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Title: Improving access to health care for minority ethnic populations with diabetes and heart disease
Author: Chauhan, Umesh
ISNI:       0000 0001 3530 6614
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2008
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Background: In the United Kingdom ethnic minority groups from the Indian sub-continent (India, Pakistan and Bangladesh) are at increased risk of diabetes and coronary heart disease. Variation in outcome these diseases in minority ethnic populations are related to inequity due, in part, to inadequate identification and treatment of underlying risk factors such as obesity but also in access to appropriate health care. Aims objectives: This thesis explores three possible contributing factors to these variations in health experience. Firstly, data from the Health Survey for England (HSE) is used to assess whether using waist circumference (WC) rather than body mass index (BMI) among patients of Indian subcontinent (South Asian) origin would improve risk prediction (related to obesity) for diabetes and hence increase the opportunity to detect those at risk. Secondly, a quantitative study using data from an electronic centralised cardiac rehabilitation register in the north west of England explores the variation in recording of cardiovascular disease risk factors and other clinical data in relation to ethnicity. Thirdly, a qualitative study explores the experiences and needs of South Asian patients following an acute cardiac event. Methods: Study 1: Subjects from the HSE 1999 were selected for analysis based on ethnicity. Logistic regression analysis was carried out to see how effective WC to an established risk score would be at identifying the South Asians with undiagnosed diabetes or impaired glucose regulation. Study 2: A shared central electronic database was developed for recording patient demographics and clinical information for all patients assessed for CR in East Lancashire. Analysis of the recording of clinical data was undertaken by ethnicity, gender and age. Study 3: Twenty participants (12 Pakistani, 6 and 2 Bangladeshi) eligible for CR were interviewed using a semi-structured format. Results: Inclusion of WC resulted a greater sensitivity (72%) and specificity (69%) increasing from 69% and 64% respectively with improved overall level of prediction for the identification of patients at risk of diabetes at the optimal cut point. WC was less likely to be recorded than BM! ( 2.5% versus 57.1 %). WC and BMl were both significantly less likely to have been recorded for women than for men (We: 20.7% vs. 28.7%; BMI: 57.0% vs. 68.2%) and for South Asian populations than for White populations (We: 18.7% vs. 26.7%; BMI: 55.0% vs. 65.3%). Patients in the study had a poor understanding of their disease and underlying risk factors with significant misconceptions. The importance of interventions by professional friends and family members (a doctor or nurse for example) was a recurrent theme in determining appropriate access to care. Reasons for non-attendance included those related to service provision (flexibility, setting, timing of classes and paternalistic attitude in relation to communication) and patient factors (language barrier, transport, health and religious beliefs). Conclusion: It was possible to include 'ethnic' specific WC cut-off points for use with the Cambridge risk score identifying individuals with diabetes among South Asian populations. CR database revealed inequity in recording of risk factors such as We. The qualitative study confirmed the inequity in both access and experience of CR services for South Asian patients. The barriers which restrict or diminish access to chronic disease health care such as CR services for the South Asian population are complex and related to not only to patient factors but also to system/provider levels and institutional factors, and the interactions between them.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available