Family medicine
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More than 9 million Latino children currently live in the United States. Latinos will soon be the largest minority group in the country, but little is known about access barriers to health care faced by Latino children. We reviewed the literature to define specific barriers to care for Latino children, identify methodologic problems, and highlight the clinical and research implications of the identified barriers. ⋯ Lack of health insurance and lack of a regular source of care are major access barriers for Latino children, but many other barriers were identified that also can have a substantial effect on health care. In addition, the behaviors and practices of both health care providers and parents can affect access to care. Too little is known about what parents perceive to be the major barriers, access differences among Latino subpopulations, the roles of language and culture, and the causes of obstacles resulting from the actions of providers.
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Despite advances in medical approaches to the management of chronic illnesses, relatively little is known about how older members of ethnic minority groups view their chronic illnesses or how they manage them in daily life. ⋯ Our findings showed that although major chronic illnesses were, for the most part, the same for all three groups, each group differed in its response to and management of its illnesses. These findings have implications for the education of physicians in training.
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There are now more than 100,000 Hmong (Southeast Asian) refugees in the United States. This study examined interactions between Hmong patients and their health care providers and identified specific factors that either enable or obstruct health care delivery. ⋯ Many basic issues in relations between clinicians and Hmong patients must be addressed to improve health care communication.
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This study examines differences in breast cancer survival between African-American and white women to determine whether there is a racial difference in survival after accounting for established influences on outcome, such as stage of cancer, health status, health behavior, utilization patterns, access to care, quality of care, and the doctor-patient relationship. ⋯ Missed appointments was a determinant of both advanced stage and shorter survival. This measure is an important component of how race affects survival. Compliance with appointment keeping and alleviating reasons for noncompliance must be considered as factors in breast cancer survival.
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Because minority physicians are more likely to practice in minority or medically underserved communities, meeting the health care needs of underserved populations requires that programs not only train such physicians but train minority faculty to act as teachers and role models. The Faculty Development Center in Family Medicine at Cook County Hospital has had more than 120 graduates, most of whom are teaching and practicing in underserved settings. ⋯ The curriculum is specifically geared to prepare faculty to work in underserved settings and nurture future physicians for these settings. Workforce diversity can be achieved only by major changes in the institutional culture of medical education, which federal policy can encourage by setting high standards for grant funding preferences and supporting centers of excellence for training minority physicians and faculty.