disparity

Inner city health systems key points

-Racial and ethnic health disparity DOES exist -Those in poverty suffer worse health outcomes -Cultural competency is essential for PAs working in inner city areas -Low-income families are composed mostly of minorities --African Americans --Hispanics/Latinos --American Indian -A majority of hospital ED visits continue to be made by low-income or no-income members of our inner city communities -PAs have provided medical stability and continuity of care in community health centers

Eliminating health disparites

"more than a single cause, so unlikely a single intervention strategy will suffice"

Accountability

"we cannot be committed to the profession part of the time" (self regulation, work ethic)

cultural complexities

**caution to assumptions of stereotyping

communicable disease

*in US, minorities represent 71% of all reported AIDS cases -80% of reported gonorrhea

Culture defined as

--> social "norms" witin a group --> behaviors and beliefs characteristic of a particular social, ethnic, or age group

Professionalism

-A set of behaviors that demonstrate care and respect for self and others -Behavior toward oneself toward other health professionals toward public toward patients

Why do PA's work in correctional health

-ability to positively impact public health

institutional factors

-access to a regular source of care -minorities more likely live in medically underserved areas -insurance burden -lack of minority physician providers (4% AA, 5%Hispanic)

when treating hearing impaired

-do not assume they are lip-readers -role of interpreter is to convey info not to explain things

American indians and alaska natives

-incidence of diabetes is more than twice that of general pop -die of the disease at a rate of 189% higher than general pop

How to address health care disparities

-increasing need for multi cultural providers -role models- explicit curriculum-req for core professionalism instruction and core cultural competencies in pa education

Provider driven contributors

-lack of cultural competency -negative stereotyping influencing clinical decisions -racial/ethnic bias -physician practice styles (minority patients may not receive literature relevant to HPDP) (reduced qualiy in health care) -lack of knowledge of available resources, referrals, and consulatants

Homeless stats

-lifespan is 30 years less -homeless children have more acute and chronic iillnesses -developmental delays -more exposure to violence

Factors contributing to health care disparities

-patient-driven contributors are -income -lack of quality education -insurance coverage -medical settings in which care is recieved -timeliness of care received -patient adherence to treatment plans (cultural and language barriers) -decreased health literacy

Role of public teaching hospitals

-provide outpatient and inpatient care for inner city populations -care for those with no insurance -no refusal to treat -funding from gov -not well suited for chronic care(patients can see same provider)

homeless adolescents

12X more llikely to contract HIV

PA's and rural medicine

15% of PA's nationwide work in rural areas -degree earned is inversely proportionate to rural emplyment (higher degrees tend to practice in urban settings)

cancer mortality rate for AA

35% higher (have higher mortality rater than white even though less incidence rates) -also twice the risk of developing diabetes -highest rate of mortality from CVD (esp poor and uneducated)

4 major paradigms to address health care disparities

Acknowledge health disparities have existed AND currently exist Acknowledge that some health and health care disparities are lessening, but effective evaluation of disparities programs is needed - "best-practice" approach Government agencies, non-profit org., foundations, schools, businesses, health care workers, hospitals and community-based organizations Acknowledge that opportunities for improvement are promising Acknowledge that research about disparities is improving

Patients bill of rights

First adopted by the american hospital association in 1973 (patiens have the right to an interpreter when language barrier)

Leading cause of death for african americans

HIV/Aids

Military PA-key pints

Military PAs provide high quality, cost-effective medical care PAs are valued and accepted as a vital component of medical care in the military The number of PAs in the military fluctuates Military experience is valued in the civilian job market Coast Guard PA's mission has changed with the fielding of the Department of Homeland Security PAs in the military have risen to new heights of leadership opportunities Military and civilian Many branches provide sign-on and relocation bonuses

homeless take home points

Most patients that are homeless DO NOT self-report homelessness Associated with shame and embarrassment Caring for the homeless requires extra patience, care and compassion They may be initially distrustful of all authority or resources offered Clinicians MUST demonstrate non-judgmental attitude Care for the homeless can also be extremely rewarding Individuals develop increased appreciation for personal living standards and family support Proper referrals and support for the homeless may result in life-altering improvements Opportunity to rebuild life and recover from illness

challenges for community health centers

Patient chall-lack of or reduced funding Provider challenges-complex patient care issues Provider apathy-decreased motivation to serve the underserved

Evaluation and Assessment of PA Competencies

Physician assistants are expected to demonstrate commitment to excellence and ongoing professional development Physician assistants must know their professional and personal limitations Physician assistants must practice without impairment from substance abuse, cognitive deficiency, or mental illness Physician assistants are expected to demonstrate self-regulation, critical curiosity and initiative

Health Disparity

Population-specific differences in the presence of disease, health outcomes, or access to health care

Asian Descent

Vietnamese-cervican cancer rates 5 times higher

health literacy

ability of an indiv to assess, understand, and use health-related information and services to make appropriate health decisions

Point to ponder

all patients with disabilities are at increase risk for abuse and neglect

Behavior toward patient

altruism

LEARN model

an educational model to assist health care workers to increase communication skills and cultural awareness in providing healthcare

Who are the homeless?

any person lacking fixed, stable, permanent housing (includes primary nighttime residence of shelter)

ethical analysis

assists clinician or committee in ethical decision making

4 bioethical principles

autonomy, beneficence, nonmaleficence(do no harm), justice

When compared to whites, minority groups have higher incidence of:

chronic diseases higher mortality poorer health outcomes

to make good ethical decisions

clinical exposure

Autonomy

concepts of privacy, freedom of choice, patient is self governing and free to choose

Community health centers

designed in 1960 to address stress on public hospitals -sliding scale payment-(payment based on ability to pay) -ability to visit same provider

public health departments

developed to protect public health through patient education, HPDP -made efoorts to prevent and control communicable disease

rural health care prob

difficult recruiting practicioners -devlopment of "safety net" --increased grant approval, loan forgiveness for clinicians

The legal difinition from the americans with disabilties act is

disabled person is someone with physical or mental impairment that substantially limits one or more major life activities (includes people with hidden diabilities like arthritis, diabetes, hearing impairment)

The hippocratic oath

do no harm

Cause of homelessness?

economic depression working poor are one check away from homelessness

culture is a learned behavior

established by Home, Community, influcenced by larger social network

what should not be used to define indiv?

gender, race, religion, or dress

Rural access to health care

geographic access to health facilities may be difficult -less local health care providers -less qualified health care providers from outside of rural area

Rural demographics

higher unemplyment rates, more poverty, and more older indiv -minorities have increased from 18.3 to over 20%, must adapt to this in many ways

Specific barriers need addressing

improve patient provider relationship cultural and linguistic competency improve access to health care

Factors driving need for cultural competency

increasing societal diversity accreditation standards-ACGME and ARC-PA require core competency state licensing regulations 2002 charter on professionalism *major factor in addressing health disparities

Correctional health systems

inmates have a higher incidence of health problems when compared with the general population -recent changes in laws were purposed to address overcrowding prisons for minor or public health crimes (public urination)

What is cultural competence?

knowledge that cultural variances do exist (patients may have diff behaviors beliefs....to delivery of healthcare)

As inner city pop became more poor patients

medicaid and medicare were unable to offer clinician reimbursement at competitive rates to private insurance companies -many practices were forced to shut down or relocate -private hospitals became specialty centers to survive (no uninsured allowed)

Health disparities

minorities with same condition less likely to receive kidney transplants, cardiac procedure

Justice

moral obligation to treat people fairly, providing equal access to resources

Language and Cultural competence

more than 40% of health care providers do not know how to obtain interpreters -providers must establish a patients ability to understand all components of health care encounter

What is a "inner city"?

neighborhoods located near industrial and commerical activity (exposure to noise, traffic, polution) most likely people of color and low economic means

Moral

of, pertaining to, or concerned with the principles or rules of right conduct or the distinction between right and wrong

scope of the prob

over the past two decades it has become more and more evident that different groups receive dissimilar levels of health care services both in quality and quantitiy of services provided

Why should pa be concerned?

pa education is an important component of an overall strategy to eliminate health disparities, *understand underlying causes of health disparities

Timliness

part of accountability

Barriers to health care for disabled person

physical barriers inadequate communication social policy barriers stereotyping and stigmatizing views of living with diabilities

What is necessary to care for patients from diff culture?

recognizing specific knowledge and skills are necessary

Diversity in inner cities

school districts may include children who speak more than 100 diff languages at home

American sign language interpreters should....

should possess national or state certification

Why is professionalism important?

shows self respect, respect for others, helps establish trust between patient and provider

The "hidden curriculum"

student observation of provider-patient and peer encounters in the health care environment

Ethics

that branch of philosophy dealing with values relating to human conduct, with respect to the rightness and wrongness of certain actions and to the goodness and badness of the motives and ends of such actions

Beneficence

to actively make safe the well being of patients and actively keep them out of harms way (act in patient interest)

goal for diabled

to function as autonomously and independently as anyone else

Hispanic americans

twice the risk of developing diabetes and twice as likely to die from the disease highest incidence of cervical cancer

homeless demo

up to 1.6 mill homeless children annually, 42% are younger than age 6

Why recognize health disparities

useful in providing effective, culturally sensitive care to patients and their families