Healthcare Providers. Healthcare providers, including primary care physicians, have an essential role to play in encouraging more Hispanic patients to be screened and treated for kidney disease and its risk factors. Physicians also have a responsibility to improve their referral of patients with kidney disease for appropriate treatment, such as dialysis, without delay.
In order to achieve the necessary improvements, healthcare providers need to become more culturally competent, providing care that will strengthen links with their Hispanic patients and improve the doctor-patient relationship. Physicians should become knowledgeable about Hispanic customs, beliefs, and language. They should incorporate cultural beliefs into the plans of care, bearing in mind that the Hispanic population is a heterogeneous group of several different cultures. It is important that physicians and other healthcare providers are aware that Hispanic patients may be skeptical about western medical practices and that they may come to the doctor only when their own traditional methods of treatment have failed.
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To offer assistance to physicians working with Hispanic populations, the National Hispanic Medical Association published its draft guidelines for the Hispanic Cultural Competence Curriculum Summer 2002. Evidence suggests that Hispanic and African-American physicians tend to care for minority group patients. Affirmative action policies aimed at increasing the number of physicians from minority groups could have a positive impact on the delivery of care to the Hispanic population.
Patients. Education programs and materials specifically targeted at Hispanics are urgently needed to raise awareness of kidney disease and its risk factors. Education for the Hispanic population needs to change people’s behavior with the aim of increasing the uptake of screening, treatment, and organ transplantation, as well as organ donation.
Such programs should complement other educational initiatives that already exist for the wider population. These initiatives include the National Kidney Foundation’s Early Education Program, which is a screening program that aims to identify populations at higher risk of kidney disease, and the Minority Organ and Tissue Transplant Education Program, which aims to encourage healthier lifestyles to prevent kidney disease and kidney failure and to increase organ donation among racial and ethnic minorities.
Effective public education should be carried out at national, community, and family levels and can be achieved through the use of patient involvement and responsibility, national and local spokespersons and role models, mass media (television, radio, newspapers, and magazines, especially in Spanish), and outreach groups.
Community education projects require the involvement of Hispanics in planning and implementing the education program and should take into account the characteristics of the local Hispanic community, as different Hispanic subgroups have their own customs and healthcare needs. At an individual and family level, education programs should take advantage of the potential support for treatment that the family may provide.
Policies. Education programs require the support of national and state initiatives that target resources for providing access to kidney disease prevention and care, thus eliminating racial and ethnic disparities. Policies that address the healthcare needs of the uninsured population are likely to benefit the Hispanic community.
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Successful policies will depend on better representation of minority groups on the panels making policy and financial decisions about healthcare. Organizations and community groups representing various racial sectors need to collaborate closely to coordinate efforts that address racial disparities. Further information is needed on the magnitude of and reasons for differences in access to and use of healthcare. Access to healthcare should be increased through the promotion of culturally and linguistically appropriate standards set forth by the U.S. Department of Health and Human Services.
Improvements in clinical research that could benefit Hispanic patients include greater representation of minority groups in clinical research trials, possibly through locating trials in centers that are geographically placed to favor the enrollment of minority groups. In the reporting of trials, more attention should be devoted to data specific to Hispanics and other minority patients participating in the trials, so that differences between groups can be identified. This will also help improve the design of the most appropriate trials in the future. In addition, training of more Hispanic researchers and improved funding of research are needed. kamagra soft tablets
Future trials need to include the assessment of community-based efforts to change outreach, enrollment, screening, and treatment patterns, along with estimates of the economic impact of inappropriate treatment of kidney disease in Hispanic groups. Compilation of data illustrating the impact of economic consequences, health outcomes, and quality-of-life issues on racial disparities in healthcare provisions may hasten policy changes that are needed to improve outcomes for such patient groups.
Ongoing studies are underway that may improve understanding of the molecular basis of kidney disease in Hispanics and other minority populations. The Family Investigation of Nephropathy and Diabetes study aims to identify genes that influence susceptibility to and severity of diabetic nephropathy in several U.S. racial populations, including Hispanics. The Prospective Cohort Study of Chronic Renal Insufficiency is designed to provide detailed information on risk factors for progression to ESRD and cardiovascular disease in patients with chronic kidney disease, particularly with respect to genetic, environmental, and healthcare factors. Patients from minority groups will be included in this study.