An important application of modern genomics is diagnosing genetic disorders. We use the largest publicly available exome sequence database to show that this key clinical service can currently be ...performed much more effectively in individuals of European genetic ancestry.
Previous studies have shown mixed evidence on ethnic disparities in antipsychotic prescribing among patients with psychosis in the UK, partly due to small sample sizes. This study aimed to examine ...the current state of antipsychotic prescription with respect to patient ethnicity among the entire population known to a large UK mental health trust with non-affective psychosis, adjusting for multiple potential risk factors.
This retrospective cohort study included all patients (N = 19,291) who were aged 18 years or over at their first diagnoses of non-affective psychosis (identified with the ICD-10 codes of F20–F29) recorded in electronic health records (EHRs) at the South London and Maudsley NHS Trust until March 2021. The most recently recorded antipsychotic treatments and patient attributes were extracted from EHRs, including both structured fields and free-text fields processed using natural language processing applications. Multivariable logistic regression models were used to calculate the odds ratios (OR) for antipsychotic prescription according to patient ethnicity, adjusted for multiple potential contributing factors, including demographic (age and gender), clinical (diagnoses, duration of illness, service use and history of cannabis use), socioeconomic factors (level of deprivation and own-group ethnic density in the area of residence) and temporal changes in clinical guidelines (date of prescription).
The cohort consisted of 43.10 % White, 8.31 % Asian, 40.80 % Black, 2.64 % Mixed, and 5.14 % of patients from Other ethnicity. Among them, 92.62 % had recorded antipsychotic receipt, where 24.05 % for depot antipsychotics and 81.72 % for second-generation antipsychotic (SGA) medications. Most ethnic minority groups were not significantly different from White patients in receiving any antipsychotic. Among those receiving antipsychotic prescribing, Black patients were more likely to be prescribed depot (adjusted OR 1.29, 95 % confidence interval (CI) 1.14–1.47), but less likely to receive SGA (adjusted OR 0.85, 95 % CI 0.74–0.97), olanzapine (OR 0.82, 95 % CI 0.73–0.92) and clozapine (adjusted OR 0.71, 95 % CI 0.6–0.85) than White patients. All the ethnic minority groups were less likely to be prescribed olanzapine than the White group.
Black patients with psychosis had a distinct pattern in antipsychotic prescription, with less use of SGA, including olanzapine and clozapine, but more use of depot antipsychotics, even when adjusting for the effects of multiple demographic, clinical and socioeconomic factors. Further research is required to understand the sources of these ethnic disparities and eliminate care inequalities.
Gender disparities in treatment are apparent across many areas of healthcare. There has been little research into whether clozapine prescription, the first-line treatment for treatment-resistant ...schizophrenia (TRS), is affected by patient gender.
This retrospective cohort study identified 2244 patients with TRS within the South London and Maudsley NHS Trust, by using a bespoke method validated against a gold-standard, manually coded, dataset of TRS cases. The outcome and exposures were identified from the free-text using natural language processing applications (including machine learning and rules-based approaches) and from information entered in structured fields. Multivariable logistic regression was carried out to calculate the odds ratios for clozapine prescription according to patients' gender, and adjusting for numerous potential confounders including sociodemographic, clinical (e.g., psychiatric comorbidities and substance use), neutropenia, functional factors (e.g., problems with occupation), and clinical monitoring.
Clozapine was prescribed to 77% of the women and 85% of the men with TRS. Women had reduced odds of being prescribed clozapine as compared to men after adjusting for all factors included in the present study (adjusted OR: 0.66; 95% CI 0.44–0.97; p = 0.037).
Women with TRS are less likely to be prescribed clozapine than men with TRS, even when considering the effects of multiple clinical and functional factors. This finding suggests there could be gender bias in clozapine prescription, which carries ramifications for the relatively poorer care of women with TRS regarding many outcomes such as increased hospitalisation, mortality, and poorer quality of life.
Rural-urban healthcare access inequality refers to a disparity between rural and urban people with severe medical ailments in gaining access to the high-quality healthcare services they need. ...Although much hope has been pinned on the use of health information technology (HIT) to alleviate this critical and enduring societal challenge, the realized societal impact of HIT is unclear. Anchoring on both social transformation theory and affordance actualization theory, we conducted an in-depth qualitative study with two rounds of data collection in China. In addition to investigating how the societal challenge has triggered transformative HIT interventions, our analysis contributes to a theory on an HIT solution for the rural-urban healthcare access inequality challenge by establishing a link between HIT affordances and HIT interventions. This is done by examining how microlevel HIT effects escalate to macrolevel HIT effects through societal-level affordance actualization, which can affect this healthcare access inequality challenge. Along with providing policy implications on introducing HIT solutions to address intricate and complex societal challenges, this study extends existing theories by revealing the adaptation of the HIT intervention and differentiating the effects of collective and shared affordances.
Existing research has found that individuals often perceive healthcare inequalities as unfair; yet, there is high variation in unfairness perceptions between countries. This raises the question of ...whether the institutional context of the healthcare system is associated with what people perceive as unfair. Using data from the ISSP study and OECD health expenditure data from 2011/13, we explore whether individual attitudes about the unfairness of healthcare inequality – the ability to purchase “better” healthcare for the affluent – vary systematically with a country's institutional environment: namely, with the prevalence of cost barriers to healthcare access, and with the degree and type of public healthcare financing. Three general findings emerge from the analysis: (1) Higher cost barriers correlate with lower levels of perceived unfairness in healthcare inequality, suggesting those exposed to greater levels of inequality tend to be more accepting of inequality. This finding is consistent with empirical justice theory and the expected relevance of an ‘existential’ standard of justice, stemming from individuals' proclivities to accept the status quo as just. (2) Further, greater public financing of healthcare correlates with higher perceived unfairness. Drawing on neo-institutionalist theory, this may suggest that greater public financing enshrines access to healthcare as a universal right, and hence provides an ideational framing that delegitimizes unequal opportunities for purchasing better healthcare. (3) Further, higher unfairness perceptions of lower income and educational groups are more strongly associated with greater public financing than those of their respective comparison groups. This may indicate that the normative right to healthcare is of particular importance to the disadvantaged, which could potentially explain the political quiescence on healthcare of lower income and educated persons in societies that lack universal health systems. In sum, this study contributes to the larger debate on the interrelatedness of healthcare institutions and public opinion, and specifically on perceptions of unfairness.
•Lower levels of perceived unfairness are found in countries with higher cost barriers.•More public financing for healthcare is related to higher levels of unfairness.•Public financing is more important for unfairness attitudes of lower income groups.•This may be evidence for institutionally-generated norms of equal healthcare rights.
Many consider inequality in health unfair if it is caused by inequality within the healthcare system but less unfair when caused by individuals’ health behaviour. However, healthcare systems are ...challenged when it comes to ensuring equal care for equal need. In Roemer’s equality of opportunity theory, people have equal opportunity for obtaining something if obtaining it reflects their effort instead of their circumstances. Very little is known about how responsibility exerted by patients prior to illness affects the healthcare they are provided by the healthcare system. We aimed to apply Roemer’s theory to an acute care setting where healthcare is most directly in the hands of the healthcare system in order to study the role of patient-exerted responsibility for their opportunities in the healthcare system. We operationalised the responsibility patients exert as Body Mass Index (BMI), smoking and alcohol habits, and their circumstances as demographics, socioeconomics, prognostic factors and year of discharge. Opportunity in healthcare was defined as patients’ attainment of clinical guideline-recommended acute hospital care. In Roemer’s theory, we detected inequality of opportunity as restricted attainment of healthcare was mainly associated with patients’ circumstances, such as lower education, old age or living alone. We also identified a strong association with BMI; being underweight negatively affected patients’ opportunities as it led to suboptimal healthcare, while the opposite was found for being overweight and, in particular, obese. Hence, patient-exerted responsibility affected patients’ opportunities in healthcare, though perhaps in an unexpected way. This improved understanding of inequality may help to focus future research and, in the long term, support clinical and political efforts to achieve equal care for equal needs.
Published: Online March 2021.
Online medical crowdfunding (OMC) has attracted massive attention and participation in China. Despite its goal to lift the financial burden caused by expensive medical expenditure, little has been ...done to evaluate its impact on healthcare inequality. We examine the social consequences of OMC based on a large random sample extracted from one of the most widely-used OMC platforms in China. Our analysis shows that a disproportionally high percentage of fundraising campaigns are launched for patients with low socioeconomic status suffering from various illnesses, including many rare diseases. These findings suggest that OMC plays a positive role in providing an alternative channel for disadvantaged patients under the current health insurance system. We further examine whether and the extent to which the narrative style of solicitation text—fundraising campaign description—influences fundraising outcomes using natural language processing (NLP). The results show that expressions conveying optimism tend to result in a higher completion ratio, whereas descriptions engaging in moral mobilization or focusing on financial burden tend to have a negative impact on fundraising outcomes.
Kamila Hawthorne, chair of the Royal College of General Practioners Council, and Bola Owolabi, director of the National Healthcare Inequalities Improvement Programme, offer a personal perspective on ...how their professional experiences have led them to see health inequality as urgent priority, and introduce initiatives that can help general practitioners make a difference individually and collectively.
Background Telehealth is a technology in medicine designed to facilitate the delivery of healthcare services remotely. These obviously, are lacking in resource-limited areas. A holistic approach to ...health care does not take out the mouth as an integral part of the body but unfortunately, the inclusion of oral health care in Primary Healthcare is still stalling in many countries. Complete and equitable healthcare access in resource-limited areas is facilitated by government policies, the presence of trained capacities, and the procurement of facilities to make the Primary Healthcare centers functional and viable for expert consultations, diagnosis, treatment, and monitoring. Purpose This topic projects Telehealth as an important 21st-century telecommunication technology for increasing access to healthcare in resource-limited areas and medical-dental integration concerted efforts as an approach to providing holistic healthcare intervention. Methods Journals and online publications were searched for this review. Search engines used were Google Scholar, Microsoft Academic, ProQuest, Cochrane Library, PubMed, and EMBASE. Also, online libraries were used to confirm if someone else has done a review on the topic. Result The effectiveness of Telehealth and medical-dental integration strategies have been tested and proven to improve interprofessional collaboration and serve as the comprehensive and integrated care plan to reduce healthcare inequality in resource-limited areas. These strategies are already adopted in many countries and that improves the outcome of their healthcare strategic goals of the countries. Conclusion The use of Telecommunication technologies in dentistry and general medicine are an effective approach to the professional delivery of healthcare services to resource-limited areas with little or no limits. Medical dental integration is another concerted strategy for reducing oral health inequality at all levels of the health care system.
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