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Biomedical subjects

George Rust

Publications and source records attributed to George Rust.

At least 19 recordsLinked to original sources
PubMed2006

A three-dimensional approach to the elimination of racial-ethnic disparities in lung health.

Significant racial, ethnic, and socioeconomic health disparities have been documented in asthma, lung cancer, sarcoidosis, vaccine-preventable pneumonias, tuberculosis, and HIV-related pulmonary infections. Given the complex causation of health disparities,and their resistance to simple interventions, the authors propose a three-dimensional approach for eliminating racial and ethnic health disparities in America. The three dimensions include surveillance and monitoring, research into causes and potential cures, and rapid-cycle testing of interventions to reduce or eliminate disparities.

Clinical Trials as Topic↗
PubMed2006

Trends in Mental Health and Substance Abuse Services at the Nation's Community Health Centers: 1998-2003.

OBJECTIVE: We examined trends in delivery of mental health and substance abuse services at the nation's community health centers. METHODS: Analyses used data from the Health Resources and Services Administration (HRSA), Bureau of Primary Care's (BPHC) 1998 and 2003 Uniform Data System, merged with county-level data. RESULTS: Between 1998 and 2003, the number of patients diagnosed with a mental health/substance abuse disorder in community health centers increased from 210,000 to 800,000. There was an increase in the number of patients per specialty mental health/substance abuse treatment provider and a decline in the mean number of patient visits, from 7.3 visits per patient to 3.5 by 2003. Although most community health centers had some on-site mental health/substance abuse services, centers without on-site services were more likely to be located in counties with fewer mental health/substance abuse clinicians, psychiatric emergency rooms, and inpatient hospitals. CONCLUSIONS: Community health centers are playing an increasingly central role in providing mental health/substance abuse treatment services in the United States. It is critical both to ensure that these centers have adequate resources for providing mental health/substance abuse care and that they develop effective linkages with mental health/substance abuse clinicians in the communities they serve.

Adolescent↗
PubMed2006

The Morehouse Faculty Development Program: evolving methods and 10-year outcomes.

BACKGROUND AND OBJECTIVES: African American physicians remain underrepresented among all medical school faculty, including faculty in departments of family medicine. This paper reports on a faculty development effort aimed at increasing the number and academic skills of underrepresented minority faculty. METHODS: In 1992, Morehouse School of Medicine began a faculty development program. The program trains faculty and community-based preceptors in teaching, scientific writing, grant writing, research, and minority career issues. Formats now include a 1-year longitudinal program, 4-6-week stand-alone modules, and an executive faculty development program for physicians from across the nation. Evaluation measures include participant enrollment, completion rate, participant feedback, and self-reported academic competencies before and after the program. RESULTS: A total of 113 participants completed the program from 1992-2003. Only seven enrollees failed to complete the program. Of 113 graduates, 104 (92.0%) were ethnically African American, Afro Caribbean, or African, while only two were white, non-Hispanic. More than four out of five (81%) now spend at least some time teaching on a regular basis, and 71% spend more than 25% time in teaching roles. Self-reported before-after competencies in specific academic skills such as teaching, writing, research, and grant writing rose from 2.7 to 4.1 on a 5-point scale. CONCLUSIONS: Faculty development is a potentially effective strategy for increasing diversity in academic primary care. Historically black and Hispanicserving institutions can make contributions to training minority faculty. More-rigorous study could elucidate which program elements have the greatest effect on minority faculty academic career choice, scholarly productivity, and career trajectory and the extent to which these programs could be adapted to majority institutions.

Adult↗
PubMed2006

Achieving health equity in America.

Health disparities are both real and deadly, but disparities are not inevitable. The causes of health disparities are complex, and their elimination will require multi-dimensional interventions. We have developed a three-dimensional model for the elimination of health disparities. The foundation of public health is surveillance, which is the first dimension. We must continually measure racial-ethnic disparities in each specific disease, in its risk factors, and in outcome-relevant quality of care. The second dimension is research into the causes of disparities and potential intervention points to eliminate disparities. These causes and potential intervention points can be in the individual's biology or their behavior, or in their physical and social environment, or in the healthcare arena (quality and access). The third dimension is intervention, which requires moving from what we know to what we do. Translation must not only take knowledge from the bedside, but to the curbside and the countryside, into each community and into each home. We can achieve health equity in America, but first, we all must care enough, know enough, do enough, and persist long enough.

Cultural Characteristics↗
PubMed2006

A crash-course in cultural competence.

America is a multi-cultural society. Yet, there are cultural dimensions to the clinician-patient relationship that have not been systematically addressed in medical education or in clinical practice. Lack of diversity and lack of cross-cultural skills in the medical profession may contribute to health disparities in America. Cultural competence for the medical profession represents a core set of skills that can be learned to respectfully and effectively communicate healthcare information with diverse patient populations. The authors blended their extensive literature review with the knowledge and experience of a culturally diverse medical team to develop the CRASH-Course in Cultural Competency training program for medical professionals. CRASH is a mnemonic for the following essential components of culturally competent health care--consider Culture, show Respect, Assess/Affirm differences, show Sensitivity and Self-awareness, and do it all with Humility. The goal of the CRASH-Course in Cultural Competency is to build confidence and competence in the clinician's ability to communicate effectively with diverse patient populations.

Clinical Competence↗
PubMed2005

Being uninsured: impact on children's healthcare and health.

PURPOSE OF REVIEW: There are 8.4 million uninsured children in the United States. Many are eligible for coverage. Current literature on how lack of health insurance affects the quality and outcome of children's healthcare in the United States is reviewed, and effective solutions are identified. Recent policy changes have produced restrictions on basic preventive and curative services, despite concurrent major efforts to increase insurance coverage rates for children. RECENT FINDINGS: With more than 70% of currently uninsured children eligible for either Medicaid or the State Children's Health Insurance Program, these public programs have not yet produced expected levels of coverage. Health systems and provider accountability for the primary care of uninsured children is not optimal. Families of uninsured children face non-financial access barriers to care such as lack of continuity with a primary care provider and inadequate visit time. These barriers are compounded for uninsured children with special healthcare needs. SUMMARY: Pediatric primary care effectiveness is significantly reduced by insurance shortfalls. Lack of coverage inhibits appropriate care seeking; diminishes provider availability; compromises care content, quality, and satisfaction; and ultimately harms the entire family unit. However, provision of insurance alone is not a panacea.

Child↗
PubMed2005

Disparities in antidepressant treatment in Medicaid elderly diagnosed with depression.

OBJECTIVES: To determine whether there were racial or ethnic disparities in the use of antidepressants in low-income elderly patients insured by Medicaid. DESIGN: Examination of 1998 Medicaid claims data. SETTING: Centers for Medicare and Medicaid Services Medicaid claims data for five U.S. states. PARTICIPANTS: All Medicaid recipients aged 65 to 84 with a diagnosis of depression. MEASUREMENTS: Treatment versus no treatment; in those treated, treatment with drugs was classified as old- or new-generation antidepressants. RESULTS: In 1998, 7,339 unique individuals aged 65 to 84 had at least one outpatient encounter with depression as the primary diagnosis. Nearly one in four (24.2%) received no antidepressant drug therapy, and 22% received neither psychotherapy nor an antidepressant. African-American individuals were substantially more likely to be untreated (37.1%) than Hispanic (23.6%), white (22.4%), or Asian (13.8%) individuals. In logistic regression models adjusting for sex, state, long-term care status, and age group, African Americans with a primary diagnosis of depression were almost twice as likely as whites not to receive an antidepressant within the study period (odds ratio=1.91, 95% confidence interval=1.62-2.24). Patients in long-term care facilities and those aged 65 to 74 were less likely to receive treatment. CONCLUSION: Substantial numbers of elderly Medicaid enrollees with a primary diagnosis of depression did not receive antidepressants or behavioral therapy. This gap in care disproportionately affected African-American patients.

Aged↗
PubMed2005

Improving health, eliminating disparities: finding solutions for better health care for all populations.

The Fourth Annual Primary Care and Prevention Conference was held October 25-27, 2004 in Atlanta, Georgia to address inequalities in primary care health outcomes and to develop strategies to improve the health status among under-served communities throughout the country. The Ninth Annual HeLa Women's Health Conference was conducted concurrently during the conference's Tuesday, October 26 sessions and were designed for those in obstetrics/gynecology. The reports herein provide a sample of the rich presentations and scientific knowledge imparted by a faculty of more than 100 who addressed disparities across disease states (heart disease and stroke; cancer; diabetes, chronic kidney disease, and obesity; infectious disease; mental health and mental disorders; environmental health/injury and violence; respiratory diseases; and substance abuse, tobacco use) and within focused areas (adult health; maternal, child and adolescent health; health policy and practice; and social and community health).

Community Health Planning↗
PubMed2005

Re-engineering the primary care practice to eliminate adult immunization disparities.

Traditional "one-patient-at-a-time," doctor-centered primary care practice models do not achieve optimal immunization rates for pneumonia and influenza, in part because of time pressures and competing demands from a burgeoning list of clinical guidelines. Some widely used quality improvement methods (physician education, provider feedback, academic detailing, etc.) have only a modest and short-lived impact on improving immunization rates. Evidence is mounting that practices can substantially improve immunization rates by changing practice systems and processes with standing orders and algorithms, expanded nurse decision-making, patient education and incentives, and partnerships with community-based pharmacies. Quality-focused, constantly-learning practices that cultivate a culture of excellence will be most effective in adopting such changes.

Adult↗
PubMed2004

Racial and ethnic disparities in the provision of epidural analgesia to Georgia Medicaid beneficiaries during labor and delivery.

OBJECTIVE: The purpose of this study was to measure racial and ethnic differences in the proportion of Medicaid patients who receive epidural analgesia during labor and delivery. STUDY DESIGN: Using 1998 Georgia Medicaid claims data in a standard State Medicaid Research File format, we identified claims for epidural analgesia among all women who had a normal vaginal delivery during 1998. RESULTS: There were 29,833 women who met our inclusion criteria, of whom 15,936 (53.4%) had epidural analgesia. Epidural analgesia rates were lower for black women (49.5%), Hispanic women (35.3%), and Asian women (48.1%) than for white, non-Hispanic women (59.6%; P<.001). Rural women had lower epidural rates (39.2%) than urban women (62.1%). CONCLUSION: The study subjects all had identical Medicaid insurance and met the same low-income Medicaid eligibility criteria, yet race/ethnicity was still a significant predictor of epidural analgesia after we had controlled for age, rural-urban residence, and availability of anesthesiologists. Further studies are needed to assess perceived benefits, risks, costs, and obstacles to epidural analgesia that are perceived by patients, physicians, nurses, and midwives.

Adolescent↗
PubMed2004

The health impact of resolving racial disparities: an analysis of US mortality data.

The US health system spends far more on the "technology" of care (e.g., drugs, devices) than on achieving equity in its delivery. For 1991 to 2000, we contrasted the number of lives saved by medical advances with the number of deaths attributable to excess mortality among African Americans. Medical advances averted 176,633 deaths, but equalizing the mortality rates of Whites and African Americans would have averted 886,202 deaths. Achieving equity may do more for health than perfecting the technology of care.

Black or African American↗
PubMed2004

Modifiable determinants of healthcare utilization within the African-American population.

BACKGROUND: Significant health disparities directly affect the African-American population. Most previous studies of disparities in access to and utilization of healthcare have focused on black-white differences rather than focusing on "within-group" analysis of African Americans. OBJECTIVE: To tease out the differential effects of modifiable risk factors (such as health insurance, usual source of care, and poverty) from personal characteristics (age, gender, rural residence) on healthcare utilization within the African-American population. METHODS: Secondary data analysis of 3462 records from African-American respondents to the 1999 Medical Expenditure Panel Survey (MEPS) Household File, a nationally representative survey of the civilian, noninstitutionalized U.S. population in 1999. RESULTS: We found significant variation in the number of office visits, outpatient clinic visits, hospital discharges, days hospitalized, and fills of prescribed medication among 3462 African-American respondents who represent a U.S. population of 36,538,639 persons. Personal nonmodifiable characteristics such as age and gender were significantly related to healthcare utilization. Poverty and rural residence were also significantly correlated, but the strongest modifiable predictors of healthcare utilization for Afrcan-American persons in 1999 were whether or not individuals had health insurance and/or a usual source of care. Emergency department visits were the only form of care that showed remarkably little variation based on these modifiable risk factors. CONCLUSIONS: The three modifiable factors of poverty, uninsurance, and having a primary care medical home have a dramatic effect on patterns of care for African-American patients and could be independently targeted for intervention.

Adolescent↗
PubMed2003

Do clinicians screen Medicaid patients for syphilis or HIV when they diagnose other sexually transmitted diseases?

BACKGROUND: Patients diagnosed with gonorrhea or chlamydia are at high risk for HIV and syphilis, and should be offered screening for both. GOAL: This study measures HIV and syphilis screening rates among Medicaid patients diagnosed with another sexually transmitted disease (STD). STUDY DESIGN: Using 1998 Medicaid claims data from 4 states, we identified individuals diagnosed with gonorrhea, urogenital chlamydia, or pelvic inflammatory disease, and then measured the proportion receiving screening tests for HIV and syphilis. RESULTS: Only 25% of STD-diagnosed Medicaid patients received screening tests for syphilis and only 15% for HIV. We found significant state-to-state variability in screening rates. CONCLUSION: Medicaid patients diagnosed with a nonbloodborne STD represent a high-risk group that is not adequately screened for syphilis and HIV despite repeated contact with medical professionals. Interventions should focus on eliminating missed opportunities for screening these high-risk individuals.

Adolescent↗
PubMed2003

The Second Annual Primary Care Conference--Programming to eliminate health disparities among ethnic minority populations: an introduction to proceedings.

From October 31, 2002 through November 2, 2002, the Second Annual Primary Care Conference was held, sponsored by the Morehouse School of Medicine's National Center for Primary Care and its Prevention Research Center. The conference was designed as a collaborative activity with the Atlanta Regional Health Forum; The Carter Center; Emory University's School of Medicine, Nell Hodgson Woodruff School of Nursing, and Rollins School of Public Health; Georgia Chapter of the American College of Physicians/American Society of Internal Medicine; Georgia Nurses Foundation; Southeastern Primary Care Consortium, Inc./Atlanta Area Health Education Center; St. Joseph's Mercy Care Services; United States Department of Health and Human Services: Agency for Healthcare Research and Quality; Centers for Disease Control and Prevention; Health and Human Services (Region IV); Health Resources and Services Administration; Office of Minority Health (Region IV); and Office on Women's Health (Region IV). The 2 and a half-day conference featured 5 plenary sessions and 3 tracks of medical education for primary care physicians and other healthcare providers. The tracks were categorized as: Track A: Adult Health; Track B: Public Health and Prevention; and Track C: Maternal/Child/Youth Health. Within each track, 6 working sessions were presented on topic areas including diabetes, obesity, cardiovascular disease, cancer, mental health, infectious disease, behavioral and social health, women's health, stroke, and asthma. A total of 18 working sessions took place and each working session included 3 presentations. Continuing medical education credits or continuing education units were granted to participants. In all, 485 individuals participated in the conference, with the majority of the participants from the southeastern United States. Of the attendees, 35% were physicians (MD); 13% were nurses (RN); 12% held master-level degrees; and 12% held other doctorate-level degrees.

Ethnicity↗
PubMed2002

Recurrent ischemia in a young man with the antiphospholipid syndrome.

Recurrent thromboses, cerebral disease, miscarriages, and antiphospholipid antibodies are characteristic of the antiphospholipid syndrome. A 31-year-old man presented with limb ischemic and isolated right ventricular failure. Antiphospholipid syndrome was suspected and limb salvage was accomplished by anticoagulation and tibial- to-plantar artery bypass surgery. However, recurrent ischemic episodes were successfully treated with thrombolytic therapy and anticoagulants. The surgeon should be aware that patients with antiphospholipid antibodies and lupus anticoagulant antibodies have a high propensity for recurrent arterial thromboses and should use multiple therapeutic approaches to effect successful long-term limb salvage.

Adult↗
PubMedDate not supplied

Metachronous thromboses and myocardial infarctions in a 32-year-old woman with antiphospholipid antibodies.

Metachronous thromboses in multiple vascular beds in a patient younger than 40 years is often suggestive of an acquired or congenital thrombophilic disorder. We present the case of a 32-year-old African American woman who presented to the emergency room with a painful right neck mass and a right hemispheric transient ischemic attack. She had 2 prior admissions for recurrent myocardial infarctions, hypertensive crises, congestive heart failure, and a left ventricular thrombus. Her warfarin therapy expired 2 weeks before her current admission. Our expanded evaluation for thrombophilia revealed high antiphospholipid antibody levels. High-dose anticoagulants were administered without further recurrence or complications. The antiphospholipid antibody syndrome should be considered early in the differential diagnosis as an important cause of recurrent, unusual, or unexplained thromboses in young patients. Education and patient compliance are vital to successful long-term medical management.

Adult↗