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?
a) Language barriers: Language discordance between physician and patient is common. Utilizing phone interpreters is not optimal because all of the information does not get transmitted accurately. Unfortunately, I have noticed that in-person interpreters are not optimal in some situations either. As a fetal cardiologist, we often have very difficult conversations with families regarding a cardiac anomaly in their fetus that in some cases can be lethal without intervention after birth. Conveying the implications of this defect in addition to the options a pregnant women has (i.e. continuing the pregnancy) is very difficult when there is concordance in language. With language discordance, my experience is that even more gets lost in translation.
b) Distance to healthcare: Patients who live far from medical facilities (i.e. rural areas) or who live far from specialty centers may have less access to care. One area of research I am interested in is prenatal diagnosis of critical congenital heart disease. It is feasible that pregnant mothers that live far from medical facilities may not obtain adequate prenatal care thus missing the opportunity for prenatal diagnosis of a fetal anomaly.
c) Lack of adequate support services such as Regional Centers/High-risk infant follow-up for children with complex medical conditions: One of my main research interests is neurodevelopmental outcomes in children with congenital heart disease. Literature has suggested that healthcare disparities exist when assessing these outcomes. For example, parental education appears to play a big role in outcome. Some of this may result from families not having access to supportive services near their neighborhood. For example, Regional centers provide needed therapies to these children. But, if these centers are overwhelmed or are not located near families, children may not benefit from their services. Thus, these children may suffer from lack of early intervention leading to worse neurodevelopmental outcomes than their peers that have access to these services.
d) Restrictions to healthcare based on insurance status. Certain hospital and practices may not accept public insurance making access to health care difficult for those with public insurance.
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?
Physicians may have intrinsic biases that may lead to healthcare disparities. This can be very subtle but very pervasive in medical practice. Physicians may have preconceived notions about levels of pain in certain racial/ethnic groups or level of intelligence a child should reach with a chronic condition. In my field, we have focused a great deal on the cardiac anomaly and only more recently have we discovered that these children suffer from developmental disabilities that impact their abilities to attain adequate education and independence. Recently, cardiologists are trying to be more proactive in identifying these deficits early on by discussing school performance and development with the parents at routine clinic visits. However, it is possible, that in certain ethnic/racial groups (particularly with a language barrier) these conversations don’t occur. This can happen either because the physician thinks it’s not worth discussing because the family has other things to worry about or they feel that the family won’t act on it anyways. To study this, we could create a survey that would be administered to both the physicians and patients after a clinic visit to assess if this discussion occurred and what the patient/family understood.