A University of California, San Francisco study found that California hospitals in areas with large minority populations are more likely to be overcrowded and divert ambulances, delaying timely emergency care.
The study, published in the August issue of Health Affairs, examined ambulance drivers in hospitals around the state to assess whether overcrowding in emergency rooms disproportionately affects racial and ethnic minorities. Researchers say this is the first study using hospital-level data to show how diversion affects minorities, and research found minorities are more at risk of being impacted by ER crowding and by diversion than non-minorities.
Ambulance diversion takes place when hospital emergency rooms are too busy to accept new patients, so they’re rerouted to the closest available ER. This is especially common in urban areas.
Researchers looked at 2007 data from 202 hospitals around the state, which showed hospitals that served the greatest percentage of minority patients turned away ambulances because of overcrowding far more than those that served the smallest number of minorities.
Researchers found that 92% of the hospitals experienced a median diversion of 374 hours over the course of the year. Those serving high numbers of minorities experienced ambulance diversion for 306 hours, compared to 75 hours with fewer minority patients.
Lead author Renee Y. Hsia, M.D., assistant professor of emergency medicine at University of California, San Francisco, notes that these diversions put patients suffering from conditions like heart attack or stroke at a much higher risk. “Minutes could mean the difference between life and death,” she says in a press release.
There are several reasons that cause emergency rooms to become overcrowded. First, many patients—especially those who are uninsured and don’t have access to primary care services—end up there for less urgent reasons or serious conditions that could have been treated earlier. Additionally, hospitals lack the proper staffi ng to admit patients into the hospital, so patients are stuck waiting. Lastly, hospitals sometimes don’t have the equipment or services needed to treat specifi c medical problems.
The study authors say their research points to the need for systemic reform, including better management of hospital flow and statewide criteria regulating diversion policies.
A study by the Boston University School of Public Health has found a need to create health programs specifically promoting the well-being of lesbian, gay, and bisexual cancer survivors. The research was lead by Ulrike Boehmer, associate professor of community health sciences.
The results found that gay men were 1.9 times more likely to report a cancer diagnosis than heterosexual men. Though there were no significant differences in cancer prevalence among women with varied sexual orientation, the study showed that lesbian and bisexual cancer survivors were respectively two and 2.3 times more likely to report fair or poor health than heterosexual cancer survivors.
In a BU Today article, Boehmer says the differences in the prevalence of cancer survivorship raises questions about possible differences in the cancer rates by sexual orientation. She also says they can only speculate that HIV status may have contributed to the higher cancer prevalence in gay men, but they were unable to address this in the study since they didn’t have data on the participants’ HIV status.
The significance of the study, according to Boehmer, is the finding that sexual orientation may be a factor in cancer incidence and outcomes. The study concludes saying lesbian and bisexual cancer survivors need to be targeted by programs and services to better assist them in improving their health perceptions. The study also suggests health care providers and public health agencies need to be made aware of the higher prevalence of cancer in gay men through increased screening and primary prevention.
The study was published online in Cancer, a peer-reviewed journal of the American Cancer Society, and included data from the California Health Interview Survey.
Hospitals For Humanity (HFH) is a registered nonprofit organization with 501(C) 3 status in the United States. The organization provides health care for people living in the least developed countries of the world. Their goals include providing health assessments and treatment for local citizens; updating existing medical facilities, assisting in the construction of modern hospitals, and providing training to local physicians; improving regional health and sustaining the quality of care through partnerships with local government; and responding to special cases of chronic illness and diseases through evaluation, diagnosis, and patient referral.
Efforts are currently focused on communities in Haiti, Nigeria, and the Philippines. HFH’s total patient population is over 65,000 and includes general surgeries, ophthalmic surgeries, dentistry, emergency medical services, and more.
HFH is looking for compassionate volunteers who desire to enroll in the organization, including CRNAs, NPs, PAs, RNs, optometrists, pharmacists, MLTs, EMTs, surgical techs, and physicians of all specialties. Currently, two Medical Mission Initiatives (MMIs) remain for 2012: one in Okija, Anambra State, Nigeria, from October 12–19, and one in Ijumu Land, Kogi State, Nigeria, from December 1–12.
If you are interested in learning more or applying for a Medical Mission Initiative, visit www.hospitalsforhumanity.org. You can view an informational video, look at pictures from past MMIs, and submit an application. Questions not answered on the website can be directed to Adrian Johnson, Director of Recruitment, at [email protected] or 224-577-5479.
What is social capital and can social capital play a role in better asthma outcomes in children residing in homeless shelters? These were some of the questions that guided a research proposal for the Research Infrastructure in Minority Institutions—Career Opportunities in Research (RIMI-COR) grant at Mercy College. Funding for this study was made possible in part by a grant from the National Institute on Minority Health and Health Disparities.
A pilot study was undertaken from October 2008 through August 2009 to quantify if social capital structures existed in three homeless shelters in New York City and if shelter residents were aware of these structures, and to examine parental perceptions about their child’s asthma (controlled/uncontrolled and mild/moderate/severe) and clinician concordance of parental assessment.
Five Mercy College nursing students assisted the researcher in this study with literature reviews and data collection. Engaging nursing students in research is an important venue because it gives students opportunities to examine health issues that are outside of their purview. Further, the students participating in data collection learned about social contributors to health disparities.
Additionally, this research is also being undertaken at a transitional homeless shelter in San Francisco, California. A medical student from University of California, San Francisco has assisted with data collection (anticipated completion in August 2012). To date, 13 parents have participated in the study.
Putnam defined social capital as social relationships (interpersonal trust, norms of reciprocity, and civic responsibilities) within communities that act as resources for individuals and facilitate collective action for mutual benefit.1 Social capital structures are systems of networks, norms, and trust relationships, which allow communities to address common problems.2
Social capital and health linkages are paltry, but research has shown that higher levels of social capital lead to better health outcomes and lower mortality rates in adults and children.3 Asthma prevalence in the United States is about 8.9% and affects more than 6.8 million children and adolescents.4 Asthma is overrepresented in children living in poverty and asthma rates in homeless children are six times the national average.5,6
Social capital in homeless shelters refers to those structures that facilitate social relationships, interpersonal trust, social engagement, and civic responsibilities. Social capital resources were viewed as case managers, onsite medical clinics, educational programs, and shelter governance meetings.
If we consider that homeless shelters might function as a community, structural features that can stimulate social capital may improve childhood asthma outcomes. Further, engaging homeless families in the tenets of social capital may be the means to facilitate participation in community events when they become permanently housed. Active community participation is essential to bring about the social and physical resources necessary to reduce the detrimental environmental exposures in lower income communities.
Self-rated health and psychological well-being are higher in individuals who reported increased levels of community trust and less political participation such as voting has been associated with poorer self-rated health.7,8,9 Therefore, if homeless shelters provided onsite medical clinics (a social capital resource) would parents rate their children’s asthma as controlled? Encouraging patterns of social engagement with the onsite medical clinic would reduce visits to the emergency room. Further, understanding how social capital interacts with the homeless shelter environments (physical and social) could influence how parents understand or perceive their child’s asthma.
The three shelters were identified by an organization that provides onsite medical services at family shelters. Nineteen parents who had asthmatic children (aged six or older) completed a questionnaire adapted from the American Academy of Pediatrics (v. 3.1; 6/02). The questions covered the child’s health, child’s activities, information about the parent, and information about the shelter. The questionnaire was also translated into Spanish. The questionnaire was read to most of the parents because literacy was a problem.
The researcher, a family nurse practitioner, used the National Heart and Lung Institute’s Guidelines for the Diagnosis and Management of Asthma to determine if the child’s asthma was controlled or uncontrolled and the severity of the child’s asthma (mild, moderate, and severe). The social capital indicators examined were voting patterns and if the shelter had case managers, onsite medical clinic, educational programs, town hall meetings, and governance meetings for the shelter residents.
Self-reported demographic characteristics of the study sample can be found in the images accompanying this article. The questionnaire asked about gender, socioeconomic status indicators (income, education, and occupation), insurance information, and if this was their first time living in a homeless shelter.
All of the homeless shelters had case managers, onsite medical clinics, education programs such as GED preparation, town hall meetings, and shelter governance meetings. Respondents were asked if they were aware of these social capital structures and if they voted and if not, their reasons. About 58% of respondents indicated their awareness of town hall meetings; 21% indicated they did not know about these meetings, and 21% answered don’t know. Most parents knew their case managers (90%), 5% indicated they did not know them, and 5% answered don’t know. Most parents knew about the onsite medical clinic (95%) and only 5% responded don’t know. Parents used the medical clinic (32%) for asthma problems and 58% chose not to use the onsite clinic because the clinic was closed; they brought their child to the ER or to their private clinician. Few parents were aware of educational programs (16%); 47% specified no and 37% responded don’t know. A minority of parents were aware of shelter governance meetings (37%); 26% were unaware of these meetings and 37% answered don’t know. Most respondents voted (68%) whereas 32% indicated they did not vote. Reasons given for not voting were (1) not registered, (2) did not know where to vote, (3) did not know about a particular election, and (4) did not want to vote.
Parents were asked to subjectively assess if their child’s asthma was controlled or uncontrolled and to rate if their child’s asthma was mild, moderate, or severe. Mild was defined as not too bad, moderate was considered bad, and severe was considered very bad. Assessment of the child’s asthma by the researcher was based on the parent’s answers about medication usage and types of medication the child had been prescribed. Cross-tabulations were performed to examine clinician and parental concordance of asthma perceptions and asthma severity.
The clinician and the parent agreed at a 91% rate that the child’s asthma was controlled and 25% that the child’s asthma was uncontrolled. The clinician-parent concordance for asthma severity was 70% for mild, 14.3% for moderate, and 50% for severe.
This small-scale exploratory study was able to quantify that social capital structures existed in family homeless shelters in New York City; however, respondents were more aware of some of these structures than others. Additionally, this study investigated parental perceptions about their child’s asthma because data suggested that social capital may be a determinant in self-rated health and thus could potentially be extended to perceptions about a child’s health status. Further, if the parent sought treatment at the onsite medical clinic, did the parent gain a better understanding of asthma triggers and medications leading to decreased visits to an emergency room?
Theoretically, social capital can broadly examine the structural inequalities that contribute to health disparities. Additionally, social capital may increase our understanding of the associations of homelessness and health problems because linking social capital and health may enable homeless shelters to address cultural norms that are detrimental to health, ensure the adequate provision of health care, and collectively build infrastructures that are conducive to better health outcomes.
References
R.D. Putnam, “Bowling alone: America’s declining social capital,” Journal of Democracy 6 (1995):65-78.
P.M. Pronyk, et al., “Is social capital associated with HIV risk in rural South Africa?” Social Science & Medicine 66(2008): 1999-2010.
I. Kawachi, B.P. Kennedy, and R. Glass, “Social capital and self-rated health: A contextual analysis,” American Journal of Public Health 89 (1999): 1187-1193.
E. Forno and J.C. Celedon, “Asthma and ethnic minorities: Socioeconomic status and beyond,” Current Opinion in Allergy and Clinical Immunology 9 (2009): 154-160.
J.J. Cutuli, J.E. Herbers, M. Rinaldi, A.S. Masten, and C.N. Oberg, “Asthma and behavior in homeless 4- to 7-year-olds,” Pediatrics 125 (2010): 145-151.
D. McLean, S. Bowen, K. Drezner, A. Rowe, P. Sherman, S. Schroeder, K. Redlener, and I. Redlener, “Asthma among homeless children: Undercounting and undertreating the underserved,” Archives of Pediatric and Adolescent Medicine 158: (2004):244-249.
T. Nieminen, T. Martelin, S. Koskinen, H. Aro, E. Alanen, and M.T. Hyyppa, “Social capital as a determinant of self-rated health and psychological well-being,” International Journal of Public Health (2010): doi: 10.1007/s00038-010-0138-3.
S.V. Subramanian, D.J. Kim, I. Kawachi, “Social trust and self-rated health in US communities: A multilevel analysis,” Journal of Urban Health 79(2002): S21-S34.
T.A. Blakely, B.P. Kennedy, and I. Kawachi, “Socioeconomic inequality in voting participation and self-rated health,” American Journal of Public Health, 91(2001): 99-104.
America’s racial and ethnic minority groups face major disparities when it comes to accessing quality mental health services, according to a recent report by the U.S. Surgeon General, Dr. David Satcher.
The study, a supplement to the 1999 first-ever Surgeon General’s report on mental health, connects the ethnic and racial-based disparities in mental health care to a number of factors, including cultural bias, lack of health insurance, language differences and a mistrust of health care professionals by minorities. According to Satcher, the current health care system has failed to address these long-standing inequities. The report calls for the development of culturally relevant health care in order to repair the current system.
The U.S. Department of Health and Human Services’ Surgeon General’s office compiled the supplemental report. It found that racial and ethnic minority groups are less likely to receive quality mental health services than the majority population, and as a result, a disproportionately high number of minorities are suffering from untreated or inadequately treated mental health problems and mental illnesses.
“While mental disorders may touch all Americans either directly or indirectly, all do not have equal access to treatment and services,” Satcher says. “The failure to address these inequalities is being played out in human and economic terms–on our streets, in homeless shelters, public health institutions, prisons and jails.”
The solution, according to Satcher, is to increase the research on cross-cultural skills, communication and cultural-specific knowledge–such as the role religion and spirituality plays in ethnic cultures and in mental health.
“This supplement carries with it a call to the people of the U.S. to understand and appreciate our many cultures and their impact on the mental health of all Americans,” Satcher states. “The main message of this supplement–that culture counts–should echo through the corridors and communities of this nation.”
The report warns that if these disparities persist, in a time when ethnic and racial minority populations are growing rapidly, the consequences could be severe.
“Mental health is fundamental to overall health and productivity,” the executive summary says. “It is the basis for successful contributions to family, community and society…Left untreated, mental illness can result in disability and despair for families, schools, communities and the workplace.”
