Access to good, timely and comprehensive Palliative care is one of the great advancements in modern medicine as it has improved the quality of life of patients and their families. However, there are still major disparities in its access, especially for members of vulnerable communities like Minority populations in the USA.
One of the most disseminated and fallacious “truths” circulating in the hospital corridors and medical offices in this great country is that Minorities, i.e. Blacks and Hispanics, do not care much about Palliative Care for socio-cultural reasons. It is true that disadvantaged members of society usually fear, with good reason, that they will be summarily treated and later abandoned by the medical establishment. They view the possibility of Palliative Care as an excuse to withhold necessary care. To complicate matters worse, many minority patients are deeply religious, for which they are confounded by the mixed messages emanating from their traditional churches.
Faigle et al. published an online article where they suggest that the culprit for this glaring inequity of access is actually the systems implemented in certain hospitals, using the data from the ICD-9-CM codes stored in the Nationwide Inpatient Sample (part of the Healthcare Cost and Utilization Project) They found that Minority patients received less PC than whites but also discovered that the same was true for all the patients admitted to largely Minority-serving hospitals.
In predominantly white hospitals., the researchers found that the median rate for the use of Palliative Care in post-Stroke patients was 8.5 per 100 ICH admissions but in mixed or largely Minority-hospitals the median usage rates were 6.3 and 2.5 per 100 ICH admissions respectively. The usage of Palliative Care after Ischemic Stroke was 2.2 per 100 admissions but it lowered to 1.5 in mixed facilities and a dismal 0.5 in largely Minority-hospitals. This data was controlled for demographics, comorbidities, socio-economic factors, hospital features and stages of the disease.
Important variables in the system were the implementation of sound institutional algorithms that could alert the medical personnel that the services were available.
What do you think? Please tell us.
Don’t leave me alone.