Variations in COPD Health Care Access and Outcomes: A Rapid Review.

Background: Health inequities among individuals with chronic obstructive pulmonary disease (COPD) are often associated with differential access to health care and health outcomes. A greater understanding of the literature concerning such variation is necessary to determine where gaps or inequities exist along the continuum of COPD care. Methods: A rapid review of the published and grey literature reporting variations in health care access and/or health outcomes for individuals with COPD was completed. Variation was defined as differential patterns in access indicators or outcome measures within sociodemographic categories, including age, ethnicity, geography, race, sex, and socioeconomic status. Emergent themes were identified from the included literature and synthesized narratively. Results: Thirty-five articles were included for final review; the majority were retrospective cohort studies. Twenty-five studies assessed variation in access to health care. Key indicators included: access to spirometry testing, medication adherence, participation in pulmonary rehabilitation, and contact with general practitioners and/or respiratory specialists. Twenty-one studies assessed variation in health outcomes in COPD and key metrics included: hospital-based resource utilization (length of stay and admissions/readmissions), COPD exacerbations, and mortality. Patients who live in rural environments and those of lower socioeconomic status had both poorer access to care and outcomes at the system and patient level. Other sociodemographic variables, including ethnicity, race, age, and sex were associated with variation in health care access and outcomes, although these findings were less consistent. Conclusion: The results of this rapid review suggest that substantial variation in access and outcomes exists for individuals with COPD, highlighting opportunities for targeted interventions and policies.

Differential response to targeted recruitment strategies to fitness promotion research by African-American women of varying body mass index.

OBJECTIVE: To assess patterns of recruitment into a community-based NCI-funded physical activity and dietary lifestyle change program targeting African-American women. DESIGN: Acquisition of a convenience sample to be screened for participation in a randomized, controlled prevention intervention. SETTING: African-American-owned and -operated health club located in an area of Los Angeles in which African Americans are concentrated. PARTICIPANTS: 893 African-American women. RECRUITMENT STRATEGIES: Social networking/word-of-mouth, staff presentations, mass and targeted media, and physician referral. MAIN OUTCOME MEASURE: Completion of screening questionnaire indicating a desire to enroll in the study. Screening questionnaire domains included self-reported height and weight, recent participation in organized weight loss programs, ability to walk one mile unassisted, current medication use, smoking status, personal medical history of cancer, sociodemographic variables, and recruitment source. RESULTS: Sociodemographic and anthropometric characteristics distinguished between respondents obtained through different recruitment strategies. In particular, women with a higher body mass index (BMI) were more likely than those with lower BMIs (P = .014) to be recruited through more personalized methods (eg, social networking). CONCLUSIONS: Culturally tailored recruitment strategies are critical in securing the participation of members of "hard-to-reach" populations, who are both under-represented in health promotion research and at high risk for chronic diseases.