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dcyphr | Achieving Health Equity: Closing The Gaps In Health Care Disparities, Interventions, And Research

Abstract

Though we are aware of the lower quality and access to healthcare of minority, rural, and impoverished individuals, the problem persists. This study discusses the gaps of knowledge and communication that keep these populations from getting healthcare. This study also recommends how to improve current healthcare access programs.


Introduction

There is a known need to minimize health care disparities between majority groups and racial/ethnic  minorities, rural residents, and low income adults. There is a lower level of care for these groups, notably in cardiovascular issues and cancer which are leading causes of death in the US. Even though here have been some programs put into place to provide better care to minority groups, we have not seen much improvement at the national level. This article discusses some aspects of health care disparity that existing plans do not address, and offers some programs by the Center for Population Health and Health Disparities that do account for the missing aspects. This article uses a model from Edwin Fisher to explore intervention targets and the key outcomes of the program.


Interventions Targeting Disparities

There are four levels of factors that influence health care. Level 1 is individual patient factors; level 2 is family, friends, and social support factors; level 3 is provider and organizational factors; and level 4 is policy and community factors. Models that intervene at multiple levels are more likely to help the situation than models that only target one of the levels.


Critical Gaps in Knowledge and Translation

Based on previous research, the study has identified 15 knowledge and translation gaps that can be categorized into the four levels mentioned earlier. Understanding these gaps could be the key to attaining health equity.


All Model Levels

Some critical gaps are present between all four levels of the model. Research can be done to compare programs that may target multiple areas (like patient education, provider communication skills, and health system staffing) to programs that target one area (patient education alone). We also need to do research on the benefit of attempting to universally help under-served populations versus the benefit of targeting specific barriers of a certain under-served population. This research must be successful in real world practice as well.


Specific Levels

Some gaps are between two specific levels of the model. For example, we see a critical gap between policy and community (level 4) and organization and provider (level 3): there should be a stronger link between health care systems and the communities they serve. 

At the organization and provider level (level 3), there are 5 critical gaps. There is a need to address the patient’s entire span of care, including prevention, primary care, specialty care, hospitalization, and post-discharge treatment. Also, the gaps of this level require us to consider how a team could benefit care, how to better use health technology, improving health worker’s communication and cultural competence skills, and to shift the focus of healthcare leaders to equity for their communities.

At the friends, family, and social support level (level 2), the gap is to better understand cultural decision making and increasing social networks.

At the individual patient level (level 1), there are important gaps. The needs are to study less commonly studied populations, increase access to treatments adherence and medication access, and ensure these changes to healthcare are successful long term.


Addressing These Gaps and Advancing Health Equity

Reducing Disparities in Cardiovascular Disease Care

The Heart Healthy Lenoir Project was one program targeting blood pressure control. It integrated a community health coach, at home blood pressure monitoring, and on site coaching. The health care facilities were taught race specific data on blood pressure management, how to encourage regular blood pressure check ups, to medicate persistent high blood pressure, and to educate their staff members on health care disparities. This was effective in lowering the blood pressure of white and African American patients, and the program had a higher retention rate for African American individuals.

Another intervention was called Reducing Disparities and Controlling Hypertension in Primary Care. This program made changes by targeting patients, providers, clinical staff members, and the health care system. Measures were taken to increase accuracy of the blood pressure readings taken in the clinic. Pharmacists and dietitians were added to the primary care team of the patients. Finally, a database was used to report the race-specific data on blood pressure management, which was intended to educate the physicians. The patients who completed all parts of the program saw a greater reduce in blood pressure, and the race disparities in systolic blood pressure was no longer present at the end of the study.


Reducing Disparities in Cancer Care

One program called Fortaleza Latina showed that culturally based tactics using community education improved the rates at which Latinas got mammography screenings. The study used promotoras, which are community members who are trained to educate their community. This program involved research institutions, primary care clinics, and cancer treatment centers.

Another program called Project Community Linked to Quit aimed to provide health care to smokers. The program offered outreach, motivational counseling, free nicotine replacement therapy, and access to community based resources. Information about race and income was recorded. This program was more effective than many current efforts to decrease smoking in low income and minority adults.


Informing Future Interventions

This study has discovered some valuable information to health disparities. Patients prefer a holistic treatment plan that includes community classes and support groups, as opposed to disease specific treatment. Incorporating all of the people who provide care into the treatment plan creates a more successful program and can increase funding as well. Research finding and other sponsorships from the community increase the effectiveness of the programs. Universal policies, like universal health care, are important, but are not enough to rescue disparities in health care. Universal policies must be used in combination with targeted care for at-risk populations in order to see the change we need. The Delaware Cancer Treatment Program is an example of a program that used universal colorectal cancer screenings with targeted insurance coverage for those in need. This program decreased the percentage of African American disease from 79 to 40 percent, almost eliminating mortality disparities.

The Affordable Care Act mainly focuses on national health overall, but also began collecting data on race, ethnicity, sex, primary language, and disability status. This information has helped physicians to use disparity interventions, target the at-risk patients, and increase health equity. In the future, we need to monitor and study health care reform to better understand how we can decrease healthcare disparities. Finally, payment model reforms are necessary to make sure disenfranchisement or penalties do not affect targeted populations or the physicians serving those populations. 


Conclusion

Though there is much to do when it comes to health care reforms and reaching equity, the research we are doing is helping to create better programs. We now know that networks and multiple level programs may be the best way to continue health care reform. Collaboration between levels of care, monitoring of the effects of new programs, and maintaining funding will be the key to healthcare equity.