1) Structural issues within health care delivery are implicated in health care disparities. Please brainstorm 4 structural issues that might contribute to these disparities. Which of these are relevant to your particular area of research, and how?
(1) Geographic location of the hospital/distance between patient’s community and the treating hospital. For communities whose health treatment facility is not within or nearby the community, this makes receiving care more difficult and therefore, patients may not present for care until late in a disease process.
(2) Multisite vs. Integrated/Single site treatment model for coordinated care. Patients who require care across disciplines will require visits at different offices with different specialists. For those patients who have a health treatment facility where all specialists are at the same site, coordinated care is more straight-forward. Patient instructions on just getting from one appointment to another are easier to follow and therefore more likely to be adhered to. For those patients who must seek care at multiple sites, especially for subspecialty care (i.e. endocrinology, oncology), these patients are more likely to have difficulty coordinating care and therefore keeping/attending all necessary appointments. This increases the rates of loss to follow-up and therefore incomplete treatment of their disease.
(3) Language barriers between providers and patients/lack of native language speakers necessitating telephone interpreters. Without native language speaking providers, patient communication becomes less reliable. Patients are more likely to not understand diagnoses/instructions and providers are less likely to understand patient concerns and therefore will not be able to address them. Both of these has the high likelihood to lead to poor patient outcome and incomplete delivery of care.
(4) Inaccessible prescription medications. Prescription medication coverage varies amongst insurance providers. Patients who do not have prescription coverage at all or have minimal coverage, may not have the ability to access the medications prescribed by their physicians and therefore will not be able to be compliant with their treatment regimen.
Geographic location of hospital, multisite v. consolidated site care treatment, and language barriers are all relevant to my area of research which is disparities in neurooncology care across patients stratified across socioeconomic and racial differences.
2) How do individual physicians contribute to health care disparities? Thinking about an area of health care of particular interest to you, what research do you think could be done to either understand the effect of individual physicians on health disparities, or to decrease this effect?
One way that individual physicians bring their personal biases to patient care even though the physicians may not be aware that they have such biases. For instance, in thinking about neurooncology care, physicians may believe that one group of patients would not be interested in undergoing a complex care regimen or, that they may not be able to follow such a treatment protocol. In this case, physicians may counsel different groups of patients differently on treatment options and how aggressive to be with one’s tumor diagnosis. A research study to assess this could be to interview patients with the same diagnosis from different race/SES/education level backgrounds directly after a discussion with their physician. In this interview, the patient’s understanding of the physician’s recommendations would be elicited and these could be compared across the groups. In addition, the physicians should also be interviewed at the same time and asked what their recommendation to the patient was and responses across patient populations matched for disease type/stage to assess for identifiable differences.