News Archives(4)
Gatekeepers' Denial of ER Care Affects Blacks Most
African-American patients seeking emergency department care are about 50% more likely than white patients to be denied authorization by their managed care organization, according to a
report published in the March issue of Academic Emergency Medicine.
The study was conducted by a team of researchers led by Dr. Robert A. Lowe of the University of Pennsylvania in Philadelphia.
They evaluated the records of more than 15,000 visits to a Philadelphia emergency department.
The reason is unclear, but the study's lead author told
Reuters Health that the findings call into question ''gatekeeping''--the practice health plans use to reduce unnecessary trips to hospital emergency departments by requiring patients to seek preauthorization for emergency care.
Experts have questioned whether gatekeeping constitutes good healthcare and actually reduces costs. And a previous pilot study found that African Americans were much more likely than whites to have their requests for emergency care denied.
All emergency department patients in the study were first seen by a nurse who evaluated the severity of their symptoms. Patients in dire need of medical care were treated immediately and no authorization was sought. In less serious cases, either the patient or a staff member called the patient's primary care physician or an official at the managed care plan to
seek approval for the emergency care.
African Americans tended to have less severe symptoms than whites, so the researchers took this into account, as well as several other factors that could have influenced the authorization process, including the day and time of the
visit to the emergency department, type of managed care plan and each
patient's age and gender.
Still, blacks were 52% more likely than whites to be denied authorization for care, Lowe's team found.
Requests were also more likely to be denied on week days,
especially during normal business hours. The investigators also found that patients in Medicaid managed care plans and plans that included both Medicaid and non-Medicaid patients were more likely to have their claims denied than patients enrolled
in commercial managed care plans.
The results ``raise important questions about the equitable application of gatekeeping across racial groups and, therefore, the appropriateness of using gatekeeping to reduce emergency department utilization,'' Lowe's team concludes.
``What we found is not about racist doctors, nor is it about racist HMOs,'' Lowe told Reuters Health. ``It is about barriers to accessing needed medical care.''
In many cases, the person in charge of authorization, either a physician or an employee of a health plan, may not have known a patient's race, he noted. One possible explanation, according to Lowe, is that African Americans may tend to see physicians who, for whatever reason, are more likely to deny authorization for emergency care. He noted, however, that this study was not designed to test this idea.
``We need to dig deeper into the possible explanations for our findings, which add to the large body of literature suggesting that nonwhite patients receive different
medical care than do whites,'' he concluded.
Since the study was conducted, at least one Medicaid managed care plan in the Philadelphia area has stopped using the gatekeeping practice. Instead, the plan pays for emergency care in cases when a ``prudent layperson'' would believe that emergency care was necessary. Prudent layperson legislation
has been passed in a number of states, according to Lowe.
(Source: Reuters Health)
Drug
Company to Test Heart medication for Blacks
On March 2, 2001, the drug firm NitroMed made the announcement that it was given
the green light to begin final testing of a drug (named BiDil) that could
treat congestive heart failure in African Americans.
Heart failure is a major problem in the black populations. They are twice
as likely to suffer from this ailment as are whites.
In the U.S., close to five million Americans suffer of heart failure. About
20 percent of them are African American.
Details about the clinical trial, which involves 600 African Americans,
will be announced in Orlando (Florida) on March 17 by the Association of Black
Cardiologists during its annual meeting, wrote Ronald Rosenberg, a staff
reporter for the Boston Globe.
The trial will be " the first time that a racial difference in
responsiveness to a drug is examined in a focused way," said Dr. Ann
Taylor , a University of Minnesota cardiologist, wrote the Globe. Dr.
Taylor will be NitroMed’s clinical investigator.
A significant number of African-American women will participate for the
first time in the trial. The participants will be administered either BiDil or
a placebo with their current medications. The goal of the trial is to measure
quality of life, reduced need for hospitalization, and improvement of heart
function.
When studies were done with BiDil’s components in 1980 and 1990 on 640
male volunteers, of which 30 were black, researchers noted that the drug was
more effective in blacks than whites. Those findings prompted NitroMed to ask
the FDA for permission to ensure whether they are scientifically valid.
(Source: The Boston Globe)
Cuban Government extends to
U.S. Medical Education Proposal
During a visit to Cuba made in early 2000 by members of the
Congressional Black Caucus, Cuban leader Fidel Castro offered to provide free
medical education in Cuba to hundreds of African Americans and Afro- Cuban
Americans. These individuals would then return to the U.S. to complete
their residency training and serve the medical needs of their communities.
The National Medical Association (NMA), an organization which
serves the interests of African- American physicians and patients in the U.S.,
is to assess the Cuban proposal's feasibility.
"This offer [from Castro] comes at a critical time when
African-American physicians are insufficiently represented in medical workplace
(comprising only 3% of the U.S. population) and the number of African-American
enrollees into medical school has declined as a result of anti-affirmative
action legislation in many states," said NMA President Rodney G. Hood,
M.D., according to the National Medical Association News (the
Winter 2001 Issue).
"Given that African Americans continue to have the
highest rate of health disparities and that the limited number of black
physicians are the ones most likely to serve African-American and other
underserved populations, any offer to reverse these trends must be given serious
attention," said Dr. Hood.
Dr. Hood recently traveled to Cuba as part of a delegation led
by Randall Robinson, president of TransAfrica, to assess the Cuban medical
education and delivery system.
The Thinness of Corneas in
Blacks May Affect Glaucoma Care
African-Americans tend to have thinner corneas than whites,
the results of a new study indicate. Ophthalmologists need
to take into account those differences when measuring pressure within the
eye. Otherwise, these differences if ignored may lead to improper
diagnosis and treatment of glaucoma in blacks, wrote the authors of the
study.
Glaucoma, a disease that strikes about six times as many
blacks as whites, occurs when pressure within the eye increases above
normal. Blacks tend to develop the disease sooner than whites.
Because of the way intraocular pressure is calculated,
pressure in people whose corneas are thinner than average will seem lower than
it really is, Dr Silvia Orengo-Nania of the Houston Veterans Medical
Affairs in Texas said in an interview with Reuters Health. This underestimation
of pressure may lead to less aggressive treatment in blacks, she said. The
method used to calculate this pressure is based on a formula that assumes that
the cornea is a standard shape and size.
The study was done on 165 men -- 83 whites and 82 blacks --
who were treated at the Houston VA Medical Center.
Adjustment needs to be done in the pressure measurements for
blacks, the authors conclude, which may provide a more accurate picture of the
severity of glaucoma in a patient.
The researchers say it is not clear why blacks are at greater
risk to have glaucoma than whites or why they are diagnosed earlier than whites.
They stress though that a thinner cornea may result in a delayed diagnosis.
The study is published in the January issue of the journal
Archives of Ophthalmology (2001;119:23-27).
African Bishops Condemn
Lawsuit Against Generic AIDS Drugs
Dakar, Senegal: On March 24, African Catholic
Archbishops lent their voices to the growing campaign against the law suit filed
by drug companies --mostly from rich countries -- to prevent the production in
Africa of cheap generic drugs for the treatment of HIV/AIDS.
In a formal statement released at the end of its week-long
meeting in the Senegalese capital, the Standing Committee of the Symposium of
Episcopal Conferences of Africa and Madagascar (SECAM) described as
"criminal", efforts by those pharmaceutical companies to "deny
the poor", free access to HIV/AIDS treatment."
The drug manufacturers has filed the lawsuit to prevent
production of generic anti-AIDS medication, which they fear may spread on the
open markets of Africa and even Europe. A spread that could hurt their business,
they argue.
But critics say the suit has been filed against the millions
of HIV/AIDS patients in South Africa and elsewhere on the continent that cannot
afford the expensive medication made by the drug companies of rich countries.
The Bishops' Symposium argued that denying the majority of
South African patients "free medication or, at least drugs at affordable
prices tantamount to "abandoning them to certain death from AIDS."
Endorsing an earlier stance taken by the South African
Episcopal Council, the Dakar Declaration affirmed that SECAM " cannot stay
passive and indifferent while HIV/AIDS destroys our communities, especially the
young," let alone condone the very idea of pursuing industrial property
rights at the expense of human life."
"Together with the South African Episcopal Conference,
the Standing Committee of SECAM calls on the association of pharmaceutical
industries [PMA] to stop their cynical approach to business," the bishops'
declaration added.
"We also demand a revision of existing conventions on the
granting of international manufacturing licenses," concluded the statement.
Meanwhile, the SECAM Standing Committee President Laurent
Mosengwo Pasinya, reiterated the Church's position on HIV/AIDS, anchored on
abstinence and fidelity in marriage.
(Source: PanAfrican News Agency, Dakar)
Footnote:
The PMA has since then dropped the suit against the
South African government, clearing the way for the fabrication by regional
firms of cheaper drugs to fight the AIDS epidemic in Africa.
Group to introduce advanced surgery in the Caribbean
A new medical group, Doctors On Call, Inc. (D.O.C.), the first
of its kind in America, will work at introducing cutting edge technology and
essential surgery in the Caribbean.
D.O.C. will supports four areas of development in specialty
and subspecialty surgery: Ear, Nose, Throat (ENT), which includes Head &
Neck & Craniofacial Surgery, Plastic & Reconstructive, General, Vascular
Surgery and Urology.
The project will draw its surgeons from New York's teaching
hospital staff who are attending staff physicians at Harlem Hospital and members
faculty at Columbia University of Physicians and Surgeons.
According to The Medical Herald ( issue of Jan. 2001),
the members of D.O.C. traveled to Jamaica recently for an official walkthrough
of the Bustamante Children's Hospital, Kingston Public Hospital, Annotto Bay
Hospital, Manville Hospital, St. Ann's Bay Hospital and Cornwall Regional
hospital. And based on the data collected, the team will move forward with
plans for their first surgical mission in April 2001.
"The Jamaican Ministry of Health is pleased to enter into
this collaboration with D.O.C.. This partnership will lead us to a greater
understanding, and the program will ultimately translate into better medicine,
innovation of technology and a new generation of top surgeons," said Basil
Bryan, M.D., Jamaican Consul General in New York, according to The Medical
Herald.
Local surgeons will get hands-on practice with specialists in
their field in local hospital throughout the islands.
The country of Haiti on the island of Hispaniola, also in the
Caribbean, has been receiving for the last two years Cuban physicians who have
apparently been involved in all aspects of care delivered to the
population of this impoverished country. And young Haitian students have
benefited of enrollment into Cuban medical universities.
This new initiative will bring some benefits of the
globalization to this region of the world.
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