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Ethnic Minority Patients (ethnic + minority_patient)
Selected AbstractsImproving Care for Minorities: Can Quality Improvement Interventions Improve Care and Outcomes For Depressed Minorities?HEALTH SERVICES RESEARCH, Issue 2 2003Controlled Trial, Results of a Randomized Objective. Ethnic minority patients often receive poorer quality care and have worse outcomes than white patients, yet practice-based approaches to reduce such disparities have not been identified. We determined whether practice-initiated quality improvement (QI) interventions for depressed primary care patients improve care across ethnic groups and reduce outcome disparities. Study Setting. The sample consists of 46 primary care practices in 6 U.S. managed care organizations; 181 clinicians; 398 Latinos, 93 African Americans, and 778 white patients with probable depressive disorder. Study Design. Matched practices were randomized to usual care or one of two QI programs that trained local experts to educate clinicians; nurses to educate, assess, and follow-up with patients; and psychotherapists to conduct Cognitive Behavioral Therapy. Patients and physicians selected treatments. Interventions featured modest accommodations for minority patients (e.g., translations, cultural training for clinicians). Data Extraction Methods. Multilevel logistic regression analyses assessed intervention effects within and among ethnic groups. Principal Findings. At baseline, all ethnic groups (Latino, African American, white) had low to moderate rates of appropriate care and the interventions significantly improved appropriate care at six months (by 8,20 percentage points) within each ethnic group, with no significant difference in response by ethnic group. The interventions significantly decreased the likelihood that Latinos and African Americans would report probable depression at months 6 and 12; the white intervention sample did not differ from controls in reported probable depression at either follow-up. While the intervention significantly improved the rate of employment for whites and not for minorities, precision was low for comparing intervention response on this outcome. It is important to note that minorities remained less likely to have appropriate care and more likely to be depressed than white patients. Conclusions. Implementation of quality improvement interventions that have modest accommodations for minority patients can improve quality of care for whites and underserved minorities alike, while minorities may be especially likely to benefit clinically. Further research needs to clarify whether employment benefits are limited to whites and if so, whether this represents a difference in opportunities. Quality improvement programs appear to improve quality of care without increasing disparities, and may offer an approach to reduce health disparities. [source] The demography of nurses and patients on acute psychiatric wards in EnglandJOURNAL OF CLINICAL NURSING, Issue 6 2009Len Bowers Aims and objectives., To describe the ethnic and demographic composition of staff and patients on acute psychiatric wards in England. Background., A significant proportion of the UK population (7·6%) belong to an ethnic minority and there are concerns that ethnic minority patients are not well served by psychiatry, in particular that they are subject to excessive force and coercion. Design., Survey of a random sample of psychiatric wards in three regions. Methods., A survey was conducted of staff (n = 1536) and patients (n = 11 128) on 136 acute admission psychiatric wards. Results., Ethnic minority patients were more likely to be admitted with a diagnosis of schizophrenia, younger, more likely to be admitted for a risk of harm to others and more likely to be legally detained. The association between ethnic minority status and detention remains, even when risk, age, gender and diagnosis are taken into account. Ethnic minority patients come from areas of greater social deprivation and fragmentation. Ethnic concordance between staff and patients varies, but the greatest difference is found in London where the proportion of minority staff is greater than the proportion of minority patients. Conclusions., There continues to be evidence that ethnic minority patients are subject to an excessive amount of legal coercion in English mental health services. However, the proportion of staff belonging to an ethnic minority is greater than the proportion of patients. Relevance to clinical practice., Solutions to the problem of excessive use of legal coercion with ethnic minority patients need to be found. Changes of recruitment strategies are required if concordance is to be achieved. [source] Effectiveness of hepatitis C treatment with pegylated interferon and ribavirin in urban minority patients,HEPATOLOGY, Issue 4 2010Paul Feuerstadt Randomized controlled trials of hepatitis C virus (HCV) therapy with pegylated interferon and ribavirin have demonstrated sustained viral response rates (SVRs) of 54%-63% (efficacy). Treatment results in clinical practice (effectiveness) may not be equivalent. The goal of this study was to assess the effectiveness of HCV treatment with pegylated interferon and ribavirin in a treatment-naïve, human immunodeficiency virus (HIV)-negative, United States urban population with many ethnic minority patients. We evaluated 2,370 outpatients for HCV therapy from 2001 to 2006 in the Faculty Practice of the Albert Einstein College of Medicine or the attending-supervised Montefiore Medical Center Liver Clinic. Care was supervised by one experienced physician under conditions of everyday clinical practice, and appropriate ancillary resources were made available to all patients. Two hundred fifty-five patients were treated with a mean age of 50 years (60% male, 40% female; 58% Hispanic, 20% African American, 9% Caucasian, 13% other; 68% genotype 1, the remainder genotypes 2 or 3). Patients had at least one liver biopsy. Intention-to-treat analysis (ITT) showed SVR in 14% of genotype 1 patients and 37% in genotype 2/3 patients (P < 0.001). SVR was significantly higher in faculty practice (27%) than in clinic patients (15%) by intention-to-treat (P = 0.01) but not per-protocol analysis (46% faculty practice, 34% clinic). 3.3% of 1,656 treatment-naïve, HIV antibody,negative individuals ultimately achieved SVR. Current hepatitis C therapies may sometimes be unavailable to, inappropriate for, and ineffective in United States urban patients. Treatment with pegylated interferon and ribavirin was less effective in this population than is implied by multinational phase III controlled trials. New strategies are needed to care for such patients. (HEPATOLOGY 2010.) [source] The demography of nurses and patients on acute psychiatric wards in EnglandJOURNAL OF CLINICAL NURSING, Issue 6 2009Len Bowers Aims and objectives., To describe the ethnic and demographic composition of staff and patients on acute psychiatric wards in England. Background., A significant proportion of the UK population (7·6%) belong to an ethnic minority and there are concerns that ethnic minority patients are not well served by psychiatry, in particular that they are subject to excessive force and coercion. Design., Survey of a random sample of psychiatric wards in three regions. Methods., A survey was conducted of staff (n = 1536) and patients (n = 11 128) on 136 acute admission psychiatric wards. Results., Ethnic minority patients were more likely to be admitted with a diagnosis of schizophrenia, younger, more likely to be admitted for a risk of harm to others and more likely to be legally detained. The association between ethnic minority status and detention remains, even when risk, age, gender and diagnosis are taken into account. Ethnic minority patients come from areas of greater social deprivation and fragmentation. Ethnic concordance between staff and patients varies, but the greatest difference is found in London where the proportion of minority staff is greater than the proportion of minority patients. Conclusions., There continues to be evidence that ethnic minority patients are subject to an excessive amount of legal coercion in English mental health services. However, the proportion of staff belonging to an ethnic minority is greater than the proportion of patients. Relevance to clinical practice., Solutions to the problem of excessive use of legal coercion with ethnic minority patients need to be found. Changes of recruitment strategies are required if concordance is to be achieved. [source] |