Does Cultural Competency Make Us in Better Delivering ... · Cultural Competency An anthropological...
Transcript of Does Cultural Competency Make Us in Better Delivering ... · Cultural Competency An anthropological...
“Does Cultural Competency Make Us Better at Delivering Patient Care?”Devyani Chowdhury, MD, FACC, FASE
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Does Cultural Competency Make
Us in Better Delivering Patient Care
Devyani Chowdhury MD, DirectorLancaster, PA
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Disclosures
Devyani Chowdhury MD, DirectorLancaster, PA
Dr. Chowdhury has provided no
disclosures.
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Lias Story
Devyani Chowdhury MD, DirectorLancaster, PA
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“Does Cultural Competency Make Us Better at Delivering Patient Care?”Devyani Chowdhury, MD, FACC, FASE
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Cultural Competency
Devyani Chowdhury MD, DirectorLancaster, PA
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Cultural Competency
Devyani Chowdhury MD, DirectorLancaster, PA
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Cultural Competency
Devyani Chowdhury MD, DirectorLancaster, PA
Definition: The ability to interact
effectively with people of
different cultures, helps to ensure
the needs of all community
members are addressed.
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“Does Cultural Competency Make Us Better at Delivering Patient Care?”Devyani Chowdhury, MD, FACC, FASE
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Cultural Competency
Does Cultural Competency
Make Us Better Delivering
Patient Care ?
Devyani Chowdhury MD, DirectorLancaster, PA
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Cultural Competency
Devyani Chowdhury MD, DirectorLancaster, PA
2 units:
1.Team giving Care
2.Team receiving care
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Cultural Competency
Devyani Chowdhury MD, DirectorLancaster, PA
4 yr. old presents to the office
Accompanied by her mother who is
full burkha, does not speak english,
accompanied by a translator
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“Does Cultural Competency Make Us Better at Delivering Patient Care?”Devyani Chowdhury, MD, FACC, FASE
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Cultural Competency
Audience question 1
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Cultural Competency
Is it important to spend time to understand the culture of this family?Will it impact the care?
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Cultural Competency
Amish familyBaby has dilated cardiomyopathy
No breast milkhome made goat milk based formula
No immunizations
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“Does Cultural Competency Make Us Better at Delivering Patient Care?”Devyani Chowdhury, MD, FACC, FASE
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Cultural Competency
Audience question #2
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Cultural Competency
Would you discharge this patient from your practice?
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Cultural Competency
Report to CYSForce formula
Force immunization
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“Does Cultural Competency Make Us Better at Delivering Patient Care?”Devyani Chowdhury, MD, FACC, FASE
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Cultural Competency
Health care literacy
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Cultural Competency
They are integrally related, along with preferred language.
Clinician can effectively and respectfully communicate with a patient if they do so in the patient's preferred language, in a way the patient can understand and act upon and one that takes the patient's cultural preferences into account.
Otherwise, it is likely that the patient will not follow through with the instructions and/or treatment plan….for several reasons as you may imagine.
Devyani Chowdhury MD, DirectorLancaster, PA
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Cultural Competency
Does this create cultural
competency?
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“Does Cultural Competency Make Us Better at Delivering Patient Care?”Devyani Chowdhury, MD, FACC, FASE
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Cultural Competency
When discussing culture I also include information on unconscious bias. I find it provides opportunities for the participants to pause, self-reflect and hopefully the "light bulb" will go off!
Especially for individual's that may have a potential comment as the one you shared.
Devyani Chowdhury MD, DirectorLancaster, PA
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Cultural Competency
An anthropological approach to teach and evaluate cultural competence in medical
students – the application of mini-ethnography in medical history taking
Devyani Chowdhury MD, DirectorLancaster, PA
Cultural Competency
Cultural competence is a crucial skill that helps health care providers to reduce
inequality in health care
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“Does Cultural Competency Make Us Better at Delivering Patient Care?”Devyani Chowdhury, MD, FACC, FASE
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
ACC’s Diversity and Inclusion Strategy: Working Toward a Diverse and Inclusive Cardiology Workforce
and Culture
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In comparison to the U.S. population, Adult cardiology is far less diverse…
• ACC 2016 Professional Life Survey suggests that African Americans and Hispanic each represent 3% to 6% of ACC membership
• <10% of medical students and less than 3% of SOM faculty are African American
• In 2015-2016, 5.4% of CV trainees were African American and 6.8% were Hispanic, compared to 5.8% and 7.8% respectively in internal medicine (ACGME)
CardiologyWhite/AsianAfrican AmericanHispanic
USA
White
African American
Hispanic
13%
17%5.0%
2.7%
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Trainees By Race/Ethnicity 2015-2016
0.0%
2.5%
5.0%
7.5%
10.0%
All residents GI Generalcardiology
EP General surgery Urology
Hispanic
ACGME GME Data Resource Book 2015-2016 Table c.23http://www.acgme.org/About-Us/Publications-and-Resources/Graduate-Medical-Education-Data-Resource-Book
AA
AA
Hisp
Hisp
African American
“Does Cultural Competency Make Us Better at Delivering Patient Care?”Devyani Chowdhury, MD, FACC, FASE
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
In comparison to U.S. medicine, Adult cardiology is far less diverse…
• In 2015, only 9.8% of FACCs who are U.S. board certified in adult CV are women
• About half of IM residents are women, compared with 21% of adult cardiology fellows. Even so, women are under represented in CV fellowships compared to almost every other specialty in the House of Medicine
• Review of ACC Awards indicates that 31 of 465 have gone to women (6.7%). Of these 10 went to pediatric cardiologists, 2 to statisticians, 1 to lay person, leaving <4% of ACC awards to adult CV women MDs.
USA Cardiology9.8%50.4%
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Adult CVD Board Certified Physicians:Distribution of Women
WY0%
12 states have <10 women CV MDs
SOURCE: ACC Database - June 2017
Prepared by: ACC Market Intelligence
CardiologyOctober 2017
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“Does Cultural Competency Make Us Better at Delivering Patient Care?”Devyani Chowdhury, MD, FACC, FASE
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Diversity Plays an Important Role in the Nation’s Health
"The fact that the nation’s health professions have not kept pace with changing demographics may be an even greater cause of disparities in health access and outcomes than the persistent lack of health insurance for tens of millions of Americans."
Report of the Sullivan Report Commission on Diversity in the Healthcare Workforce: Missing Persons: Minorities In The Health Professions: A Report Of The Sullivan Commission On
Diversity In The Healthcare Workforce
Louis Sullivan, MD, ChairPast Secretary of US HHS
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Cultural Competency
Health care professionals cannot become culturally competent solely by readingtextbooks and listening to lectures.
They must be educated in environmentsthat are emblematic of the diverse society they will be called upon to serve
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Cultural Competency
“Stagnation in minority representation in the physician workforce
will have unwelcome consequences for the health of the nation.”
Devyani Chowdhury MD, DirectorLancaster, PA
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“Does Cultural Competency Make Us Better at Delivering Patient Care?”Devyani Chowdhury, MD, FACC, FASE
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Cultural Competency
Access for the underserved.
To provide improved access to high-quality health care for persons in our society who remain underserved.
Inadequate access to health care services remains a major problem within minority
populations.
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Cultural Competency
Broadened research agenda.
United States is plagued by unsolved health problems, many of which disproportionately affect minority populations
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Cultural Competency
Augment the pool of medicallytrained executives and public policymakers
available to assume management rolesin the future health care system and to
contribute to governmental efforts that addressimportant health care issues.
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“Does Cultural Competency Make Us Better at Delivering Patient Care?”Devyani Chowdhury, MD, FACC, FASE
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Trends in Race/Ethnicity and Gender in Pediatrics
Diversity and Inclusion Task Force June, 2016
Data analysis and summary by
AAP Division of Health Services Research
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1.71.92.12.22.42.52.72.82.93.03.23.23.33.43.53.63.73.83.83.93.73.83.93.94.04.14.24.34.44.54.64.74.84.95.05.05.15.25.35.45.45.55.65.75.75.85.96.06.16.26.26.36.46.56.56.66.76.76.86.97.07.07.17.27.27.37.37.47.57.57.68.99.29.59.810.110.510.811.211.511.912.312.613.113.514.14.414.915.516.16.617.217.818.318.919.520.120.821.522.122.723.223.523.824.124.424.624.925.125.325.525.725.926.26.226.326.426.626.726.927.27.227.427.727.928.228.528.729.29.329.529.830.130.330.530.831.31.231.431.631.831.9
14.514.614.614.614.614.614.614.614.714.714.714.915.15.115.215.315.315.415.415.514.814.814.814.714.614.514.514.414.314.214.114.13.913.813.813.713.713.613.613.513.513.513.513.513.513.513.513.513.513.413.413.413.413.413.413.413.313.313.313.313.213.213.213.213.213.113.113.113.113.113.1
74.073.472.972.472.071.571.070.569.969.368.968.267.666.966.365.765.164.463.762.961.260.459.758.958.257.456.655.855.054.353.753.252.852.351.951.651.350.950.550.249.849.549.148.848.548.247.947.647.346.946.646.245.845.445.044.644.243.743.342.942.542.141.741.340.940.640.239.839.539.238.8
0.
20.
40.
60.
80.
1980 1990 2000 2010 2020 2030 2040 2050
% o
f Po
pu
lati
on
Non-Hispanic Asian Hispanic Non-Hispanic Black Non-Hispanic White
Projected (2015-2050)
Source: U.S. Census Bureau (http://www.childstats.gov/americaschildren/tables/pop3.asp)
Trends in Race/Ethnicity of U.S. Children (under 18), Recorded (1980-2014) and Projected (2015-2050)
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0
17500
35000
52500
70000
87500
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
Nu
mb
er o
f R
esid
ents
White Asian
Hispanic Black
58%
28%
8%
6%
Source: Graduate Medical Education, Brotherton & Etzel, JAMA, 2006 through 2015
All Residents in ACGME-Accredited Programs: Race and Ethnicity
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“Does Cultural Competency Make Us Better at Delivering Patient Care?”Devyani Chowdhury, MD, FACC, FASE
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
0
1500
3000
4500
6000
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
Nu
mb
er o
f R
esid
ents
White Asian
Hispanic Black
Source: Graduate Medical Education, Brotherton & Etzel, JAMA, 2006 through 2015
62%
23%
6%
9%
Pediatric Residents in ACGME-Accredited Programs: Race and Ethnicity
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-0.8
6.5
13.8
21.
28.3
35.5
42.8
50.
2006
2007
2008
2009
2010
2011
2012
2013
20
14
2015
Per
cen
tage
of
IMG
Res
iden
ts
All Docs Pediatrics
Source: Graduate Medical Education, Brotherton & Etzel, JAMA, 2006 through 2015
International Medical Graduates in Residency Programs 2006-2015
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2.1 2.6 2.9 3.6 4.15. 4.2 4.14.6 4.9 4.1 4.7 5.6
4. 4.8 5.3
12.9 12.814.8 14.8
16.7 15.8 15.4 15.2
0.
5.
10.
15.
20.
25.
Black Hispanic Asian
Race/Ethnicity of Pediatricians by Year (Including Residents)
% o
f P
ed
iatr
icia
ns
Source: AAP Periodic Survey 1990-2013
1990-92 1993-95 1996-98 1999-01 2002-04 2005-07 2008-10 2011-13
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“Does Cultural Competency Make Us Better at Delivering Patient Care?”Devyani Chowdhury, MD, FACC, FASE
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Conclusions: Race and Ethnicity
• Increase in the racial/ethnic diversity of children
• No change in the racial/ethnic diversity of pediatricians
• Similar to medicine overall
• Major leak in diversity pipeline between start of high school and end of college
• IMGs provide a source of increased diversity
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Cultural Competency
Understanding patients' diverse cultures — their values, traditions, history and institutions — is not simply political correctness. It is integral to
eliminating health care disparities and providing high-quality patient care. Culture shapes individuals' experiences, perceptions, decisions and how they relate to others. It influences the way patients respond to medical services and preventive interventions and impacts the way physicians deliver those services. In a society as culturally diverse as the United States, physicians and others in health care delivery need sensitivity toward diverse patient
populations and work to understand culturally influenced health behaviors.
Devyani Chowdhury MD, DirectorLancaster, PA
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Cultural Competency
Self test for cultural competency
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“Does Cultural Competency Make Us Better at Delivering Patient Care?”Devyani Chowdhury, MD, FACC, FASE
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Cultural Competency
Devyani Chowdhury MD, DirectorLancaster, PA
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Devyani Chowdhury MD, DirectorLancaster, PA
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Cultural Competency
Devyani Chowdhury MD, DirectorLancaster, PA
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“Does Cultural Competency Make Us Better at Delivering Patient Care?”Devyani Chowdhury, MD, FACC, FASE
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Cultural Competency
Devyani Chowdhury MD, DirectorLancaster, PA
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Cultural Competency
Devyani Chowdhury MD, DirectorLancaster, PA
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Devyani Chowdhury MD, DirectorLancaster, PA
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