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SOCIAL DETERMINANTS SOCIAL DETERMINANTS
OF HEALTH OF HEALTH

expected outcomes, religion, patient and provider level factors, hos- partnerships would result in a more targeted approach to addressing
pital distance and patient’s willingness to travel are among the factors the specific needs of the patients in a specific community. This ulti-
that have been associated with disparities, but they fail to explain un- mately leads to improved wellbeing by many suffering from knee OA
derutilization (Zhang 2016). Even among only Medicare recipients and an increase in surgeries that are needed. This increases patient ac-
these disparities persist. cess for private practices, an opportunity for mutual wins.
It is essential to better understand the healthcare decision-making Presently, outcomes are not as good in minority populations. An
process in patients with OA of the local Hispanic population, espe- investment in understanding the reasons for this, as well, is needed to
cially those on the south, east, and west sides of town (underserved close that gap. In addition to socioeconomic factors, provider and pa-
areas). Ideally, improved utilization rates will mean fewer individuals tient factors are significant contributors to disparities observed in
unnecessarily enduring life altering pain and discomfort and thus in- TKA (Perez 2020). Working as a privademic partnership, clinicians
creased surgical volumes; essentially a win-win for community wellness can get a more customized understanding about their patients’ con-
and the healthcare industry. cerns rather than combing through generalized population studies that
may or may not fit the demographic in which they are working.
What are some solutions? Listening to the narratives of our patients and working collabora-
An ongoing study conducted by a team from the UIWSOM and tively to better understand their perspective will take upfront effort on
the private sector is investigating the overall patient healthcare expe- the physicians’ part, but investing time now will pay off in the future.
rience and how it relates to underutilization of TKA in local minority This will help San Antonio achieve better health outcomes, increased
populations. The survey study, led by Dr. Roberto Fajardo, strives to patient satisfaction and improved community health as a whole.
identify cultural, social, and socioeconomic factors that influence a
person’s decision to pursue medical attention and undergo a surgical Katelyn Franck and Margaret Jonas are both third
joint replacement procedure due to osteoarthritis (OA). year medical students at UIWSOM and part of the
This work, supported by the offices of city councilwomen Rebecca research team studying health disparities and TKA
Viagran and Adriana Rocha Garcia, as well as Dr. Matthew Morrey underutilization. They are also members of the Bexar County Medical
with Ortho San Antonio, will better inform researchers and clinicians Society.
about the decision-making process of patients from the south, east,
and west sides of San Antonio. So far, the research team has recruited Jaydee Foster, MA is a Clinical Research Coordinator at UIWSOM.
over 120 people for their study. Subjects are being recruited at local Matthew Morrey, MD is an orthopaedic surgeon with Ortho-San Anto-
senior centers and public events such as farmer’s markets, YMCA’s and nio and Clinical Associate Professor at UIWSOM and UT Health San
other UIWSOM sponsored health events. In these interviews with Antonio. Roberto Fajardo, PhD is an Associate Professor of Anatomy at
southside residents, interesting patterns have emerged. Of our present UIWSOM.
Underutilization of Total Knee Arthroplasty: sample of respondents, over 90% reported that they currently have References:

health insurance and indicate they are comfortable with their current
medical knowledge. Among patients that live with daily knee or hip Zhang, Y., & Jordan, J. M. (2010). Epidemiology of Osteoarthritis.
Active Efforts and Proposed Solutions to Address this Locally pain, 47% indicated financial concerns would prevent them from pur- Clinics in Geriatric Medicine, 26(3), 355–369.
suing surgery. Half believed joint replacement surgery is common and https://doi.org/10.1016/j.cger.2010.03.001
By Katelyn Franck , Margaret Jonas, MS, Jaydee Foster, MA, Matthew Morrey, MD, and Roberto Fajardo, PhD
successful for knee and hip OA. But, 41 and 43%, respectively re- Irgit, K., & Nelson, C. L. (2011). Defining racial and ethnic dispar-
ported they would avoid a total joint arthroplasty due to fear or cost ities in THA and TKA. Clinical orthopaedics and related research,
even though surgery could alleviate joint pain. 469(7), 1817–1823. https://doi.org/10.1007/s11999-011-1885-z
The south side of San Antonio is a medically underserved area with to non-Hispanic Whites. In San Antonio, this suggests that approxi- This is an interesting result given that research overwhelmingly Zhang, W., Lyman, S., Boutin-Foster, C., Parks, M. L., Pan, T. J.,
both a shortage of physicians and a significant amount of need. Total mately several hundred to a thousand Hispanic individuals with end- proves these highly successful procedures infrequently result in major Lan, A., & Ma, Y. (2016). Racial and Ethnic Disparities in Utilization
knee arthroplasty (TKA) is a common and successful treatment for stage OA will likely not seek out a TKA to treat their disease (Zhang complications. This study is ongoing, however it is coming to light Rate, Hospital Volume, and Perioperative Outcomes After Total Knee
end stage arthritis that significantly decreases pain levels and improves and Jordan 2010) in any one year. This number will only increase as that fear, finances and doubts about the benefit of the procedure ap- Arthroplasty. The Journal of bone and joint surgery. American volume,
quality of life. The incidence of knee arthritis is similar among non- demographic trends change and the Hispanic population, which has pear to fuel decisions to forego surgery. 98(15), 1243–1252. https://doi.org/10.2106/JBJS.15.01009
Hispanic Whites, Blacks, and Hispanics, yet when compared to non- a large young population, ages more and more. A proposed solution is development of private and academic (pri- Perez, B. A., Slover, J., Edusei, E., Horan, A., Anoushiravani, A., Ka-
Hispanic Whites (NHW), minority populations such as Hispanics The reasons for lower utilization are poorly understood. Lower uti- vademic) partnerships that invest in the underlying causes of under- math, A. F., & Nelson, C. L. (2020). Impact of gender and race on ex-
utilize TKA 20-30% less despite a similar incidence of osteoarthritis lization is documented in Hispanics even after controlling for educa- utilization. These partnerships will allow researchers and clinicians to pectations and outcomes in total knee arthroplasty. World journal of
(OA). This means approximately 25% fewer Hispanics with end stage tion, income, geographic location, education, insurance status and/or be able to address and rectify these concerns in a more timely and effi- orthopedics, 11(5), 265–277.
knee OA (among all with end stage OA) seek out a TKA compared medical comorbidities (Irgit and Nelson 2011). Patient preferences, cient manner. Small, upfront monetary investments by privademic https://doi.org/10.5312/wjo.v11.i5.265

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