10 steps for avoiding health disparities in your practice
You are caring for a 55-year-old person with acute coronary syndrome whose angiogram shows significant obstruction in 2 arteries. Will your patient’s race, ethnicity, gender, or ability to pay influence your treatment recommendation?
Use evidence-based guidelines
To minimize the effect of possible bias and stereotyping in caring for patients of different races, ethnicities, and cultures, an important foundation is to standardize care for all patients by using evidence-based practice guidelines when appropriate. Clinical guidelines such as those published by the US Preventive Services Task Force and those available on the Internet through the National Guideline Clearinghouse provide well-researched and substantiated recommendations (available at www.ngc.gov).
Using guidelines is consistent with national recommendations to incorporate more evidence-based practices in clinical care.
Make your office patient-friendly
Create an office environment that is sensitive to the needs of all patients. Addressing language issues, having front desk staff who are sensitive and unbiased, and providing culturally relevant patient education material (eg, posters, magazines) are important components of a supportive office environment.1
Advocate patient education
Strategies to improve patient health literacy and physician cultural competence may be of benefit. The literacy issue can be helped considerably by enabling patients to increase their understanding of health terminology, and there are national efforts to address patient health literacy. Physicians can also help by explaining options and care plans simply, carefully, and without medical jargon. The American Medical Association has a national campaign in support of health literacy (www.amaassn.org/ama/pub/category/8115.html).
Increase cross-cultural communication skills
The Institute of Medicine and academicians have increasingly recommended training healthcare professionals to be more culturally competent. Experts have agreed that the “essence of cultural competence is not the mastery of ‘facts’ about different ethnic groups, but rather a patient-centered approach that incorporates fundamental skills and attitudes that may be applicable across ethnic boundaries.”6
A recent national survey supported this idea by showing that racial differences in patient satisfaction disappeared after adjustment for the quality of physician behaviors (eg, showing respect for patients, spending adequate time with patients). The fact that these positive physician behaviors were reported more frequently by white than non-white patients points to the need for continued effort at improving physicians’ interpersonal skills.
Eliminating health disparities is one of the top 2 goals of Healthy People 2010, the document that guides the nation’s health promotion and disease prevention agenda. Healthy People 2010 (www.health.gov/healthypeople) is a compilation of important prevention objectives for the Nation identified by the US Public Health Service that helps to focus health care system and community efforts. The vision for Healthy People 2010 is “Healthy People in Healthy Communities,” a theme emphasizing that the health of the individual is closely linked with the health of the community.
The Leading Health Indicators are a subset of the Healthy People 2010 objectives and were chosen for emphasis because they account for more than 50% of the leading preventable causes of morbidity and premature morality in the US. 5 Data on these 10 objectives also point to disparities in health status and health outcomes among population groups in the US. Most states and many local communities have used the Healthy People 2010/Leading Health Indicators to develop and implement state and local “Healthy People” plans.
Physicians have an important role in efforts to meet these goals because many of them can only be met by utilizing multicomponent intervention strategies that include actions at the clinic, health care system and community level.
Corresponding author
Eric Henley, MD, MPH, Co-Editor, Practice Alert, 1601 Parkview Avenue, Rockford, IL 61107. E-mail: ehenley@eic.edu.
