). We believe that better understanding of minority populations will increase access to TAVR and other medical procedures.…”

Section: Cultural Differences and Lack Of Understanding Of The Proceduresmentioning

confidence: 99%

A review of racial disparities in transcatheter aortic valve replacement (TAVR): accessibility, referrals and implantation

et al. 2018

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Racial disparities in transcatheter aortic valve replacement (TAVR) implantation results from several factors, including socioeconomic disparities, inherent biases in healthcare provision, fewer referrals to specialists and language barriers in some minority populations. In this review article, we discuss the current data on the racial disparities in TAVR, explore the prevalence of aortic stenosis in different demographics in the United States and we proffer practical solutions to these problems.

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Cultural Competence And Health Care Disparities: Key Perspectives And Trends

Cited by 477 publications

References 5 publications

Primary-care Clinician Perceptions of Racial Disparities in Diabetes Care

Primary-care Clinician Perceptions of Racial Disparities in Diabetes Care

Medical Home Access Among American Indian and Alaska Native Children in 7 States: National Survey of Children’s Health

A review of racial disparities in transcatheter aortic valve replacement (TAVR): accessibility, referrals and implantation

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