Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Population, Health Science and Policy and Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Epilepsia. 2023 Nov;64(11):2878-2890. doi: 10.1111/epi.17728. Epub 2023 Sep 19.
With the unanimous approval of the Intersectoral Global Action Plan on epilepsy and other neurological disorders by the World Health Organization in May 2022, there are strong imperatives to work towards equitable neurological care.
Using epilepsy as an entry point to other neurologic conditions, we discuss disparities faced by marginalized groups including racial/ethnic minorities, Americans living in rural communities, and Americans with low socioeconomic status.
The National Institute on Minority Health Disparities Research Framework (NIMHD) was used to conduct a narrative review through a health equity lens to create an adapted framework for epilepsy and propose approaches to working towards equitable epilepsy and neurological care.
In this narrative review, we identified priority populations (racial and ethnic minority, rural-residing, and low socioeconomic status persons with epilepsy) and outcomes (likelihood to see a neurologist, be prescribed antiseizure medications, undergo epilepsy surgery, and be hospitalized) to explore disparities in epilepsy and guide our focused literature search using PubMed. In an adapted NIMHD framework, we examined individual, interpersonal, community, and societal level contributors to health disparities across five domains: (1) behavioral, (2) physical/built environment, (3) sociocultural, (4) environment, and (5) healthcare system. We take a health equity approach to propose initiatives that target modifiable factors that impact disparities and advocate for sustainable change for priority populations.
To improve equity, healthcare providers and relevant societal stakeholders can advocate for improved care coordination, referrals for epilepsy surgery, access to care, health informatics interventions, and education (i.e., to providers, patients, and communities). More broadly, stakeholders can advocate for reforms in medical education, and in the American health insurance landscape.
Equitable healthcare should be a priority in neurological care.
2022 年 5 月，世界卫生组织一致通过了《癫痫和其他神经系统疾病部门间全球行动计划》，这有力地推动了公平的神经科护理工作。
我们以癫痫为切入点，探讨了边缘化群体（包括少数族裔、居住在农村社区的美国人以及社会经济地位较低的美国人）所面临的差异。
我们使用国家少数民族健康差异研究所研究框架（NIMHD）通过卫生公平视角进行叙述性综述，创建了一个适合癫痫的适应框架，并提出了实现公平的癫痫和神经科护理的方法。
在这项叙述性综述中，我们确定了重点人群（患有癫痫的少数族裔、农村居民和社会经济地位较低的人群）和结果（看神经科医生、开抗癫痫药物、接受癫痫手术和住院的可能性），以探讨癫痫和神经科护理中的差异，并指导我们使用 PubMed 进行重点文献搜索。在一个适应的 NIMHD 框架中，我们研究了五个领域中影响健康差异的个体、人际、社区和社会层面的因素：（1）行为，（2）物理/建筑环境，（3）社会文化，（4）环境和（5）医疗保健系统。我们采取卫生公平方法，提出针对影响差异的可改变因素的倡议，并倡导为重点人群实现可持续的改变。
为了改善公平性，医疗保健提供者和相关社会利益相关者可以倡导改善护理协调、癫痫手术转诊、获得护理、健康信息学干预和教育（即向提供者、患者和社区）。更广泛地说，利益相关者可以倡导医学教育和美国医疗保险格局的改革。
公平的医疗保健应该是神经科护理的重点。
