Physicians Cite Hurdles Ranging From Lack Of Coverage To Poor Communication In Providing High-Quality Care To Latinos
ABSTRACT We surveyed physicians about their ability to provide high-quality care to patients from diverse ethnic backgrounds. Primarily, we wanted to explore the challenges faced by physicians treating Latino patients compared to physicians whose patients were primarily white and non-Latino. We found that physicians treating Latinos, particularly those who worked in primary care in comparison to specialists, were less likely than physicians treating primarily white patients to believe in their ability to provide high-quality care. They cited problems of inadequate time with patients, patients' ability to pay, patients' nonadherence to recommended treatment, difficulties communicating with patients, relative lack of specialist availability, and lack of timely transmission of reports among physicians. Insurance expansions and complementary reforms mandated by the Affordable Care Act of 2010 and other recent legislation should aid physicians in closing some of these gaps in quality.
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ABSTRACT: Unwarranted breast cancer adjuvant chemotherapy dose reductions have been documented in black women, women of lower socioeconomic status, and those who are obese. No information on the quality of chemotherapy is available in Hispanic women. The purpose of this study was to characterize factors associated with first cycle chemotherapy dose selection in a multi-ethnic sample of low-income women receiving chemotherapy through the Breast and Cervical Cancer Prevention Treatment Program (BCCPT) and to investigate the impact of Hispanic ethnicity and patient self-efficacy on adjuvant chemotherapy dose selection. Survey and chemotherapy information were obtained from consenting participants enrolled in the California BCCPT. Analyses identified clinical and non-clinical factors associated with first cycle chemotherapy doses less than 90 % of expected doses. Of 552 patients who received chemotherapy, 397 (72 %) were eligible for inclusion. First cycle dose reductions were given to 14 % of the sample. In multivariate analyses, increasing body mass index and non-academic treatment site were associated with doses below 90 % of the expected doses. No other clinical or non-clinical factors, including ethnicity, were associated with first cycle doses selection. In this universally low-income sample, we identified no association between Hispanic ethnicity and other non-clinical patient factors, including patient self-efficacy, in chemotherapy dose selection. As seen in other studies, obesity was associated with systematic dose limits. The guidelines on chemotherapy dose selection in the obese may help address such dose reductions. A greater understanding of the association between type of treatment site and dose selection is warranted. Overall, access to adequate health care allows the vast majority of low-income women with breast cancer to receive high-quality breast cancer chemotherapy.Breast Cancer Research and Treatment 03/2014; 144(3). DOI:10.1007/s10549-014-2869-y · 4.47 Impact Factor
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ABSTRACT: Racial disparities in healthcare in the United States are widespread and have been well documented. However, it is unknown whether racial disparities exist in the use of blood transfusion for patients undergoing major surgery. We used the University HealthSystem Consortium database (2009-2011) to examine racial disparities in perioperative red blood cells (RBCs) transfusion in patients undergoing coronary artery bypass surgery (CABG), total hip replacement (THR), and colectomy. We estimated multivariable logistic regressions to examine whether black patients are more likely than white patients to receive perioperative RBC transfusion, and to investigate potential sources of racial disparities. After adjusting for patient-level factors, black patients were more likely to receive RBC transfusions for CABG (AOR = 1.41, 95% CI: [1.13, 1.76], p = 0.002) and THR (AOR = 1.39, 95% CI: [1.20, 1.62], p < 0.001), but not for colectomy (AOR = 1.08, 95% CI: [0.90, 1.30], p = 0.40). Black-white disparities in blood transfusion persisted after controlling for patient insurance and hospital effects (CABG: AOR = 1.42, 95% CI: [1.30, 1.56], p < 0.001; THR: AOR = 1.43, 95% CI: [1.29, 1.58], p < 0.001). We detected racial disparities in the use of blood transfusion for CABG and THR (black patients tended to receive more transfusions compared with whites), but not for colectomy. Reporting racial disparities in contemporary transfusion practices may help reduce potentially unnecessary blood transfusions in minority patients.BMC Health Services Research 03/2014; 14(1):121. DOI:10.1186/1472-6963-14-121 · 1.66 Impact FactorThis article is viewable in ResearchGate's enriched formatRG Format enables you to read in context with side-by-side figures, citations, and feedback from experts in your field.
Annual Review of Public Health 03/2014; 36(1):150112150436006. DOI:10.1146/annurev-publhealth-031914-122421 · 6.63 Impact Factor