PRINCIPLES OF ORAL HEALTH MANAGEMENT FOR THE HIV/AIDS PATIENT CULTURAL COMPETENCY Elias J. Llerandi,...
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Transcript of PRINCIPLES OF ORAL HEALTH MANAGEMENT FOR THE HIV/AIDS PATIENT CULTURAL COMPETENCY Elias J. Llerandi,...
PRINCIPLES OF ORAL HEALTH MANAGEMENT FOR THE HIV/AIDS
PATIENT
CULTURAL COMPETENCY
Elias J. Llerandi, DMDClinical Instructor, NY Medical College
Consultant, NYS Dept. of HealthStaff Dentist, Dept. of V.A.Private Practice, Queens
Former Chief of Service, Spellman Dental Clinic, SVMH
OBJECTIVES
• Define and Recognize fundamental characteristics of Culture
• Identify components of the process of Cultural Competence
• Discuss the importance of understanding cultural variation in the dental clinical setting and how it influences our Tx plan and its implementation
CULTURE
• What is it?
…acting, feeling, judging, perceiving, and organizing (Shade, Kelly and Oberg, 1997)
• Why is it important?
-facilitates tx plans that can be followed by pts and supported by their families
-enhances communication and clinical interaction
-helps Bottom line: Leads to retention of pts in a competitive environment ($$$)
CHARACTERISTICS OF CULTURE
• Learned Behavior
• Shared
• Ever-changing
• No culture is better of worst than another, they are just different
CULTURAL COMPETENCY
• A SET OF CONGRUENT BEHAVIORS, ATTITUDES AND POLICIES THAT COME TOGETHER IN A SYSTEM, AGENCY OR AMONG PROFFESIONALS AND ENABLE THAT GROUP TO WORK EFFECTIVELY IN CROSS-CULTURAL SITUATIONS
SPECIAL POPULATIONS IN HIV
• Racial & Ethnic Minorities
• Women
• Substance Abusers
• Gay/Lesbian/Bi-sexual/Transgender
• MSM
Disproportionate Incidence of New Cases of HIV/AIDS in People of Color in 2002
Total US PopulationTotal US Population(n=288,369,000)(n=288,369,000)
White*69%
Black*Black* HispanicHispanic
OtherOther
12%12%13%
5%
15
30
45
60
Black* White* Hispanic Black* White* Hispanic
54%54%
26%26%19%19%
New HIV CasesNew HIV Cases(n=40,000)(n=40,000)
Cas
es (
%)
Cas
es (
%)
15
30
45
60
Black* White* Hispanic Black* White* Hispanic
50.4%50.4%
28.4%28.4%
19.6%19.6%
New AIDS CasesNew AIDS Cases(n=42,024)(n=42,024)
Cas
es (
%)
Cas
es (
%)
*Not Hispanic.CDC: HIV/AIDS Surveillance Report. 12/2003.
CULTURAL VARIATIONS
Communication: Verbal, non-verbal, silence, eye contact
Space: Degree of comfort, perception of space
Social Organization: church, family
Time: latinos/substance abusers
Environmental controls: ‘I am undetectable’
CULTURAL VARIATIONS
Communication: Verbal, non-verbal, silence, eye contact
Space: Degree of comfort, perception of space
Social Organization: church, family
Time: latinos/substance abusers
Environmental controls: ‘I am undetectable’
Incorporating Culture into Health
• Individual Pt-Provider & System Level
• Culture influences help seeking behavior and attitudes toward HCP
• Communication must be clear
• Pt has personal experiences of biases within the healthcare system
• HCP from culturally and linguistically diverse groups are under represented
Recipe for Disaster
• Alcohol• Ether (starting fluid)• Benzene• Paint thinner• Freon• Acetone• Camp stove fuel• Ammonia• Red Phosphorous
• Toluene (brake cleaner)• Red Devil Lye• Drain cleaner• Battery Acid• Lithium from batteries• Ephedrine• Cold tablets• Diet aids• Energy boosters
POTENTIAL FAILURES!!!
• HCP are reluctant to offer Tx plan option to pts they believe will be non-compliant
• MDs are more likely to Rx HAART to those perceived to be likely to be adherent
• MDs were more likely to tx African Americans as non-adherent
( Bogart et al.,2001)
Do not limit tx plan choices based on assumptions about a cultural group…
PT-HCP COMMUNICATION CHALLENGES
• 40-80% OF MEDICAL INFORMATION IS
IMMEDIATELY FORGOTTEN
• HALF IS REMEMBERED INCORRECTLY
• THE MORE GIVEN, THE MORE FORGOTTEN
• SPEAKING INFO-17%
• SPEAK AND SHOW-84%
PROCESS OF CULTURAL COMPETENCE
• Cultural Awareness: Front desk
appreciates/respects values and problem solving
strategies
• Cultural Knowledge: Seeking/obtaining factual info
on different cultures…’TWO MASK JOB’…
• Cultural Skill: Collect relevant data about health
hx/problems latinos HIV is taboo/’DL’ in aa
FROM DESTRUCTIVENESS TO PROFICINECY
• Cultural Destructiveness: misinforming pt of
medical risks and benefits e.g.: LA Co. DHS
measles study, sargenti
• Cultural Blindness: color or culture makes no
difference , all people are the same OR making
services so ethno centric as to render them useless to
other cultures
FROM DESTRUCTIVENESS TO PROFICINECY
• Cultural Pre-Competence:
hire staff that reflects different cultures
Training
Needs assessments
Recruit diverse individuals to advisory committees
FROM DESTRUCTIVENESS TO PROFICINECY
• Cultural Competence:
Respect for difference
Continue self-assessment
Continue expansion
Adapt
FROM DESTRUCTIVENESS TO PROFICINECY
• Cultural Proficiency:
Hold culture in high esteem
Close cultural gaps and improve service delivery
Positive tx outcome
Minimize oral disease with systemic consequences
Improve quality of life
MINORITIES AND HIV
• 63.8% of new AIDS cases in men (3/5)
• 81.9% of new AIDS cases in women (4/5)
• 85.6% of new AIDS cases in children (4/5)
• Latinos receive an AIDS diagnosis at early
ages(<30yrs old)
LATINOS AND HIV
• Latinos have different perception of time, more
flexible understanding of punctuality
• Saving time less important than a warm
relationship.
• May see as rudeness a hurried pace or focus on
saving time
TRANSGENDER (LGBT)
• Bigender, MTF, FTM
• Identities change
• Hormones and Surgery
• Transgender=Gay
TRANSGENDER (LGBT)
• The Office:
‘Scan’
Train staff
Forms
Unisex bathroom
Non discrimination policy poster visibly