Infectious Disease Issues in Underserved Populations

Grief, Samuel N.; Miller, Jamie K.

doi:10.1016/j.pop.2016.09.011

Cited by 19 publications

(12 citation statements)

References 88 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Underserved populations are at risk for health disparities, and potential barriers to care include the high prevalence of comorbid medical and psychiatric disorders, substance abuse, unstable housing, limited access to transportation, and low health literacy, among others. (24)(25)(26) Further, despite expansion of health insurance coverage as a result of health care reform, a recent report highlighted the ongoing challenge of integrating clinical services between the safety-net hospitals and their community health centers, making it difficult to deliver more efficient and effective care to this population. (27) Potential strategies and opportunities to enhance post-SVR care in the underserved are summarized in Fig.…”

Section: Discussionmentioning

confidence: 99%

Liver Disease Monitoring Practices After Hepatitis C Cure in the Underserved Population

Kim

Magee

Cummings

et al. 2018

Hepatology Communications

View full text Add to dashboard Cite

Recent hepatitis C virus (HCV) guidelines recommend disease monitoring and hepatocellular carcinoma (HCC) screening in patients with advanced fibrosis after a sustained virologic response (SVR) with direct‐acting antiviral (DAA) therapy. However, data on practice patterns in this setting is lacking. We aimed to characterize disease monitoring and HCC screening practices post‐SVR in an underserved HCV‐infected cohort. Records of 192 patients who received DAA therapy at the San Francisco safety‐net health care system between January 2014 and January 2016 with ≥12 months of follow‐up post‐SVR were reviewed. Patient characteristics were median age 58 years, 61.5% men, 39.1% White (23.4% Black, 16.7% Latino, 16.2% Asian), 78.1% English proficient, 48.9% intravenous drug use, 53.2% alcohol use, and 41% advanced (F3 and F4) fibrosis (26.6% with decompensation, 11.4% with HCC). Median post‐SVR follow‐up time was 22 months. A higher proportion of patients with advanced fibrosis attended liver clinic visits (mean, 1.94 ± 2.03 versus 1.12 ± 1.09 visits; P = 0.014) and had liver imaging (41.4% versus 9.73%; P < 0.001) post‐SVR, but there was no difference in alanine aminotransferase (ALT) testing (72.2% versus 66.4%; P = 0.40) compared to those without advanced fibrosis. However, 20% with advanced fibrosis had no HCC screening while 35% with no advanced fibrosis had liver imaging. Three patients with cirrhosis developed new HCC. Conclusion: Although the majority of patients with advanced fibrosis in this underserved cohort received post‐SVR monitoring, gaps in HCC screening were identified and new cases of HCC occurred during a short follow‐up. This highlights the importance of incorporating recently enhanced guidelines to optimize post‐SVR monitoring, especially in difficult to engage populations.

show abstract

Section: Discussionmentioning

confidence: 99%

Liver Disease Monitoring Practices After Hepatitis C Cure in the Underserved Population

Kim

Magee

Cummings

et al. 2018

Hepatology Communications

View full text Add to dashboard Cite

show abstract

“…These issues were highlighted in 2020 during the COVID-19 pandemic where different patient characteristics resulted in different risk levels for disease and disease severity [ 42 ]. During the pandemic, the biggest patient threat has likely been underutilization, particularly among tests to manage chronic diseases and in traditionally underserved communities and people of color [ 43 , 44 ]. Laboratory professionals have access to data that can provide insight into clinical practices and identify potentially pandemic-related gaps in care.…”

Section: Implementation Of a Laboratory Stewardship Programmentioning

confidence: 99%

Strategies for laboratory professionals to drive laboratory stewardship

White

Wong²,

Janowiak³

et al. 2021

Practical Laboratory Medicine

View full text Add to dashboard Cite

Appropriate laboratory testing is critical in today's healthcare environment that aims to improve patient care while reducing cost. In recent years, laboratory stewardship has emerged as a strategy for assuring quality in laboratory medicine with the goal of providing the right test, for the right patient, at the right time. Implementing a laboratory stewardship program now presents a valuable opportunity for laboratory professionals to exercise leadership within health systems and to drive change toward realizing aims in healthcare. The proposed framework for program implementation includes 5 key elements: 1) a clear vision and organizational alignment; 2) appropriate skills for program execution and management; 3) resources to support the program; 4) incentives to motivate participation; and, 5) a plan of action that articulates program objectives and metrics. This framework builds upon principles of change management, with emphasis on engagement with clinical and administrative stakeholders and the use of clinical data as the basis for change. These strategies enable laboratory professionals to cultivate organizational support for improving laboratory use and take a leading role in providing high-quality patient care.

show abstract

“…Does our training reflect the needs of the patient populations that we serve? Infectious diseases, including COVID-19, disproportionately affect ethnic minorities and economically disadvantaged populations [ [53] , [54] , [55] ]. Medical training often overlooks the basics of care for marginalized populations; ask yourself how often have you seen common rashes taught on non-white skin [ 56 ]?…”

Section: Inequalities and Discrimination Based On Gender Economic Status And Ethnicity/racementioning

confidence: 99%

Future developments in training

Power

Dellière

Velikov

et al. 2021

Clinical Microbiology and Infection

View full text Add to dashboard Cite

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

Infectious Disease Issues in Underserved Populations

Cited by 19 publications

References 88 publications

Liver Disease Monitoring Practices After Hepatitis C Cure in the Underserved Population

Liver Disease Monitoring Practices After Hepatitis C Cure in the Underserved Population

Strategies for laboratory professionals to drive laboratory stewardship

Future developments in training

Contact Info

Product

Resources

About