種族差異存在於ESRD患者及其醫師


  【24drs.com】根據美國腎臟醫學會臨床期刊上的研究,腎臟疾病患者以及照顧他們的醫師之間存在著種族差異。
  
  明尼蘇達州明尼阿波里斯市退伍事務醫療中心內科部門的Chavon Onumah醫師寫到,腎臟疾病不均等地影響非裔美國人,信任被認為是影響病患預後一個重要因子,當患者與醫師的種族一致時,有較高程度的信任與較好的人際照護。
  
  這項分析的目的在於評估美國醫學院畢業生、內科住院醫師、腎臟科訓練醫師以及罹患末期腎臟疾病(ESRD)患者的種族背景。由美國醫學院協會提供醫學畢業生的資料,內科醫學與腎臟科訓練醫師的資料來自GEM追蹤資料庫,而ESRD患者資料則是來自美國腎臟數據系統與報告。
  
  雖然有32%的ESRD患者是黑人,但只有3.8%的腎臟科訓練醫師是黑人,代表種族組成對比上有很大的差異;考慮到ESRD患者增加,黑人腎臟科訓練醫師太少,在不久將來的新進腎臟科醫師,對於以患者為中心的腎臟照護有重要角色。
  
  其他發現包括,只有6.5%到7.1%的美國醫學院畢業生、5.5%的內科住院醫師,以及3.3%在大學醫學中心執業的腎臟科醫師是黑人。
  
  研究作者們寫到,需要付出更多努力在增加少數種族的腎臟科訓練計畫,更緊密地平衡接受訓練醫師與患者們的種族背景,希望能夠促進ESRD照護提供者與患者之間更好的信任、增加接受照護的管道、減輕ESRD健康照護差異,最終改善患者照護。
  
  這項研究的限制包括無法確認種族差異對患者預後的影響。
  
  研究作者們的結論是,腎臟科訓練醫師計畫的主任們應與目前機構內少數種族委員會密切合作,或是努力促成該委員會形成,以找出招募少數種族學生、住院以及訓練醫師,還有少數種族工作人員培育的挑戰。少數種族能夠被招募留在學術單位且代表醫學院教職員還有關鍵機構內委員會成員是非常重要的,特別是類似腎臟科這樣的次專科,在患者與醫師們之間存在著種族上的差異。腎臟科訓練醫師應受到鼓勵與支持進入學術單位擔任臨床醫師、教師或研究者。
  
  研究作者們表示沒有相關資金上的往來。

Ethnic Disparities Exist Between Patients With ESRD, Their Physicians

By Laurie Barclay, MD
Medscape Medical News

February 1, 2011 — Disparities exist between the race of patients with kidney disease and that of the physicians who will care for them, according to a study appearing online January 27 in the Clinical Journal of the American Society of Nephrology.

"Renal disease disproportionately affects African-American patients," write Chavon Onumah, MD, MPH, from the Department of Medicine, Minneapolis Veterans Affairs Medical Center in Minnesota, and colleagues. "Trust has been implicated as an important factor in patient outcomes. Higher levels of trust and better interpersonal care have been reported when race of patient and physician are concordant."

The goal of this analysis was to assess trends in the racial background of US medical school graduates, internal medicine residents, nephrology fellows, and patients with end-stage renal disease (ESRD). The Association of American Medical Colleges provided data on medical school graduates. Data for internal medicine and nephrology trainees were obtained from GME Track, and those for patients with ESRD were obtained from US Renal Data System annual reports.

Although 32% of patients with ESRD were black, only 3.8% of nephrology fellows were black, suggesting a significant disparity between the proportional race makeup. Considering the increase in patients with ESRD, the low numbers of black nephrology fellows — and therefore of new nephrologists in the near future — has important implications regarding patient-centered nephrology care.

Other findings were that only 6.5% to 7.1% of US medical school graduates, 5.5% of internal medicine residents, and 3.3% of kidney specialists practicing in academic medical centers were black.

"Efforts are needed to increase minority recruitment into nephrology training programs, to more closely balance the racial background of trainees and patients in hopes of fostering improved trust between ESRD caregivers and patients, increasing access to care, alleviating ESRD health care disparities, and improving patient care," the study authors write.

Limitations of this study include the inability to determine the effect of racial disparities on patient outcomes.

"Nephrology fellowship program directors should work closely with already existing diversity councils at their institutions or work toward the development of diversity councils to identify specific challenges to minority medical student, resident, and fellow recruitment and minority faculty development," the study authors conclude. "It is critical that minorities are recruited to stay in academics and are represented on medical school faculties and key institutional committees, particularly in specialties such as nephrology in which racial disparities exist between patients and physicians. Nephrology fellows should be encouraged and supported to enter academics as clinicians, educators, or researchers."

The study authors have disclosed no relevant financial relationships.

Clin J Am Soc Nephrol.

    
相關報導
乳房鈣化可能可以反映出腎臟病的心血管風險
2011/1/25 下午 03:21:00
新的臨床指標可以協助預測末期腎臟疾病患者的預後
2010/4/14 上午 11:16:00
疲倦評比分數可能預測透析患者的心臟血管事件
2010/3/11 上午 11:36:00

上一頁
   1   2   3  




回上一頁