背景:随着世界卫生组织于2022年5月一致批准关于癫痫和其他神经系统疾病的部门间全球行动计划,迫切需要努力实现公平的神经系统护理。
目的:使用癫痫作为其他神经系统疾病的切入点,我们讨论了包括种族/族裔少数群体在内的边缘化群体面临的差距,生活在农村社区的美国人,和社会经济地位低的美国人。
方法:国家少数民族健康差异研究框架研究所(NIMHD)用于通过健康公平视角进行叙述性审查,以创建一个适应癫痫的框架,并提出实现公平癫痫和神经系统护理的方法。
结果:在这篇叙述性综述中,我们确定了优先人群(种族和少数民族,农村居民,和低社会经济地位的癫痫患者)和结果(看神经科医生的可能性,被开处方抗癫痫药物,接受癫痫手术,并住院)以探索癫痫的差异,并指导我们使用PubMed进行重点文献检索。在改编的NIMHD框架中,我们检查了个人,人际关系,社区,和社会层面的贡献者在五个领域的健康差异:(1)行为,(2)物理/建筑环境,(3)社会文化,(4)环境,(5)医疗系统。我们采取健康公平的方法,提出针对影响差距的可改变因素的倡议,并倡导优先人群的可持续变革。
结论:为了提高公平性,医疗保健提供者和相关的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,对提供者来说,病人,和社区)。更广泛地说,利益相关者可以倡导医学教育改革,在美国健康保险领域。
结论:公平医疗应该是神经系统护理的优先事项。
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.