Reversing DEI pulls the rag from under the canons such as patient rights, rights and evidence-based medicine regimes affecting the US healthcare space

Introduction

Public health addresses felt needs and lived experiences. So, it is important that healthcare providers connect to the diversified peoples’ stories. Other than the expectation of better health outcomes, health care ethical and legal practices promote participation in care by say, women who need abortion, cancer, child spacing or sexual reproductive health literacy sessions or those who need multimorbidity post care. It is an equalizer leveraging cooperation among professions, which may reduce wait or referral time between wards such as the admission unit, psychiatric ward, emergency room, surgical ward, post-surgery care, physiotherapy and billing departments. ?Maintaining ethics, rights and evidence-based settings contribute to measurable indicators, such as numbers of people who report for care; scopable activities such as providing an inventory of events open for different people according to age, mental health, status, education and physical nature; scalable models such as sharing tested and tried services; tangible outcomes; and synthesized reports to inform better health outcomes programming, policy and planning (Brahmbhatt, et al., 2021; Donner-Banzhoff, et al., 2021; Edwards, et al., 2010; Maun, et al., 2023; Rogers, et al., 2021; Rosendal, et al., 2015; & Rosendal, et al., 2017).

Taking a Leaf from The Human Potential Movement

Patient rights can remain on the books if deliberate shift toward regarding health seekers as viable and dignified humans is not the established culture in any healthcare space. Translating ethical practice into better health outcomes is possible through tapping into human agency, capacities, self-preservation interests, autonomy, self-wellness goals and a desire to do and be well.? These are the postulates of the Human Potential Movement. According to them, all individuals have a natural drive toward self-actualization, synthesize ideas, have capacity to contemplate, reason, benefit from interventions and can compare actions which set the stage for engaging in care or otherwise to bring about one’s full potential. Patient rights are fulfilled better in a person-centered, patient-centered or client-centered setting too (Abu-Bakr, et al., 2021; Bates, 2010; Cardoso, et al., 2021; Crowley, et al.,2020; Cyr, et al., 2019; & da silva, et al. 2014).In this setting the relationship between provider and care seeker builds shared respect. It promotes reflective listening, empathy, and acceptance in therapy rather than being paternalistic, out to interpret behaviors or unconscious drives. This is a setting that upholds: non-discrimination, non-stigmatization, engaging and empowering people and communities (engagement of community, empowerment and empathy); strengthening governance and accountability (organizational leadership, and mutual accountability); reorienting the model of care (community or home-based care, residential care, care for multi-morbidity, participatory care); coordinating services within and across sectors (partnership with stakeholders and sectors, and coordination of care or public-private mix); creating an enabling environment and funding support (flexible management for change; establishing an enabling environment); create a variety of care options; maintain dignity-affirming safe spaces, inclusive protocols; recognise and reward potential; provide information, education, communication (IEC) materials in formats comprehended by health seekers; establish and maintain peer-led navigation teams; hold regular meetings or platforms to share knowledge back and forth; and informing health seekers of their rights and responsibilities. Upholding patient rights is the foundation of a rights and evidence based regime that makes healthcare spaces bastions of including more people in care, models of integrated primary care, quality care and catalysts for better life outcomes (Abu-Bakr, et al., 2021; Gunja, et al., 2023; Khatri, et al., 2023; Kindig, et al., 2010; MGH, 2024; Pope, 2023; Pozgar, 2020; & Shi, 2012).

Upholding Patient Rights Has Its Benefits

There are benefits for upholding patient rights and one of them translates into better health outcomes at a lower cost in the US. Secondly, upholding patient rights fosters appropriate and integrated primary care mediated through patient-centered care. The third benefit of upholding patient rights is directly linked to demand for health improvement. At the state level different investment portfolios will depend on local patterns of modifiable and non-modifiable determinants. Health improvement that is patient-rights mediated is quantifiable in ways that improve empathy, compassion, critical interface meetings between provider and care seeker; patient rights center diagnostic algorithms and quality metrics?around people-related outcomes; improve outcomes and due to frequency of interface reduces costs. Some areas to ensure that the US benefits from the patient-centered primary care include: reforming health care; behavioral change; social determinants of health; reform the payment model; fix the EHR technology; redesign the medical education model;? mainstreaming care to gender equity and climate change; aligning with accessibility, acceptability, availability and affordability principles (Abu-Bakr, et al., 2021; Pozgar, 2020; & Shi, 2012).

Conclusion and recommendations

Some states are reversing Diversity, Equity and Inclusion innovations but this could affect public health and Primary Care services in the US. Training more Primary care physicians (PCP) and establishing systems upholding patient or client–centered care to promote targeted and tailored care may be affected too. Yet Primary Care services foster reduced costs and improvement of outcomes; established strategic interface and conversation between care-seeker and care giver; longitudinal relationships; and a whole-person approach necessary for?achieving results that impact outcomes and costs. Primary Care is a proxy for patient-rights and centered care which connect lifestyles to the root cause of poor health and catalyzes a path to better livelihoods, wellness, coverage, reduced hospitalization, lower costs promoting longer life and a reduction in health-related deaths in the US (Abu-Bakr, et al., 2021; Bates, 2010; Cardoso, et al., 2021; Crowley, et al.,2020; Cyr, et al., 2019; da silva, et al. 2014; Fong, 2021; Gunja, et al., 2023; Khatri, et al., 2023; Kindig, et al., 2010; MGH, 2024; Pope, 2023; Pozgar, 2020; & Shi, 2012).

References

Abu-Bakr, et al., 2021; Bates, 2010; Cardoso, et al., 2021; Crowley, et al.,2020; Cyr, et al., 2019; da silva, et al. 2014; Fong, 2021; Gunja, et al., 2023; Khatri, et al., 2023; Kindig, et al., 2010; MGH, 2024; Pope, 2023; Pozgar, 2020; & Shi, 2012

Abu-Baker, N. N., AbuAlrub, S., Obeidat, R. F., & Assmairan, K. (2021). Evidence-based practice beliefs and implementations: a cross-sectional study among undergraduate nursing students.?BMC nursing,?20(1), 13. https://doi.org/10.1186/s12912-020-00522-x

Bates D. W. (2010). Primary care and the US health care system: what needs to change?.?Journal of general internal medicine,?25(10), 998–999. https://doi.org/10.1007/s11606-010-1464-0

Brahmbhatt, A., Richardson, L. & Prajapati,S. (2021). Identifying and Managing Anxiety Disorders in Primary Care. The Journal for Nurse Practitioners, Volume 17, Issue 1. Retrieved from https://doi.org/10.1016/j.nurpra.2020.10.019

Cardoso, D., Couto, F., Cardoso, A. F., Bobrowicz-Campos, E., Santos, L., Rodrigues, R., Coutinho, V., Pinto, D., Ramis, M. A., Rodrigues, M. A., & Apóstolo, J. (2021). The Effectiveness of an Evidence-Based Practice (EBP) Educational Program on Undergraduate Nursing Students' EBP Knowledge and Skills: A Cluster Randomized Control Trial.?International journal of environmental research and public health,?18(1), 293. https://doi.org/10.3390/ijerph18010293

Crowley,R., Daniel,?H.,?Cooney,?T.G.& Enge, L.S. (2020). American College of Physicians. Envisioning a Better U.S. Health Care System for All: Coverage and Cost of Care. Retrieved from https://www.acpjournals.org/doi/10.7326/M19-2415

Cyr, M. E., Etchin, A. G., Guthrie, B. J., & Benneyan, J. C. (2019). Access to specialty healthcare in urban versus rural US populations: a systematic literature review.?BMC health services research,?19(1), 974. https://doi.org/10.1186/s12913-019-4815-5

da Silva, E.P., Saturno-Hernández, P.J., de Freitas, M.R. & da Silva Gama, A.Z. (2024).?Motivational drivers for health professionals in a large quality improvement collaborative project in Brazil: a qualitative study.?BMC Health Services Research Res?24, 183. https://doi.org/10.1186/s12913-024-10678-w

Donner-Banzhoff, N., Kunz R. & Rosser W. (2001). Studies of symptoms in primary care.?Family Practice?2001;?18:?33–38. Retrieved from https://academic.oup.com/fampra/article/18/1/33/486070

Edwards, T. M., Stern, A., Clarke, D. D., Ivbijaro, G., & Kasney, L. M. (2010). The treatment of patients with medically unexplained symptoms in primary care: a review of the literature.?Mental health in family medicine,?7(4), 209–221.

Fong, K. (2021). The U.S. Health Care System Isn’t Built for Primary Care. Harvard Business Review.nbsp; Retrieved from https://hbr.org/2021/09/the-u-s-health-care-system-isnt-built-for-primary-care

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Gunja, M.Z., Gumas, E.D. & Williams II, R.D. (2023 January, 31). U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes. The Commonwealth Fund. Retrieved from https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022

Khatri, R.B., Wolka, E., Nigatu, F., Zewdie,?A., Erku, D., Endalamaw, A. &?Assefa, Y.? (2023)?.?People-centred primary health care: a scoping review.?BMC Prim. Care?24, 236. https://doi.org/10.1186/s12875-023-02194-3

Kindig, D., Peppard, P., & Booske, B. (2010). How healthy could a state be?.?Public health reports (Washington, D.C. : 1974),?125(2), 160–167. https://doi.org/10.1177/003335491012500203

Maun, A., Bj?rkelund, C. & Arvidsson, E. (2023). Primary care utilisation, adherence to guideline-based pharmacotherapy and continuity of care in primary care patients with chronic diseases and multimorbidity – a cross-sectional study.?BMC Prim. Care?24, 237. Retrieved from https://doi.org/10.1186/s12875-023-02191-6

MGH. (2024).?About the office of patient advocacy. Massachusetts General Hospital. Retrieved from https://www.massgeneral.org/patient-advocacy/about

MGH. (2024). ?Patient rights and responsibilities . Massachusetts General Hospital. Retrieved from https://www.massgeneral.org/patient-advocacy/patient-rights

Pope, M.T., (2023 October). Capacity to Make Health Care Decisions. Merck Manual Consumer Version.? Retrieved from https://www.merckmanuals.com/home/fundamentals/legal-and-ethical-issues/capacity-to-make-health-care-decisions

Pozgar, G.D. (2020).?Legal and ethical issues for health professionals?(5th ed.). Jones and Bartlett Learning.

Rogers, R., Hartigan, S.E. & Sanders, C.E. (2021). Identifying Mental Disorders in Primary Care: Diagnostic Accuracy of the Connected Mind Fast Check (CMFC) Electronic Screen.?J Clin Psychol Med Settings?28, 882–896. Retrieved from https://doi.org/10.1007/s10880-021-09820-1

Rosendal, M., Olde Hartman, T., Aamland, A., Van der Horst, H., Lucassen,?P., Budtz-Lilly?A. & Burton, C. (2017)?“Medically unexplained” symptoms and symptom disorders in primary care: prognosis-based recognition and classification.?BMC Fam Pract?18, 18. Retrieved from https://doi.org/10.1186/s12875-017-0592-6

Rosendal, M., Carlsen, A. H., Rask, M. T., & Moth, G. (2015). Symptoms as the main problem in primary care: A cross-sectional study of frequency and characteristics.?Scandinavian journal of primary health care,?33(2), 91–99. https://doi.org/10.3109/02813432.2015.1030166

Shi, L. (2012). The impact of primary care: a focused review.?Scientifica,?2012, 432892. https://doi.org/10.6064/2012/432892