Journal of general internal medicine
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Comparative Study
Differences in Medicare expenditures during the last 3 years of life.
To examine age, gender, race, and area income differences in Medicare expenditures in the 3 years before death. ⋯ Age-associated differences in aggregate Medicare payments for end-of-life care are more substantial than other differences. The fact that other differences attenuate in the LYOL may reflect having overcome barriers to health care, or reflect an effective ceiling on the opportunities to provide services for persons with overwhelming illness.
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Comparative Study
Barriers to colorectal cancer screening in Latino and Vietnamese Americans. Compared with non-Latino white Americans.
To identify current colorectal cancer (CRC) screening practices and barriers to screening in the Latino, Vietnamese, and non-Latino white populations. ⋯ Rates of CRC screening are lower in ethnic minority populations than in whites. Differences in attitudes and perceived barriers suggest that culturally tailored interventions to increase CRC screening will be useful in these populations
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Comparative Study
Racial and ethnic differences in patient perceptions of bias and cultural competence in health care.
To determine: 1) whether racial and ethnic differences exist in patients' perceptions of primary care provider (PCP) and general health care system-related bias and cultural competence; and 2) whether these differences are explained by patient demographics, source of care, or patient-provider communication variables. ⋯ While demographics, source of care, and patient-physician communication explain most racial and ethnic differences in patient perceptions of PCP cultural competence, differences in perceptions of health care system-wide bias and cultural competence are not fully explained by such factors. Future research should include closer examination of the sources of cultural bias in the US medical system.
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Comparative Study
Disparities in care for depression among primary care patients.
Ethnic minorities traditionally receive less care for depression than do white populations; we examine ethnic minority care for depression in a large cross-national primary care sample. ⋯ Primary care providers are now able to recognize depression and recommend treatment for Latino and African-American patients, with this care recommended at equal rates to that of white patients. However, Latino and African-American patients remain less likely to obtain appropriate care, such as antidepressant medications or specialty care. New approaches to improving access to appropriate care for Latino and African-American primary care patients are needed.
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Comparative Study
Race/ethnicity and the receipt of watchful waiting for the initial management of prostate cancer.
Several recent studies have noted that African Americans disproportionately receive "watchful waiting" for the initial management of their prostate cancer. To determine whether racial/ethnic differences in the receipt of watchful waiting are explained by differences in clinical presentation and life expectancy at the time of diagnosis, we examined Surveillance, Epidemiology, and End Results (SEER)-Medicare data for men diagnosed with prostate cancer in 1994 to 1996. ⋯ The disproportionate receipt of watchful waiting among African Americans and Hispanics is not completely explained by racial/ethnic variation in clinical characteristics or life expectancy as measured in this study. These data suggest that there are other factors that contribute to racial/ethnic differences in receipt of watchful waiting that warrant investigation.