Report spells out 6 steps to reduce health disparities
■ Researchers outline a road map designed to help physicians and organizations evaluate disparities in their practices and move toward solutions.
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A six-step process can help physicians and health care organizations tackle the complex task of reducing health disparities by tailoring interventions to the specific communities and patients they serve, says a report in the August Journal of General Internal Medicine.
Too often, disparities efforts are marginalized — such as when a hospital hosts a health fair but never makes decreasing disparities an intrinsic part of their system of care, said lead author Marshall Chin, MD, MPH, the Richard Parrillo Family Professor of Medicine at the University of Chicago Pritzker School of Medicine. He said it’s important for physicians and organizations not to become overwhelmed by the problems and recognize that they can make a difference for their patients.
“We need to consciously address these disparities,” Dr. Chin said. “We need to make it an integral part of what we do. The good news is we do know a lot about what works, so now is the time to take action.”
By evaluating proven approaches in HIV, colorectal cancer, cervical cancer, prostate cancer and asthma, the report outlines a six-step process that physicians, hospitals and other health care organizations can take to address health disparities.
Those steps are: recognize disparities and commit to reducing them; implement a quality improvement process; make equity an integral component of quality improvement efforts; design interventions; implement, evaluate and continually improve the interventions; and sustain the interventions over time.
The road map is an initiative of the Robert Wood Johnson Foundation’s Finding Answers: Disparities Research for Change National Program Office, which Dr. Chin directs.
“I really think it is needed,” Moon Chen Jr., PhD, MPH, associate director for cancer disparities and population research at the University of California-Davis Cancer Center, said of the report. “It covers a lot of things, and it recognizes that there is no silver bullet.”
Reducing health disparities is not like cooking, said Chen, who also directs the Asian American Network for Cancer Awareness, Research and Training. One can’t follow a recipe in a book and expect to solve the problems. Situations and needs will vary from place to place. For programs to work, they must be tailored to specific communities and have leadership support, he said.
Some of the most common disparities efforts center on educating patients. Physicians can help make positive changes by ensuring that their care is culturally tailored to individual patients and by connecting with patients multiple times throughout their care. Team-based approaches to care in which doctors share the responsibilities with other health professionals to ensure that patients don’t fall through gaps in care have proven particularly effective, the report said.
In educating patients, physicians should use an interactive approach and get patients actively involved, Dr. Chin said.
“The classic way to do it wrong is to lecture a patient,” Dr. Chin said. “That’s one of the least effective ways to learn. If you engage the patient in problem solving, it is a lot more effective.”
Patient navigators who help guide patients through the many steps of care also have been effective, especially if the individual providing the navigation is someone the patient can relate to, the report said.
One program in Cleveland involved hiring former kidney transplant recipients to serve as patient navigators for new kidney transplant candidates, said Ashwini Sehgal, MD, Duncan Neuhauser Professor of Community Health Improvement at the university and director of the Case Western Reserve University’s Center for Reducing Health Disparities.
“They had the experience of kidney failure, being on dialysis and going through the transplant process themselves, so they were able to relate to what the patients were going through,” Dr. Sehgal said.
The navigators helped patients complete twice as many of the steps needed to qualify for a kidney transplant, compared with patients who did not have them, according to a study on the program published online July 12 in the Journal of the American Society of Nephrology.
It also is important that programs maintain contact with patients and connect with them multiple times throughout the care process, said Chen, of UC Davis. The UC Davis Health System has a detailed electronic health records system that incorporates a patient’s demographic information, such as race, ethnicity and country of birth. Using that information and known health disparities, the system prompts physicians when certain tests and checks are recommended, Chen said.
Dr. Sehgal said disparities efforts need to move beyond health care. A person’s health is determined by so many factors outside of a physician’s office. Cultural and environmental factors should be taken into consideration.
“Ideally we would work on all of these things, not just health care,” he said.
Efforts need to be tailored to specific populations, Dr. Chin said. For example, an educational video interviewing black diabetes patients in the Mississippi Delta that has proven to help others in the region learn to better manage their disease would not be as effective at helping blacks in urban Chicago.
“Each of us at the local level must adapt to our local clientele,” Chen said. “The solutions are local, not universal.”