Following the people and events that make up the research community at Duke

Tag: health

What are Healthcare Researchers Doing to Address Health Equity?

“Community engagement” and “health disparities” are some of the most trending terms in healthcare right now, but what are people actually doing about them? On Wednesday, February 2, panelists in healthcare sat down as part of Duke’s Research Week to talk about ways in which they and their organizations were actively addressing health disparities by focusing on communities. (View the session)

Dr. L. Ebony Boulware, professor at the Duke University School of Medicine and director of the Duke Clinical and Translational Science Institute, set the stage by defining health equity for the vast number of us that might only have read about it in a mission statement or an article but weren’t exactly sure how it was conceptualized. To work towards health equity, she said, means that “everyone has an opportunity to attain their full health potential regardless of any socially defined circumstance.” These circumstances could range from poverty to structural racism, but the main theme was that community engagement is a key player as we think about how best to achieve equity.

Slide taken from Dr. L. Ebony Boulware’s presentation.

COVID-19 is a great example of why health equity matters, as we ponder whether the pandemic could have turned out any different if more people had access to vaccines, personal protective equipment, and the capacity to socially distance. Dr. Michael Cohen-Wolkowiez, a professor of Pediatrics at the Duke University School of Medicine, and Dr. Giselle Corbie-Smith, a professor at the UNC School of Medicine gave a pertinent example of their work addressing the health disparity on our minds right now– access to COVID-19 testing – and the RADx program out of the NIH that is funding work to address this problem.

But even before COVID-19, attaining health equity was a tough goal to address for virtually every country in the world. Health equity isn’t just a nicety, it affects how long we are alive. And while progress in terms of life expectancy differences is improving, much work remains to be done to close the myriad gaps that remain. Dr. Tyson Brown, associate professor of Sociology at Duke, highlighted his research into structural racism to stress the fact that structural racism is toxic for population health and disproportionately affects people of color.

Slide taken from Dr. Tyson Brown’s presentation.

Dr. Schenita Davis Randolph, a registered nurse and professor at the Duke School of Nursing, zoomed in a little to highlight what true community engagement looks like. As part of her lab’s research to improve uptake of pre-exposure prophylaxis (PrEP) treatment to address HIV in Black women, they designed an intervention for beauty salons, known to be trusted venues for health promotion in the Black female community. But “how do we use community engagement so it’s not just a checkmark?” This, among other pressing challenges to community engagement in addressing health disparities, is what Dr. Keisha Bentley-Edwards, developmental psychologist and professor at the Duke University School of Medicine, talked about.

As the panel discussion came to a close, a key message emerged. As Dr. Davis remarked, both disparities and the communities that are hurt by them are complex, and so until we take a multi-faceted approach to understanding them, we continue to grasp for the ultimate goal of health equity.

But while these disparities are complex, they are certainly not unsolvable. Dr. Corbie-Smith emphasized that “we have a clear understanding of of how health disparities work.” All that’s left to do is solve them, and Dr. Bentley-Edwards highlights this move from awareness to solutions as a challenge to achieving health equity. Perhaps most significantly, though, it’s important to move from inertia to action. While there are seemingly thousands of ways in which communities in the U.S and around the world face barriers to health access, it’s important to do something – however small. As Dr. Bentley-Edwards concluded, by everyone working within their sphere of influence to close the health equity gap, that sphere becomes bigger and bigger and the gap becomes smaller and smaller.   

Integrating Pediatric Care in NC: Behavioral Health Perspectives

In healthcare, developing a new treatment is often half of the battle. The other half lies in delivering these treatments to those communities who need them the most. Coordinating care delivery is the goal of NC Integrated Care for Kids (InCK), an integrated pediatric service delivery and payment platform looking to serve 100,000 kids within five counties — Alamance, Orange, Durham, Granville, and Vance — in central North Carolina. The project is a collaborative effort between Duke, UNC, and the NC Department of Health and Human Services (DHHS) funded by a federal grant from the Centers for Medicare and Medicaid Services (CMS). The program’s executive director is Dr. Charlene Wong (MD, MSPH), a Duke researcher, physician, and professor who leads an interdisciplinary team of researchers and policy experts as they explore ways to reduce costs via integrating care for North Carolina youth enrolled in Medicaid and Children’s Health Insurance Program (CHIP).

The five counties that are part of NC InCK

I recently had the opportunity to speak with two of InCK’s service partners: Dr. Gary Maslow (MD, MPH) and Chris Lea (Duke ’18). Both work within the Behavioral Health group of InCK, which seeks to use behavioral health expertise through collaborative care and training providers to help support pediatric care. Maslow, a professor at the Duke Medical School, has focused heavily on child and developmental psychiatry throughout his career. Having entered medical school with a desire to work in pediatric hematology, Maslow recalls how a conversation with a mentor steered him in the direction of behavioral health. At the time, Maslow was part of the Rural Health Scholars program at Dartmouth College; while discussing his aspirations, one of his professors asked him to consider conditions outside of cancer, leading Maslow to consider chronic illness and eventually child psychiatry. “Kids have other problems,” Maslow’s professor told him.

Dr. Gary Maslow (MD, MPH)
Chris Lea (Duke ’18)

When looking at healthcare networks, especially those in rural areas in North Carolina, Maslow noticed a disaggregated service and payment network where primary care providers were not getting the necessary education to support the behavioral health needs of children. His work with Lea, a third-year medical student at Duke, has centered around looking at Medicaid data to understand provider distribution, medication prescription, and access to therapy based one’s area of residence. Lea’s path to NC InCK began as an undergraduate at Duke, where he obtained a B.S. in psychology in 2018. As he explains, mental health has been a vested interest of his for years, a passion reinforced by coursework, research at the Durham VA Medical Center, and NC InCK. He discussed the important of appropriate crisis response, specifically how to prepare families and providers in the event of pediatric behavioral health crises such as aggression or suicidality, as critical in improving behavioral health integration. These safety plans are critical both before a potential crisis and after an actual crisis occurs.

Two main goals of Maslow and Lea’s work are to increase the implementation of safety plans for at-risk youth and expand follow-up frequency in primary care settings. The focus on primary care physicians is especially critical considering the severe shortage of mental health professionals around North Carolina.

The behavioral health group is but one subset of the larger NC InCK framework. The team is led by Chelsea Swanson (MPH). Other collaborators include Dr. Richard Chung (MD), Dan Kimberg, and Ashley Saunders. NC InCK is currently in a two-year planning period, with the program’s launch date slated for 2022.

Services provided by NC InCK

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