Happy Tuesday! This week is dedicated to one of our important missions aimed at improving equity in healthcare. While we work to include topics identifying disparities weekly, Juneteenth commemorates the freedom of slaves in the U.S. and is a perfect opportunity to highlight the work we need to do to improve outcomes in African-Americans. APPs (PAs/NPs) have the intelligence, grit, and workforce to effect change. We hope some of these topics will spark that fire we know you have! Let’s get to work!

In Today’s Edition:

• Black representation needed in the primary care physician workforce

• Tori Bowie, dies of eclampsia, is a gut-wrenching reminder of Black maternal health disparities in the U.S.

• Are you treating hypertension based on race? Time to change

• Let’s define what wealth equity means

• Let’s talk money. The mind-blowing economic burden of health inequity

• Our featured APP this week is a true inspiration! Introducing, Dwayne Alleyne DNP, APRN, ACNP-C. Air Force Veteran, network leader, entrepreneur, educator, and all-around role-model!

• Clinical Case discussion: We weren’t blowing smoke! Let’s talk asthma

🩺 APP Trending News

We Need Black Representation in the Primary Care Workforce

According to a study published in JAMA Network Open, there is a correlation between a higher proportion of Black doctors, reduced mortality rates, and increased life expectancy among Black communities. This is the first study to establish such a link. We’d like to reiterate the call to action published in our May 23rd edition. The Federation of Associations of Schools of the Health Professions (FASHP) has declared the low number of historically underrepresented men of color (HUMOC) graduating and entering the health care professions a national crisis. We couldn't agree more with the CEO's sentiment that a "more racially and ethnically diverse health care professionals are essential for meeting future health care needs; tied to improved patient satisfaction, increased access to quality health care and reduced health disparities; and critical for elevating the nation’s responsiveness to the health care needs of a society with rapidly changing demographics." All healthcare providers, current, and future APPs (PAs and NPs) on the front line are in a perfect position to effect change as mentors, community leaders, and active participants in our respective organizations at the state and national level. Let’s get to work!

Addressing Black Maternal Health Disparities and Advocating for Change

The United States has a higher rate of pregnancy-related deaths compared to other high-income countries. The CDC reported 1,205 deaths in 2021 alone (a 40% increase from the prior year). Severe maternal morbidity, which refers to life-threatening pregnancy complications, disproportionately affects Black individuals. Non-Hispanic Black women are more likely to die from pregnancy-related causes than White people, regardless of income or education level. While we appreciate that Black Maternal Health Week as an annual observance in the U.S. aiming to raise awareness about the state of Black maternal health, the eclampsia related death of Olympic champion, Tori Bowie on June 13, is a gut-wrenching reminder that awareness should be a year-round effort.

The National Institute of Health (NIH) reports that Black Americans face an elevated risk of preeclampsia and eclampsia, which contribute to a higher death rate before and after childbirth. Brazil has reported similar statistics with disproportionately higher death rates in their non-Hispanic Black population, and inequality is undeniably a contributor.

The NIH recognizes the existence of a direct connection between institutional racism and the poor care that is provided to Black parturients, who were reported to have a maternal death rate of 2.6 times higher than non-Hispanic White women. To address these disparities, the National Institutes of Health (NIH) launched the Implementing a Maternal health and Pregnancy Outcomes Vision for Everyone (IMPROVE) initiative in 2019. The IMPROVE initiative is a comprehensive effort to reduce preventable and severe maternal mortality, promote health equity, and support research to aid in understanding biological, behavioral, sociocultural, and structural factors contributing to maternal mortality.

Are You Treating Hypertension Based on Race? Here Is Why It's Ineffective

It should be a common and intuitive practice to know that the approach to hypertensive treatment therapy should be individualized and comprehensive. Gone should be the days of narrow focused race-based guidelines. A study from UC San Francisco reveals that race-based prescribing practices for hypertension medications, particularly for Black patients, have no apparent benefit and may even be detrimental in the long run. The study found that primary care doctors prescribed angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) less frequently to Black patients compared to non-Black patients, despite similar median blood pressure levels. The authors argue that treatment decisions should be individualized rather than based on race, and other factors such as medication adherence, lifestyle interventions, and addressing social determinants of health should be given greater attention.

A similar publication from the American Heart Association, agrees and concludes that we need to “shift the focus from race-specific monotherapy treatment recommendations by adopting comprehensive team-based multi-level care models that use race-informed communication, self-care, and dietary strategies coupled with race-agnostic treatment algorithms that minimize therapeutic inertia and promote prescription of an adequate intensity of drug therapy.”

⚙️ The More You Know

Let’s Define Health Equity

Health equity is a fundamental principle aimed to ensure every individual has an equal opportunity to achieve optimal health, regardless of their social or demographic background. It encompasses the idea that everyone should have fair and just access to the resources, opportunities, and conditions necessary for good health and well-being. Health equity recognizes and seeks to address the systemic and avoidable differences in health outcomes that are often rooted in social determinants such as race, ethnicity, socioeconomic status, education, and access to healthcare. Achieving health equity requires dismantling barriers, eliminating disparities, and promoting inclusive policies and practices that prioritize the health and well-being of all individuals, particularly those who have historically been marginalized or disadvantaged. Sometimes we need to get creative, and APPs have the brain power to come up with solutions!

Let’s Talk Money. The Mind-Blowing Economic Burden of Health Inequity

A recently published paper in JAMA aims to quantify the economic burden of health inequities in the U.S., and undoubtedly justifies some spending for better access to care. The data, used from 2018, reports that inequities based on race and ethnicity cost the United States $421 billion, while education-related health inequities amounted to $940 billion. Black/African Americans had the highest economic burden of racial and ethnic health inequities in most states, followed by Hispanic/Latino, American Indian/Alaska Native, and Native Hawaiian/Pacific Islanders.

The discussion concludes that “the economic burden of health inequity is affecting all individuals in the US. Prioritizing and implementing proven policies and practices that promote health equity would vastly improve quality of life at all levels of society.” Wish to dive deeper or obtain resources for an evidenced based solution to funding? The Institute for Innovation in Health Equity at Tulane University is an incredible resource!

Knowledge is Power, it Leads to Solutions.

Health disparities disproportionately affect Black communities in the U.S., leading to higher rates of certain conditions and worse outcomes. These disparities are influenced by a combination of genetic, social, and economic factors. The reasons behind these disparities are complex and compounded by physical conditions that disproportionately affect Black people (think heart disease, obesity, diabetes, hypertension, sickle cell anemia), and efforts to address these disparities are equally complex. We found this informative article aimed at awareness and how to promote healthy lifestyle changes while managing risk factors and advocating for culturally competent healthcare and conditions within the Black community.

💡Inspiration for Aspirations

Introducing, Dwayne Alleyne DNP, APRN, ACNP-C. Air Force Veteran, network leader, entrepreneur, educator, and all-around role-model!

Q: Tell us about your background?

A: Currently, I work as a clinical assistant professor at the University of South Carolina. I have been in this position going on 3 years in August. I have been in nursing for over 20 years. I became an LPN in 1998 and got my start in a nursing home. Then I obtained my BSN from Adelphi University in 2002. Served 3 years in the Air Force, where I started my career as a bachelor’s prepared nurse. I was deployed to Iraq shortly before I was honorably discharged. After leaving the Air Force, I worked as an ICU nurse. As an ICU nurse, I applied to the University of South Carolina College of Nursing to become an Acute Care Nurse Practitioner. I obtained my first job as a nurse practitioner at a VA hospital, where I worked as a hospitalist. Continued my hospitalist career in a teaching hospital. During that time, I obtained a position as adjunct faculty for the University of South Carolina. Eventually, I transitioned to full-time faculty after receiving my DNP in 2020.

Other activities that I am involved in include serving as the Executive Director and founder of Capitol Nurse Practitioner Group, one of the largest nurse practitioner networking groups in South Carolina. I am also a member at large of the South Carolina Nurses Association, where I assist with member engagement. I am serving my first term as one of the Board of Directors of DNPs of Color, a national organization dedicated to promoting nursing excellence in underserved communities.

Q: How did you get into the legal aspect of healthcare?

A: My wife is a medical malpractice personal injury attorney. She would often request my assistance with some of her medical malpractice cases. Then she recommended that I form my own company and start practicing independently. I have been doing it for about 10 years.

Q: Have you faced any barriers or challenges throughout your educational and professional journey as both a male and a black male, in a predominately female field?

A: In almost every aspect of my professional career, I have faced challenges because I looked “different.” There has often been the expectation that I would fail at a task set before, and there was a big surprise not only when I completed that task but also when I did it well. One of the more recent challenges I have faced in my career is when I became a full-time professor. I could tell that some students were not used to someone that looked like me. This was evident in the end-of-semester course evaluations. During one of my first semesters working full time, students attacked my character, stating that I didn’t belong in academia and that the school needed to eliminate me. I was also directly confronted via email and video conference. I withstood those challenges, held my head high, and pressed on.

Q: Representation matters, especially in healthcare. How do you believe your presence as a black male nurse practitioner positively impacts patients, particularly those from underrepresented communities?

A: I would have to say that representation definitely matters, particularly in healthcare. Some patients have never seen a provider that looked like them. I recall a time when I went to see one of my patients with a cardiologist (who was also African-American) who was accompanying me. When we came in the room, and he saw both of us, he was overfilled with joy, rolling back and forth and yelling, “I have 2 black doctors taking care of me!!” That was a moment that I will never forget. There were also many times when I had to ease patients’ anxieties because they did not trust the care they received from “white” doctors because of past experiences when they were dismissed or received poor treatment.

Q: Wow, that’s powerful. In light of the current disparities in healthcare access and outcomes, what steps do you think can be taken to increase diversity and representation, specifically for black men, within the nurse practitioner profession?

A: The first step is to make myself visible and tell my story. I am the only black male nursing professor at the University of South Carolina College of Nursing. This is one of the primary reasons I am on social media so often. I have been approached by many people (men and women) who heard my story and have been inspired to advance their careers in nursing. A second step is to reach out to the younger generation. I often speak or volunteer at high school functions and discuss my profession and its benefits. I also talk about the potential challenges and ways to beat those challenges. The third step is to develop a pipeline into the nursing field. I serve on the DEI committee at the University of South Carolina College of Nursing, so I work closely with them to help develop programs that would assist in bringing underrepresented students into the school programs.

As far as black men, that is a problematic demographic that I am trying to tap into. I have been involved in academia at the University of South Carolina graduate level since 2019 and have seen only 1 black male student. I teach advanced pharmacology as one of my primary courses, so I know every nurse practitioner that comes through the College of Nursing. I am unsure why this is happening, but it is somewhat troubling. Even at the undergraduate level, the black males appear apathetic and never ask for assistance or appear at review sessions that we offer to help them be successful. I am hopeful that I will eventually make a breakthrough.

Wow. Keep up the good work Dr. Alleyne. For ongoing leadership and inspiration, be sure to connect with him on LinkedIn!

📈Future APPs

Pro-tip: Stay informed. All of these articles are relevant to your growing knowledge base, current, and future role in healthcare.

🧪Clinical Conundrums: Because We Love a Challenge!

Last Week We Weren’t Blowing Smoke! Let’s Talk Asthma.

According to the U.S. Dept. of Health and Human Services, non-Hispanic African Americans were 30 percent more likely to have asthma than non-Hispanic whites. It seems given the current air quality issues and our focus on health equity this week, asthma is a fitting subject.

Given the clinical vignette from last week, if you chose ‘absence of wheezing’ as the MOST concerning sign of impending respiratory failure, you are CORRECT! Your next step should also be getting this person on a high dose neb, steroids, and consider epi (off label if indicated/available while waiting) but don’t hesitate to jump into action. The “silent” chest is ominous because it could indicate the bronchioles are so clamped down, they no longer move air. Pro-tip: don’t confuse this for sounding clear! Other indicators include:

• RR>30

• Excessive accessory muscle use (the patient just looks bad) or is “tripoding” (they can’t lay flat)

• Paradoxical breathing

• Worsening hypoxemia and bradycardia = impending cardiac arrest

• Somnolence is also worrisome → they may no longer be ventilating (i.e. exhaling C02)

We mentioned a favorite resource, Osmosis.org for pathophysiology and medical disease states. A great resource for emergency care is EMCrit.org and their Internet Book of Critical Care (IBCC). It’s an evidence-based resource and the podcast can fill that commute time! You. Are. Welcome.

** Disclaimer, this is a case-based exercise and not medical advice or a substitution for individualized care. By the time you read this, the current treatment may even be outdated. Do your due diligence when seeking patient care resources. **

🔎ICYMI

Last Week Was on Fire: Go Home Wildfire Smoke, You're Lost

• APP Leader Dr. Sharon Pappas shares leadership insight

• PAs are proven crucial to NY healthcare in an interview with Maria Patricia Cuartas, PA-C, MBA, PMP, FACHE, ACHIP

• As wildfires spread, air quality declines and business booms for Midwest and Northeast Providers

• Look out for our vulnerable peeps, the dangers of wildfire smoke are real, so is the severity of respiratory distress

• For future APPs: We highlight the top notch and unique programs at The University of Pittsburgh

• Clinical Conundrums: Let’s take a breather to refresh our knowledge on emergency care for asthmatics with a case-based exercise

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