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Health Disparities: Access and Utilization

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Ethnogeriatrics

Abstract

This chapter focuses on disparities in access and utilization of health services by older adults of racial and ethnic backgrounds. It highlights the data challenges associated with frequent exclusion of this population from clinical research and consequent irrelevance or unavailability of evidence-based information to support clinical practice guidelines recommendations, and how this affects clinical practice and systems of care. Systematic approaches to identify, analyze, and address disparities; change providers and systems; and educate health care professionals are discussed.

The views expressed in this chapter are those of the author and do not necessarily represent the views of the National Institutes of Health-National Institute on Aging, The U.S. Department of Health and Human Services, or the U.S. Federal Government.

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References

  1. Herrera AP, Snipes SA, King DW, Torres-Vigil I, Goldberg DS, Weinberg AD. Disparate inclusion of older adults in clinical trials: priorities and opportunities for policy and practice change. Am J Public Health. 2010;100 Suppl 1:S105–12.

    Article  PubMed  PubMed Central  Google Scholar 

  2. The Henry J. Kaiser Family Foundation. Medicare: a primer. Washington, DC; 2010.

    Google Scholar 

  3. The Henry J. Kaiser Family Foundation. Medicaid: a primer. Washington, DC; 2013.

    Google Scholar 

  4. Hanchate A, Kronman AC, Young-Xu Y, Ash AS, Emanuel E. Racial and ethnic differences in end-of-life costs: why do minorities cost more than whites? Arch Intern Med. 2009;169(5):493–501.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Weech-Maldonado R, Pradhan R, Powell MP. Medicare and health care utilization. In: Whitfield KE, Baker TA, editors. Handbook of minority aging. New York: Springer; 2014. p. 539–56.

    Google Scholar 

  6. Weech-Maldonado R, Morales LS, Elliott M, Spritzer K, Marshall G, Hays RD. Race/ethnicity, language, and patients’ assessments of care in Medicaid managed care. Health Serv Res. 2003;38(3):789–808.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE. Knowledge translation of research findings. Implement Sci. 2012;7:50.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hill NL, Penrod J, Milone-Nuzzo P. Merging person-centered care with translational research to improve the lives of older adults: creating community-based nursing research networks. J Gerontol Nurs. 2014;40(10):66–74.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ortman JM, Velkoff VA, Hogan H. An aging nation: the older population in the United States. Current Population Reports. Washington, DC: U.S. Census Bureau; 2014.

    Google Scholar 

  10. McMurdo ME, Witham MD, Gillespie ND. Including older people in clinical research.BMJ. 2005;331(7524):1036–7.

    Google Scholar 

  11. Lind K D. Excluding older, sicker patients from clinical trials: issues, concerns, and solutions. Insight on the issues. Washington, DC: AARP Public policy Institute; 2011.

    Google Scholar 

  12. Friedman E. Supporting diversity in research participation: a framework for action. Report (Contract # 22 14) commissioned by the California Institute for Regenerative Medicine (CIRM), 30 Nov 2009. Available from http://www.cirm.ca.gov/sites/default/files/files/about_cirm/Diversity_Report.pdf. Accessed 15 March 2015.

  13. Cherubini A, Del Signore S, Ouslander J, Semla T, Michel JP. Fighting against age discrimination in clinical trials. J Am Geriatr Soc. 2010;58(9):1791–996.

    Article  PubMed  Google Scholar 

  14. Huang S-M, Temple R. Is this the drug or dose for you?: Impact and consideration of ethnic factors in global drug development, regulatory review, and clinical practice. Clin Pharmacol Ther. 2008;84(3):287–94.

    Article  PubMed  Google Scholar 

  15. Lesko LJ. The critical path of warfarin dosing: finding and optimal dosing strategy using pharmacogenetics. Clin Pharmacol Ther. 2008;84(3):301–3.

    Article  CAS  PubMed  Google Scholar 

  16. Cherubini A, Oristrell J, Pla X, Ruggiero C, Ferretti R, Diestre G, Clarfield AM, Crome P, Hertogh C, Lesauskaite V, Prada GI, Szczerbinska K, Topinkova E, Sinclair-Cohen J, Edbrooke D, Mills GH. The persistent exclusion of older patients from ongoing clinical trials regarding heart failure. Arch Intern Med. 2011;171(6):550–6.

    Article  PubMed  Google Scholar 

  17. Avni T, Shiver-Ofer S, Leibovici L, Tacconelli E, DeAngelis G, Cookson B, Pagani L, Paul M. Participation of elderly adults in randomized controlled trials addressing antibiotic treatment of pneumonia. J Am Geriatr Soc. 2015;63(2):233–43.

    Article  PubMed  Google Scholar 

  18. Bulpitt CJ, Beckett NS, Cooke J, Dumitrascu DL, Gil-Extremera B, Nachev C, Nunes M, Peters R, Staessen JA, Thijs L. Hypertension in the Very Elderly Trial Working Group. Results of the pilot study for the Hypertension in the Very Elderly Trial. J Hypertens. 2003;21(12):2409–17.

    Article  CAS  PubMed  Google Scholar 

  19. Park IU, Taylor AL. Race and ethnicity in trials of antihypertensive therapy to prevent cardiovascular outcomes: a systematic review. Ann Fam Med. 2007;5:444–52.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Maglo KN, Rubinstein J, Huang B, Ittenbach RF. BiDil in the clinic: an interdisciplinary investigation of physicians’ prescription patterns of a race-based therapy. AJOB Empir Bioeth. 2014;5(4):37–52.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ellison GTH, Kaufman JS, Head RF, Martin PA, Kahn JD. Flaws in the U.S. Food and Drug Administration’s rationale for supporting the development and approval of BiDil as a treatment for heart failure only in black patients. J Law Med Ethics. 2008;36(3):449–57.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hawkins-Taylor C, Carlson AM. Communication strategies must be tailored to a medication’s targeted population: lessons from the case of BiDil. Am Health Drug Benefits. 2013;6(7):401–12.

    PubMed  PubMed Central  Google Scholar 

  23. Zhang T, Tsang W, Wijeysundea HC, Ko DT. Reporting and representation of ethnic minorities in cardiovascular trials. Am Heart J. 2013;166:52–7.

    Article  CAS  PubMed  Google Scholar 

  24. Mochari-Greenberger H, Liso M, Mosca L. Race/ethnic differences in statin prescription and clinical outcomes among hospitalized patients with coronary disease. Am J Cardiol. 2014;113(3):413–7.

    Article  PubMed  Google Scholar 

  25. Fuentes D, Aranda MP. Depression interventions among racial and ethnic minority older adults: a systematic review across 20 years. Am J Geriatr Psychiatry. 2012;20(11):915–31.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Scott IA, Guyatt GH. Cautionary tales in the interpretation of clinical studies involving older persons. Arch Intern Med. 2010;170(7):587–95.

    Article  PubMed  Google Scholar 

  27. Felix HC, Adams B, Cornell CE, Fausett JK, Krukowski RA, Love SJ, Prewitt TE, West DS. Barriers and facilitators to senior centers participating in translational research. Res Aging. 2014;36(1):22–39.

    Article  PubMed  Google Scholar 

  28. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases. Implications for pay for performance. JAMA. 2005;294(6):716–24.

    Article  CAS  PubMed  Google Scholar 

  29. Vitry AI, Zhang Y. Quality of Australian clinical guidelines and relevance to the care of older people with multiple comorbid conditions. Med J Aust. 2008;189(7):360–5.

    PubMed  Google Scholar 

  30. Mutasingwa DR, Ge H, Upshur RE. How applicable are clinical practice guidelines to elderly patients with comorbidities? Can Fam Physician. 2011;57(7):e253–62.

    PubMed  PubMed Central  Google Scholar 

  31. Cox L, Kloseck M, Crilly R, McWilliam C, Diachun L. Underrepresentation of individuals 80 years of age and older in chronic disease clinical practice guidelines. Can Fam Physician. 2011;57(7):e263–9.

    PubMed  PubMed Central  Google Scholar 

  32. Blaum CS, Cigolle CT, Boyd C, et al. Clinical complexity in middle-aged and older adults with diabetes: The Health and Retirement Study. Med Care. 2010;48:327–34.

    Article  PubMed  PubMed Central  Google Scholar 

  33. American Diabetes Association. Standards of medical care in diabetes 2015. Diabetes Care. 2015;38(Suppl 1).

    Google Scholar 

  34. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25):2889–934.

    Google Scholar 

  35. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147–239.

    Google Scholar 

  36. 2014 evidence-based guideline for the management of high blood pressure in adults report from the panel members appointed to the eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.

    Google Scholar 

  37. American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Guiding principles for the care of older adults with multimorbidity: an approach for clinicians. J Am Geriatr Soc. 2012;60:E1–25.

    Article  PubMed Central  Google Scholar 

  38. American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Patient-centered care for older adults with multiple chronic conditions: a stepwise approach from the American Geriatrics Society. J Am Geriatr Soc. 2012;60:1957–68.

    Article  PubMed Central  Google Scholar 

  39. Patient Protection Affordable Care Act. Washington, DC. 2010. Available at http://housedocs.house.gov/energycommerce/ppacacon.pdf. Accessed 15 March 2015.

  40. Aronson L, Bautista CA, Covinsky K. Medicare and care coordination. Expanding the clinician’s toolbox. JAMA. 2015;13(8):797–8.

    Article  Google Scholar 

  41. National Quality Forum. Preferred practices and performance measures for measuring and reporting care coordination. A consensus report. Washington, DC; 2010.

    Google Scholar 

  42. National Quality Forum. Healthcare disparities and cultural competency consensus standards: disparities-sensitive measure assessment. Technical report. Washington, DC; 15 Nov 2012.

    Google Scholar 

  43. Public Law 106-525. Available from http://www.gpo.gov/fdsys/pkg/PLAW-106publ525/pdf/PLAW-106publ525.pdf. Accessed 20 Aug 2013.

  44. Dilworth-Anderson P, Pierre G, Hilliard TS. Social justice, health disparities, and culture in the care of the elderly. J Law Med Ethics. 2012;40(1):26–32.

    Article  PubMed  Google Scholar 

  45. Periyakoil VS, Stevens M, Kraemer H. Multicultural long-term care nurses’ perceptions of factors influencing patient dignity at the end of life. J Am Geriatr Soc. 2013;61(3):440–6.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Periyakoil VS, Neri E, Fong A, Kraemer H. Do unto others: doctors’ personal end-of-life resuscitation preferences and their attitudes toward advance directives. PLoS One. 2014;28:9(5).

    Google Scholar 

  47. The HHS National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care: A Blueprint for Advancing and Sustaining CLAS Policy and Practice (The Blueprint). Available at http://www.healthinfolaw.org/sites/default/files/article-files/EnhancedCLASStandardsBlueprint.pdf. Accessed 15 March 2015.

  48. Adler R, Kamel H. Doorway thoughts: cross-cultural health care for older adults. Sudbury: Jones and Bartlett; 2004.

    Google Scholar 

  49. Levkoff S, Hongtu C, Norton M. Two approaches to developing health interventions for ethnic minority elders: from science to practice and from practice to science. In: Whitfield KE, Baker TA, editors. Handbook of minority aging. New York: Springer; 2014. p. 205–19.

    Google Scholar 

  50. Schneider Institute for Health Policy, Brandeis University. Cancer prevention and treatment demonstrations for ethnic and racial minorities: evidence report and evidence-based recommendations. Rep. Baltimore, MD: Centers for Medicare and Medicaid Services; 2003.

    Google Scholar 

  51. U.S. Department of Health and Human Services. An evaluation protocol for systematically evaluating efforts to improve racial and ethnic minority health, reduce health disparities, and effect systems approaches to racial and ethnic minority health problems. Rockville, MD: HHS Office of Minority Health; 2010.

    Google Scholar 

  52. Robert Wood Johnson Foundation. Responding to culture: beyond cultural competence training. Washington, DC; 2014.

    Google Scholar 

  53. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10.

    Article  CAS  PubMed  Google Scholar 

  54. U.S. Department of Health and Human Services. Implementation guidance on data collection standards for race, ethnicity, sex, primary language, and disability status. October 2011. Available at http://aspe.hhs.gov/datacncl/standards/ACA/4302/index.shtml. Accessed 15 March 2015.

  55. Lie DA, Lee-Rey E, Gomez A, Bereknyei S, Braddock III CH. Does cultural competency training of health professionals improve patient outcomes? A systematic review and proposed algorithm for future research. J Gen Intern Med. 2011;26(3):317–25.

    Article  PubMed  Google Scholar 

  56. Truong M, Paradies Y, Priest N. Interventions to improve cultural competency in healthcare: a systematic review of reviews. BMC Health Serv Res. 2014;14:99.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Rosaly Correa-de-Araujo M.D., M.Sc., Ph.D. .

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Correa-de-Araujo, R. (2017). Health Disparities: Access and Utilization. In: Cummings-Vaughn, L., Cruz-Oliver, D. (eds) Ethnogeriatrics. Springer, Cham. https://doi.org/10.1007/978-3-319-16558-5_7

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  • DOI: https://doi.org/10.1007/978-3-319-16558-5_7

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