The relationship between clinician and patient has been the bedrock of the global health equity movement. It was the call for access to basic medical services for patients—and patients demanding empowerment for their community health workers—that drove the Health for All movement in the 1970s. It was the insistence by patients, activists, and clinicians for all people with AIDS to receive treatment that led to the transformation in access starting just 10 years ago in the developing world. That insistence will continue to be the energy and lifeblood of the movement—patients claiming their rights, and physicians supporting their patients—together advocating for a world in which a child born anywhere can have a life of opportunity, dignity, and access to quality health care.
The theoretical constructs of allostasis and allostatic load (AL) have contributed to our understanding of how constantly changing social and environmental factors impact physiological functioning and shape health and aging disparities, particularly along socioeconomic, gendered, racial, and ethnic lines. AL represents the cumulative dysregulation of biological systems with prolonged or poorly regulated allostatic responses. Nearly two decades of empirical research has focused on operationalizing the AL construct for examining the antecedents and health outcomes accompanying multisystem biological dysregulation. The purpose of this systematic review is to examine the empirical literature that quantifies the AL construct; the review also evaluates the social, environmental, and genetic antecedents of AL as well as its predictive utility for a variety of health outcomes. A total of 58 articles published between 1997 and 2012 were retrieved, analyzed, and synthesized. The results revealed considerable heterogeneity in the operationalization of AL and the measurement of AL biomarkers, making interpretations and comparisons across studies challenging. There is, however, empirical substantiation for the relationships between AL and socioeconomic status, social relationships, workplace, lifestyle, race/ethnicity, gender, stress exposure, and genetic factors. The literature also demonstrated associations between AL and physical and mental health and all-cause mortality. Targeting the antecedents of AL during key developmental periods is essential for improving public health. Priorities for future research include conducting prospective longitudinal studies, examining a broad range of antecedent allostatic challenges, and collecting reliable measures of multisystem dysregulation explicitly designed to assess AL, at multiple time points, in population-representative samples.
Perspective from The New England Journal of Medicine — Taking Our Medicine — Improving Adherence in the Accountability Era
Our hope is that providers, hospitals, and health systems participating in new payment models will find economies of scale in working together to improve adherence. Groups that previously functioned independently, such as pharmacists, pharmacy benefit managers, and doctors, will share a business interest in fostering population health and have added incentives to communicate and collaborate. Already, new marketplace solutions are emerging for using data and predictive analytics more effectively to support targeted interventions. As integrated health systems spread, providers may well invest in studying lower-cost ways to help patients be healthier.
For example, a practice could easily provide its physicians with monthly data on their patients' pharmacy claims. This approach has shown promise among early adopters of new care-coordination efforts. For instance, Community Care of North Carolina, a group of 14 physician networks serving Medicaid patients, paid physicians a monthly fee for care coordination; collected data on patients' prescription-filling rates; and had clinical pharmacists reach out to patients, explain the need for the medications, and often reduce a regimen's complexity. This approach led to a 5-to-7% improvement in adherence.4
A lo largo de este artículo se expone que es la metodología Crowd y en qué medida puede contribuir de forma efectiva en la investigación sanitaria, en la prevención y control máxime en tiempos de crisis y de recortes en presupuestarios.
A lo largo de este artículo se expone que es la metodología Crowd y en qué medida puede contribuir de forma efectiva en la investigación sanitaria, en la prevención y control máxime en tiempos de crisis y de recortes en presupuestarios. Como ejemplo se comenta la aplicación de esta metodología en el caso de la investigación y tratamiento de la malaria. Actualmente, la malaria es uno de los problemas de salud a escala mundial más devastadores. Si bien puede afectar a cualquier persona independientemente de su edad y sexo, a nivel infantil es considerada la tercera causa de mortalidad en todo el mundo. A pesar de que actualmente puede ser tratada con cierta eficacia, el cambio de patrón en esta enfermedad, y el desarrollo de cierta resistencia a los medicamentos, dificulta mucho la investigación. Aunque insuficiente, la financiación internacional ha sido responsable de muchos de los avances en esta lucha. Sin embargo, el panorama financiero actual no es muy alentador y prevé serios recortes en esta materia. A pesar del progreso realizado hasta la actualidad aún queda mucho camino por recorrer para conseguir erradicar el paludismo.
A listing of resources that provide information about the structural determinants of poverty in the United States.
The Office of Socioeconomic Status is pleased to provide this annotated bibliography of resources that provide information about the structural determinants of poverty in the United States. The annotation for each reference listed in the bibliography provides a brief summary of the item’s contents. The bibliography contains listings of relevant books, research and technical reports, and scholarly literature. Given the large amount of literature on this topic, this bibliography provides only a purposeful sampling. In searching for materials to include in the bibliography, researchers carried out keyword searches of several major social science databases and of websites of federally funded poverty research centers in the U.S. The research centers examined included those housed at the University of California, Davis (UC Davis Center for Poverty Research); the University of Kansas (UK Center for Poverty Research), the University of Wisconsin (Institute for Research on Poverty); and Stanford University (Stanford Center on Poverty and Inequality). The search intentionally excluded materials published prior to the 1996 Welfare Reform ACT, as that landmark legislation clearly altered the structural landscape in this country.
Integrated behavioral health care is an emerging field with the potential to improve health outcomes for patients and health care delivery within practices. Integrated behavioral health care can systematically enhance a primary care practice’s ability to effectively address behavioral health issues that naturally emerge in the primary care, prevent fragmentation between behavioral health and medical care, and create effective relationships with mental health specialists outside the primary care setting.
As greater numbers of primary care practices and health systems begin to design and implement integrated behavioral health services, there is a growing need for quality measures that are rigorous and appropriate to the specific characteristics of different approaches to integration.
The Atlas of Integrated Behavioral Health Care Quality Measures (the IBHC Measures Atlas) aims to support the field of integrated behavioral health care measurement by:
Presenting a framework for understanding measurement of integrated care;Providing a list of existing measures relevant to integrated behavioral health care; andOrganizing the measures by the framework and by user goals to facilitate selection of measures.Intended Audience
There are certainly plenty of people who think that research ethics scandals happen everywhere else, but not in Canada. Well, it seems that a recent report by food historian Ian Mosby at the Univer...
There are certainly plenty of people who think that research ethics scandals happen everywhere else, but not in Canada. Well, it seems that a recent report by food historian Ian Mosby at the University of Guelph has uncovered that, yes, in fact research ethics scandals can, do and have happened in Canada.
Mosby’s report, published in Histoire Sociale/Social History, provides “a narrative record of a largely unexamined episode of exploitation and neglect by the Canadian government” and describes ten years of nutritional experiments conducted on 1300 Aboriginal adults and children, including those in residential schools. These funded studies were done without community or individual consent, without an assessment of potential benefits and risks, without any consideration of the extreme vulnerability of the persons and without any clear humanitarian or altruistic aims or realization of benefits to any people involved while exposing them to real harms. That’s just the beginning of the problems.
The details of the report are horrific.
What is most shocking about this is that these researchers were in communities in which they already knew there were significantly higher general and infant mortality rates (compared to anywhere else at that time in Canada), high rates of malnutrition and hunger along with high rates of TB and other diseases, and yet when they arrived — and these documented facts were clearly confirmed by what they observed ‐ they saw this as a clear opportunity and a kind of living laboratory, rather than a humanitarian tragedy that required their intervention.
In this animated video, the YouToons get ready for Obamacare and explore health insurance changes under the Affordable Care Act. This cartoon serves as a health reform tutorial for consumers and organizations.
2014 is coming–are you ready for Obamacare? Join the YouToons as they walk through the basic changes in the way Americans will get health coverage and what it will cost starting in 2014, when major parts of the Affordable Care Act, also known as “Obamacare,” go into effect.
Written and produced by the Kaiser Family Foundation. Narrated by Charlie Gibson, former anchor of ABC’s World News with Charlie Gibson and a member of the Foundation’s Board of Trustees. Creative production and animation by Free Range Studios.
To request to download the video, fill out the form below.
If you are unable to view the video on YouTube or within the player box above, click here to view it in an alternative player.
The YouToons first appeared in the 2010 animated movie, “Health Reform Meets Main Street,” which explained how the health reform law would work. A Spanish-language version of the 2010 cartoon is available here.
The traditional doctor’s visit is ripe for reinvention—both because it is such a valuable interaction, and because we know there are ways to make it better.
We believe that new tools, technologies, and strategies can empower people to be more informed and more engaged when they walk into the doctor’s office and better equipped to improve their health when they walk out the door. And we believe that doctors, nurses, and other care providers can improve the ways they communicate with and engage patients during visits, and they can take advantage of new tools for monitoring, supporting, and connecting with their patients outside of the office, too.
We think that by tapping into these strategies, we could to turn the provider-patient interaction on its head—and promote better, and relationships while doing so.
PubMed comprises more than 23 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.
Doctor visits should be meaningful. All too often, they're not, says Thomas Goetz, RWJF Entrepreneur in Residence. How can we change the way we deliver primary care?
Consider the doctor’s office: the sanctum of care in American medicine, where a patient enters with a need—a question, or an ailment, or a concern—and leaves with an answer, a diagnosis, or a treatment. That room, with its emblematic atmosphere of exam table and tiny sink and bottles of antiseptic, is in many ways the engine of our health care system, the locus of all our collective knowledge and all our collective resources. It’s where health care happens
This course guide is for a course on racial and ethnic disparities in healthcare and health status. The guide is intended for use with the book “Minority Populations and Health: An introduction to health disparities in the United States.” The book was written based on the course that I teach in the program of public health studies at Johns Hopkins University. My course is for upper-division undergraduates (juniors and seniors). This course and book can also be used as an introductory course for graduate students in public health, medicine, nursing or other related fields (social work, policy studies, ethnic studies, etc.).
I use both lecture and seminar format. I teach both an undergraduate and graduate-level version of the course. I teach an undergraduate course during Spring Semester, an advanced graduate seminar during 4th quarter (April-May) and a 3-day mini course which is a graduate-level introductory course.
For the advanced graduate seminar, the majority of the course consists of student-led seminar style discussions of the assigned readings. For this course I use “Race, Ethnicity and Health” (Jossey-Bass Publishers October 2003 ISBN: 0-7879-6451-4. If you are interested in the course guide for the advanced graduate seminar, click here.
For the undergraduate course I mainly lecture. I also include occasional films and some times guest lecturers, but I rarely use more than one or two guest lecturers in a semester-long format. I like the continuity of having one teacher. I think it makes for a much better experience for students. For this course I use “Minority Populations and Health” as the required text.
The 3-day mini-course is mostly lecture format, but there are some class discussions as well. For this class I use “Minority Populations and Health” as the required text and I also use “Race, Ethnicity and Health” as additional reading.
Checklists garnered well-deserved publicity as a result of their use in the Keystone ICU project, a multicenter study in which a checklist of evidence-based infection control interventions was implemented to reduce the risk of central line–associated bloodstream infections in intensive care unit patients. This intervention achieved a stunning reduction in line infections, with many ICUs completely eliminating line infections for months at a time. An AHRQ-funded initiative subsequently disseminated the use of the Keystone ICU interventions nationwide, and initial results indicate further sustained success. A similar level of success was achieved through implementation of a surgical safety checklist, which included specific steps during induction of anesthesia, surgical timeout, and transfer of the patient out of the operating room. Remarkable reductions in surgical mortality and morbidity were achieved across a wide range of clinical settings. Further research has investigated the use of checklists to improve safety at the time of hospital discharge, improve transfer of information during in-hospital handoffs, and improve the care of intensive care unit and trauma patients.