Yelton Mitchell J, Jildeh Toufic R
Michigan State University College of Human Medicine, East Lansing, Michigan, U.S.A.
Department of Orthopaedics, Michigan State University, East Lansing, Michigan, U.S.A.
Arthrosc Sports Med Rehabil. 2023 May 23;5(4):100733. doi: 10.1016/j.asmr.2023.04.016. eCollection 2023 Aug.
Healthcare inequities exist across healthcare and have been shown to influence patient care and outcomes. In the field of orthopaedic surgery, healthcare disparities have been shown to manifest in the realms of postoperative pain management and rehabilitation. Previous literature has demonstrated that socioeconomic status, sex, gender, race, and ethnicity influence postoperative pain management and can precipitate a negative patient experience, manifesting as poorly managed pain and undertreatment of minorities and patients of lower socioeconomic status. A similar body of literature has revealed similar barriers in postoperative rehabilitation, particularly with regard to accessibility, language, rapport, and culture. These disparities impact patients, ranging from diminished surgical satisfaction to postoperative morbidity. As the United States becomes increasingly diverse, cultural competence plays a major role in combating these disparities. This article presents methods to promote cultural competence, including greater diversity in the medical field, a greater emphasis on cultural competency in education and training programs at all levels of healthcare, increased resources allocated to researching healthcare inequities, and more effective mechanisms of patient education.
医疗保健方面的不公平现象在整个医疗领域都存在,并且已被证明会影响患者护理及治疗结果。在整形外科领域,医疗保健差异已在术后疼痛管理和康复方面显现出来。以往文献表明,社会经济地位、性别、种族和族裔会影响术后疼痛管理,并可能导致患者体验不佳,表现为疼痛管理不善以及少数族裔和社会经济地位较低的患者治疗不足。类似的文献表明,术后康复也存在类似障碍,尤其是在可及性、语言、融洽关系和文化方面。这些差异会对患者产生影响,从手术满意度降低到术后发病。随着美国日益多元化,文化能力在消除这些差异方面发挥着重要作用。本文介绍了促进文化能力的方法,包括医疗领域增加多样性、在各级医疗保健的教育和培训项目中更加强调文化能力、增加用于研究医疗保健不公平现象的资源,以及更有效的患者教育机制。