10 steps for avoiding health disparities in your practice

We hope the answer to the question above is no. However, the evidence regarding differences in the care of patients based on race, ethnicity, gender, and socioeconomic status suggests that if this patient is a woman or African American or from a lower socioeconomic class, resultant morbidity or mortality will be higher.

Differences are seen in the provision of cardiovascular care, cancer diagnosis and treament, and HIV care. African Americans, Latino Americans, Asian Americans, and Native Americans have higher morbidity and mortality than Caucasian chemical dependency, diabetes, heart disease, infant Americans for multiple problems including cancer, mortality, and unintentional and intentional injuries.¹

This article explores possible explanations for health care disparities and offers 10 practical strategies for tackling this challenging issue.

Examples of health disparities

The United States has dramatically improved the health status of its citizens—increasing longevity, reducing infant mortality and teenage pregnancies, and increasing the number of children being immunized. Despite these improvements, though, there remain persistent and disproportionate burdens of disease and illness borne by subgroups of the population (Table 1). ^2,3

The Institute of Medicine in its recent report, “Unequal Treatment,” approaches the issue from another perspective: they define these disparities as “racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences and appropriateness of intervention.”⁴

TABLE 1
Examples of health disparities that could be changed

Correcting health disparity begins with understanding its causes

A number of factors account for disparities in health and health care.

Population-influenced factors

Leading candidates are some population groups’ lower socioeconomic status (eg, income, occupation, education) and increased exposure to unhealthy environments. Individuals may also exhibit preferences for or against treatment (when appropriate treatment recommendations are offered) that mirror group preferences.

For example, African American patients’ distrust of the healthcare system may be based in part on their experience of discrimination as research subjects in the Tuskegee syphilis study and Los Angeles measles immunization study. Research has shown that while these issues are relevant, they do not fully account for observed disparities.

System factors

Problems with access to care are common: inadequate insurance, transportation difficulties, geographic barriers to needed services (rural/urban), and language barriers. Again, research has shown that access to care matters, but not necessarily more than other factors.

Individual factors

At the individual level, a clinical encounter may be adversely affected by physician-patient racial/ethnic discordance, patient health literacy, and physician cultural competence. Also, there is the high prevalence of risky behavior such as smoking.

Finally, provider-specific issues may be operative: bias (prejudice) against certain groups of patients, clinical uncertainty when dealing with patients, and stereotypes held by providers about the behavior or health of different groups of patients according to race, ethnicity, or culture.

Addressing disparities in practice

Clearly, improving the socioeconomic status and access to care for all people are among the most important ways to eliminate health disparities. Physicians can influence these areas through individual participation in political activities, in nonprofit organizations, and in their professional organizations.

Steps can also be taken in your own practice (Table 2).

TABLE 2
Ten practical measures for avoiding health disparity in your practice

Use evidence-based guidelines

To minimize the effect of possible bias and stereotyping in caring for patients of different races, ethnicities, and cultures, an important foundation is to standardize care for all patients by using evidence-based practice guidelines when appropriate. Clinical guidelines such as those published by the US Preventive Services Task Force and those available on the Internet through the National Guideline Clearinghouse provide well-researched and substantiated recommendations (available at www.ngc.gov).

Using guidelines is consistent with national recommendations to incorporate more evidence-based practices in clinical care.

Make your office patient-friendly

Create an office environment that is sensitive to the needs of all patients. Addressing language issues, having front desk staff who are sensitive and unbiased, and providing culturally relevant patient education material (eg, posters, magazines) are important components of a supportive office environment.¹

Advocate patient education

Strategies to improve patient health literacy and physician cultural competence may be of benefit. The literacy issue can be helped considerably by enabling patients to increase their understanding of health terminology, and there are national efforts to address patient health literacy. Physicians can also help by explaining options and care plans simply, carefully, and without medical jargon. The American Medical Association has a national campaign in support of health literacy (www.amaassn.org/ama/pub/category/8115.html).

Increase cross-cultural communication skills

The Institute of Medicine and academicians have increasingly recommended training healthcare professionals to be more culturally competent. Experts have agreed that the “essence of cultural competence is not the mastery of ‘facts’ about different ethnic groups, but rather a patient-centered approach that incorporates fundamental skills and attitudes that may be applicable across ethnic boundaries.”⁶

A recent national survey supported this idea by showing that racial differences in patient satisfaction disappeared after adjustment for the quality of physician behaviors (eg, showing respect for patients, spending adequate time with patients). The fact that these positive physician behaviors were reported more frequently by white than non-white patients points to the need for continued effort at improving physicians’ interpersonal skills.

Corresponding author
Eric Henley, MD, MPH, Co-Editor, Practice Alert, 1601 Parkview Avenue, Rockford, IL 61107. E-mail: [email protected].

We hope the answer to the question above is no. However, the evidence regarding differences in the care of patients based on race, ethnicity, gender, and socioeconomic status suggests that if this patient is a woman or African American or from a lower socioeconomic class, resultant morbidity or mortality will be higher.

Differences are seen in the provision of cardiovascular care, cancer diagnosis and treament, and HIV care. African Americans, Latino Americans, Asian Americans, and Native Americans have higher morbidity and mortality than Caucasian chemical dependency, diabetes, heart disease, infant Americans for multiple problems including cancer, mortality, and unintentional and intentional injuries.¹

This article explores possible explanations for health care disparities and offers 10 practical strategies for tackling this challenging issue.

Examples of health disparities

The United States has dramatically improved the health status of its citizens—increasing longevity, reducing infant mortality and teenage pregnancies, and increasing the number of children being immunized. Despite these improvements, though, there remain persistent and disproportionate burdens of disease and illness borne by subgroups of the population (Table 1). ^2,3

The Institute of Medicine in its recent report, “Unequal Treatment,” approaches the issue from another perspective: they define these disparities as “racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences and appropriateness of intervention.”⁴

TABLE 1
Examples of health disparities that could be changed

Correcting health disparity begins with understanding its causes

A number of factors account for disparities in health and health care.

Population-influenced factors

Leading candidates are some population groups’ lower socioeconomic status (eg, income, occupation, education) and increased exposure to unhealthy environments. Individuals may also exhibit preferences for or against treatment (when appropriate treatment recommendations are offered) that mirror group preferences.

For example, African American patients’ distrust of the healthcare system may be based in part on their experience of discrimination as research subjects in the Tuskegee syphilis study and Los Angeles measles immunization study. Research has shown that while these issues are relevant, they do not fully account for observed disparities.

System factors

Problems with access to care are common: inadequate insurance, transportation difficulties, geographic barriers to needed services (rural/urban), and language barriers. Again, research has shown that access to care matters, but not necessarily more than other factors.

Individual factors

At the individual level, a clinical encounter may be adversely affected by physician-patient racial/ethnic discordance, patient health literacy, and physician cultural competence. Also, there is the high prevalence of risky behavior such as smoking.

Finally, provider-specific issues may be operative: bias (prejudice) against certain groups of patients, clinical uncertainty when dealing with patients, and stereotypes held by providers about the behavior or health of different groups of patients according to race, ethnicity, or culture.

Addressing disparities in practice

Clearly, improving the socioeconomic status and access to care for all people are among the most important ways to eliminate health disparities. Physicians can influence these areas through individual participation in political activities, in nonprofit organizations, and in their professional organizations.

Steps can also be taken in your own practice (Table 2).

TABLE 2
Ten practical measures for avoiding health disparity in your practice

Use evidence-based guidelines

To minimize the effect of possible bias and stereotyping in caring for patients of different races, ethnicities, and cultures, an important foundation is to standardize care for all patients by using evidence-based practice guidelines when appropriate. Clinical guidelines such as those published by the US Preventive Services Task Force and those available on the Internet through the National Guideline Clearinghouse provide well-researched and substantiated recommendations (available at www.ngc.gov).

Using guidelines is consistent with national recommendations to incorporate more evidence-based practices in clinical care.

Make your office patient-friendly

Create an office environment that is sensitive to the needs of all patients. Addressing language issues, having front desk staff who are sensitive and unbiased, and providing culturally relevant patient education material (eg, posters, magazines) are important components of a supportive office environment.¹

Advocate patient education

Strategies to improve patient health literacy and physician cultural competence may be of benefit. The literacy issue can be helped considerably by enabling patients to increase their understanding of health terminology, and there are national efforts to address patient health literacy. Physicians can also help by explaining options and care plans simply, carefully, and without medical jargon. The American Medical Association has a national campaign in support of health literacy (www.amaassn.org/ama/pub/category/8115.html).

Increase cross-cultural communication skills

The Institute of Medicine and academicians have increasingly recommended training healthcare professionals to be more culturally competent. Experts have agreed that the “essence of cultural competence is not the mastery of ‘facts’ about different ethnic groups, but rather a patient-centered approach that incorporates fundamental skills and attitudes that may be applicable across ethnic boundaries.”⁶

A recent national survey supported this idea by showing that racial differences in patient satisfaction disappeared after adjustment for the quality of physician behaviors (eg, showing respect for patients, spending adequate time with patients). The fact that these positive physician behaviors were reported more frequently by white than non-white patients points to the need for continued effort at improving physicians’ interpersonal skills.

Corresponding author
Eric Henley, MD, MPH, Co-Editor, Practice Alert, 1601 Parkview Avenue, Rockford, IL 61107. E-mail: [email protected].

We hope the answer to the question above is no. However, the evidence regarding differences in the care of patients based on race, ethnicity, gender, and socioeconomic status suggests that if this patient is a woman or African American or from a lower socioeconomic class, resultant morbidity or mortality will be higher.

Differences are seen in the provision of cardiovascular care, cancer diagnosis and treament, and HIV care. African Americans, Latino Americans, Asian Americans, and Native Americans have higher morbidity and mortality than Caucasian chemical dependency, diabetes, heart disease, infant Americans for multiple problems including cancer, mortality, and unintentional and intentional injuries.¹

This article explores possible explanations for health care disparities and offers 10 practical strategies for tackling this challenging issue.

Examples of health disparities

The United States has dramatically improved the health status of its citizens—increasing longevity, reducing infant mortality and teenage pregnancies, and increasing the number of children being immunized. Despite these improvements, though, there remain persistent and disproportionate burdens of disease and illness borne by subgroups of the population (Table 1). ^2,3

The Institute of Medicine in its recent report, “Unequal Treatment,” approaches the issue from another perspective: they define these disparities as “racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences and appropriateness of intervention.”⁴

TABLE 1
Examples of health disparities that could be changed

Correcting health disparity begins with understanding its causes

A number of factors account for disparities in health and health care.

Population-influenced factors

Leading candidates are some population groups’ lower socioeconomic status (eg, income, occupation, education) and increased exposure to unhealthy environments. Individuals may also exhibit preferences for or against treatment (when appropriate treatment recommendations are offered) that mirror group preferences.

For example, African American patients’ distrust of the healthcare system may be based in part on their experience of discrimination as research subjects in the Tuskegee syphilis study and Los Angeles measles immunization study. Research has shown that while these issues are relevant, they do not fully account for observed disparities.

System factors

Problems with access to care are common: inadequate insurance, transportation difficulties, geographic barriers to needed services (rural/urban), and language barriers. Again, research has shown that access to care matters, but not necessarily more than other factors.

Individual factors

At the individual level, a clinical encounter may be adversely affected by physician-patient racial/ethnic discordance, patient health literacy, and physician cultural competence. Also, there is the high prevalence of risky behavior such as smoking.

Finally, provider-specific issues may be operative: bias (prejudice) against certain groups of patients, clinical uncertainty when dealing with patients, and stereotypes held by providers about the behavior or health of different groups of patients according to race, ethnicity, or culture.

Addressing disparities in practice

Clearly, improving the socioeconomic status and access to care for all people are among the most important ways to eliminate health disparities. Physicians can influence these areas through individual participation in political activities, in nonprofit organizations, and in their professional organizations.

Steps can also be taken in your own practice (Table 2).

TABLE 2
Ten practical measures for avoiding health disparity in your practice

Use evidence-based guidelines

To minimize the effect of possible bias and stereotyping in caring for patients of different races, ethnicities, and cultures, an important foundation is to standardize care for all patients by using evidence-based practice guidelines when appropriate. Clinical guidelines such as those published by the US Preventive Services Task Force and those available on the Internet through the National Guideline Clearinghouse provide well-researched and substantiated recommendations (available at www.ngc.gov).

Using guidelines is consistent with national recommendations to incorporate more evidence-based practices in clinical care.

Make your office patient-friendly

Create an office environment that is sensitive to the needs of all patients. Addressing language issues, having front desk staff who are sensitive and unbiased, and providing culturally relevant patient education material (eg, posters, magazines) are important components of a supportive office environment.¹

Advocate patient education

Strategies to improve patient health literacy and physician cultural competence may be of benefit. The literacy issue can be helped considerably by enabling patients to increase their understanding of health terminology, and there are national efforts to address patient health literacy. Physicians can also help by explaining options and care plans simply, carefully, and without medical jargon. The American Medical Association has a national campaign in support of health literacy (www.amaassn.org/ama/pub/category/8115.html).

Increase cross-cultural communication skills

The Institute of Medicine and academicians have increasingly recommended training healthcare professionals to be more culturally competent. Experts have agreed that the “essence of cultural competence is not the mastery of ‘facts’ about different ethnic groups, but rather a patient-centered approach that incorporates fundamental skills and attitudes that may be applicable across ethnic boundaries.”⁶

A recent national survey supported this idea by showing that racial differences in patient satisfaction disappeared after adjustment for the quality of physician behaviors (eg, showing respect for patients, spending adequate time with patients). The fact that these positive physician behaviors were reported more frequently by white than non-white patients points to the need for continued effort at improving physicians’ interpersonal skills.

Corresponding author
Eric Henley, MD, MPH, Co-Editor, Practice Alert, 1601 Parkview Avenue, Rockford, IL 61107. E-mail: [email protected].