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      Disparities in Health Care and the Digital Divide

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          Abstract

          Purpose of Review

          Disparities in health outcomes are a well documented and worrisome part of our health care system. These disparities persist in spite of, and are occasionally exacerbated by, new technologies that are intended to improve health care. This results in a “digital divide” in which populations that have poorer health outcomes continue to have poorer health outcomes despite technological improvements.

          Recent Findings

          In many ways, the digitical divide is already shrinking via improved access to internet and technology/process improvements. For example, people with schizophrenia, PTSD, and bipolar disorder have had their care successfully augmented by new technology. However, problems persist- being impoverished, female, and black all correlate with decreased probability of completing a telehealth visit, and millions of americans have insufficient internet access to complete telehealth visits.

          Summary

          We must continue to utilize new technology in health care to improve outcomes, but we must also be wary to ensure those outcomes are equitable across different populations.

          Related collections

          Most cited references15

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          Systematic review: impact of health information technology on quality, efficiency, and costs of medical care.

          Experts consider health information technology key to improving efficiency and quality of health care. To systematically review evidence on the effect of health information technology on quality, efficiency, and costs of health care. The authors systematically searched the English-language literature indexed in MEDLINE (1995 to January 2004), the Cochrane Central Register of Controlled Trials, the Cochrane Database of Abstracts of Reviews of Effects, and the Periodical Abstracts Database. We also added studies identified by experts up to April 2005. Descriptive and comparative studies and systematic reviews of health information technology. Two reviewers independently extracted information on system capabilities, design, effects on quality, system acquisition, implementation context, and costs. 257 studies met the inclusion criteria. Most studies addressed decision support systems or electronic health records. Approximately 25% of the studies were from 4 academic institutions that implemented internally developed systems; only 9 studies evaluated multifunctional, commercially developed systems. Three major benefits on quality were demonstrated: increased adherence to guideline-based care, enhanced surveillance and monitoring, and decreased medication errors. The primary domain of improvement was preventive health. The major efficiency benefit shown was decreased utilization of care. Data on another efficiency measure, time utilization, were mixed. Empirical cost data were limited. Available quantitative research was limited and was done by a small number of institutions. Systems were heterogeneous and sometimes incompletely described. Available financial and contextual data were limited. Four benchmark institutions have demonstrated the efficacy of health information technologies in improving quality and efficiency. Whether and how other institutions can achieve similar benefits, and at what costs, are unclear.
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            Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis.

            We conducted a systematic review and meta-analysis, the first to our knowledge, summarizing and quantifying the published evidence on associations between type 2 diabetes incidence and socio-economic position (SEP) (measured by educational level, occupation and income) worldwide and when sub-divided into high-, middle- and low-income countries. Relevant case-control and cohort studies published between 1966 and January 2010 were searched in PubMed and EMBASE using the keywords: diabetes vs educational level, occupation or income. All identified citations were screened by one author, and two authors independently evaluated and extracted data from relevant publications. Risk estimates from individual studies were pooled using random-effects models quantifying the associations. Out of 5120 citations, 23 studies, including 41 measures of association, were found to be relevant. Compared with high educational level, occupation and income, low levels of these determinants were associated with an overall increased risk of type 2 diabetes; [relative risk (RR) = 1.41, 95% confidence interval (CI): 1.28-1.51], (RR = 1.31, 95% CI: 1.09-1.57) and (RR = 1.40, 95% CI: 1.04-1.88), respectively. The increased risks were independent of the income levels of countries, although based on limited data in middle- and low-income countries. The risk of getting type 2 diabetes was associated with low SEP in high-, middle- and low-income countries and overall. The strength of the associations was consistent in high-income countries, whereas there is a strong need for further investigation in middle- and low-income countries.
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              Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care.

              Socioeconomic and racial/ethnic disparities in health care quality have been extensively documented. Recently, the elimination of disparities in health care has become the focus of a national initiative. Yet, there is little effort to monitor and address disparities in health care through organizational quality improvement. After reviewing literature on disparities in health care, we discuss the limitations in existing quality assessment for identifying and addressing these disparities. We propose 5 principles to address these disparities through modifications in quality performance measures: disparities represent a significant quality problem; current data collection efforts are inadequate to identify and address disparities; clinical performance measures should be stratified by race/ethnicity and socioeconomic position for public reporting; population-wide monitoring should incorporate adjustment for race/ethnicity and socioeconomic position; and strategies to adjust payment for race/ethnicity and socioeconomic position should be considered to reflect the known effects of both on morbidity. JAMA. 2000;283:2579-2584
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                Author and article information

                Contributors
                saeeds@ecu.edu
                mastersr18@students.ecu.edu
                Journal
                Curr Psychiatry Rep
                Curr Psychiatry Rep
                Current Psychiatry Reports
                Springer US (New York )
                1523-3812
                1535-1645
                23 July 2021
                2021
                : 23
                : 9
                : 61
                Affiliations
                [1 ]GRID grid.255364.3, ISNI 0000 0001 2191 0423, Department of Psychiatry and Behavioral Medicine, , East Carolina University Brody School of Medicine, ; 4E-100 Brody Building, Greenville, NC 27834 United States
                [2 ]GRID grid.255364.3, ISNI 0000 0001 2191 0423, East Carolina University Brody School of Medicine, ; Greenville, NC United States
                Author information
                http://orcid.org/0000-0003-0217-8892
                Article
                1274
                10.1007/s11920-021-01274-4
                8300069
                34297202
                c1dd91f7-b54a-4dbd-9695-826b4a1e4cbe
                © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 25 June 2021
                Categories
                Psychiatry in the Digital Age (J Shore, Section Editor)
                Custom metadata
                © Springer Science+Business Media, LLC, part of Springer Nature 2021

                Clinical Psychology & Psychiatry
                digital divide,telehealth,telepsychiatry,health information technology,health disparities,social determinants of health

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