Reducing health disparities: Every PAʼs obligation (2008)

FigureThe chart for your next patient reads as follows: “53-year-old overweight female with diabetes is here for evaluation and treatment of…” She is an African-American woman whose visit is related directly or indirectly to her diabetes. Take a moment to imagine this woman and reflect on the clinical issues that come to mind. Then take a moment to consider what you know (or don't know) about similar people treated for this condition. Racial and ethnic inequalities exist consistently across medicine, according to health care authorities such as the Institute of Medicine (IOM), the CDC, the Agency for Healthcare Research and Quality, and the Kaiser Family Foundation. African-Americans and Latinos with diabetes are more likely to be hospitalized for uncontrolled diabetes than are whites of European descent. Furthermore, more than half of Latinos and Asians with diabetes are not given plans to manage their chronic condition at home. Latinos are less likely to have received the recommended A1C test, retinal examination, or foot care. African-Americans are more likely to undergo lower limb amputation and to receive inadequate analgesia for pain; they are also less likely than whites of European descent to be recommended for advanced cardiac interventions like cardiac catheterization.1-3 Health disparities are the results of health care systems issues; legal and regulatory factors; and bias, stereotyping, and discrimination on the part of the clinician.1 Most often, clinician bias is unconscious and a reflection of bias in our society. Whether these biases stem from historical residue, media images, or a lack of experience, clinicians may unconsciously bring some biases into their clinical practice. Physician assistants have heard about health disparities, but what can we do to help insure healthy outcomes for our patients? Individually and collectively, we can make a difference in health disparities. Here are a few places to start: Educate yourself on health disparities, particularly in your area of medicine. Use your Web search engine and combine “health disparities” and any area or topic in medicine. The IOM's Unequal Treatment is a comprehensive source.1 Go to Project Implicit, a Harvard University Web site that identifies personal embedded preferences (https://implicit.harvard.edu/implicit/). Take the demonstration site's tests from several categories. The results will show your unconscious preferences—certainly important to know in order to overcome bias in patient care. Visit Head's Up! at www.stop-disparities.org. This health disparities reduction project was initiated by the AAPA's Committee on Diversity and focuses on developing solutions to reduce health disparities that are caused by clinician stereotyping. Encourage and recruit racial and ethnic minorities to become PAs. Doing so will help to increase the number of providers serving all patients, especially minority patients, as well as to increase understanding of the issues associated with caring for all of the nation's population. Take steps to improve your cross-cultural communication skills. The Health Resource and Services Administration promotes cultural competency resources for clinicians at www.hrsa.gov/culturalcompetence/;. Take free online CME training at www.hrsa.gov/healthliteracy/training.htm to improve your communication skills for health literacy. Work to provide patient-centered care for everyone, re gardless of your specialty. Health disparities begin to disap pear when quality care is utilized across racial and ethnic boundaries. For example, disparities in primary care screening rates improve when patients have a regular clini cian and a medical home.4 Advocate among colleagues, health system leaders, and community and government leadership for measures that will promote quality health care and reduce barriers that contribute to disparities. These are activities that each of us can do in our own pri vate space and time. When our diabetic patient walks into any of our practices, the care she received before she arrives at our door, as well as the care she receives after entering our door, will help determine her health and well-being. Each of us must accept the challenge and responsibility of overcom ing health inequalities. The nation's health is part of our responsibility.