Wednesday, March 11, 2009

Barriers to health care

We know what works in health care: prevention, early identification, efficient treatment.
We know how to prevent chronic diseases: stop smoking, eat well: a balance of food groups, exercise (FITT- flexibility, endurance, strength), relax, socialize, monitor your blood pressure, live well, and listen to your body.

The Canadian Institute for Health Information published a report: Reducing Gaps in Health: A Focus on Socio-Economic Status in Urban Canada. In it Low Socio-Economic Status (SES) is identified as a barrier to good health.

WHAT IS A BARRIER?

Within the Ontarians with Disabilities Act (ODA), a barrier is defined as “anything that prevents a person with a disability from fully participating in all aspects of society because of his or her disability, including a physical barrier, an architectural barrier, information or communications barrier, an attitudinal barrier, a technological barrier, a policy or a practice” (ODA, 2001).

Barriers to access can also include:
  • family issues - dysfunctional families
  • communication deficiencies or disorders: language barriers, auditory, visual, cognitive disorders
  • denial
  • bias or prejudice - i.e., inaccurate statistics: women die of stroke and heart disease
  • fears - of diagnosis or treatment
  • patients who do not speak English
  • poor or ineffective treatment plans
  • cognitive disorders - delirium, dementia,
  • mental health issues
  • mistakes in diagnosis
  • attitudes: i.e., discrimination, being treated as incompetent, expressive or receptive language disorders
  • Primary Care workers who speak down to patients, or use acronyms, or complicated language
  • wait times
  • lack of staffing
  • crowded hospitals
A recent Oprah show, with guest Dr. Oz, spoke about the issues in American hospitals.
They quoted a figure of 40% of patients who stated they experienced mistakes in surgery, diagnosis, discharge plans or home care interventions.
For this reason they suggest several steps, some of which I have already mentioned, and some that do not apply to Canadian hospitals, to avoid medical mistakes.
  1. Prevent infection - see my post on Superbugs.
  2. Invite family or friends to come with you as an advocate, especially if you are a senior.
  3. Take notes while speaking with physicians.
  4. Keep a medical journal.
  5. Get all the information you can.
  6. Ask for copies of tests results or numbers, i.e., ask for your blood pressure reading each time it is taken.
  7. Be honest with your physician. They need accurate information for an accurate diagnosis.
  8. If you sense that something isn't right, get a 2nd opinion.
  9. Take a list of your prescriptions into the physician.
  10. Ask health care professionals if they have washed their hands (hand sanitizer isn't good enough!) and/or cleaned their stethoscopes.
  11. Seek a treatment plan that suits you, not the surgeon or oncologist.
  12. Ask about contraindications of medications, side effects, length of treatment, and other options. (Your pharmacist is a valuable person to speak to.)
  13. Know which medications you are supposed to take and the dosage.
  14. Avoid wrong-site surgery: label the site, as well as the 'do not cut' site.
  15. Do not chitchat before surgery - to allow health workers to stay on-task.
These guidelines are especially important for caregivers, as well as parents.

Resources
  1. Accessibility for Ontarians with disabilities Act, The Legislative Library Office of the Legislative
  2. Assembly of Ontario, S.O. 2005, c.11 Cong. Rec.(2004).
  3. Act to promote patients' rights and to increase accountability in Ontario's health care system, 181999 Cong. Rec.(2006).
  4. Health Care Consent Act, Ministry of Health and Long Term Care(1996).
  5. Substitute Decisions Act, Ministry of the Attorney General, 0-7794-2147-7 Cong. Rec.(1996).

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