Racial, ethnic, and rural disparities in distance to physicians among decedents with Alzheimer's disease and related dementias in Washington State.

INTRODUCTION: Distance to physicians may explain some of the disparities in Alzheimer's disease and related dementia (AD/ADRD) outcomes. METHODS: We generated round trip distance between residences of decedents with AD/ADRD and the nearest neurologist and primary care physician in Washington State. RESULTS: The overall mean distance to the nearest neurologist and primary care physician was 17 and 4 miles, respectively. Non-Hispanic American Indian and/or Alaska Native and Hispanic decedents would have had to travel 1.12 and 1.07 times farther, respectively, to reach the nearest neurologist compared to non-Hispanic White people. Decedents in micropolitan, small town, and rural areas would have had to travel 2.12 to 4.01 times farther to reach the nearest neurologist and 1.14 to 3.32 times farther to reach the nearest primary care physician than those in metropolitan areas. DISCUSSION: These results underscore the critical need to identify strategies to improve access to specialists and primary care physicians to improve AD/ADRD outcomes. HIGHLIGHTS: Distance to neurologists and primary care physicians among decedents with AD/ADRD American Indian and/or Alaska Native decedents lived further away from neurologists Hispanic decedents lived further away from neurologists Non-metropolitan decedents lived further away from neurologists and primary care Decrease distance to physicians to improve dementia outcomes.

Are committee experiences of minoritized family medicine faculty part of the minority tax? a qualitative study.

BACKGROUND AND OBJECTIVES: Because much of the work in academic medicine is done by committee, early career URiM faculty, are often asked to serve on multiple committees, including diversity work that may not be recognized as important. They may also be asked to serve on committees to satisfy a diversity "check box," and may be asked more often than their non-URiM peers to serve in this capacity. We sought to describe the committee experiences of early career URiM faculty, hypothesizing that they may see committee service as a minority tax. METHODS: Participants in the Leadership through Scholarship Fellowship (LTSF) were asked to share their experiences with committee service in their careers after participating in a faculty development discussion. Their responses were analyzed and reported using qualitative, open, axial, and abductive reasoning methods. RESULTS: Four themes, with eight sub-themes (in parenthesis), emerged from the content analysis of the LTSF fellows responses to the prompt: Time commitment (Timing of committee work and lack of protected time for research and scholarship), URiM Committee service (Expectation that URiM person will serve on committees and consequences for not serving), Mentoring issues (no mentoring regarding committee service, faculty involvement is lacking and the conflicting nature of committee work) and Voice (Lack of voice or acknowledgement). CONCLUSIONS: Early career URiM faculty reported an expectation of serving on committees and consequences for not serving related to their identity, but other areas of committee service they shared were not connected to their URiM identity. Because most of the experiences were not connected to the LTSF fellows' URiM identity, this group has identified areas of committee service that may affect all early career faculty. More research is necessary to determine how committee service affects URiM and non-URiM faculty in academic family medicine.

Systemic Racism Affecting Latinx Population Health During the COVID-19 Pandemic and Beyond: Perspectives of Latinx Community Health Workers and Community-Based Organization Leaders.

Introduction: The purpose of this study is to identify forms of systemic racism experienced by Latinx communities in North Carolina during the COVID-19 pandemic as identified by Latinx community health workers (CHWs) and community-based organization (CBO) leaders. Methods: We conducted three focus groups in July 2022 (N=16). We performed qualitative analysis of data using an iterative inductive approach of the original language in Dedoose. Results: Four central themes emerged: (1) Access to resources for Latinx individuals; (2) Immediate, transitional, and future fears; (3) Benefits of CHWs; and (4) Lessons learned. Discussion: Institutional and state policies often do not involve community members, such as CHWs and CBO leaders, at the start of the development process, leading to ineffective interventions that perpetuate health disparities and systemic racism. Health Equity Implications: Community-informed policy recommendations can improve alignment of community and policy priorities to create more effective interventions to address systemic racism and promote health equity.

Racial and ethnic disparities in the perception of respect from physicians among skin cancer patients in the United States.

Background: Racial and ethnic minority groups are at increased risk of poor skin cancer outcomes. Successful patient-physician communication is linked to better health outcomes, but it is unknown whether disparities in perceived care exist among skin cancer patients. Objective: To investigate whether there are racial and ethnic disparities in the perception of physicians showing respect, listening, and explaining during clinical encounters. Methods: A cross-sectional study was conducted using data from participants with a self-reported skin cancer history from the 2008 to 2017 and 2019 Medical Expenditure Panel Survey. Race and ethnicity were self-identified. Results: Of 5570 participants, 5263 were non-Hispanic White and 307 were racial and ethnic minority individuals. Racial and ethnic minority participants were less likely to report that their doctors show them respect, listen to, and explain to them than non-Hispanic White participants, even when adjusting for age, sex, insurance type, health status, and survey year. Among racial and ethnic minority participants, perceptions of physicians listening and explaining were strongly associated with perceived respect. Limitations: Lack of disaggregated racial and ethnic subgroup analysis. Conclusions: Our findings suggest racial and ethnic disparities in perceived care among skin cancer patients. Future research is warranted to determine whether such perceptions contribute to disparities in skin cancer care and/or outcomes.

Physician Workforce Disparities and Patient Care: A Narrative Review.

Background: Ensuring the strength of the physician workforce is essential to optimizing patient care. Challenges that undermine the profession include inequities in advancement, high levels of burnout, reduced career duration, and elevated risk for mental health problems, including suicide. This narrative review explores whether physicians within four subpopulations represented in the workforce at levels lower than predicted from their numbers in the general population-women, racial and ethnic minorities in medicine, sexual and gender minorities, and people with disabilities-are at elevated risk for these problems, and if present, how these problems might be addressed to support patient care. In essence, the underlying question this narrative review explores is as follows: Do physician workforce disparities affect patient care? While numerous articles and high-profile reports have examined the relationship between workforce diversity and patient care, to our knowledge, this is the first review to examine the important relationship between diversity-related workforce disparities and patient care. Methods: Five databases (PubMed, the Cochrane Library of Systematic Reviews, EMBASE, Web of Knowledge, and EBSCO Discovery Service) were searched by a librarian. Additional resources were included by authors, as deemed relevant to the investigation. Results: The initial database searches identified 440 potentially relevant articles. Articles were categorized according to subtopics, including (1) underrepresented physicians and support for vulnerable patient populations; (2) factors that could exacerbate the projected physician deficit; (3) methods of addressing disparities among underrepresented physicians to support patient care; or (4) excluded (n=155). The authors identified another 220 potentially relevant articles. Of 505 potentially relevant articles, 199 (39.4%) were included in this review. Conclusions: This report demonstrates an important gap in the literature regarding the impact of physician workforce disparities and their effect on patient care. This is a critical public health issue and should be urgently addressed in future research and considered in clinical practice and policy decision-making.

Strategies for Teaching Linguistic Preparedness for Physicians: Medical Spanish and Global Linguistic Competence in Undergraduate Medical Education.

In accordance with Liaison Committee on Medical Education (LCME) curriculum content standards, medical schools are expected to teach physician communication skills and cultural competence. Given the sustained U.S. Spanish-speaking population growth, importance of language in diagnosis, and benefits of patient-physician language concordance, addressing LCME standards equitably should involve linguistic preparedness education. The authors present strategies for implementation of linguistic preparedness education in medical schools by discussing (1) examples of institutional approaches to dedicated medical Spanish courses that meet best practice guidelines and (2) a partnership model with medical interpreters to implement integrated global linguistic competencies in undergraduate medical curricula.

Hispanic Patient Perspectives of the Physician's Role in Obesity Management.

BACKGROUND: Little is known concerning Hispanic patients' perceptions about the role of the physician in obesity management. This study seeks to describe the perspectives of Hispanic patients toward weight loss, and what they believe their doctor's role should be in the management of obesity. METHODS: A cross-sectional study utilizing semi-structured interviews was conducted in a university-based family medicine clinic. Open-ended questions explored beliefs about the relationship between weight and health, previous weight loss experience, perceptions about the role of the physician in weight loss, past experiences with their physician, and preferences for how a physician could help facilitate weight loss. The free recall listing technique was used to elicit responses. Common themes were identified by a group coding process. RESULTS: Patients were open to discussion from physicians concerning weight loss but many had not been approached. They wanted assistance from their doctors in the form of dietician referrals, specific weight loss goals, and encouragement. Patients' knowledge about the implications of excess weight on health was lacking. CONCLUSION: Hispanic patients want more help and advice from their doctors. General knowledge of the health implications of obesity was lacking, indicating a need for more health education by the healthcare team.

Rationale and design of the Miami Healthy Heart Initiative: a randomized controlled study of a community health worker intervention among Latino patients with poorly controlled diabetes.

BACKGROUND: Type 2 diabetes mellitus disproportionately affects the Latino community. Latinos with diabetes are also less likely to have adequate control of cardiovascular risk factors such as cholesterol and blood pressure. Community health workers (CHWs) are increasingly being used to address various health disparity conditions, including diabetes. However, evidence of their effectiveness from randomized controlled trials is limited. METHODS: The Miami Health Heart Initiative is a randomized controlled trial of 300 Latino patients with diabetes. Patients with hemoglobin A1c (HbA1c) ≥8.0% were recruited from Miami-Dade's public hospital system. At baseline, all patients underwent phlebotomy, physical examination, and a structured 90-minute research interview. They were then randomized to either usual care or a CHW intervention called Cariño. For participants in the Cariño arm of the study, CHW services included assistance with nonmedical social services, health education, and patient navigation in which the CHWs serve as a bridge between patients and the health care system. These services were delivered through home visits, phone calls, and group visits. At 12 months, all subjects had a follow-up examination. The primary outcomes at 1 year are changes in systolic blood pressure, low-density lipoprotein, and HbA1c. Secondary outcomes include medication adherence, medication intensification, diabetes self-efficacy, physical activity, and self-reported fruit and vegetable intake. DISCUSSION: The Miami Healthy Heart Initiative is one of the first rigorously conducted randomized controlled trials to provide evidence on the impact of CHWs on diabetes intermediate outcomes among Latinos. If the data support our primary hypotheses, the study would lend added support to ongoing efforts to incorporate CHWs as part of our national efforts to reduce and ultimately eliminate health disparities.

Impact of a pilot pharmacy health-care professional out-of-school time physical activity and nutrition education program with exercise on fourth and fifth graders in a rural Texas community.

OBJECTIVES: Childhood obesity continues to be a problem. Children in rural populations are more likely to be overweight or obese and a lack of resources in those areas may contribute to this problem. We aimed to assess the impact of a pilot pharmacy health-care professional out-of-school time vigorous physical activity and nutrition education program on fourth and fifth graders in a rural Texas community. METHODS: We conducted a prospective 12-week cohort study from August to November 2012. Thirty-three children, aged 8-11 years, in Bailey County, Texas, were enrolled in the study. Body mass index, body mass index percentile, blood pressure, waist circumference, and a diet preferences and activities knowledge survey were obtained at 0, 4, 8, and 12 weeks. Study participants completed a twice weekly physical activity and nutrition education program with exercise over weeks 1-4 with no intervention during weeks 5-12. RESULTS: Thirty-one (94%) of the 33 children, predominately Hispanic girls, completed the program. Body mass index (-0.30 (95% confidence interval, -0.44 to -0.17); P = <0.0001), body mass index percentile (-2.75 (95% confidence interval, -4.89 to -0.62); P = 0.0026), systolic blood pressure (-1.9 (95% confidence interval, -2.9 to -0.9); P = <0.0001), and waist circumference (-0.47 (95% confidence interval, -0.85 to -0.10); P = <0.0001) mean change decreased between baseline and week 12 with no intervention for 8 weeks. Positive survey results at 3 months indicated a decrease in fried/sweet foods; increase in exercise; decreases in video games and computer use; and a change in knowledge regarding the selection of the most healthy food group servings per day. CONCLUSION: In this pharmacy health-care directed pilot study, participants had a reduction of body mass index, body mass index percentile, systolic blood pressure, waist circumference, and improvement in certain survey results at the end of 12 weeks despite no further intervention after 4 weeks.

Nursing's role in advance care planning for hispanic / latino individuals / El papel de enfermería en la planificación anticipada de la atención de las personas hispanas / latinas

End-of-life care decisions are challenging for most people and cultural beliefs may facilitate or hinder such decisions. Advance care planning provides a venue to interact with and communicate to healthcare professionals a person's documented health and medical treatment wishes at end of life. Open communication, cultural accommodation, and mutual understanding among the healthcare provider, patient, andfamily are key to effective advance care planning. This article discusses how Hispanic / Latino people address end-of-life care and what cultural aspects are especially relevant for this population. The nurse's role in assisting Hispanics / Latinos with advanced care planning is presented at various levels of the nursing professional spectrum.

Las decisiones relacionadas con las fases terminales de la vida son difíciles para la mayoría de las personas. Las creencias culturales pueden facilitar o dificultar dichas decisiones. La planeación adelantada del cuidado provee el mecanismo para interactuar y comunicarse con los profesionales de la salud sobre los deseos de la persona para el final de su vida. La comunicación abierta, la adaptación cultural y el entendimiento mutuo entre el proveedor de la salud, el paciente y la familia son la clave para una planeación adelantada efectiva. Este artículo analiza cómo la gente hispano/latina enfrenta las fases terminales de la vida y qué aspectos culturales tienen una relevancia especial para esta población. El papel del personal de enfermería que trabaja con los hispano/latinos en la planeación de las fases terminales de la vida es presentado en los varios niveles profesionales de enfermería.