Health Disparities
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/32081
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Browsing Health Disparities by Author "Hadley, Lesca"
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Item Assessing Incontinence Reporting by Women at a Rural Texas Clinic(2023) Katz, Hannah; Hadley, LescaAbstract Urinary incontinence is estimated to affect between 20-45% of women in the US; a potential reason that estimates vary is due to underreporting of symptoms. In Eagle Lake, Texas, family physicians are the main source of health education concerning uro-gynecologic issues in women. No local Ob-Gyn or urology specialists practice in Eagle Lake. The two most established family physicians in Eagle Lake are male and they recently discontinued obstetric care. The goal of this project was to assess the prevalence of incontinence and reporting of symptoms by female patients in Eagle Lake, in lieu of a local Ob-Gyn or urologist. The goal of this project was to assess the prevalence of incontinence and reporting of symptoms by female patients in an Eagle Lake Family Medicine clinic, where factors exist which might present barriers to reporting. Methods A paper survey was created the Questionnaire for female Urinary Incontinence Diagnosis was used to screen for incontinence in female patients 55 years and older. Questions concerning willingness to discuss symptoms and use of UI medications were asked in multiple-choice format. Data was collected for 10 weeks, and percentages were calculated in Microsoft Excel. Results Out of 51 total participants, 50.9% screened positive for incontinence and 17.86% take bladder control medications. Out of women with incontinence, 60.71% indicated they have not brought up symptoms to a physician. Out of those who have not brought up symptoms, 13.89% indicated they would not see a physician for bladder symptoms, 13.89% indicated they would see a female physician only, and 69.44% indicated they would see either a female or male physician. Out of women with incontinence who have brought up symptoms with a physician, 27.27% reported symptoms to a female physician, 54.54% have reported symptoms to a male physician, and 18.18% reported symptoms to both a male and a female physician. Conclusions This data demonstrates that more than half of female patients 55 years and older at Rice Medical Associates are incontinent, that more than half of the incontinent women have not discussed their symptoms with a physician, and that less than twenty percent of the incontinent women are on medication for it. Some reasons for underreporting may include insufficient screening in clinic, lack of health literacy on when to seek care, and patient avoidance of discussions concerning "delicate” uro-gynecologic matters. The data shows that some women choose only to discuss bladder symptoms with a female physician, while some choose not to discuss their symptoms at all. Additionally, there were two patients who refused to complete the survey because they were uncomfortable with the topic. Due to research bias from sampling patients in a male family practitioner’s clinic, further studies should survey women outside of a healthcare setting and clarify whether reporting would be different at an Ob-Gyn office. This study indicates the need for purposeful screening for incontinence by rural family physicians, to compensate for underreporting of uro-gynecologic issues by women in areas with limited healthcare options.Item The Impact of the Social Determinants of Health on a Patient with Renal Cell Cancer: A Case Report(2023) Luka, Stacy; Hadley, LescaBackground Renal cancer is the seventh most common cancer and 90% of cases are renal cell carcinoma (RCC). Symptoms of RCC may include hematuria, abdominal/flank pain, or fatigue, but over half of those with RCC are asymptomatic and diagnosed incidentally by an unrelated abdominal imaging study. Renal tumor size provides the greatest insight into a patient’s chance of survival. For every 1 cm increase in tumor size there is a 16% increase in malignant potential and masses greater than 7 cm have only a 7% chance of being benign. RCC has a 40% mortality rate that disproportionately affects those of low socioeconomic status (SES) who often present with larger and more advanced RCC. This correlation with low SES reflects decreased healthcare access and an increased prevalence of poor prognostic factors including obesity, hypertension, and hyperlipidemia. Additionally, patients without health insurance are 5.6% less likely to survive RCC. Case Information A 56-year-old Hispanic male first presented to a community clinic in Fort Worth, Texas in early 2017 for occasional fatigue and right flank pain that began in 2002. In addition to managing his hypertension, diabetes mellitus, and hyperlipidemia, the physician ordered an abdominal and pelvic CT that revealed a 5.4cm cystic and solid-enhancing right renal mass that was highly suspicious for RCC. Further disease progression was suggested with a 2019 ultrasound showing internal blood flow to the solid component of the mass and 2022 laboratory studies that revealed an elevated BUN (21 mg/dL), serum calcium (10.6 mg/dL), and ALT (56U/L). At the end of 2022, the patient brought in his latest CT report that he could not read because it was only provided in English. The CT revealed the 6.4cm x 4.1cm x 3.7cm mass and while medical translators communicated with the patient, differences in language may have impacted his understanding of his condition. For five years imaging and labs were performed repeatedly to monitor the large tumor, but treatment was never initiated because the patient believed he could not afford care without health insurance. The patient was referred to a local charity program for evaluation, but the program had a policy of not providing cancer treatment. The patient was encouraged to seek treatment in the local county health system, but he believed he could not afford treatment there or the expenses to relocate for treatment elsewhere. At this point, no further options exist for the patient. Conclusions Surgery would provide the greatest odds of survival for this patient, and ideally, it would have been performed before the mass reached such a concerning size. However, the patient believed he could not afford care without health coverage. With such a dismal prognosis, one can only speculate how the outcome would have changed if prompt medical care had been accessible to the patient. His financial resources, health coverage, language barrier, documentation status, and lifestyle all contributed to the unfavorable disease progression. This case serves as a single example of how social determinants of health continue to alter patient outcomes.Item Review of an Advanced Case of Psoriatic Arthritis and Barriers to Management of Chronic Disease in the West Texas Region(2023) Martin, Delaney; Joseph, Matthew; Iloani, Nwamaka Amy; Tadesse, Meron; Hadley, Lesca; Allsopp, Leslie C.Background: Psoriatic arthritis is a debilitating, inflammatory musculoskeletal spondyloarthritis associated with the skin condition psoriasis that affects the hands, feet, spine, and other parts of the body. Nearly 80% of patients develop the associated arthritis after skin lesions of psoriasis develop. Management of psoriatic arthritis can be difficult, with severe variants recommended to receive specialized care from a rheumatologist for optimal treatment. The clinical case that will be discussed refers to a patient presenting with psoriatic exacerbation, which progressed from skin lesions to psoriatic arthritis with unmanaged pain. Despite the severity of this progression, he received minimal education on psoriatic arthritis management. Case Presentation: A 34-year-old male presented to clinic with a primary complaint of pain for uncontrolled psoriatic arthritis that had been diagnosed one year prior, two years after an original diagnosis of psoriasis. He reports the diagnosis of psoriatic arthritis was made after diffuse rashes spread over his body and extensor surfaces with increasing joint pain. At the clinic, the patient complained of weakness in his extremities; severe pain at elbow, ankle, knee, and toe joints bilaterally; a diffuse erythematous rash particularly at the ankles; and difficulty with daily activity due to pain. Notable physical exam findings included a personal history of psoriasis, joint pain, nodules growing past the distal interphalangeal joint of his hands and feet along with dactylitis and nail dystrophy consistent with psoriatic arthritis. Based on Classification for Psoriatic Arthritis criteria (CASPAR), he would be due to a score above 5 classified as having psoriatic arthritis. He has a known history of epilepsy, spinal stenosis, generalized anxiety disorder, chronic PTSD, and type 1 bipolar disorder. Patient reported recurrent methamphetamine use along with frequent use of marijuana for pain control. His social history was significant for lack of employment and symptoms worsening while uninsured. He stated an inability to attend scheduled appointments due to lack of transportation, the distance from Terlingua to the clinic in Alpine, TX, and inability to obtain telemedicine visits with his current provider. Conclusion: This case study on management of advanced psoriatic arthritis examines the health disparities faced by patients in rural west Texas regions, including lack of patient education, access to qualified rheumatologists, and adequate resources to manage disease exacerbation. A literature search on PubMed was conducted to clarify the current standard of care for treatment of advanced psoriatic arthritis, as well as current restrictions in management within the West Texas area. For social determinant factors, the social vulnerability index for west Texas regions was reviewed using public Center for Disease Control and Prevention data to note qualified health centers for this level of need and found appropriate services are lacking within the town of Terlingua and its neighboring areas. In addition to the healthcare team, an appropriate and safe environment for those suffering with psoriatic arthritis also includes stable infrastructure, social support, and public transportation. Without public health measures and capable providers, there are increased barriers to care of chronic disease for those living in rural areas like Terlingua.