Health Equity in Kidney Care (Dikun)

health equity

everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and healthcare

Health Disparities

preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations

disparities in healthcare

-systems contribute

-bias

-stereotyping

-prejudice

-clinical uncertainty

African Americans

Health disparities and outcomes are worse in _____________

240,000

__________ rural patients with ESRD have less access to care and a higher mortality

15%

Over 15,000 rural patients began dialysis in 2017 which was ~______ of new dialysis nationwide

transportation

is a need for rural patients with ESRD

social determinants of health

-economic stability

-neighborhood and physical environment

-education

-food

-community and social context

-health care system

socioeconomic things that leads to CKD progression

-low birth weight

-obesity

-DM

-HTN

-CV disease

-Endothelial Dysfunction

Epigentic changes

-increased psychological stresses

-increased Physical and Environmental Stresses

-accelerated decline in renal function

-increased CVD complications

What effects do epigenetic changes have?

CMS health equity framework

1) expand the collection, reporting and analysis of standardized data

2) assess causes of disparities within CMD programs and address inequities in polices and operative to close gaps

3) build capacity of health care organizations and the workforce to reduce health and healthcare disaparities

4) advance language access, health literacy, and the provision of culturally tailored services

5) increase all forms of accessibility to health care services and coverage

evidence based practices to address SDOH

1. Train and promote awareness about disparities, SDOH and communication effects on patients with chronic kidney disease

2. Screen for social needs especially during primary care visits and identify risk factors

3. Timely referrals for services to patients with chronic kidney disease

4. Increase access to home dialysis for diverse populations

5. Improve patient education and consider health literacy and cultural competency

pharmacists role in improving overall CKD outcomes

-CKD screening

• HBP, CVD, DM, FH, AKI Hx

-Risk stratification

• Referrals for labs

-Treatment

-Education

limited english proficiency (LEP)

-20% of US pop speak another language than English

-25 million ppl with expectations to double by 2050

Title VI Civil Rights Act of 1964

protects need for competent interpreter services

systematic effects of LEP

-30 percent higher readmission rates

-4.3-day longer hospitalizations

-30 percent longer emergency department visits

-Greater risk of surgical infections, falls, and pressure ulcers

-Greater risk of surgical delays due to difficulty understanding instructions including how to prepare for a procedure

-Difficulty understanding how to manage their conditions and take their medications, as well as which symptoms should prompt a return to care or when to follow up

culturally and linguistically appropriate services (CLAS) standards

-Administered federally by the HHS Office of Minority Health

-Ensure that the services are respectful and responsive to each patient's culture and communication needs

CLAS standards

address cultural health beliefs, preferred language, health literacy, and communication needs to care

imp in CKD/ESRD population

-health disparities

-language barriers and health literacy

-health education and prevention

language barriers and health literacy

25% of CKD patients have linguistic barriers and poor health literacy, leading to poor outcomes

health education and prevention

adding necessary cultural context to ensure communication of prevention and management