Plus ça change, plus c'est la même chose [The More Things Change, the More They Stay the Same].
Plus ça change, plus c'est la même chose [The More Things Change, the More They Stay the Same].
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再加上“变化，加上这就是我”选择的[事物变化越多，它们就越保持不变]。
DOI：
10.1097/mlr.0000000000000469
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发表时间：
2015
期刊：
影响因子：
3
通讯作者：
Lapane,KateL
中科院分区：
文献类型：
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作者：
Lapane,KateL
《健康人2020》的目标是“实现健康公平，消除差距，提高所有群体的健康水平”。2.由于认识到描述性的科学工作几乎没有能力改变普遍存在的种族/民族卫生保健差异而感到绝望。50年前，马丁·路德·金博士说：“在所有形式的不平等中，医疗保健中的不公正是最令人震惊和不人道的。(http：//www.赫芬顿邮报com/amanda-moore/martin-luther-king-health-care_b_2506393. html）。同意了在读研究生时，对托德等人令人不安的工作的批评打开了我一直不知道的医疗保健社会不公正的潘多拉盒子。令人无法接受的事实是，在美国，促进医疗保健公平的全面、广泛的变革还没有发生。奥巴马当选总统后就不会了。海德尔及其同事1对因急性腹痛到急诊室就诊的成年人在疼痛管理方面基于种族/民族的差异进行了仔细分析。使用国家医院门诊护理调查（NHACS），作者提供了具有全国代表性的估计值，表明相对于非西班牙裔白色患者，非西班牙裔黑人患者的镇痛药使用频率较低，并且在中度/重度疼痛患者中观察到了差异。接受止痛药的差异并没有随着疼痛严重程度的增加而减少，这令人恶心。2011年医学研究所报告“缓解美国疼痛”认识到管理疼痛的挑战，并呼吁在理解和管理疼痛方面进行文化转型。4 NHACS的数据不允许进一步探讨引起所观察到的差异的原因。因此，我们不知道减少差异的循证策略是否可以应用于急诊室的疼痛管理。很明显，急诊室为内隐偏见（对有色人种的无意识的负面偏见）提供了高压环境，使其丑陋的头颅抬起。最近的一项系统性综述显示，低至中等水平的内隐偏见在医疗保健提供者中普遍存在，并指出，当人们疲惫、忙碌和有压力时，内隐偏见的“自动激活”最有可能表现出来。隐性偏见的背景是急诊室环境的典型代表，但如何减少医疗保健提供者偏见的证据基础是“几乎不存在”。6
Healthy People 2020 goal “to achieve health equity, eliminate disparities, and improve the health of all groups”. 2 Despair because of the realization that descriptive scientific work has little ability to change pervasive racial/ethnic health care disparities. Fifty years ago, Dr Martin Luther King was purported to have said “Of all the forms of inequality, injustice in health care is the most shocking and inhuman.”(http://www. huffington post. com/amanda-moore/martin-luther-king-health-care_b_2506393. html). Agreed. Critiquing the disturbing work by Todd et al 3 as a graduate student opened the Pandora’s box of social injustice in health care to which I had been ignorant. The unacceptable truth is that sweeping, widespread change to promote equity in health care in the United States has not occurred. Not with the election of President Obama. Not with the enactment of the Affordable Care Act.Haider and colleagues 1 conducted a careful analysis of race/ethnicity-based disparities in pain management for adults presenting to emergency departments with acute abdominal pain. Using the National Hospital Ambulatory Care Survey (NHACS), the authors provide nationally representative estimates showing that analgesics were less frequently provided to Non-Hispanic Blacks relative to Non-Hispanic White patients, and that the differences were observed in patients with moderate/severe pain. That the disparities in receipt of analgesics were not diminished with increasing pain severity is sickening. The 2011 Institute of Medicine report “Relieving Pain in America” recognizes the challenges of managing pain and called for a cultural transformation in understanding and managing pain. 4 The NHACS data do not permit further exploration of reasons that give rise to the observed disparities. So, we do not know whether evidence-based strategies to reduce disparities 5 could be applied to the setting of pain management in the emergency room. It is clear that the emergency department provides the high-pressure environment for implicit bias—insentient negative bias toward people of color—to rear its ugly head. A recent systematic review revealed that low to moderate levels of implicit bias were prevalent among health care providers 6 and noted that the “automatic activation” of implicit bias is most likely exhibited when people are tired, busy, and pressured. The context ripe for implicit bias is typified by the emergency department setting, yet the evidence-base on how to reduce health care provider bias is “virtually absent.” 6