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The update also summarizes recent journal articles and other research developments in the field and features a data slide from a relevant Kaiser Family Foundation publication. 1. Richer White Women More Prone to Melanoma, Study Finds
9. Rural Lung Cancer Survivors Face Higher Mental Distress DISPARITIES IN RESEARCH 12. Assessing Deaf Cultural Competency of Physicians and Medical Students 14. Racial/Ethnic Disparities in Survival among Men Diagnosed With Prostate Cancer in Texas 15. Racial/Ethnic Disparities in Exercise and Dietary Behaviors of Middle-Aged and Older Adults 16. An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era DISPARITIES DATA SPOTLIGHT Improving Access to Adult Primary Care in Medicaid: Exploring the Potential Role of Nurse Practitioners and Physician Assistants DISPARITIES IN THE NEWS 1. Richer White Women More Prone to Melanoma, Study Finds According to the results of a study discussed in a recent article published by Health Day, young rich white women are being diagnosed with skin cancer at a rate that is six times higher than that of lower income women. 2. Tribal Leaders Say Prescription Drug Abuse is Epidemic A recent article from the Minnesota Public Radio reported on what health officials are referring to an “epidemic of prescription drugs” in Minnesota’s two largest Indian reservations. The article noted that members of the health, law and drug treatment communities at Red Lake will be working together as part of a task force to develop ways to address the problem (Robertson 3/18). 3. Training Minority Doctors a Big Priority for Georgia A recent article from the Georgia Health News reported on the high demand for minority physicians and for physicians practicing in the medically underserved areas (MUAs) in the state, many of which are rural. According to the American Association of Medical Colleges (AAMC), by 2050, racial and ethnic minorities are expected to make up fifty percent of the U.S. population, yet only 1 in 16 of today’s practicing physicians identify as black, Hispanic, or Native American. In Georgia in 2008, 13 percent of practicing physicians were black, while blacks made up 30 percent of the state’s population. Studies have indicated that minority doctors are more likely to engage minority patients in decisions about treatment options and perform more tests than white physicians. Patients like Shirley Mapp, admitted to delaying care when the only physicians available were white. Yet for minority patients in rural areas, the problem is two-fold. There is both a shortage of any doctors and a shortage of minority providers. A 2005 U.S. government analysis indicated that 15 percent of Georgia residents lived in a medically underserved area, but according to Pam Reynolds, director of the Southwest Georgia Area Health Education Center, 90 percent of the state’s doctors practice within a 60-mile radius of Atlanta. Medical schools like Morehouse, Mercer, and Emory are working hard to alleviate the shortage of physicians willing to work in medically underserved areas of Georgia by working to increase the number of medical school students from underserved areas. These schools are very interested in students from underserved communities because studies show they are more likely to go back and practice in their community. Some schools are also offering pipeline programs, innovative admissions criteria, and cultural competency training. The Georgia medical schools are also expanding their students’ perspectives through field trips to rural parts of the states, through exposure to some of the poorer neighborhoods in Atlanta, and through residency training at Grady Memorial Hospital, in “the hope that all doctors will be equipped to care for all who need them” (Collins 3/15). 4. Breast Cancer May Not Change Lifespan for Older Women A recent article from Reuters discussed the findings of a new study from the Journal of Clinical Oncology, which found that older women diagnosed with breast cancer were likely to live as long as older women without any history of breast cancer. Each year, 200,000 women are diagnosed with breast cancer in the United States, and a woman’s risk increases with age. Dr. Elena Elkin, a breast cancer researcher at Memorial Sloan-Kettering Cancer Center, noted that “more of the breast cancers we find are very small and diagnosed at an early stage. For older women especially these cancers generally have a favorable diagnosis.” Lead author of the study, Dr. Mara Schonberg of the Beth Israel Deaconess Medical Center in Brookline, Massachusetts, identified nearly 65,000 older women on Medicare diagnosed with breast cancer and 170,000 similar aged women who were not diagnosed between 1992 and 2003, and followed them through 2006 to determine how many of them passed away and to identify their cause of death. The authors found that women diagnosed with ductal carcinoma in situ (DCIS), the earliest stage of breast cancer, were just as likely to survive as women never diagnosed, and women less than 80 years of age were slightly more likely to survive for at least 5 years than women who were not diagnosed with breast cancer. Women under 80 years old diagnosed with DCIS and stage 1 breast cancer had an 89 and 87 percent survival five years after diagnosis. Women over 80 years old diagnosed with DCIS and stage 1 breast cancer had a 70 and 66 percent survival five years after diagnoses. Survival rate decreased with increased breast cancer stage. The authors suggested that the increase survival rate among women under the age of 80 and diagnosed with DCIS may be due to the “healthy user effect” in which diagnosed women may be more health-conscious and more likely to have been screened for cancer than women who are not diagnosedAccording to the study authors, the doctors should be discussing the risks and benefits associated with being screened for breast cancer with their older patients, and according to Dr. Elkin, the main point is “screening can be effective even in older women” (Pittman 3/15). 5. Hmong Shamans Learn Western Medicine Practices A recent article from the Merced Sun_Star reported on a program Mercy Medical Center initiated to introduce Hmong shamans to Western medicine. Mercy Medical Center is the first hospital to implement a policy that incorporates healing ceremonies performed by shaman women into care provided at the hospital. Patients can request Hmong spiritual healers to help meet their needs and providers can refer patients to the healers. The knowledge shaman healers have of Western medicine is increased through the Partners in Healing program, which was initiated in Merced 11 years ago. Although funding for the Partners in Healing program ran out, Mercy Medical Center continues its outreach efforts by inviting Partners in Healing graduates to extend their education in Western medicine every quarter through money it received from Catholic Healthcare West. The most recent event involved taking tours of the imaging department such as the mammography room and learning about diabetes. Palee Moua, director of cultural services at Healthy House, noted that she would like to see further collaborations between shamans and doctors, including involving shamans when patients are going to have a critical surgery, having doctors refer patients to shamans, and having shamans refer patients to doctors. The Partners in Healing program was facilitated by Healthy House Within, a MATCH Coalition in Merced in partnership with Mercy and other community organizations (Amaro 3/11). 6. Report: Immigrants Living in N.J. Healthier than Their Native Counterparts A recent article from The Star-Ledger (New Jersey) reported on the health disparities between native and foreign born U.S. residents, noting differences between racial and ethnic populations. According to a recent report released by the New Jersey Department of Health and Senior Services, foreign born residents are generally healthier than their native born counterparts. Foreign born residents account for only 20 percent of New Jersey’s population, but comprise 45 percent of the uninsured. In spite of this disparity, foreign born residents have lower mortality rates than those who are native born for all ten leading causes of death, which includes heart disease, cancer, and stroke. Mortality rates for diabetes were higher for U.S.-born blacks than they were for foreign-born blacks, at 59.3 and 42.0 per 100,000 people respectively and a similar pattern was observed for U.S.-born and foreign-born Hispanics, where mortality rates were 41.8 and 19.0 per 100,000 people respectively. Meredeth Turshen, a professor at the Edward J. Bloustein School of Public Planning and Policy at Rutgers University suggested that “selective migration” may be a key factor in the health status of immigrants. “The foreign born are a younger population, generally only the healthier emigrate, they have had fewer years of exposure to the toxic New Jersey environment, and in general they’re still eating a healthier diet from their homeland,” she said. Some experts have noted that the health advantage and healthier lifestyle of foreign-born residents seems to fade after a decade of residency in the United States. Smoking, binge-drinking, obesity, and hypertension are more prevalent in foreign-born residents who have lived in the U.S. for 10 or more years. Stakeholders and health leaders met to discuss the findings of the report at the Institute for Health, health Care Policy and Aging at Rutgers. “This report is truly a call to action,” said Poonam Alaigh, the commissioner of the state health department. She went on to say, "This is not the endpoint — this is the beginning" (Augenstein 3/07). 7. Black Babies at Twice Risk of Whites, Study Indicates A recent article from The Record reported on the differences in infant mortality rates between African American and white mothers, citing stress as a contributing factor o the higher rates observed among African American women. In the most recent infant mortality rates from New Jersey, for every 1,000 live births, 11.2 black babies and 3.4 white babies died. African American women are also more likely to experience a miscarriage or an early term delivery than white women. In 2006, 16 percent of black women went into pre-term labor compared to 10% of white women. "Race in America puts your pregnancy at risk," says Ilise Zimmerman, CEO of the Northern New Jersey Maternal-Child Health Consortium in Paramus, where the nation's first Black Infant Mortality Reduction Resource Center was founded in 1999. The observed disparities are not simply the result of differences in income and education. Yvonne Wesley, a health care consultant and expert on maternal-child health notes that “Regardless of their age, education, income or marital status, black women are more than twice as likely to deliver a baby prematurely.” She went on to say that “If you're looking at black women making $100,000 a year, and white women making $100,000 a year, black women are twice as likely to deliver early.” Experts agree that poverty, chronic diseases, and poor access to health care contribute to the high mortality rates, including another factor, stress, but the explanation is more complicated. Some researchers argue that the stress of being black in America puts women at risk for a premature delivery.Although infant mortality rates differ between black and white women in the state of New Jersey, the state holds the fifth lowest rate in the nation, 5.2 deaths for every 1,000 live births (Washburn 3/05). 8. White Patients Most Likely to Get Kidney Transplants: Study A recent article from HealthDay discussed the findings of a new study from the Journal of the American Society of Nephrology which found that minorities are significantly less likely to get a kidney transplant than non-Hispanic whites. According to the National Institutes of Health (NIH), approximately 23 million Americans had chronic kidney disease in 2004. Each year, approximately 7,000 kidneys are donated, but 110,000 people are in need of one. The author of the study, Dr. Yoshio Hall, a professor of medicine and a researcher at the Kidney Research Institute in the Department of Medicine at the University of Washington, analyzed data from more than half a million people who began kidney dialysis between 1995 and 2006 and found that it takes longer for members of minority groups to get on the waitlist for a kidney. Moreover, once waitlisted, white patients are 40 percent more likely to receive a kidney transplant than blacks, Hispanics, and Asians. Along with poverty, cultural barriers, and a lack of health insurance, the current formula used to allocate kidneys poses a barrier to racial and ethnic minorities. “Unfortunately, the disparities that we describe largely mirror racial or ethnic disparities in general health care in the United States,” said Dr. Yoshio Hall. Furthermore, a suitable candidate for a kidney transplant must have a stable economic situation in addition to social support. The best matches for organ donation are family members or people in the same racial group, and most donors are white, noted Dr. Sander Florman, director of the Recanati/Miller Transplantation Institute at Mount Sinai Hospital in New York City. Geographic location of the kidney can also be a barrier because the United States is divided into 11 regions for the purposes of organ sharing, and donated organs often never leave their region of origin, despite their ability to remain viable for up to 36 hours. Dr. Florman called for more education to get people “to sign the back of their driver's license,” a common way to donate organs (Holohan 3/03). 9. Rural Lung Cancer Survivors Face Higher Mental Distress A recent article from Internal Medicine News discussed the results of a study presented at an annual meeting of the American Psychosocial Oncology Society, which found that rural lung cancer survivors in Kentucky experience higher mental distress compared to non-rural lung cancer survivors in the state. Michael Andrykowski, professor of behavioral science at the University of Kentucky in Lexington and author of the study, previously focused on symptoms and psychosocial outcomes among cancer patients. As a result of his prior work, he developed an interest in rural health disparities. Dr. Andrykowski and his colleagues used surveys and telephone interviews to 144 non-small cell lung cancer survivors in rural and non-rural areas. They found that respondents from rural areas were more likely to have less formal education, to be less optimistic, and to be less efficacious in seeking mental health support and cancer information than were nonrural patients. Along with more financial constraints, rural respondents also had less access to mental health resources including a psychologist, support group, and a computer for Internet access. Using three different mental health outcome measurements, the author found that rural cancer survivors were more likely to report mental health distress than non-rural cancer survivors. Rural survivors were more likely to have a lower score on each of the following measurements: Medical Outcomes Study (MOS) mental health subscale (63.0 rural vs. 73.2 nonrural), Hospital Anxiety and Depression Scare (HADS) anxiety subscale (7.4 vs. 5.7), and HADS depression subscale (6.4 vs. 4.4). Professor Andrykowski also found that rural residents had fewer interpersonal and intrapersonal coping resources because “friends and family may be less supportive if [the survivors] use mental health services.” Until Dr. Andrykowski began collecting research on geographic disparities, he said, “I thought it was a good thing [that rural patients] were embedded in a close-knit community…but privacy and confidentiality may be compromised” (Bates 3/03). 10. Schools Feel Trickle-Down Effect of Families without Insurance A recent article from the Lake Country Reporter reported on the increasing demand for school services in response to the high rates of uninsured students in the Lake Country area. According to school officials in the Lake Country area, school psychologists, social workers, and part-time nurses are taking on added workload due to high rates of uninsured students. The effects of being uninsured are manifested through higher rates of school “absenteeism, more health room visits, and the additional need for social worker contacts and visits to school psychologists.” Melinda Vose, coordinator of Nursing Services, noted that many parents want to know whether they should go to the doctor or “wait it out.” She said, “I’m finding people, because medication is getting more expensive, reducing the dose, or don’t give it as often as required or supplement with over-the-counter medications instead of filling the prescription.” Besides the increasing rate of students seeking medical services, school psychologists have also noted a rise in mental illness. Some parents who notice signs of depression in their child may not be able to address the issue because they can not afford to pay for either a visit to a mental health provider or the medication their child may be prescribed for treatment. “That’s heartbreaking, to hear a family who can clearly see there is an issue with their child and have to make choices between: am I not going to pay the rent, get food or pay for heat or do we get the medical treatment? That’s really, really hard to see,” noted Associate Principal Mike O’Connor. To help address some of the challenges school psychologists are meeting with students to offer support, and social workers are trying to put families in contact with various resources, including free medical and dental community services.Community Memorial Hospital, St. Joseph’s in Waukesha, and the Lake Area Free Clinic offer family medical and dental services (Frake 2/28). RESEARCH 11. Geographic Variation in Diagnosis Frequency and Risk of Death among Medicare Beneficiaries In a recent study published in The Journal of American Medical Association, researchers determined the association between frequency of diagnoses for chronic conditions in geographic areas and case-fatality rate among Medicare beneficiaries and found that there is an inverse relationship between the regional frequency of diagnosis and the case-fatality rate for chronic conditions. Previous studies have indicated that the frequency of diagnosis varies by region, prompting the authors of the study to evaluate case-fatality rates among Medicare beneficiaries in varying regions. The authors analyzed a 20 percent sample of Medicare beneficiaries who were enrolled in Part A and Part B throughout 2007 and who were between the ages of 65 and 99 years on December 31, 2007, or who were fully enrolled beginning January 1, 2007. The final sample included 5,153,877 beneficiaries. The researchers examined the mean number of 9 chronic conditions (cancer with poor diagnosis, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure, peripheral artery disease, severe liver disease, diabetes with end-organ disease, chronic renal failure, and dementia) diagnosed in 306 hospital referral regions (HRRs), and found the frequencies varied substantially. Diagnosis frequencies were reported in quintiles categorized as: very low (less than 0.80), low (0.80-0.86), middle (0.87-0.93), high (0.94-0.99), and very high (greater than or equal to1.0). The authors found that a greater number of diagnoses corresponded to a higher case fatality rate, such that for patients diagnosed with 0, 1, 2, and 3 conditions the case-fatality rate was 16, 45, 93, and 154 per 1000, respectively. To analyze systemic factors that may contribute to the likelihood of diagnosis, the authors evaluated physician encounters and diagnostic testing and found a strong positive correlation with each measure. The authors also noted an inverse relationship between regional diagnosis frequency and the case-fatality rate for a given condition. Among patients diagnosed with 1 condition, the case-fatality rate decreased in a stepwise fashion across quintiles of diagnosis frequency, from 51 per 1000 in the lowest quintile to 38 per 1000 in the highest quintile (relative rate, 0.74 [95% CI, 0.72-0.76]), and among patients diagnosed with 3 conditions, the corresponding case-fatality rates were 168 and 137 per 1000 (relative rate, 0.81 [95% CI, 0.79-0.84]).The authors noted that the paradoxical findings would suggest that hospital referral regions with high diagnosis frequencies are either more effective in treating sick patients or have better access to services which lead to decreased case fatality. (Welch HG, Sharp SM, et. al. “Geographic variation in diagnosis frequency and risk of death among Medicare beneficiaries.” The Journal of American Medical Association, 305, no. 11(March 2011): 1113-1118).12. Assessing Deaf Cultural Competency of Physicians and Medical Students A recent study published in the Journal of Cancer Education evaluated a Deaf Community (DCT) Training program intended to create physicians who are culturally competent to care for deaf patients, and found that medical students who underwent the training program scored significantly higher than faculty and non-DCT student on knowledge related to deaf cultural competency. Prior studies have demonstrated that members of the Deaf community experience health disparities due to language barriers. Many physicians do not feel comfortable with deaf patients and have a lack of understanding of deaf culture. They also tend to be unaware of the rights of deaf patients. The University of California, San Diego (UCSD) School of medicine created a two year NCI-funded fellowship program, Medical Students, Cancer Control, and the Deaf Community (DCT) to train a cohort of medical students in ASL and deaf culture in effort to create partnerships with the Deaf community. As part of the program, DCT participants completed ASL classes, attended a residential ASL/deaf culture immersion program at Galluadet University, and completed medical school rotations where participants interacted with the Deaf community. Medical school faculty, non-DCT medical students and DCT-students and alums were surveyed regarding their knowledge of deaf culture and some of the challenges deaf patients face. The final sample size included 22 DCT medical students, 211 non-DCT medical students, and 130 medical school faculty members. The results showed that on average, DCT students have higher knowledge scores than non-DCT students (p<0.01) and than medical faculty. There was a positive correlation between prior exposure to the Deaf community and cultural knowledge scores, but only for faculty participants (p<0.05), and they still scored lower than DCT students. Exposure to the Deaf community through immediate social circles was also evaluated, and faculty members who reported not having a deaf or hard-of-hearing person in their social circle scored higher than non-DCT students. Respondents were also asked to complete and open-ended question listing five problems they believe deaf patients have when hospitalized. DCT students listed “understanding terms and medical language” along with maltreatment or mistreatment among the top three most frequent problems, while faculty and non-DCT students listed “communication with persons other than healthcare providers” as a difficulty. The authors concluded that understanding that the Deaf community is a linguistic and socio-cultural minority will help clinicians more effectively respond to issues of human diversity in the healthcare setting. (Hoang L, Lahousse SF, et. al. “Assessing deaf cultural competency of physicians and medical students.” Journal of Cancer Education, 26, no. 1. (March 2011): 175-182).13. Racial and Ethnic Disparities in Sexual Risk Behaviors and STDs during Young Men’s Transition to Adulthood A recent study from the journal of Perspectives on Sexual and Reproductive Health examined racial and ethnic health disparities in sexually transmitted diseases (STD) and sexual behavior among youth, and found large disparities between young black and white men and also within racial and ethnic groups that had very low levels of risky behavior. The authors used data from the National Survey of Adolescent Males (NSAM), a longitudinal survey that explores sexual relationships, contraceptive practices, and STD knowledge and attitudes of males from adolescence into young adulthood. The study was conducted in three waves, with the first wave occurred in 1998 and included 1,880 males ages 15-19. The second wave took place between 1990 and 1991, and included 1,676 males ages 17-22, and the third wave was in 1995, and included 1,377 males ages 21-26. Respondents were asked to answer questions regarding their STD history, social and demographic characteristics, and sexual risk behavior, in an effort to better understand observed racial and ethnic health disparities in STDs. For each wave, the average age at first sex was 16 and a higher proportion of black men were in the highest risk, multiple-partners/some-protection category compared to white and Latino men. Multiple-partners/some-protection category was defined as men who had an average of 7.4 female sexual partners in the past year and used condoms 39% of the time. Furthermore, a greater proportion of black men were in the low-risk/high protection group than white or Latino men. The low-risk/high-protection cluster consisted of men who had an average of 1.4 female sexual partners in the past year and used condoms 85% of the time. Assessing sexual risk trajectory, black men were less likely to follow a “steady low” trajectory compared to white, 33% vs 54% (p<.05). Black men were also more likely to follow a “steady high” trajectory compare to white men, 9% vs 2% (OR = 1.9, CI: 1.3-2.8; p<.001). Controlling for socioeconomic factors, black males along with Latino males were more likely to be in steady high-risk and upward trajectory groups as opposed to the steady low-risk group. The authors noted that even among those who had a “steady low” risk trajectory, a greater proportion of black men than white or Latino men had ever received an STD diagnosis. The authors noted that “social context” may contribute to racial and ethnic health disparities, which suggests that regardless of sexual behavior, members of a specific high risk group who choose partners within that group may be putting themselves at risk. The authors also recommend mapping the availability of reproductive health services in a community to outline disparities in STD prevention and treatment. (Dariotis JK, Sifakis F, et.al. “Racial and Ethnic Disparities in Sexual Risk Behaviors and STDs During Young Men's Transition to Adulthood.” Perspectives on Sexual and Reproductive Health, 43, no.1. (March 2011): 51-59). 14. Racial/Ethnic Disparities in Survival among Men Diagnosed With Prostate Cancer in Texas In a recent study published in the journal Cancer, researchers evaluated racial and ethnic disparities in prostate cancer survival among men living in Texas, and found that Hispanic and African American men diagnosed with prostate cancer were more likely to die than non-Hispanic white and Asian American men. Few studies have focused on the expected prostate cancer survival rates of traditionally understudied groups like Hispanic and Asian men aged greater than 25. The authors of this study used data from the Texas Cancer Registry to obtain information on men over 25 years of age diagnosed with invasive primary prostate cancer. The sample size of 87,444 men comprised of about 75% non-Hispanic white men, 12% black men, 12% Hispanic men, and 0.62% Asian/Pacific Islander men. To consider contributing factors to survival, the socioeconomic status, patient, and tumor characteristics were taken into account. The authors found that black men were more likely to have an unknown state of the disease at diagnosis and were diagnosed with prostate cancer at an age of one year earlier than white men. Also, compared to white men, Black, Asian, and Hispanic men were more likely to be diagnosed at a distant stage than white men. Aside from disparities in cancer diagnoses, the authors found significant racial and ethnic differences in survival. The authors found that prostate-specific survival probability was 94% for Asian men, 92% for white men, 88% for Hispanic men, and 84% for black men. Demographic characteristics also influenced survival; those who resided in neighborhoods of low socioeconomic status had a 70% all-cause survival compared to 83% for individuals in neighborhoods of high socioeconomic status. The authors found that a higher percentage of black (32.4%) and Hispanic (34.1%) resided in very low SES compared to white men (7.9%). Even after controlling for SES, age, tumor state, residence, and year of diagnosis, black men were more likely to die and Asian men were less likely to die compared with white men. The study underscores disparities in survival among men living in Texas with prostate cancer and notes that further research is needed to identify contributing factors. The authors noted that racial and ethnic differences in survival could be possibly due to differences in treatment, prostatectomy, and access to high quality health care. White A, Coker AL, Du XL, et.al. “Racial/Ethnic Disparities in Survival among Men Diagnosed with Prostate Cancer in Texas.” Cancer,117, no.5. (March 2011): 1080-1088). 15. Racial/Ethnic Disparities in Exercise and Dietary Behaviors of Middle-Aged and Older Adults Acculturated and middle-aged racial and ethnic minorities are less likely to engage in healthy exercise and to maintain healthy diets than whites, according to a recent study published in the Journal of General Internal Medicine. There are few studies on the differences in dietary and physical activity for racial and ethnic minorities in existence that come from a population-based data set. This study is unique because it is the first time a study like this included Asian/Pacific Islanders while focusing on age differences (45-64 years old and 65-85 years old) and level of acculturation. Using data from the 2007 California Health Information Survey (CHIS), a random-digit dial telephone survey, the authors assessed healthy behaviors including leisure-time physical activity (respondents were asked if they engaged in moderate or vigorous physical acticity) and consumption of a healthy diet (respondents were asked about the recommended consumption of daily fruits and vegetables). The authors found that racial and ethnic minorities were less likely to report healthy diets and physical activity during middle, but not late adulthood compared to non-Hispanic whites. Middle aged whites were more likely to report engaging in vigorous physical activity compared to all racial and ethnic minorities (OR = 0.28 to 0.73; 95% CI: 0.16-1.00). The authors also analyzed the effect of acculturation, which they measured as English language proficiency, on healthy behaviors for Hispanic and Asian respondents. Limited English-proficient Asian and Pacific Islanders ages 65 years and older reported to engage in more moderate physical activity than whites (p<0.001). The results for vigorous exercise were similar for middle and older-aged adults with the exception of limited English-proficient Asian and Pacific Islanders ages 65 years and older, who were less likely to be involved in vigorous activity compared to whites. Furthermore, poor consumption of a healthy diet was only seen in middle aged English-proficient Hispanics compared to middle aged whites. For adults in late adulthood, blacks and Hispanics ages 65 years and older were less likely to eat the recommended amount of fruits and vegetables compared to whites. The authors noted that the low rate of physical activity among racial and ethnic minorities underscores the need to further identify barriers to exercise by focusing on health related issues or environmental and social factors. (August KJ, Sorkin DH. “Racial/Ethnic Disparities in Exercise and Dietary Behaviors of Middle-Aged and Older Adults.” Journal of General Internal Medicine, 26, no.3. (March 2011): 245-250). 16. An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era In a recent article published in the Journal of Urban Health, the authors discussed the evolving healthcare needs of the HIV community and the need to develop a new model for HIV care. Compared to the health of HIV-infected adults during the start of the epidemic, HIV-infected adults now have longer life expectancies and must adjust to the management of chronic diseases such as diabetes and hypertension. New challenges exist within the HIV community such as disease management in the aging population, increasing co-morbidity rates, and a shortage of health care providers with HIV-management expertise. These challenges are compounded in minority and low-income populations where HIV/AIDS survival rates are far worse compared to those of non-Hispanic whites and high-income communities. The paradigm shift in HIV management suggests a new model for HIV care which the authors recommend involves increasing primary care and community-based collaborative practices and encouraging HIV specialist to train in primary care-related knowledge and skills. The authors note that HIV specialist may not have the training necessary to care for HIV patients with chronic diseases or initiate a discussion on transmission risk reduction. The authors note that research has demonstrated the benefits of primary care delivery on survival and propose that patients will benefit from HIV clinicians who assume a primary care provider role to manage common co-morbidities, coordinate treatment, and provide HIV-specific expertise.The authors concluded that primary care providers are the “front-line” and “backbone” of our health care delivery and serve as invaluable collaborators for the restructuring of HIV care in the current disease era. (Chu C, Selwyn PA. “An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era.”Journal of Urban Health, (March 2011)).Improving Access to Adult Primary Care in Medicaid: Exploring the Potential Role of Nurse Practitioners and Physician Assistants
Sixty-five million people live in areas designated by the federal government as having a shortage of primary care providers. By 2020, the U.S. will face an estimated shortage of 91,000 physicians, split about evenly between primary care physicians and specialists. At the same time, the demand for access is certain to grow as millions of newly insured people are expected to enter the health care system as a result of the Patient Protection and Affordable Care Act (ACA). Nurse practitioners and physician assistants could help fill the void, yet the scope of practices for nurses varies by state. This brief provides basic information about two major types of primary care providers – nurse practitioners and physician assistants – and considers their potential to increase the supply of primary care as Medicaid expands to cover more uninsured adults To learn more, please read Improving Access to Adult Primary Care in Medicaid: Exploring the Potential Role of Nurse Practitioners and Physician Assistants. |
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This free, monthly update synthesizes news coverage from hundreds of print and broadcast news sources related to health and health care issues affecting underserved and racial and ethnic communities. 
