Alicea-Alvarez Norma, Swanson-Biearman Brenda, Kelsen Steven G
Center for Bioethics, Urban Health and Policy, Temple University School of Medicine , Philadelphia, PA , USA .
J Asthma. 2014 Feb;51(1):97-105. doi: 10.3109/02770903.2013.845205. Epub 2013 Oct 17.
Among the Hispanic community, Puerto Ricans have the highest prevalence of asthma and manifest the worst outcomes. The expected growth of the Hispanic population in the USA in the next several decades make elimination of disparate care in Puerto Rican asthmatics a matter of national importance. The purpose of this review of the literature (ROL) is to examine a variety of health system, genetic and cultural barriers in the Puerto Rican community which have created disparities in asthma care and outcomes among adult and pediatric Hispanic populations. In addition, this ROL describes several culturally sensitive, community-based educational interventions which can be used as a framework for future projects to improved asthma outcomes.
Databases searched included Medline, PubMED, EBSCOhost, PsycINFO, CINAHL, Google Scholar and ERIC. Papers published in English from January 1990 to January 2012 were reviewed.
Health system policies, insurer compensation patterns, clinician attitudes and cultural values/folk remedies in the Puerto Rican community represent barriers to effective asthma management, the use of controller medication and the implementation of educational interventions. In addition, genetic factors involving the beta-2 adrenergic receptor gene, which impair the response to albuterol, appear to contribute to poorer outcomes in Puerto Rican asthmatics. In contrast, several comprehensive, community-based, culturally sensitive educational interventions such as Controlling Asthma in American Cities Project (CAACP), the Racial and Ethnic Approach to Community Health in the US Program and Healthy Hoops programs (REACH) have been described.
We believe that culturally sensitive community-based asthma education programs can serve as models for programs targeted toward Puerto Ricans to help decrease asthma morbidity. Moreover, greater sensitivity to Puerto Rican mores and folk remedies on the part of healthcare providers may improve the patient-clinician rapport and, hence, asthma outcomes. Finally, given ethnically based differences in pharmacogenomics, clinical trials targeting the Puerto Rican population may help to better define optimal asthma medication regimens in this ethnic group.
在西班牙裔社区中，波多黎各人的哮喘患病率最高，且病情表现最为严重。预计在未来几十年里，美国西班牙裔人口将会增长，因此消除波多黎各哮喘患者的医疗差异具有全国性的重要意义。这篇文献综述（ROL）的目的是研究波多黎各社区中各种健康系统、基因和文化方面的障碍，这些障碍导致了西班牙裔成人和儿童哮喘患者在医疗护理及治疗结果上存在差异。此外，这篇ROL还描述了几种具有文化敏感性的、基于社区的教育干预措施，这些措施可作为未来项目的框架，以改善哮喘治疗效果。
检索的数据库包括Medline、PubMED、EBSCOhost、PsycINFO、CINAHL、谷歌学术和教育资源信息中心（ERIC）。对1990年1月至2012年1月期间发表的英文论文进行了综述。
健康系统政策、保险公司的赔付模式、临床医生的态度以及波多黎各社区的文化价值观/民间疗法都是有效管理哮喘、使用控制药物以及实施教育干预的障碍。此外，涉及β-2肾上腺素能受体基因的遗传因素会削弱对沙丁胺醇的反应，这似乎导致波多黎各哮喘患者的治疗效果更差。相比之下，已经描述了几种全面的、基于社区的、具有文化敏感性的教育干预措施，如美国城市哮喘控制项目（CAACP）、美国社区健康的种族和民族方法项目以及健康篮球项目（REACH）。
我们认为，具有文化敏感性的基于社区的哮喘教育项目可以作为针对波多黎各人的项目的典范，以帮助降低哮喘发病率。此外，医疗保健提供者对波多黎各习俗和民间疗法有更高的敏感度，可能会改善医患关系，从而改善哮喘治疗效果。最后，鉴于药物基因组学存在种族差异，针对波多黎各人群的临床试验可能有助于更好地确定该种族群体的最佳哮喘药物治疗方案。
