Attitudes and issues in treating Latino patients with type 2 diabetes: views of healthcare providers.

The purpose of this study was to explore the concerns of Latino patients with Type 2 diabetes. Focus groups were conducted with healthcare practitioners to chart their perceptions of the issues faced by their Latino patients. One group consisted of professionals working among Mexican American clients in an inner-city clinic; another group was held at an inner-city hospital serving mostly Puerto Rican Americans; and a third group involved providers practicing with more affluent, suburban Mexican Americans. Practitioners agreed that communication with patients was hindered by low reading levels, lack of proficiency in English, and an excessive respect for physicians. Emotional barriers to adequate treatment were often more important than financial concerns, even among low-income patients. Fear of insulin therapy was expressed in Hispanic communities, and folk remedies were commonly used. Because family needs were considered most important, adhering to a treatment regimen might be viewed as self-indulgent. Yet families provided valuable reinforcement and emotional support. Important questions facing Latinos with diabetes were effectively identified using focus groups of healthcare providers.

Do the right thing. When it comes to your community, do you know what that is? Roundtable discussion.

What is the health care organization's responsibility to maintaining a healthy community, and how does the board fit into that role? Has the field's understandable fixation on costs and the penetration of managed care into most markets affected that role? Leaders of both for-profit and not-for-profit organizations often believe that they are fulfilling their community obligations as long as they provide uncompensated care to the indigent and the uninsured. But is that really being accountable to the community? And if it's not, then what is community accountability? The American Hospital Association's Division of Trustee Leadership and Trustee magazine posed these questions to 13 health care and community leaders last December. Their different perspectives provide for some surprising answers.

Health outcomes research on Hispanics/Latinos.

Outcomes research studies the impact of the health and medical interventions on the health status and quality of life of the population. This paper discusses some of the issues and challenges involved in conducting health and medical outcomes research on the Latino population in the U. S., and also provides some solutions or strategies to overcome some of the most common problems in studying this population.

Practice variations in treating urban minority asthmatics in Chicago.

This study explores provider adherence to national guidelines in treating Latino and African-American asthmatics. We hypothesized that there would be more variations in asthma treatment existing for minorities as a result of variation in physician's adherent to the guidelines. A 96-item survey was administered to 138 Latino and African-American asthmatics attending a hospital emergency department. Data were obtained on demography, severity, access, patient satisfaction, and patient's assessment of physician asthma management. Results were analyzed by ethnicity, gender, practice site of regular provider, and severity. Variation in physician practice was found in these variables. Asthma treatment received by Latino and African-American respondents was deficient compared to guidelines. Regression analyses showed that Latinos fared more poorly on the number of prednisone bursts taken, use of written crisis plans and dispensation of peak flow meters controlling for gender, practice site and severity. African-Americans expressed less dissatisfaction in obtaining services, while both groups expressed high degrees of satisfaction with their providers.

Factors affecting diabetes treatment and patient education among Latinos: results of a preliminary study in Chicago.

UNLABELLED: Non-insulin-dependent diabetes mellitus (NIDDM) is a major health problem among Latinos, yet the quality of diabetes treatment among them has not been fully examined. GOALS: A pilot study was conducted with adult diabetic patients for the purposes of describing their diabetes-related knowledge and behaviors and evaluating whether these patients were receiving effective outpatient care. METHODS: Demographic data, health knowledge, and behavioral information was collected using face-to-face interviews with 101 patients diagnosed for at least 1 year at three primary care clinics. The medical record of each interviewee was abstracted for evidence that medical follow-up was being conducted with the recommended frequency. RESULTS: Most respondents spoke only or mostly Spanish, yet 14% of these patients reported that they had received instruction about diabetes in English alone. A majority of patients exhibited a basic understanding of their disease, and more than half reported positive health behaviors within the past year. Nonetheless, 54% of Puerto Rican Americans and 26% of Mexican-Americans had been admitted to the hospital or had used the emergency room for diabetes-related conditions. Recommended medical procedures were infrequently documented in clinic records. CONCLUSIONS: Diabetes education was available in Spanish, and patients appeared to have a basic knowledge of the disease process. However, recommended clinical follow-up was not uniformly provided. The large number of diabetes-related hospitalizations may be related to sub-optimal management among at least some of these patients.

Challenges and opportunities in establishing a Latino health research center in a majority academic institution.

This article provides a practical perspective of the issues, challenges and the opportunities involved in establishing a Latino Health Research Center in an academic institution. This article will use as an illustration the experiences related to the establishment of a Center on Latino Medical Treatment Effectiveness Program at a large public academic institution in Chicago. Some of the sociopolitical processes of establishing the Center's structure, and the recruitment and training of a multi-disciplinary core research staff are summarized, while simultaneously pursuing an ambitious research and training agenda. The article ends by suggesting a series of strategies in meeting the multiple and, at times, conflicting demands of the academic institution, the funding sources and the community, as well as the lessons learned.

Minority use of community long-term care services: a comparative analysis.

A series of national surveys since 1982 have examined health needs of elders. Small proportions of minority elders in each sample have limited our understanding of service use by minorities. This research sought to determine (1) the extent to which minorities have restricted use of community long-term care services as a result of socioeconomic status, family structure, and health status, and (2) the replicability and validity of results across three national surveys: Supplement on Aging, National Long-Term Care, and National Medical Expenditure. Results indicate no bivariate or multivariate differences between African American, Hispanic, or White frail older persons in use of community long-term services. Living arrangements, Medicaid use, and overall health and functional status were primary predictors of service use. Taking methodological limitations into account, the results suggest similarity in processes influencing use of community long-term care services for African American and White older persons.

Women's satisfaction with prenatal care settings: a focus group study.

BACKGROUND: Patient satisfaction is considered, together with health status, to be an outcome of the delivery of health care services as well as a measure of its quality. A focus group study of 50 low-income Mexican-American Puerto Rican, African-American, and white women in Chicago, Illinois, explored the characteristics of prenatal care that affect women's satisfaction. METHODS: Transcripts from the focus groups were analyzed using researcher-derived coding categories to develop broad themes. RESULTS: Despite their diverse ethnic backgrounds, participants revealed few differences with respect to what they value in prenatal care. Aspects of care that appeared to affect women's satisfaction included the "art of care, " the technical competence of the practitioner, continuity of caregiver, and the atmosphere and physical environment of the care setting. The one characteristic that did not appear to affect satisfaction was the caregiver's ethnicity. CONCLUSION: Knowledge of how the characteristics of prenatal care affect women's satisfaction can help increase use of care and ultimately improve perinatal outcomes.

Improving access to health care in Latino communities.

Public debate about health care reform often focuses on the need for health insurance coverage, but in Latino communities many other barriers also inhibit access to medical care. In addition, basic public health services often go underfunded or ignored. Thus, health care reform efforts, nationally and in each State, must embrace a broader view of the issues if the needs of Latino communities are to be served. This report reviews and summarizes information about the mounting problems Latino communities face in gaining access to medical care. Access to appropriate medical care is reduced by numerous financial, structural, and institutional barriers. Financial barriers include the lack of health insurance coverage and low family incomes common in Latino communities. More than 7 million Latinos (39 percent) go without health insurance coverage. Latinos without health insurance receive about half as much medical care as those who are insured. Structurally, the delivery system organization rarely reflects the cultural or social concerns of the communities where they are located. Therefore, providers and patients fail to communicate their concerns adequately. These communication problems are exacerbated by the extreme shortage of Latino health care professionals and other resources available. Institutional barriers often reflect the failure to consider what it means to provide good service as well as high-quality medical care. Reducing these barriers to medical care requires modifying governmental and institutional policies, expanding the supply of competent providers, restructuring delivery system incentives to ensure primary care and public health services, and enhancing service and satisfaction with care.

Access of Hispanics to health care and cuts in services: a state-of-the-art overview.

The most current research literature on the access of Hispanics to medical care is reviewed, and data from a 1982 national survey by Louis Harris and Associates on access to health care are presented to document current levels of access to health care of the Hispanic population. Through telephone interviews, 4,800 families were contacted, yielding a total sample of 6,610 persons. According to the survey's data, the ability of Hispanics to obtain health services is hampered by relatively low incomes, lack of health insurance coverage, and ties to a particular physician. However, Hispanics do not differ significantly from whites in their use of hospitals, physicians, or outpatient departments and emergency rooms. Hispanics are less satisfied than whites on a host of measures describing the most recent medical visit. These levels of dissatisfaction with the visit are similar to those of blacks. The recession and public care service cutbacks did not appear to result in a substantial reduction in the volume of medical care received by Hispanics and blacks. Still, the services available to minorities are viewed by them as less effective in meeting their needs in comparison with how whites view the services they receive. Further, the 1982 survey reveals particular difficulties and barriers for Hispanics in obtaining needed medical services. More than one-fifth of the Hispanic families had one or more significant problems in obtaining needed services.

Prevention: a Hispanic perspective.

Any approach to America's fast growing Hispanic cohort must overcome the presumption of homogeneity, if we are ever to develop sound health policy for prevention--or anything else. Elegantly, this article orients us to the diversity and particularly of the several unique components of Hispanic America.

Self-care. Substitute, supplement, or stimulus for formal medical care services?

This article examines the relationship between selected self-care practices during an episode of illness and the use of formal medical care. Stimulated by conflicting evidence and assertions, the general question addressed is: "Is self-care a substitute, a supplement, or a stimulus for use of formal medical care services?" Multiple Classification Analysis was used in a secondary data analysis of a 1976 nationwide study on access to medical care. The results suggest that self-care users may visit the physician less often and stay fewer days in the hospital, and thus they are expected to have lower expenditures for hospital and physician services. Therefore, the self-care activities examined appear to be substitutes for, rather than supplements or stimuli to, health services utilization. The results must be viewed with some caution due to limitations in the data. However, the results also argue for a greater research emphasis on self-care.

Uses of the 1980 census for Hispanic health services research.

The 1980 Census data provide a valuable resource for health services research on Hispanics. Hispanics are the fastest growing minority group in the United States and yet there is a paucity of large-scale empirical research on their health care and access needs. This paper describes how the census can assist in: 1) estimating the overall health care needs of this group, 2) identifying target groups within the Hispanic population who may have special health care problems (e.g., children, elderly, pregnant women, etc.); and 3) using other data sources to improve the quality of studies carried out on Hispanics. It also discusses problems in using the census for Hispanic health services research and some strategies for dealing with these problems.