Thursday, September 26, 2002: 4:30 PM-6:00 PM | |||
Reducing Health Disparity: Barriers to Health Care Utilization | |||
| Reducing disparities in health care associated with race, ethnicity, gender, age and socioeconomic position has emerged as a major challenge for the United States health care system. The Journal of American Medical Women’s Association has provided a conceptual framework that illustrates how access to and quality of care mediate health outcomes. The framework identifies barriers that if removed would result in improved interaction between patients and providers. Among the primary barriers that present obstacles to health care services are lack of or inadequate health insurance, proximity of providers, lack of transportation. Other, secondary barriers serve as structural barriers. These barriers include difficulty getting appointments, specialty referrals or advice after hours. Tertiary access barriers reflect the ability of the providers and health care system to understand and address the patient’s needs, including the provider’s communication skills, cultural competence, knowledge and clinical skills. The five papers in this symposium will provide examples of specific primary, secondary and tertiary barriers that disportionately impact low-income, minority individuals and older women. The first paper discusses the impact of health disparity linked patient characteristics on the effectiveness of interventions that are designed to inform persons about health concerns and to support them in engaging in appropriate self-management. The barriers that block or limit full information sharing are specifically addressed as impediments for health care utilization. At the same time the barriers may interfere with nurse-delivered interventions that are designed to increase knowledge, self-care skills, help-seeking and health services utilization. This presentation offers approaches to assessment of the amount of influence such barriers have on intervention effectiveness and provides important information about which patients receive best benefit from an intervention as well as information about which patients receive least benefit. Interventions can then be appropriately reformulated and/or strengthened to address barriers that are found to impede intervention effectiveness. The second paper addresses many of the primary barriers that are present for inner city young Black men with hypertension. An intervention consisting of a community-based, nurse-run clinic is being offered as an alternative to traditional medical care. In this population illicit substance use is a patient characteristic factor that interacts with the intervention’s effectiveness. However, as compared to standard care, the community-based intervention is demonstrating effectiveness relative to increasing regular contact with a health care provider and to being on antihypertensive medication. Health disparities persist into old age, particularly for persons whose culture and language differs from that of most health care providers. The third paper describes the barriers to health care utilization experienced by Korean American elders. Primary barriers such as lack of insurance coverage appear to be among the strongest obstacles to accessing health care resources. Alternative culturally relevant sources of health care were relied on rather than accessing ambulatory health facilities. Such care may well handle common illnesses, but referral to specialty care is difficult. When the primary physician was also Korean elderly Korean American persons less often sought alternative (Oriental) medicine resources. The last two papers discuss barriers experienced by women who were receiving treatment for breast cancer. Women living in a rural area, older Mexican-American women and Mexican-American women who speak Spanish experienced barriers having to do with receiving culturally appropriate materials about what to expect in their response to the cancer diagnosis and treatment. For example, depressive symptoms and fatigue are commonly experienced by all women receiving breast cancer treatment, with those who live in the rural area having less access to interpersonal counseling interventions. The fourth paper describes a telephone delivered intervention that is improving symptom management. The final paper in this symposium describes a patient characteristic, resourcefulness, that may work to overcome barriers that limit access to information. People, even those who experience health disparity, have personal resources that when supported by interventions result in ability to overcome barriers. | |||
| Organizer: | Carrie Jo Braden, RN, PhD, FAAN, Hugh Roy Cullen professor of Nursing & associate dean for research | ||
| Health Disparity: Impact on Intervention Effects Souraya Sidani, RN, PhD, associate professor, Carrie Jo Braden, RN, PhD, FAAN, Hugh Roy Cullen professor of Nursing & associate dean for research, Miyong T. Kim, RN, PhD, associate professor, Terry A. Badger, RN, PhD | |||
| Reducing Barriers to Hypertension Care Utilization among Inner City Young Black Men with Hypertension Hae-Ra Han, RN, PhD, post-doctoral fellow, Miyong T. Kim, RN, PhD, associate professor, Martha N. Hill, RN, PhD, professor | |||
| Barriers to Health Care Utilization among Korean American Elderly Miyong T. Kim, RN, PhD, associate professor, Hae-Ra Han, RN, PhD, post-doctoral fellow, Martha N. Hill, RN, PhD, professor | |||
| Telephone Interpersonal Counseling Intervention: Reducing Health Disparities in Rural Women with Cancer Terry A. Badger, RN, PhD | |||
| Health Disparities, Resourcefulness and Time: Older Spanish-Speaking Women Receiving Breast Cancer Treatment Carrie Jo Braden, RN, PhD, FAAN, Hugh Roy Cullen professor of nursing & associate dean for research | |||
The Advancing Nursing Practice Excellence: State of the Science