Camryn
Johnson
Barriers to healthcare exist for many people, especially those from more vulnerable populations. Refugees face unique challenges such as language barriers, acculturation challenges, and diPiculties navigating an unfamiliar medical system. In addition, all have recently faced persecutory conditions in their countries of origin resulting in their refugee status. These barriers frequently compound, creating challenges for refugees trying to seek primary and specialty care. In the US, each clinic or hospital system has its own system for setting up interpretation and other existing systems to mitigate these barriers. An extraordinarily high number of these systems have flaws that leave many refugees struggling to navigate the healthcare system. As a result, they often do not receive necessary care. When individuals are sick, they should focus on healing, not on navigating a complex health system. Refugees have high levels of resilience, but they should not have to exercise it when seeking healthcare. In this study, I wanted to better understand common barriers and challenges that refugees face when accessing healthcare. I worked to identify specific barriers to accessible healthcare for refugees by interviewing and surveying healthcare providers in Durham County. This research defines "healthcare provider" as anyone involved in the care cascade, including physicians, nurses, administrators, and social workers. Under the best of circumstances, all these individuals collaborate to provide medical and social support for refugees so they can thrive. I surveyed 20 providers and interviewed an additional six. Through the surveys and semi- structured interviews, it became evident language, cultural diPerences, and a lack of health literacy relating to the US healthcare system form refugees' largest barriers to care. The current structure of the healthcare system does not accommodate for taking care of these populations due to time, resource, and financial constraints. Providers see many of these issues, but lack a sustainable, systemic solution to improve these barriers. Existing literature supports many of these findings. Comparing my research to this body of work, I also make a series of recommendations for areas of fruitful future research. For some of my findings, little research exists, highlighting the need for further research to improve the healthcare experience and outcomes for refugees. Intervention to Improve Self-Management of Blood Pressure for Low-Income Black Patients
Abstract profile. Full document pending author claim.
Authors:
Camryn Johnson
Date Created:
Not specified
Course Title:
Professor:
Not specified
About Paper:
Hypertension is a leading cause of preventable mortality and morbidity and is disproportionately represented among minority populations. Despite proven interventions outlined in practice guidelines, only 48% of patients who are diagnosed with hypertension have their condition controlled. Additionally, health-related social needs (HSRN) are associated with hypertension incidence. In a southeastern US county, the prevalence of hypertension is 42%, with a strong association with race, suggesting opportunities to intervene at a neighborhood level to reduce hypertension disparities and improve overall population health. We aim to implement a novel intervention to understand the HSRN influence within this population, and how the identification of these needs can impact blood pressure. We used a pre-post single cohort design over 2-cycles of quality improvement evaluation. We identify Black low-income patients with uncontrolled hypertension (SBP > 160 mmHg and/or DBP > 100 mmHg) from a local federally qualified health center (FQHC). Trained student ambassadors provided health education via telephone outreach, BP cuPs, and HSRN identification, with follow-up at 7 months. Among Black participants (n=345), average age was 55.4 years (SD 8.7), and a majority were male (n=173, 50.1%) and uninsured (n=159, 46.1%). Engagement in calls occurred for 67.8% (n=234) of the cohort; cuP distribution was 22.9% (n=79); and goal setting occurred for 64 patients. BP improved for 40% of the cohort (mean pre: 168/98 mmHg, mean post: 150/89 mmHg; p<0.0001). Of the cohort reached, 33% expressed social needs including food insecurity, housing, and medication costs. This innovative, community-based, telephonic outreach intervention identifies HSRN that can negatively influence blood pressure in underserved patient populations. Goal setting, feedback follow-up on needs, and skills-teaching with didactic education content (i.e. AHA Essential 8 handouts) provide an aPordable and individualized method to address HSRN. Findings can be feasibly scaled to other low-income, low-resource populations in community settings.
Source:
Duke University / 2024
Topics:
No topics listed
Co-authors:
Camryn Johnson