Inequitable Care Delivery Toward COVID-19 Positive People of Color and People with Disabilities

Overview

Journal PLOS Glob Public Health

Specialty Public Health

Date 2023 Apr 19

PMID 37074996

Authors

Danbi Lee

Paula M Kett

Selina A Mohammed

Bianca K Frogner

Janice Sabin

Affiliations

Soon will be listed here.

Abstract

This study aimed to explore provider observations of inequitable care delivery towards COVID-19 positive patients who are Black, Indigenous, and Other People of Color (BIPOC) and/or have disabilities and to identify ways the health workforce may be contributing to and compounding inequitable care. We conducted semi-structured interviews between April and November 2021 with frontline healthcare providers from Washington, Florida, Illinois, and New York. Using thematic analysis, major themes related to discriminatory treatment included decreased care, delayed care, and fewer options for care. Healthcare providers' bias and stigma, organizational bias, lack of resources, fear of transmission, and burnout were mentioned as drivers for discriminatory treatment. COVID-19 related health system policies such as visitor restrictions and telehealth follow-ups inadvertently resulted in discriminatory practices towards BIPOC patients and patients with disabilities. As patients experience lower quality healthcare during the pandemic, COVID-19-related restrictions and policies compounded existing inequitable care for these populations.

References

Gracia J . COVID-19's Disproportionate Impact on Communities of Color Spotlights the Nation's Systemic Inequities. J Public Health Manag Pract. 2020; 26(6):518-521. DOI: 10.1097/PHH.0000000000001212. View

Horner-Johnson W, Dobbertin K, Lee J, Andresen E . Disparities in health care access and receipt of preventive services by disability type: analysis of the medical expenditure panel survey. Health Serv Res. 2014; 49(6):1980-99. PMC: 4254135. DOI: 10.1111/1475-6773.12195. View

Eftekhar Ardebili M, Naserbakht M, Bernstein C, Alazmani-Noodeh F, Hakimi H, Ranjbar H . Healthcare providers experience of working during the COVID-19 pandemic: A qualitative study. Am J Infect Control. 2020; 49(5):547-554. PMC: 7536124. DOI: 10.1016/j.ajic.2020.10.001. View

Frier A, Barnett F, Devine S, Barker R . Understanding disability and the 'social determinants of health': how does disability affect peoples' social determinants of health?. Disabil Rehabil. 2016; 40(5):538-547. DOI: 10.1080/09638288.2016.1258090. View

Powell W, Richmond J, Mohottige D, Yen I, Joslyn A, Corbie-Smith G . Medical Mistrust, Racism, and Delays in Preventive Health Screening Among African-American Men. Behav Med. 2019; 45(2):102-117. PMC: 8620213. DOI: 10.1080/08964289.2019.1585327. View

Manchanda E, Couillard C, Sivashanker K . Inequity in Crisis Standards of Care. N Engl J Med. 2020; 383(4):e16. DOI: 10.1056/NEJMp2011359. View

Aguillard K, Hughes R, Gemeinhardt G, Schick V, McCurdy S . "They Didn't Ask." Rural Women With Disabilities and Experiences of Violence Describe Interactions With the Healthcare System. Qual Health Res. 2022; 32(4):656-669. DOI: 10.1177/10497323211059142. View

Mitchell J, Perry R . Disparities in patient-centered communication for Black and Latino men in the U.S.: Cross-sectional results from the 2010 health and retirement study. PLoS One. 2020; 15(9):e0238356. PMC: 7523955. DOI: 10.1371/journal.pone.0238356. View

Campo-Arias A, Pedrozo-Pupo J, Caballero-Dominguez C . Relation of perceived discrimination with depression, insomnia and post-traumatic stress in COVID-19 survivors. Psychiatry Res. 2021; 307:114337. PMC: 8665839. DOI: 10.1016/j.psychres.2021.114337. View

10.

Reith T . Burnout in United States Healthcare Professionals: A Narrative Review. Cureus. 2019; 10(12):e3681. PMC: 6367114. DOI: 10.7759/cureus.3681. View

11.

Agaronnik N, Campbell E, Ressalam J, Iezzoni L . Communicating with Patients with Disability: Perspectives of Practicing Physicians. J Gen Intern Med. 2019; 34(7):1139-1145. PMC: 6614249. DOI: 10.1007/s11606-019-04911-0. View

12.

Blay N, Seremetkoska M, Morris J, Holters G, Ioannou S, Thomas V . Interpreter Provision and Hospital-Associated Outcomes Within the Limited English Proficiency Population: Analysis of Administrative Data. J Gen Intern Med. 2019; 34(6):820-822. PMC: 6544717. DOI: 10.1007/s11606-019-04852-8. View

13.

Wilkinson J, Dreyfus D, Cerreto M, Bokhour B . "Sometimes I feel overwhelmed": educational needs of family physicians caring for people with intellectual disability. Intellect Dev Disabil. 2012; 50(3):243-50. PMC: 3708475. DOI: 10.1352/1934-9556-50.3.243. View

14.

VanPuymbrouck L, Friedman C, Feldner H . Explicit and implicit disability attitudes of healthcare providers. Rehabil Psychol. 2020; 65(2):101-112. PMC: 9534792. DOI: 10.1037/rep0000317. View

15.

Mackey K, Ayers C, Kondo K, Saha S, Advani S, Young S . Racial and Ethnic Disparities in COVID-19-Related Infections, Hospitalizations, and Deaths : A Systematic Review. Ann Intern Med. 2020; 174(3):362-373. PMC: 7772883. DOI: 10.7326/M20-6306. View

16.

Ricks T, Abbyad C, Polinard E . Undoing Racism and Mitigating Bias Among Healthcare Professionals: Lessons Learned During a Systematic Review. J Racial Ethn Health Disparities. 2021; 9(5):1990-2000. PMC: 8415190. DOI: 10.1007/s40615-021-01137-x. View

17.

Clough J, Lee S, Chae D . Barriers to health care among Asian immigrants in the United States: a traditional review. J Health Care Poor Underserved. 2013; 24(1):384-403. DOI: 10.1353/hpu.2013.0019. View

18.

Ju M . Addressing Health Inequities for Limited English Proficiency Patients: Interpreter Use and Beyond. Pediatrics. 2021; 147(2). DOI: 10.1542/peds.2020-032383. View

19.

Moreland C, Ruffin C, Morris M, McKee M . Unmasked: How the COVID-19 Pandemic Exacerbates Disparities for People With Communication-Based Disabilities. J Hosp Med. 2021; 16(3):185-188. DOI: 10.12788/jhm.3562. View

20.

Cooper L, Roter D, Carson K, Beach M, Sabin J, Greenwald A . The associations of clinicians' implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am J Public Health. 2012; 102(5):979-87. PMC: 3483913. DOI: 10.2105/AJPH.2011.300558. View