Keith C. Ferdinand 2017-06-22 06:07:10
Improving Health Care Access For Minority and High-Risk Populations Despite advances in medical therapies and new treatment modalities for patients with or at risk for cardiovascular diseases, health equity and access to care remain significant areas of concern. African Americans are disproportionately burdened with the highest rate of heart disease and stroke of any racial or ethnic group in the U.S. Moreover, there remains indisputable evidence that the presence of health disparities continues to be a major concern in the health care for cardiovascular disease and the black-white gap in life expectancy has persisted over the last several decades. Access to quality health care remains a challenge, particularly for underserved minority patient populations with limited availability of evidencebased therapies leading to premature deaths, diminished quality of life and loss of optimal productivity.The cause of these disparities is complex, existing both within and outside of the health care system.What is promising is that there are remediable interventions with potential improved outcomes for all. Key stakeholders and patients must be willing to take a comprehensive look at these issues with the intention of developing real solutions. It’s critical that we move beyond simply acknowledging issues related to patient access to identifying significant solutions that remove barriers to optimize health care. The challenge is to appropriately explore how we can overcome the divide and develop evidence-based, high-impact strategies for both health care providers and patients. The Access to Health Care Initiative of the Association of Black Cardiologists (ABC), which I chair, has set as its mission to address these critical issues in a changing health care landscape by revealing disparities faced by minorities and high-risk patients and promulgating solutions to diminished access, especially to newer medications and therapies. A critical concern is that the improvement in cardiovascular mortality has recently shown a deceleration in the rate of decline in cardiovascular disease, heart disease and stroke mortality. This is an alarming trend that warrants innovative approaches and we must be responsive to the unacceptable mortality rates among blacks from cardiovascular disease compared with whites. We will not be a healthy society until we begin dissecting these problems and finding solutions that lead to the elimination of disparities and equal care for all. The ABC Access Initiative takes an in-depth look at the key barriers to access quality care, such as unveiling how frequently prescriptions for new evidence-based therapies are delayed or denied.The most challenging obstacles are: cost of drugs to patients, suboptimal access to primary care, low number of referrals to specialists when indicated, socioeconomic determinants of health, lack of culturally competent providers, limited access to affordable generics and refusal of some health care providers to accept Medicaid or certain health insurances amongst others. Five consensus-driven solutions have been identified by the ABC Access Initiative and its multidisciplinary team of stakeholders. These recommendations have been developed to improve patient access to care and innovative therapies by crafting definitive, collaborative solutions that expand existing services, streamline processes or address problematic policies. The solutions identified are the advancement of telehealth and telemedicine for minority populations, advocacy for policy reform, standardization of health plan authorization processes, promulgation of pharmacy- based programs and mobilized community health workers for greater patient engagement. As health care professionals, we need to be able to offer our patients evidence-based therapies, regardless of race, ethnicity or socioeconomic status. There must be an emphasis on understanding the importance of health literacy and the social determinants of health, including adverse environments and the stresses of having a disadvantaged socioeconomic status. As cardiovascular and public health stakeholders, we encourage groups and organizations around the U.S. to join us in advancing and identifying solutions to aid minority or high-risk populations.The ABC consensus report, Improving Health Care Access for Minority and High-Risk Populations, supports its mission to promote the prevention and treatment of cardiovascular disease by eliminating inequalities and improving access to health care, including evidence-based treatments and newer modalities. We can all be partners in this effort by contributing to the identified solutions. For more information on the summary of recommendations and the ABC, visit abcardio.org. From the Starting Line Nkechi Ijioma, MD Health Equity and the Early Career Physician Heart Month, February 2013. I had just concluded my community talk on heart disease prevention strategies.A middle-aged lady approached me after my presentation. She wanted to eat healthy, but felt she could not afford to incorporate daily servings of vegetables into her meal plan. “Frozen vegetables” was my response. “Cheaper than fresh vegetables, healthier than canned vegetables, and might fit within your budget.” She smiled; frozen vegetables had not occurred to her. It suddenly dawned on her that she could afford to eat healthy. Society is made up of people with different backgrounds. Social, economic, racial, educational and cultural differences exist in nearly every community. For a variety of reasons, not everyone is able to achieve the highest level of [cardiovascular] health. This is known as health inequity. The reasons may be socioeconomic, political or environmental.1 These social determinants of health play an important role in health inequity. Children born in certain countries may have shorter lifespans. Residence in certain zip codes may determine access to healthcare, the quality of school choices and eventual economic status for adults in the community.2 Economic or social status, in turn, play a role in determining people’s life choices, career opportunities and quality of life. The political and health care policies of a country can also lead to health inequity within a country or geographic region. Health inequity ultimately leads to health disparities, i.e., differences in health care outcomes among groups of people, due to obstacles or other characteristics which lead to exclusion or discrimination.3,4 As early career physicians, we are uniquely positioned to engage in activities that can make a difference over the course of our career. The big picture problem regarding health inequity may initially seem daunting. We may not have the power to alter the inequitable distribution of resources, money or power in our communities,1 and our work-family life schedule may render us too busy for large projects such as volunteer mission trips abroad. However, if we pause and look around us, opportunities exist whereby, with a little effort on our part, we can make a difference and promote health equity in our local communities. On a personal level, we can examine ourselves for implicit bias in our patient-provider healthcare encounters,5 and ensure that we practice evidencebased medicine with all our patients. In addition, there are several ways that we can assist with the identification and resolution of the factors which contribute to health inequity in our local community.Many health care institutions have a number of communityhealthcare center partnerships, such as an annual free community health day or a “walk-withthe- doc” program.We can sign up as a physician volunteer or take up a leadership role and organize similar events in our community. We can raise public awareness, give talks on preventive cardiology at local community social events or spend a couple of hours as a career role model at the local high school. One changed life can have a positive impact on an entire family. Early career physicians can also engage in health disparity research. Several national grants and fellowships exist for physicians interested in health disparity research.6 Collectively, we can partner with our ACC State Chapter, and/or other cardiovascular societies to work to eliminate health inequity and disparity in health care. The ACC Political Action Committee (ACCPAC), a non-partisan branch of the College, is devoted to promoting and advocating for relevant cardiovascular health policies on Capitol Hill. As early career physicians, our support of ACCPAC helps the College in its global mission to reduce health inequity and eliminate health care disparities. References World Health Organization, Commission on Social Determinants of Health. Closing the Gap in a Generation: Health Equity Through Action On The Social Determinants Of Health. Available at http://www.who.int/social_determinants/finalreport/csdh finalreport_2008.pdf. Accessed May 19, 2017. Gebreab SY, Davis SK, Symanzik J, Mensah GA, et al. J Am Heart Assoc 2015;4:e001673. Health Disparities. Available at https://medlineplus.gov/healthdisparities.html. Accessed May 19, 2017. Paving the Road to Health Equity. Available at https://www.cdc.gov/healthequity/index.html. Accessed May 19, 2017. Cooper LA, Roter DL, Carson KA, et al. Am J Public Health 2012;102:979-87. Grants, Funding and Fellowships. https://www.nlm.nih.gov/hsrinfo/disparities.html#498. Accessed May 19, 2017. Scan the QR code to learn more about advocacy at ACC and how to get involved with ACCPAC.
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