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Emergency room usage [...] why African-Americans utilize emergency departments instead of primary doctors. What are the age, gender, and income of the African-Americans that come to E.D? What type of insurance (if any) do they have? Why do they utilize the E.D. (chronic conditions vs. acute conditions)? How is the health system viewed by the African-Americans and what if anything is being done to change and/or correct their conception? What obstacles exist and what accommodations are needed in African-American teaching? The use of emergency rooms by African-Americans is well documented and studied. There are many reasons African-Americans turn to emergency rooms rather than their own primary care physicians, and many ways the United States could turn this healthcare problem around.
Studies have clearly documented that African-Americans on the average receive less health care than whites, and there are several reasons for this dissimilarity in the health care process. One of the main reasons African-Americans receive a poorer quality health care is because of a lack of health insurance. Many black Americans do hot have health insurance, and so, they do not have a primary care physician, or regular checkups. Because of this, black Americans tend to rely on the emergency room for their necessary health care. A recent study into black American healthcare found, "Zuvekas et al. concluded from their own analyses of MEPS data that while health insurance did not by itself explain the persistent racial & ethnic disparities, it was a significant contributing factor" (Rust et al., 2004, pg. 1170). Other studies have shown there are a variety of reasons for this reliance on emergency rooms besides a lack of health insurance. For example, many young mothers may take their children to emergency rooms for care because they themselves were taken to emergency rooms for medical care when they were children (Davidson et al., 2003, pg. 59). There are other issues that also factor in to emergency room visits, from age, to income, to urban or rural dwellers, and much more. However, the clear common factor in black American's health care is that they do not receive the same quality of health care because they rely so heavily on emergency room medicine, rather than preventative medicine from primary care physicians.
Emergency rooms used for primary care place African-Americans in jeopardy for a number of reasons. First, they often rely on emergency room treatments for ailments that should really be treated by a primary care physician, such as asthma, allergies, breast cancer, and much more. Another researcher notes, "The emergency room does not perform screenings for breast cancer or Pap smears, nor is the emergency room able to focus on any preventive measures to promote health maintenance" (Daniels, 1996, p. 194). Often by the time African-Americans visit the emergency room, their cases are too far developed for treatment or cure. This researcher continues, "In one study in Harlem, over half of the black women who entered the hospital with breast cancer were already incurable, compared to 8% of white women" (Daniels, 1996, p. 194). Majorities of African-Americans are receiving poorer quality health care because they rely on emergency rooms rather than primary care physicians, and they wait until it is too late to begin effective treatments for their ailments.
African-Americans utilize emergency rooms for both chronic and acute conditions, but often, the acute conditions win out, because of increasing need for treatment. Chronic conditions, such as asthma, allergies, and other ongoing conditions are also often treated in emergency rooms, and the main problem with treatment like this is that it is not ongoing, and so the patient does not improve, or does not improve as quickly, and so must make repeated visits to the emergency room. A primary care physician could develop preventative medical procedures that would rule out the need for repeated emergency visits. Since older black Americans over 65 are the primary users of emergency room visits, often, their treatments are for acute conditions, such as heart attacks, lung problems, and other conditions that may have been coming on for years, but have finally come to a head.
The age, gender, and income of African-Americans who utilize emergency rooms differ, but there are some compelling commonalities that indicate just how widespread the practice is. According to the recent study by Dr. Rust and his associates, the heaviest users of emergency room visits, at 0.22%, were those African-Americans aged 65 and over. Under 18 comprised 0.15% of visits, ages 18-44 comprised 0.19% of visits, and ages 44-64 comprised 0.20% of visits. Females were more apt to visit the emergency rooms than males. 0.20% of visits were female, while 0.16% were male. Poor and nearly poor income levels made up nearly half of the emergency room visits (0.24 and 0.17 respectively). Low income comprised another 0.19% of the usage. 0.27% of those using emergency rooms had some form of public health insurance, while 0.15 were uninsured, and 0.15 had private insurance. 0.19 had a usual sort of care, but visited the emergency room, while 0.15 did not have a usual sort of care at all. These figures indicate that a majority of black Americans do not have access to regular health care, and they utilize the emergency rooms as a sort of last resort in their health care. The researchers continue, "For example, use of doctor's office visits was four times higher among African-American patients who were 'health-advantaged' (i.e., individuals with all three factors present -- insured, nonpoor persons with a defined medical home) compared with the 'health disadvantaged'" ((Rust et al., 2004, pg. 1173). Thus, being poor, black, and uninsured in America today ensures that your health care will not rate as highly as others' health care.
African-Americans, (and many other ethnic groups) tend to have different views on health, health care, and what causes diseases. Historically, African-Americans have often relied on "folk healers" and "root doctors" for much of their health care. These healers use a blend of folk medicine, herbs, and healing practices to cure ailments. Culturally, many African-Americans feel more comfortable with spiritual and supernatural explanations of disease and the cause of disease. Another researcher writes,
Western conceptualizations of the etiology focus on disease and illness as person centered as opposed to non-Western cultures, in which views of illness and disease may be seen as caused by forces outside the individual. Some of the beliefs in more supernatural explanations for the cause of illness and disease are held among African-Americans today, although to a lesser degree (Belgrave, 1998, pg. 37).
Thus, African-Americans often see health care as a last resort in the healing process, and they have a more spiritual feeling about health care, seeing disease often as a result of "karma" and evil, rather than medical conditions. Many African-Americans may view traditional health care facilities with a mixture of fear and distrust, especially since so many African-Americans wait too long to seek care, and are often incurable as a result.
To change this perception of health care in African-Americans is partly an educational process, but partly a cultural process, too. Education can begin at any age, and clear examples of health care that works should be available to illustrate the positive aspects of health care, especially preventative health care. Black Americans should understand that health care is available at clinics, county health centers, and more, and that preventative health care is imperative to save lives and create a better quality of life.
Probably the biggest obstacle in education black Americans about health care is culture. Many ethnic groups in America have quite differing views of health care than the white community, and education alone cannot change those views. Making more health care options available to a greater number of black Americans can help change the view by creating better health even in…[continue]
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