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Health care interventions that tackle health disparities

July 26, 2017

How can these disparities be reduced? A supplement to the October 2007 issue of Medical Care Research and Review, published by SAGE, thoroughly explores the effectiveness of health care interventions to answer that question.

The supplement features research from the Finding Answers: Disparities Research for Change initiative, which reviewed over 200 interventions to reduce racial and ethnic disparities in health care. The literature review provides health care organizations, providers and payers with promising intervention recommendations on how they can reduce racial and ethnic disparities in their own organizations in the areas of: cardiovascular disease, diabetes, depression, and breast cancer. The study also examined the effect of two specific approaches??cultural leverage, and pay-for-performance incentives.

???The authors in this supplement provide a cutting-edge, systematic summary of strategies to promote equitable health outcomes for communities of color,??? writes the supplement's editor, Dr. Jeroan Allison, professor of medicine at the University of Alabama at Birmingham ???This work serves as a tangible reminder that, although progress has been made, much remains to be done.???

???Policy makers should support proven interventions and funding agencies should invest in expanded and coordinated research to better clarify the causes and consequences of health disparities,??? he added. ???Interventions should be developed to promote equitable health outcomes for communities of color and researchers should address our understanding of how disparities operate, testing new interventions to move from understanding to change.???

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In the first Comment, Dr John Cleland and Dr Stephen Atkin, Department of Cardiology, Castle Hill Hospital, University of Hull, UK, say: ???All the meta-analyses fail to spot the elephant in the room. Treatments should be effective, rather than merely innocuous. Improved glycaemic control is not a surrogate for effective care of patients who have diabetes, which should be to reduce disability and increase lifespan??the regulatory authorities need greater emphasis on ensuring that drugs have effects that are clinically relevant, both in their actions and extent, without stifling innovation in an industry that is valuable to society.???

In the second Comment, Dr Victor Montori, Mayo Clinic of Medicine, MN, USA, and colleagues say drugs based on trials with surrogate outcomes represent a false economy despite saving money initially and allowing new drugs more rapid access to the market. They say: ???Any savings are quickly overwhelmed by expenses associated with potentially ineffective or even harmful (yet heavily advertised) expensive therapies??.patients and society may end up paying dearly for drugs that cause more harm than good.

???The medical community should insist that we invest the resources needed to do trials that ascertain the effect of interventions on patient-important outcomes.???

The linked Editorial says that future trials need to be designed with the issues pointed out by the commentators in mind. It concludes: ???Manufacturers must do - in a timely fashion - postmarketing studies that assess the long-term safety of their drugs, and regulatory agencies must hold manufacturers?? feet to the fire to ensure that these are performed, performed properly, and thoroughly evaluated and made available to guide decisions about prescribing??unless limitations on the understanding, analysis, and communication of drug safety issues are addressed, the TZDs will simply become the latest in a series of preventable drug disasters.???

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