By Amy Knight, PhD, ABPP, AACVPR President-Elect
This year’s AACVPR keynote panel aims to present a conversation around disparities in healthcare and ideas for equity. But what is equity? And what is my responsibility?
Longstanding disparities exist, not just in healthcare, but also interwoven in the socioeconomic foundation of every institutional system. It gets complicated, quickly. And yet, our commitment to ideals of service, to care for another human being and for justice suggests a role and a responsibility to take up this cause. But, again, what is equity? And how do we start?
To quote Lisa Cooper, MD, MPH, from Why Are Health Disparities Everyone’s Problem, “Equality aims to promote fairness, but it can only work if everyone starts from the same place and needs the same things. Equity means that everyone is given what they need to be successful, even if those opportunities come in different forma and are used in different ways.”
Discrepancies in Referrals, Attendance and Completion
Getting eligible patients of all backgrounds to participate in cardiac rehabilitation and pulmonary rehabilitiation is tough enough, but the data indicates it’s even more elusive for some. A big part of the problem is that many patients in underrepresented groups simply aren’t being referred for CR or PR in the first place. Part of the referral gap is likely related to provider bias in are the right candidates for rehab. This might be influenced by assumptions about who is likely to complete or have the ability to take advantage of the program, as well as assumptions about who is willing to make lifestyle changes and graduate. Acknowledging the discrepancies and opening the dialogue is a good starting point to correct the bias.
Providing financial assistance with copays, offering incentives for completion of programs, changing CR/PR hours to extend into the evening and being accessible on weekends to help women and/or working patients, and adopting automatic referrals to eliminate bias are examples of steps that are being taken to right the ship. While these measures are meaningful, we must pay attention to multi-dimensional aspects, or the intersectionality of gender, race and socioeconomic status that combines in more entrenched ways that impact access and utilization of care. Ownership at the individual level is a powerful catalyst for change as well. Asking ourselves “What can I do to make this patient more comfortable? What can I do to get a translator for someone who doesn’t speak English? Maybe I can work a little harder on my recruitment of other staff and be more mindful of making sure that my colleagues represent the diversity of people that are in this area and in this field and have we done a good job of that?”
It’s important for all of us to recognize that we may unwittingly contribute to the perpetuation of health disparities. By the same token, all of us could recognize the opportunity to make a difference. Participating in these conversations is its own effort toward seeking out other solutions. The opening keynote presentation at AACVPR’s 36th Annual Meeting, titled “Building Equity in Rehabilitation – A Panel Discussion to Facilitate Inclusion” will be addressing these themes. Our panelists include interventional cardiologist Columbus D. Batiste, MD, FACC, FSCAI and exercise physiologists Yvette Gerdes, MS, ACSM-RCEP, CCRP and Salim B. Street, M.Ed, CSCS, who will share their insights and thoughts on several video vignettes of patient and provider stories. The session will serve to generate ideas and strategies that will resonate with attendees and inspire them to implement similar strategies in their own practices.
Register for the Annual Meeting today.