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?
My area of research is cardiovascular pharmacotherapy, specifically prescribing of and adherence to anti-hypertensives and anti-diabetes medications in older adults. I am studying a particular type of health care delivery rather than a health outcome, the structural issues are quite focused. One major structural issue is continuity of care within the physician-patient relationship, which is frequently not always present in federally qualified health centers, free clinics and county hospitals that form the safety net for underserved populations. Another structural issue is differences in the availability of patient-centered services by insurance status, i.e. the availability in-clinic pharmacists or diabetes educators to teach patients how to take medications correctly. A third structural issue is language discordance between patients and providers which as the DISTANCE study reading demonstrates, can directly impact chronic disease control. Finally, the limitations posed by a 15-20 minute patient visit in primary care may be adequate for to discuss diabetes or hypertension management for patients who understand the disease and are having success with monitoring/treatment but this short time frame may limit a physician’s ability to identify barriers to adherence or disease monitoring in patients having difficulty with BP or diabetes control – often this leads to the prescribing of more or different medications rather than discovering the root source of the adherence problem.
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?
Individual physicians are not immune too racial and gender and other social biases, as described in the Hoffman article. Physicians may make treatment decisions or explain medications differently to patients based on their judgement of patient education or understanding. A physician may mean well in this behavior but the result is differential treatment, in which a patient deemed more educated due to their dress or manner of speech may receive more detailed instruction or a more effective though complex medication, because the physician believes they will be able to comply with medication while another patient deemed less educated may not receive the same explanation or may even receive an entirely different treatment.