Facing Disparities and

Cultural Competency in
Health Care
Megan Alsmeyer, Amie Roberta Howard,
Caitlin LaJoie & Lindsay Umeda
University of San Francisco
Defining the topic
! Cultural Competency (Finkelman, 2012)

! Health Disparities (Finkelman, 2012)

! Stereotypes (AACN, 2008)


Southern Comfort, 2001
LGBTQ
Health disparities:

! Lack of access to health coverage and care

! Lower overall health status



LGBTQ
Practices and Strategies to Improve the
Quality of Care:

-Leadership

-Provision of Care and Treatment of Services

-Data Collection and Use

-Patient, Family, and Community Engagement
http://www.jointcommission.org/assets/1/18/LGBTFieldGuide_WEB_LINKED_VER.pdf
Mental Health & Substance-Use
! > 33 million Americans
! Disability & death
! Wide range of diagnoses, severity of illness
& disability
! HOPE
! Longer treatment duration
(IOM, 2001)
Mental Health & Substance-Use
! Key Issues:
! Poor quality of care
! Co-occurrence w/a substantial # of general
medical illnesses
! Pain management
! Misinterpretation of unrelated health problems
! Poor system integration
IOM, 2001
Mental Health & Substance-Use
! Druss (2000):
! Hospitalization: MI w/secondary Dx of M/
SU
! Guideline medical therapies
! Mortality rate
(IOM, 2001)
Mental Health & Substance-Use
! What Can Be Done?
! Ethical decision making:
" For ex., Pain management & Beneficence (doing
good)
! IOM Report (2001): Crossing the Quality
Chasm (IOM, 2001)
Mental Health & Substance-Use
! Quality Chasm:
! IOM 2001 report
! 6 Goals for improvement:
" Safe
" Effective
" Patient-centered
" Timely
" Efficient
" Equitable
(IOM, 2001)
Women and Health Care
! Healthcare coverage
Employment Status & Income level
Vision & Dental

! Cardiovascular care
Delayed intervention
Misdiagnosis

! Prenatal Care
(Ahluwalia, 2007)

Women and Health Care
! HIV
Stereotypes
Less optimal pattern of care

! Pain Management
Intervention Strategies

! Homeless Women
Access to clinics & Barriers
(Blackstock, et al., 2012)

Women and Health Care
Strategies to Improve the Quality of
Care among women:

! Build Awareness

! Develop a coordinated strategy

! Support ongoing efforts

Knowing is not enough; we must apply.
Willing is not enough; we must do.

Goethe
Closing the Gap
! Eliminate disparities in access to health
insurance
! Improve health care in medically
underserved areas
! Develop health care institutions that are
welcoming and respectful to all people
! Track disparities in health care provision
! Provide medical interpretation services
for all clinical encounters
! Improve access to traditional and non-
Western treatments
! Adopt and enforce policies that promote
safety and health
! Include public health expert and
community organizations in community
development and planning process
! Provide funding and support for
improved nutrition, physical education
and health education in schools
! Support programs that incorporate
cultural traditions (ARC, 2005)
Culturally Competent Care
L isten
E xplain
A cknowledge
R ecommend
N egotiate
(Campinha-Bacote, 2011)
Tools and Resources
! Diversity calendar
http://www3.kumc.edu/diversity/
! Fun & Cheap SF
http://sf.funcheap.com/
! Join American Nurses Association
http://www.nursingworld.org
! Health Insurance Exchanges
http://www.healthexchange.ca.gov/
! The California Endowment
http://www.calendow.org/

Questions?
References
Ahluwalia, IB, J Bolen, and B Garvin. 2007. "Health insurance coverage and use of Selected Preventive Services by
Working-Age Women, BRFSS, 2006." Journal Of Women's Health (15409996) 16, no. 7: 935-940. CINAHL Complete,
EBSCOhost (accessed October 4, 2013).

Blackstock, O. J., Beach, M., Korthuis, P., Cohn, J. A., Sharp, V. L., Moore, R. D., & Saha, S. (2012). HIV Providers' Perceptions
of
and Attitudes Toward Female Versus Male Patients.AIDS Patient Care & Stds, 26(10), 582-588. doi:10.1089/apc.
2012.0159

Cho, L., Hoogwerf, B., Huang, J., Brennan, D., & Hazen, S. (2008). Gender differences in utilization of effective
cardiovascular secondary prevention: a Cleveland clinic prevention database study. Journal Of Women's Health
(15409996), 17(4), 515-521. doi:10.1089/jwh.2007.0443

Giger, J., Davidhizar, R., Purnell, L., Harden, J., Phillips, J., & Strickland, O. (2007). American Academy of Nursing Expert Panel
Report: Developing cultural competence to eliminate health disparities in ethnic minorities and other vulnerable
populations. Journal of Transcultural Nursing, 18(2), 95-102.

The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and FamilyCentered
Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: A Field Guide. Oak Brook, IL,
Oct. 2011. LGBTFieldGuide.pdf.

Leresche, L. (2011). Defining gender disparities in pain management. Clinical Orthopaedics & Related Research, 469(7),
1871-1877. doi:10.1007/s11999-010-1759-9