Journal Article•
A national minority organ/tissue transplant education program: the first step in the evolution of a national minority strategy and minority transplant equity in the USA.
TL;DR: The emergence of ASMHTP as the responsible brain trust for future minority-related efforts along with MOTTEP, a community based, empowering transplant education program, highlights the importance of a national strategy necessary for the survival of minority communities.
Abstract: 1. These successful education programs initially aimed at the AA community are being expanded into other minority groups such as Native American (Alaskan and American Indian), Hispanic (Latino), and Asian-Pacific Islander populations; and if the same modus operandus, ie, a minority-targeted message delivered by ethnically and culturally similar and sensitive messengers is used, this will have equal applicability to the majority population. MOTTEP, the first grass roots national transplant education program, while directed first to the minority population, can when presented to the majority population help all groups address the number one problem in transplantation today--the shortage of donors. 2. Active inclusion and involvement of minorities at all levels of problem resolution (resource allocation, research, and education), emphasizing community participation, education, and empowerment are the important next steps to allow for minority transplant equity in America. 3. The emergence of ASMHTP as the responsible brain trust for future minority-related efforts along with MOTTEP, a community based, empowering transplant education program, highlights the importance of a national strategy necessary for the survival of minority communities. This will enhance the interaction between minority transplant health professionals and the minority community and requires minority inclusion at all decision making levels of problem resolution within the transplant community.
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01 Aug 2012
TL;DR: Overall, QI interventions were not shown to reduce disparities, and some increased effect is seen in disadvantaged populations; these studies should be replicated and the interventions studied further as having potential to address disparities.
Abstract: Objective This review evaluates the effectiveness of quality improvement (QI) strategies in reducing disparities in health and health care. Data sources We identified papers published in English between 1983 and 2011 from the MEDLINE® database, the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science Social Science Index, and PsycINFO. Review methods All abstracts and full-text articles were dually reviewed. Studies were eligible if they reported data on effectiveness of QI interventions on processes or health outcomes in the United States such that the impact on a health disparity could be measured. The review focused on the following clinical conditions: breast cancer, colorectal cancer, diabetes, heart failure, hypertension, coronary artery disease, asthma, major depressive disorder, cystic fibrosis, pneumonia, pregnancy, and end-stage renal disease. It assessed health disparities associated with race or ethnicity, socioeconomic status, insurance status, sexual orientation, health literacy/numeracy, and language barrier. We evaluated the risk of bias of individual studies and the overall strength of the body of evidence based on risk of bias, consistency, directness, and precision. Results Nineteen papers, representing 14 primary research studies, met criteria for inclusion. All but one of the studies incorporated multiple components into their QI approach. Patient education was part of most interventions (12 of 14), although the specific approach differed substantially across the studies. Ten of the studies incorporated self-management; this would include, for example, teaching individuals with diabetes to check their blood sugar regularly. Most (8 of 14) included some sort of provider education, which may have focused on the clinical issue or on raising awareness about disparities affecting the target population. Studies evaluated the effect of these strategies on disparities in the prevention or treatment of breast or colorectal cancer, cardiovascular disease, depression, or diabetes. Overall, QI interventions were not shown to reduce disparities. Most studies have focused on racial or ethnic disparities, with some targeted interventions demonstrating greater effect in racial minorities--specifically, supporting individuals in tracking their blood pressure at home to reduce blood pressure and collaborative care to improve depression care. In one study, the effect of a language-concordant breast cancer screening intervention was helpful in promoting mammography in Spanish-speaking women. For some depression care outcomes, the collaborative care model was more effective in less-educated individuals than in those with more education and in women than in men. Conclusions The literature on QI interventions generally and their ability to improve health and health care is large. Whether those interventions are effective at reducing disparities remains unclear. This report should not be construed to assess the general effectiveness of QI in the health care setting; rather, QI has not been shown specifically to reduce known disparities in health care or health outcomes. In a few instances, some increased effect is seen in disadvantaged populations; these studies should be replicated and the interventions studied further as having potential to address disparities.
275 citations
TL;DR: Data is reviewed highlighting the racial/ethnic disparities that exist in the incidence and treatment of CKD, with particular emphasis on ESRD.
191 citations
Cites background from "A national minority organ/tissue tr..."
...Cultural beliefs may also limit the number of minority kidney donors [75, 76]....
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TL;DR: The results suggest that a culturally sensitive LDKT education program that reaches out to blacks and their social support network can overcome some barriers to LDKT in this population.
114 citations
Cites background from "A national minority organ/tissue tr..."
...Open discussions bout such disparities in transplantation have roved to be a critical component of public ducation efforts targeting increases in deceased rgan donation among minorities.(28-31) Integratng similar race-based messages into LDKT and iving donation education may be an important ngredient in the success of such educational fforts with minority patients....
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TL;DR: Wait‐list and transplant rates were relatively lower in high ESRD incidence DSAs, but wait‐list rates were not drastically affected by E SRD incidence at the patient level.
108 citations
TL;DR: Logistic and multiple regression analyses revealed that family talk attitudes and behaviors were predicted by attitudes, knowledge, and social norms associated with organ donation, and variables such as bodily integrity, medical mistrust, religiosity, and altruism were found to contribute significantly to the explained variance.
Abstract: Because organ donation does not take place without the consent of next-of-kin and because family discussion is known to be the strongest predictor of consent to donate, transplant advocates have promoted family communication about organ donation, but without much success. Fewer than half of all people who are willing to be organ donors discuss their wishes with family members. Family discussions about donation in the African-American community are especially critical because the need for organs in this ethnic group dramatically outstrips the availability, thus leading to a disproportionate number of deaths among African Americans. This study, grounded in the Organ Donation Model, surveyed 311 African-American adults about their attitudes and behaviors regarding family discussions about organ donation. Logistic and multiple regression analyses revealed that, as hypothesized, family talk attitudes and behaviors were predicted by attitudes, knowledge, and social norms associated with organ donation. In addit...
106 citations
References
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TL;DR: The six major contributors to the disparity between black and white death rates are cancer, cardiovascular disease and stroke, diabetes, chemical dependency, homicide and accidents, and infant mortality.
Abstract: THE HEALTH status of blacks, other minorities, and the poor remains unconscionably low when contrasted with that of white Americans. This disparity is not new but is an historical trend that can be seen across all categories of the leading causes of death and disease. In August 1985, the Report of the Secretary's Task Force on Black and Minority Health2 noted that minorities experienced approximately 60 000 "excess deaths" annually. Margaret Heckler, who was then the secretary of the US Department of Health and Human Services, emphasized that the disparity is "an affront both to our ideals and to the ongoing genius of American Medicine." The six major contributors to the disparity between black and white death rates are cancer, cardiovascular disease and stroke, diabetes, chemical dependency, homicide and accidents, and infant mortality. Since the 1985 report, blacks and Latinos, in particular, also have evidenced a disproportionately high rate
139 citations
TL;DR: The past decade has witnessed an inexorable widening in the gap between the supply of organs for transplantation and the need for organs on the part of desperately ill candidates for transplants, and the scarcity of organs has become the chief limiting factor in clinical transplantation.
Abstract: The past decade has witnessed an inexorable widening in the gap between the supply of organs for transplantation (i.e., the donors) and the need for organs on the part of desperately ill candidates for transplantation. As of June 1990, some 20,882 persons were waiting for organs to become available.1 Three patients on the waiting list die every day as a consequence of this shortage,1 and the scarcity of organs has become the chief limiting factor in clinical transplantation.2 In 1978 the Southeastern Organ Procurement Foundation asked us to identify obstacles to organ donation in the black population, and in particular . . .
85 citations
Journal Article•
TL;DR: A research program designed to determine the nature of attitudes of blacks toward kidney donations was developed disclosed a lack of knowledge about kidney transplantation; disassociation and lack of communication between blacks and the medical community; religious fears; fears of premature death; and racism.
Abstract: PATIENTS REQUIRING KIDNEY TRANSPLANTS HAVE THREE POSSIBLE SOURCES: (1) a kidney from an individual who dies suddenly (approval for the transplant must be given by the next-of-kin of the deceased); (2) a kidney from a relative; and (3) a kidney from one who "willed" it to be transplanted following his or her death. Each of these circumstances requires decision making. On the basis of this information, a research program designed to determine the nature of attitudes of blacks toward kidney donations was developed. Results disclosed a lack of knowledge about kidney transplantation; disassociation and lack of communication between blacks and the medical community; religious fears; fears of premature death; and racism.
76 citations
01 Jun 1989
29 citations