Centering Patient Voices Through Community Engagement in Cardiovascular Research.
Centering Patient Voices Through Community Engagement in Cardiovascular Research.
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DOI：
10.1161/circulationaha.122.061112
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发表时间：
2023-01-10
期刊：
影响因子：
37.8
通讯作者：
Powell-Wiley, Tiffany M.
中科院分区：
文献类型：
--
作者：
Powell-Wiley, Tiffany M.
关键词：
我们正经历着大流行的融合。冠状病毒病2019年(新冠肺炎)大流行突出并加剧了全球心脏代谢性疾病大流行。肥胖、糖尿病和心血管疾病(CVD)的患病率在人口和地理区域中保持停滞或上升。这些流行病与日益明显的社会不平等和系统性歧视交织在一起，这些歧视促进了种族/族裔和性别/性别群体之间的健康差距。1此外，心血管疾病结果的持续差异强调了健康的社会决定因素(SDH)或我们在一生中暴露于的社会经济、环境和心理社会因素在确定保健机会和心血管疾病结果方面的关键作用。2我们可以将肥胖、糖尿病和心血管疾病描述为一个整体的一部分，这些疾病协同作用，恶化人口健康，以及SDH定义的这些聚合疾病的影响(图)。合并症还以生物途径将社会和心理因素与临床结果联系起来的疾病为特征。3肥胖症、糖尿病和心血管疾病的综合治疗方法可能有助于制定潜在的解决方案，以改善人群水平的心脏代谢健康。4我们赖以降低心血管疾病死亡率的现有临床护理模式，即要求患者在临床环境中获得治疗和预防护理，将不足以遏制日益恶化和相互关联的心脏代谢性疾病的趋势。我们目前的护理模式不起作用，因为它依赖的解决方案没有考虑到边缘化人口获得保健的结构性障碍。3、4此外，卫生保健组织传统上不会根据那些在改善人口水平的心脏代谢健康方面投入最多的人的反馈来调整其临床护理模式，这些人来自最容易患心脏代谢疾病的社区。新兴的患者护理框架已开始将SDH纳入临床护理，通过瞄准心脏代谢健康的上游障碍来满足患者的社会需求，例如产生不同住房准入或健康素养的结构性种族主义。1专业组织正在制定指南，以创建可包括在电子健康记录中的标准化SDH指标，为具有高度社会需求的患者提供有针对性的资源，并制定考虑SDH的护理做法。然而，社区参与方法为受心血管疾病影响最大的人群提供了声音，并可涉及各种方法，从与社区健康倡导团体合作、社区-学术伙伴关系或完全以社区为基础的参与性研究。社区参与可以更广泛地用于在迭代社区投入的基础上共同开发临床干预或患者护理模型。1社区参与可以在历来在卫生保健系统中受到虐待的人群中赢得信任，并符合改善人口一级心脏代谢健康的共同办法。心血管研究界还必须考虑心脏代谢性疾病的共同特点，以此作为动力，为临床研究中有限的不同人群找到可持续的解决方案。亚裔、拉丁裔、非西班牙裔黑人、美国原住民/阿拉斯加原住民、夏威夷原住民/太平洋岛民以及妇女和性别者
We are experiencing converging pandemics. The coronavirus disease 2019 (COVID-19) pandemic has highlighted and exacerbated the cardiometabolic disease pandemics globally. Obesity, diabetes, and cardiovascular disease (CVD) prevalence remains stagnant or is rising across populations and geographic regions. These pandemics intersect in the midst of increasingly glaring social inequities and systemic discrimination that promote health disparities across racial/ethnic and sex/gender groups. 1 Moreover, persistent disparities in CVD outcomes emphasize the critical role of social determinants of health (SDH), or socioeconomic, environmental, and psychosocial factors to which we are exposed over the life course, in defining health care access and CVD outcomes. 2 We can characterize obesity, diabetes, and CVD as parts of a syndemic, with these diseases acting synergistically to worsen population health and the effects of these converging diseases defined by SDH (Figure). A syndemic is also characterized by diseases in which biologic pathways connect social and psychological factors to clinical outcomes. 3 A syndemic approach to the treatment of obesity, diabetes, and CVD may help to frame potential solutions to improve population-level cardiometabolic health. 4 The current clinical care model on which we have relied to reduce CVD mortality, in which patients are required to access treatment and preventive care in the clinical setting, will not be sufficient to stem the tide of worsening and interrelated cardiometabolic diseases. Our current care model does not work in a syndemic given that it depends on solutions that have not been designed to account for structural barriers to health care access for marginalized populations. 3, 4 Moreover, health care organizations do not traditionally adapt their clinical care models based on feedback from those who are most invested in improving population-level cardiometabolic health: individuals from communities that are most vulnerable to cardiometabolic diseases. Emerging patient care frameworks have started to incorporate SDH into clinical care to address patients’ social needs by targeting upstream barriers to cardiometabolic health, such as structural racism that produces differential housing access or health literacy. 1 Professional organizations are developing guidance on creating standardized SDH metrics that can be included in electronic health records, providing targeted resources to patients with high levels of social need, and developing care practices that account for SDH. However, community engagement approaches provide a voice for populations most affected by CVD and can involve a variety of methods that span from work with community health advocacy groups, community–academic partnerships, or full community-based participatory research. Community engagement can be used more extensively to codevelop clinical interventions or patient care models on the basis of iterative community input. 1 Community engagement can garner trust among populations that have been historically mistreated in the health care system and fits within a syndemic approach for improving population-level cardiometabolic health. The cardiovascular research community must also consider the syndemic of cardiometabolic diseases as an impetus to identify sustainable solutions for the limited representation of diverse populations in clinical research. Asian, Latinx, non-Hispanic Black, Native American/Alaska Native, and Native Hawaiian/Pacific Islander populations, as well as women and sexual and