414 Lec 26-28

Define healthcare disparities

•Differences in quality of care received by racial and ethnic minority groups and non hispanic whites who have equal access to care

Health disparity

the difference among population groups in the incidence, prevalence and outcomes of health conditions

Healthcare disparities

differences among population groups in the availability, accessibility, and quality of healthcare services aimed at the prevention, treatment and management of diseases

Describe the various causes and sources of healthcare disparities

•Not one simple cause

•The way healthcare systems are organized and operated

•Lack of translation services

•Bias, prejudice and uncertainty when treating underserved patients 

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•Healthcare system

•Clinical encounter 

Describe several pieces of evidence of disparities in healthcare

•Access and quality of care disparities by insurance, poverty, race/ethnicity, geographical location

•WI disparity by race though high overall state quality of care

Discuss the evolution of research looking at health and healthcare disparities

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1. Existence of disparities → 2) Reasons→ 3) Solutions

Understand and describe the possible solutions to addressing healthcare disparities

•Diversity of workforce

•Reducing bias

•Upstream interventions- Policies 

•Collaborations 

Determinants of health

•The range of personal, social, economic, environmental and biological factors which determine the health status of individuals or populations 

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•Determinants can be either modifiable or unmodifiable 

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Social determinants of health: conditions in which we are born, grow, live , learn, worship and work that contribute to health

Identify the most and least important determinants of health based on their relative contribution to health

Social and economic factors (40%), Health behaviors (30%), clinical care (20%), physical environemnt (10%)

 components of the SDOH framework

Behaviors &Biological Factors 

Social Support

Socioeconomic Factors

Education

Health System

Behaviors &Biological Factors 

•Behaviors shaped by social environment, physical environment, genetics

•Adoption of health threatening behaviors is sometimes a response to material deprivation and stress

•Tobacco consumption 

•Nutrition and physical activity

•Alcohol use

•Violence 

•Non adherence 

Social Support

•Social support: An interpersonal transaction between two (or small groups of people) involving one or more of:

→Emotional concern (caring, loving, empathy)

→Instrumental aid(provision of goods or services)

→Information (advice, information)

→Appraisal (info relevant to oneself)

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•Increases a person’s ability to cope with a stressor and reduces the negative effects of the stressor on health

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•Improves adherences with medical regimens 

•Consistent relationship between lack of social relationships and all cause mortality 

Socioeconomic Factors

•SES: the position of an individual on a social economic scale that measures such factors as education, income, type of occupation, place of residence etc,

→Material goods for survivial

→Provide means for social participation

→Means to control one’s life circumstance

Education

•Carry early childhood experiences under our skin our entire lives

→Obesity

→Heart disease

→Mental health

→Literact and numeracy skills

→Aging and memory loss 

→Hypertension

→ Non insulin dependent diabetes

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•Education can create opportunities for better health

Health System

•Access and quality 

HiAP ( Health in All Policies)

 Large scale action to improve health through attention to the full range of health determinants, All policies contribute to health in some way

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Goal: Equip decision makers with information about how choices made within non health policy sectors also infleunces health and health equity

Policies that have implications for health improvements becuase of their mediating effects on social determinants

•Minimum wage

•Safe work environment 

•Housing for homeless and low income persons

•Parenting leaves of absence

•High school graduation rats, educational financing

•Environmental protection

Describe how pharmacists can address SDOH in their practice.

•Where people live- increase access and information 

•Where people learn- reach out to school districts in need of health education and offer services 

•Employ trained community health workers to refer patietns to services and assist in addressing their SDOH

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Challenges: Many pharmacists can identify SDOH issues but need education regarding available resources to address barriers

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Technology/ structure to coordinate with a social service organization 

Define and identify questions that reduce interview effectiveness

•Double questions (two in one)

•Loaded qs (implies judgement)

→ Did you take the medicine every 4 hours like the rx says?

•Leading questions 

→Did the chest pain travel down your arm?

•Double negative questions

Describe the stages of interviewing patients

1) Opening : Identify name and role, Identify other persons’s name and role, Identify purpose and time needed 

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2) Exlporation

•Name, address, DOB

•Insurance information

•Allergies, medication problems/reactions

•Current medication use (Rx, OTC , Herbal)

•Special needs

•Toward end cue you are almost done

•Nonverbal cues 

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3) Closure

•Structure closure

•Sum up and check accuracy

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•Give next step

Identify strategies to establish rapport with a patient

•Be responsive to patient 

•Reinforce

•Balance of active and passice participation

•Show respect fot the patient’s experience 

•Be aware of environment

•Nonverbal cues are particularly important

•Be careful bout 1st questions

•Explain why you are asking sensitive questions 

Pros and Cons of open ended questions

•May build more rapport

•Allows the unexpected answer needed to understand needs

•May give insight about hearing literacy, language

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Cons: 

•If used too much can make interview lengthy

•May lead to a rambling disorganized interview

•May not get the specific information you need for a single question

Pros and Cons of closed ended questions

•Quicker

•Can get specific info

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Cons:

•If overused, can lead to choppy interview

•Person can simply nod & you never realize they don’t understand

•You & person can feel on assembly line with little human contact 

Describe assessing patient’s unvoiced agendas and their implications

•Solicit the patient’s agenda

→health concerns and priorities 

→What concerns would you like us to cover today?

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•Their response is an opportunity to

→Adress patient concerns

→build rapport

→Active listening and empathy

Identify the Indian Health Service 3 ‘prime’ questions for initial prescriptions

What did you prescriber tell you your medication is for?

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How did the prescriber tell you to take the medication

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What did the prescriber tell you to expect ?