25 results on '"Razon, Na’amah"'
Search Results
2. Extra/ordinary medicine: Toward an anthropology of primary care
- Author
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Sideman, Alissa Bernstein and Razon, Na'amah
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Health Services and Systems ,Health Sciences ,Human Society ,Health Services ,Clinical Research ,Prevention ,8.1 Organisation and delivery of services ,7.1 Individual care needs ,7.3 Management and decision making ,Generic health relevance ,Good Health and Well Being ,Humans ,United States ,Anthropology ,Anthropology ,Cultural ,Delivery of Health Care ,Medicine ,Primary Health Care ,Dementia ,Extra/ordinary ,Primary care ,Qualitative methods ,Social determinants of health ,Medical and Health Sciences ,Economics ,Studies in Human Society ,Public Health ,Health sciences ,Human society - Abstract
Primary care is at the forefront of healthcare delivery. It is the site of disease prevention and health management and serves as the bridge between communities and the health care system As ethnographers of primary care, in this article we discuss what is gained by situating anthropological inquiry within primary care. We articulate how anthropologists can contribute to a better understanding of the issues that emerge in primary care. We provide a review of anthropological work in primary care and offer empirical data from two ethnographic case studies based in the United States, one focused on social risk screening in primary care and the other examining the diagnosis and care of people with dementia in primary care. Through these cases, we demonstrate how research of and within primary care can open important avenues for the study of the multidimensionality of primary care. This multidimensionality is apparent in the ways the medical field addresses the social and structural experiences of patients, scope of practice and disciplinary boundaries, and the intersection of ordinary and extraordinary medicine that emerge in the care of patients in primary care.
- Published
- 2024
3. Storylines of family medicine X: standing up for diversity, equity and inclusion.
- Author
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Ventres, William B, Stone, Leslie A, Bryant, Wayne W, Pacheco, Mario F, Figueroa, Edgar, Chu, Francis N, Prasad, Shailendra, Blane, David N, Razon, Na'amah, Mishori, Ranit, Ferrer, Robert L, and Kneese, Garrett S
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Health Services and Systems ,Health Sciences ,Generic health relevance ,Good Health and Well Being ,Humans ,Family Practice ,Diversity ,Equity ,Inclusion ,Physicians ,Family ,Education ,Medical ,Health Equity ,Family Medicine ,General Practice ,Global Health ,Minority Health ,Social Determinants of Health ,Health services and systems ,Public health - Abstract
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'X: standing up for diversity, equity and inclusion', authors address the following themes: 'The power of diversity-why inclusivity is essential to equity in healthcare', 'Medical education for whom?', 'Growing a diverse and inclusive workforce', 'Therapeutic judo-an inclusive approach to patient care', 'Global family medicine-seeing the world "upside down"', 'The inverse care law', 'Social determinants of health as a lens for care', 'Why family physicians should care about human rights' and 'Toward health equity-the opportunome'. May the essays that follow inspire readers to promote change.
- Published
- 2024
4. Essential not Supplemental: Medicare Advantage Members’ Use of Non-Emergency Medical Transportation (NEMT)
- Author
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Razon, Na’amah, Gottlieb, Laura M, and Fraze, Taressa
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Health Services and Systems ,Health Sciences ,Health Services ,Clinical Research ,Health and social care services research ,8.1 Organisation and delivery of services ,Generic health relevance ,Good Health and Well Being ,Aged ,Humans ,United States ,Medicare Part C ,Reproducibility of Results ,Transportation of Patients ,Health Services Accessibility ,Emergency Medical Services ,transportation ,social risk ,medicare advantage ,supplemental benefits ,Clinical Sciences ,General & Internal Medicine ,Clinical sciences ,Health services and systems ,Public health - Abstract
BackgroundOver five million people in the USA miss or delay medical care because of a lack of transportation. Transportation barriers are especially relevant to Medicare Advantage (MA) health plan enrollees, who are more likely to live with multiple chronic conditions and experience mobility challenges. Non-Emergency Medical Transportation (NEMT) helps to address transportation gaps by providing rides to and from routine medical care (for example, medical appointments, laboratory tests, and pharmacy visits) and has been added as a supplemental benefit to some MA health plans.ObjectiveWe aimed to characterize MA enrollees' experiences with supplemental NEMT benefits.DesignQualitative interviews focused on participants' experiences with existing NEMT benefits, transportation, and mobility.ParticipantsTwenty-one MA enrollees who used their MA NEMT benefit in 2019 and who remained eligible for ongoing transportation benefits through 2021.ApproachUsing purposive sampling from a list of eligible participants, we recruited individuals who used their MA NEMT benefit in 2019 and who remained eligible for benefit-covered transportation services through 2021.Key resultsParticipants considered NEMT an essential service, particularly because these services helped them decrease social isolation, reduce financial insecurity, and manage their own medical needs. Navigating logistical challenges associated with arranging NEMT services required participants to commit considerable time and energy and limited the effectiveness and reliability of NEMT.ConclusionParticipants described NEMT as a valued service essential to their ability to access health care. They suggested ways to increase service flexibility and reliability that could inform future NEMT policy and practice. As health systems and payers learn how to best address social risks, particularly as the US population ages, our findings underscore the importance of NEMT services and highlight opportunities to advance comprehensive transportation solutions for MA participants.
- Published
- 2023
5. “More than just giving them a piece of paper”: Interviews with Primary Care on Social Needs Referrals to Community-Based Organizations
- Author
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Beidler, Laura B, Razon, Na’amah, Lang, Hannah, and Fraze, Taressa K
- Subjects
Health Services and Systems ,Health Sciences ,Behavioral and Social Science ,Health Services ,Clinical Research ,Health and social care services research ,Management of diseases and conditions ,7.1 Individual care needs ,8.1 Organisation and delivery of services ,Generic health relevance ,Humans ,Referral and Consultation ,Qualitative Research ,Delivery of Health Care ,Primary Health Care ,social determinants of health ,primary care ,clinicians ,social risks ,referrals ,Clinical Sciences ,General & Internal Medicine ,Clinical sciences ,Health services and systems ,Public health - Abstract
BackgroundPrimary care practices are responding to calls to incorporate patients' social risk factors, such as housing, food, and economic insecurity, into clinical care. Healthcare likely relies on the expertise and resources of community-based organizations to improve patients' social conditions, yet little is known about the referral process.ObjectiveTo characterize referrals to community-based organizations by primary care practices.DesignQualitative study using semi-structured interviews with healthcare administrators responsible for social care efforts in their organization.ParticipantsAdministrators at 50 diverse US healthcare organizations with efforts to address patients' social risks.Main measuresApproaches used in primary care to implement social needs referral to community-based organizations.ResultsInterviewed administrators reported that social needs referrals were an essential element in their social care activities. Administrators described the ideal referral programs as placing limited burden on care teams, providing patients with customized referrals, and facilitating closed-loop referrals. We identified three key challenges organizations experience when trying to implement the ideal referrals program: (1) developing and maintaining resources lists; (2) aligning referrals with patient needs; and (3) measuring the efficacy of referrals. Collectively, these challenges led to organizations relying on staff to manually develop and update resource lists and, in most cases, provide patients with generic referrals. Administrators not only hoped that referral platforms may help overcome some of these barriers, but also reported implementation challenges with platforms including inconsistent buy-in and use across staff; integration with electronic health records; management and prioritization of resources; and alignment with other organizations in their market.Conclusion and relevanceReferrals to community-based organizations were used in primary care to improve patients' social conditions, but despite strong motivations, interviewees reported challenges providing tailored and up-to-date information to patients.
- Published
- 2022
6. Adjusting for Patient Economic/Access Issues in a Hypertension Quality Measure
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Donovan, Jenna, Cottrell, Erika K, Hoopes, Megan, Razon, Na'amah, Gold, Rachel, Pisciotta, Maura, and Gottlieb, Laura M
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Health Services and Systems ,Health Sciences ,Clinical Research ,Health Services ,Hypertension ,Cardiovascular ,Good Health and Well Being ,Humans ,United States ,Quality Indicators ,Health Care ,Community Health Centers ,Quality of Health Care ,Electronic Health Records ,Medical and Health Sciences ,Education ,Public Health ,Biomedical and clinical sciences ,Health sciences - Abstract
IntroductionThe American Heart Association and American College of Cardiology have proposed adjusting hypertension-related care quality measures by excluding patients with economic/access issues from the denominator of rate calculations. No research to date has explored the methods to operationalize this recommendation or how to measure economic/access issues. This study applied and compared different approaches to populating these denominator exceptions.MethodsElectronic health record data from 2019 were used in 2021 to calculate hypertension control rates in 84 community health centers. A total of 10 different indicators of patient economic/access barriers to care were used as denominator exclusions to calculate and then compare adjusted quality measure performance. Data came from a nonprofit health center‒controlled network that hosts a shared electronic health record for community health centers located in 22 states.ResultsA total of 5 of 10 measures yielded an increase in adjusted hypertension control rates in ≥50% of clinics (average rate increases of 0.7-3.71 percentage points). A total of 3 of 10 measures yielded a decrease in adjusted hypertension control rates in >50% of clinics (average rate decreases of 1.33-13.82 percentage points). A total of 5 measures resulted in excluding >50% of the clinic's patient population from quality measure assessments.ConclusionsChanges in clinic-level hypertension control rates after adjustment differed depending on the measure of economic/access issue. Regardless of the exclusion method, changes between baseline and adjusted rates were small. Removing community health center patients experiencing economic/access barriers from a hypertension control quality measure resulted in excluding a large proportion of patients, raising concerns about whether this calculation can be a meaningful measure of clinical performance.
- Published
- 2022
7. The work of reform: a critical examination of health policy
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Razon, Na’amah and Sideman, Alissa Bernstein
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Policy and Administration ,Human Society ,Health Services ,Clinical Research ,Humans ,Health Care Reform ,Anthropology ,Medical ,Health Policy ,Politics ,Israel ,reform ,health policy ,health inequities ,Bolivia ,Public Health and Health Services ,Public Health ,Anthropology - Abstract
Anthropologists have critically examined a range of reforms from education and land to finance and health. Yet the predominant way of looking at reforms has been through a lens focused on neoliberal governance. For example, prior studies of health reforms focus on insurance, financing, and access to care. Yet, seeing reform in this way fails to attend to other types of cultural work at play when calling a policy or law a reform. In this paper, we draw on ethnographic research on health policy reforms in Israel and Bolivia to examine the concept of reform and the work it does within national movements. We argue that while the language of reform often signals change or novelty, reforms also carry forward historical continuities and reifications of the past. By delving into the past and its relationship with ongoing health reforms, we attend to how reforms can reinforce and maintain health inequities in some cases, while creating a national language for new possibilities in others. Reform, as we will discuss in this paper, is not only about political ideology, neoliberal governance, or on-the-ground policy implementation, but centrally it is about representations of aspirations, and about crafting relationships between past, present, and future.
- Published
- 2022
8. Social Care Recommendations in National Diabetes Treatment Guidelines.
- Author
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Aceves, Benjamin, Gunn, Rose, Pisciotta, Maura, Razon, Na'amah, Cottrell, Erika, Hessler, Danielle, Gold, Rachel, and Gottlieb, Laura M
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Humans ,Diabetes Mellitus ,Type 2 ,Social Support ,Adult ,Referral and Consultation ,Delivery of Health Care ,Diabetes ,Health disparities ,Social care ,Treatment guidelines ,Clinical Research ,Health Services ,Behavioral and Social Science ,Management of diseases and conditions ,7.1 Individual care needs ,8.1 Organisation and delivery of services ,Health and social care services research ,Generic health relevance ,Metabolic and endocrine ,Clinical Sciences ,Nutrition and Dietetics ,Public Health and Health Services ,Endocrinology & Metabolism - Abstract
Purpose of reviewAn expanding body of research documents associations between socioeconomic circumstances and health outcomes, which has led health care institutions to invest in new activities to identify and address patients' social circumstances in the context of care delivery. Despite growing national investment in these "social care" initiatives, the extent to which social care activities are routinely incorporated into care for patients with type II diabetes mellitus (T2D), specifically, is unknown. We conducted a scoping review of existing T2D treatment and management guidelines to explore whether and how these guidelines incorporate recommendations that reflect social care practice categories.Recent findingsWe applied search terms to locate all T2D treatment and management guidelines for adults published in the US from 1977 to 2021. The search captured 158 national guidelines. We subsequently applied the National Academies of Science, Engineering, and Medicine framework to search each guideline for recommendations related to five social care activities: Awareness, Adjustment, Assistance, Advocacy, and Alignment. The majority of guidelines (122; 77%) did not recommend any social care activities. The remainder (36; 23%) referred to one or more social care activities. In the guidelines that referred to at least one type of social care activity, adjustments to medical treatment based on social risk were most common [34/36 (94%)]. Recommended adjustments included decreasing medication costs to accommodate financial strain, changing literacy level or language of handouts, and providing virtual visits to accommodate transportation insecurity. Ensuring that practice guidelines more consistently reflect social care best practices may improve outcomes for patients living with T2D.
- Published
- 2022
9. Exploring the impact of mifepristone's risk evaluation and mitigation strategy (REMS) on the integration of medication abortion into US family medicine primary care clinics✰,✰✰
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Razon, Na’amah, Wulf, Sarah, Perez, Citlali, McNeil, Sarah, Maldonado, Lisa, Fields, Alison Byrne, Carvajal, Diana, Logan, Rachel, and Dehlendorf, Christine
- Subjects
8.1 Organisation and delivery of services ,Health and social care services research ,7.1 Individual care needs ,Management of diseases and conditions ,Good Health and Well Being ,Abortion ,Induced ,Abortion ,Spontaneous ,Family Practice ,Female ,Humans ,Mifepristone ,Pregnancy ,Primary Health Care ,Risk Evaluation and Mitigation ,United States ,Family medicine ,Medication abortion ,Primary care ,REMS ,Clinical Sciences ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Obstetrics & Reproductive Medicine - Abstract
ObjectivesIn 2000, the United States' Food and Drug Administration (FDA) approved mifepristone for medication abortion. In this article, we explore how the Risk Evaluation and Mitigation Strategy (REMS) criteria for mifepristone specifically impede family physicians' ability to provide medication abortion in primary care settings.Study designWe conducted 56 qualitative interviews with a national sample of family physicians across the US who were not opposed to abortion. We examined how the REMS criteria for mifepristone impact family physicians' ability to provide medication abortion.ResultsOf the 56 interviews conducted, 23 participants (41%) raised the REMS criteria as a barrier to providing medication abortion in primary care. These participants reported the REMS added a layer of bureaucratic complexity that made it difficult for family physicians to navigate, even when trained, to provide abortion care. These family physicians described 2 predominant ways the REMS impede their ability to provide medication abortion: (1) The REMS require substantial involvement of clinic administration, who can be unsupportive; (2) The complexity of navigating the REMS results in physicians and clinic administration in primary care viewing medication abortion as not worth the effort, since it is only a small component of services offered in primary care.ConclusionRemoving the REMS could simplify integration of medication abortion into primary care, which could meet patient preferences, improve access, and reduce abortion stigma. The FDA's revised REMS criteria may ease administrative burden but will likely maintain key barriers to integrating medication abortion into family physicians' practice.ImplicationsOur study highlights that the REMS criteria are barriers to family physicians' ability to integrate medication abortion into their primary care practices. The FDA's removal of in person dispensing criteria may provide some impetus for trained family physicians to integrate medication abortion into their scope of practice but the revised REMS criteria maintain key barriers to broader adoption.
- Published
- 2022
10. How Hypertension Guidelines Address Social Determinants of Health: A Systematic Scoping Review.
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Razon, Na'amah, Hessler, Danielle, Bibbins-Domingo, Kirsten, and Gottlieb, Laura
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Humans ,Hypertension ,Guidelines as Topic ,Social Determinants of Health ,Behavioral and Social Science ,Health Services ,Clinical Research ,Cardiovascular ,Management of diseases and conditions ,7.3 Management and decision making ,Good Health and Well Being ,hypertension ,blood pressure ,social determinants of health ,guideline ,Public Health and Health Services ,Applied Economics ,Health Policy & Services - Abstract
BackgroundPatient-level and community-level social and economic conditions impact hypertension risk and control. We examined adult hypertension management guidelines to explore whether and how existing guidelines refer to social care activities.ObjectiveThe objective of this study was to explore how hypertension guidelines reference social care activities.Research designA systematic scoping review of clinical guidelines for adult hypertension management. We employed a PubMed search strategy to identify all hypertension guidelines published in the United States between 1977 and 2019. We reviewed all titles to identify the most updated versions focused on nonpregnant adults with hypertension. We extracted instances where guidelines referred to social determinants of health (SDH) or social care activities. The primary outcome was how guidelines covered social care activities, defined using a framework adapted from the National Academies of Sciences, Engineering, and Medicine (NASEM).ResultsSearch terms yielded 126 guidelines. Thirty-six guidelines met the inclusion criteria. Of those, 72% (26/36) recommended social care activities as part of hypertension management; 58% recommended clinicians change clinical practice based on social risk information. These recommendations often lacked specific guidance around how to directly address social risk factors or reduce the impact of these risks on hypertension management. When guidelines referred to specific social factors, patient financial security was the most common. Over time, hypertension guidelines have included more references to SDH.ConclusionInformation about SDH is included in many hypertension guidelines, but few guidelines provide clear guidance for clinicians or health systems on how to identify and address social risk factors in the context of care delivery.
- Published
- 2021
11. "Far More than Just a Prescription": Focus Groups With U.S. Family Planning Providers and Staff About Integrating PrEP for HIV Prevention Into Their Work.
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Razon, Na'amah, Rodriguez, Amanda, Carlson, Kimberly, Witt, Jacki, Logan, Rachel, Chambers, Brittany, Weber, Shannon, and Seidman, Dominika
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Humans ,HIV Infections ,Focus Groups ,Family Planning Services ,United States ,Philadelphia ,Missouri ,San Francisco ,Female ,Prescriptions ,Pediatric ,Pediatric AIDS ,Clinical Research ,Behavioral and Social Science ,Infectious Diseases ,HIV/AIDS ,Prevention ,Public Health ,Paediatrics and Reproductive Medicine ,Public Health and Health Services - Abstract
BackgroundCisgender women in the United States use pre-exposure prophylaxis (PrEP) for HIV prevention at lower rates relative to other groups. Advocacy groups and patients identify family planning clinics as the preferred sites to lead PrEP implementation for women in the United States. However, limited qualitative exploration exists of U.S. family planning practitioners' attitudes toward integrating PrEP into their work.MethodsWe conducted qualitative focus groups with a convenience sample of family planning clinicians, counselors, and clinic managers to explore barriers and facilitators to PrEP provision in U.S. family planning clinics.ResultsWe conducted six focus groups (total participants = 37) with respondents who worked in family planning clinics in San Francisco, California; Kansas City, Missouri; and Philadelphia, Pennsylvania. Key themes emerged highlighting how PrEP at times runs contrary to other family planning agendas, including efficient clinic visits, condom promotion, and long-acting reversible contraception counseling. Throughout these discussions, participants expressed discomfort with HIV vulnerabilities rooted in social and structural determinants of health.ConclusionsFindings suggest that those seeking to implement PrEP for U.S. cisgender women may benefit from exploring 1) how to integrate patient/provider conversations about the structural determinants of health and their relationship to HIV and other sexual and reproductive health outcomes and 2) how to foster person-centered prevention conversations in the context of busy family planning visits.
- Published
- 2021
12. Evaluating Community Health Center Social Care Activities
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De Marchis, Emilia, Aceves, Benjamin, Razon, Na'amah, and Gottlieb, Laura
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Social service -- Usage ,Physician and patient -- Analysis ,Medical records -- Analysis ,Health planning -- Methods ,Data entry -- Methods ,Electronic records -- Analysis ,Health ,Science and technology - Abstract
Context: Despite the expansion of social risk data collection, little research has examined how the increased availability of social risk information influences care delivery. Objective: To explore the collection and use of social risk data in community health centers (CHC) in Texas, and the facilitators/barriers to these social care activities in pre/peri-COVID-19 pandemic periods. Study Design & Analysis: Mixed methods: 1) interviews and thematic analysis; 2) surveys and electronic health record (EHR) review and descriptive statistics. Setting: Four urban/suburban CHCs. Population Studied: Providers, staff and patients. Instrument: Semi-structured interview guide, online survey. Outcome Measures: Perspectives on integrating a range of social care activities; reach of social screening. Results: We conducted 27 interviews (15 providers; 12 staff), 97 provider surveys, and reviewed EHR data from two CHCs. There was broad support for integrating social care; support increased peri-pandemic. 90% of survey respondents reported incorporating social screening into patient conversations; 46% of those screening used standardized screening tools. 29% of all survey respondents were unaware their clinic had a standardized tool. EHR data showed that both numbers of screens per month and rates of screens per encounters increased (4% of patient encounters in 8/2019 to 44% in 2/2021). There were significant differences in whether patients were screened by race/ethnicity and language (p Conclusions: CHCs were in the early phases of social care delivery, primarily focused on awareness and assistance with little dedicated attention to adjustment or population health-level evaluations. Differences in screening reach by patient demographics raise concern that social care might exacerbate disparities. Future research should explore equity in implementation and effectiveness. Overcoming barriers to reach, sustainability and equity will require supports targeted to program design and development, workforce capacity, quality improvement, and community investments in social services., Presenters Emilia De Marchis, MD, MS, MAS, Benjamin Aceves, PhD, Na'amah Razon, MD, PhD, Laura Gottlieb, MD, [...]
- Published
- 2023
13. Entangled Bodies: Jews, Bedouins, and the Making of the Secular Israeli
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Razon, Na’amah
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Policy and Administration ,Human Society ,Reduced Inequalities ,Anthropology ,Medical ,Arabs ,Healthcare Disparities ,Humans ,Israel ,Jews ,Bedouin ,Jewish ,Negev/Naqab ,secular ,Anthropology ,Cultural Studies ,Public Health ,Sociology - Abstract
Taking Israel's National Health Insurance Law as a point of entry, in this article I probe how notions of equality and citizenship, secularism, and religion become entangled in the experience of Negev/Naqab Bedouins, who are Palestinian citizens of Israel. Drawing on ethnographic and archival research, I show how Jewish citizens have come to represent the secular and modern citizens in the region, while Bedouins, although mandated and claimed by policy and providers to be the 'same' and 'equal,' are always already imagined and characterized as other. Universal health care and the daily manner in which biomedicine is practiced in southern Israel provides an avenue for examining the Jewish valences medicine carries in southern Israel, Israel's boundaries of inclusion, and the connection between biomedicine and secularism.
- Published
- 2016
14. Transportation Justice and Health
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HANSMANN, KELLIA J., primary and RAZON, NA'AMAH, additional
- Published
- 2023
- Full Text
- View/download PDF
15. “Wanting the Best for Our Folks”—A Mixed Methods Analysis of Community Health Center Social Risk Screening Initiatives
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De Marchis, Emilia H., primary, Aceves, Benjamin, additional, Razon, Na’amah, additional, Chang Weir, Rosy, additional, Jester, Michelle, additional, and Gottlieb, Laura M., additional
- Published
- 2023
- Full Text
- View/download PDF
16. Primary Care Pracitioner Perspectives on the Role of Primary Care in Dementia Diagnosis and Care
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Sideman, Alissa Bernstein, primary, Ma, Melissa, additional, Hernandez de Jesus, Alma, additional, Alagappan, Cecilia, additional, Razon, Na’amah, additional, Dohan, Daniel, additional, Chodos, Anna, additional, Al-Rousan, Tala, additional, Alving, Loren I., additional, Segal-Gidan, Freddi, additional, Rosen, Howie, additional, Rankin, Katherine P., additional, Possin, Katherine L., additional, and Borson, Soo, additional
- Published
- 2023
- Full Text
- View/download PDF
17. “They Go Hand in Hand”: Perspectives on the Relationship Between the Core Values of Family Medicine and Abortion Provision Among Family Physicians Who Do Not Oppose Abortion
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Wulf, Sarah, primary, Carvajal, Diana N., additional, Razon, Na’amah, additional, Perez, Citlali, additional, McNeil, Sarah, additional, Maldonado, Lisa, additional, Fields, Alison Byrne, additional, Silverstein, Ilana, additional, and Dehlendorf, Christine, additional
- Published
- 2023
- Full Text
- View/download PDF
18. The work of reform: a critical examination of health policy.
- Author
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Razon, Na'amah, Razon, Na'amah, Sideman, Alissa Bernstein, Razon, Na'amah, Razon, Na'amah, and Sideman, Alissa Bernstein
- Abstract
Anthropologists have critically examined a range of reforms from education and land to finance and health. Yet the predominant way of looking at reforms has been through a lens focused on neoliberal governance. For example, prior studies of health reforms focus on insurance, financing, and access to care. Yet, seeing reform in this way fails to attend to other types of cultural work at play when calling a policy or law a reform. In this paper, we draw on ethnographic research on health policy reforms in Israel and Bolivia to examine the concept of reform and the work it does within national movements. We argue that while the language of reform often signals change or novelty, reforms also carry forward historical continuities and reifications of the past. By delving into the past and its relationship with ongoing health reforms, we attend to how reforms can reinforce and maintain health inequities in some cases, while creating a national language for new possibilities in others. Reform, as we will discuss in this paper, is not only about political ideology, neoliberal governance, or on-the-ground policy implementation, but centrally it is about representations of aspirations, and about crafting relationships between past, present, and future.
- Published
- 2022
19. Family Physicians' Barriers and Facilitators in Incorporating Medication Abortion
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Razon, Na'amah, primary, Wulf, Sarah, additional, Perez, Citlali, additional, McNeil, Sarah, additional, Maldonado, Lisa, additional, Fields, Alison Byrne, additional, Holt, Kelsey, additional, Fox, Edith, additional, Silverstein, Ilana, additional, and Dehlendorf, Christine, additional
- Published
- 2022
- Full Text
- View/download PDF
20. Content Analysis of Transportation Screening Questions in Social Risk Assessment Tools: Are We Capturing Transportation Insecurity?
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Razon, Na'amah, primary and Gottlieb, Laura, additional
- Published
- 2022
- Full Text
- View/download PDF
21. "More than just giving them a piece of paper": Interviews with Primary Care on Social Needs Referrals to Community-Based Organizations.
- Author
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Beidler, Laura B., Razon, Na'amah, Lang, Hannah, and Fraze, Taressa K.
- Subjects
- *
QUALITATIVE research , *RESEARCH funding , *MEDICAL care , *PRIMARY health care , *PSYCHOLOGICAL tests , *MEDICAL referrals , *SOCIAL participation - Abstract
Background: Primary care practices are responding to calls to incorporate patients' social risk factors, such as housing, food, and economic insecurity, into clinical care. Healthcare likely relies on the expertise and resources of community-based organizations to improve patients' social conditions, yet little is known about the referral process.Objective: To characterize referrals to community-based organizations by primary care practices.Design: Qualitative study using semi-structured interviews with healthcare administrators responsible for social care efforts in their organization.Participants: Administrators at 50 diverse US healthcare organizations with efforts to address patients' social risks.Main Measures: Approaches used in primary care to implement social needs referral to community-based organizations.Results: Interviewed administrators reported that social needs referrals were an essential element in their social care activities. Administrators described the ideal referral programs as placing limited burden on care teams, providing patients with customized referrals, and facilitating closed-loop referrals. We identified three key challenges organizations experience when trying to implement the ideal referrals program: (1) developing and maintaining resources lists; (2) aligning referrals with patient needs; and (3) measuring the efficacy of referrals. Collectively, these challenges led to organizations relying on staff to manually develop and update resource lists and, in most cases, provide patients with generic referrals. Administrators not only hoped that referral platforms may help overcome some of these barriers, but also reported implementation challenges with platforms including inconsistent buy-in and use across staff; integration with electronic health records; management and prioritization of resources; and alignment with other organizations in their market.Conclusion and Relevance: Referrals to community-based organizations were used in primary care to improve patients' social conditions, but despite strong motivations, interviewees reported challenges providing tailored and up-to-date information to patients. [ABSTRACT FROM AUTHOR]- Published
- 2022
- Full Text
- View/download PDF
22. Producing Equality: Citizenship, Science, and Medicine in the Negev/Naqab
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Razon, Na'amah
- Subjects
Public health ,Near Eastern studies ,Medical ethics ,Bedouin ,Citizenship ,Equality ,Israel ,National Health Insurance Law ,Negev/Naqab - Abstract
In 1994 Israel passed the National Health Insurance Law (NHIL), guaranteeing universal and equal healthcare services to all citizens. Universal healthcare, while unprecedented in Israel, did not have a significant impact on the country's Jewish majority. Yet for minority citizens such as the Bedouin community in the southern Israel, the NHIL transformed access to medical services, increasing insurance coverage from 60% to 100%, and changing the patient demographic in the regional hospital. Nonetheless, since 1995 when the law was implemented, disparities in health outcomes between Jewish and Arab citizens in the country have widened. Healthcare reform took place within a geo-political landscape that continues to marginalize its Arab citizens. Thus the paradigm of equality of healthcare intersects with national policies that create a differential citizenship in Israel. This dissertation, Producing Equality: Citizenship, Science, and Medicine in the Negev/Naqab, examines the impact of Israel's National Health Insurance Law as a site to understand how Israel's policies of inclusion and exclusion of Bedouin Arab citizens become entangled. My work highlights the tensions that exist between expansive and technical medical care that the state allocates to its Bedouin citizens, and the limited financial and political support the Bedouin community receives from the government in other spheres. Healthcare in southern Israel provides an important site to study the active production of the boundaries of citizenship, medicine, and reconfiguring of discrimination. I argue that the emphasis on scientific discourse in the medical arena ignores the social and political problems that place much of the Bedouin community in poor health. Therefore social, political, and historical questions that are central to understanding health disparities in the region remain beyond the scope of what providers view as relevant to their work. This bounding of medical care allows for the continuation of discriminatory policies towards the Bedouin citizens, while permitting the state and healthcare providers to assert they provide equal care to all patients.
- Published
- 2013
23. Entangled Bodies: Jews, Bedouins, and the Making of the Secular Israeli.
- Author
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Razon, Na'amah, Razon, Na'amah, Razon, Na'amah, and Razon, Na'amah
- Abstract
Taking Israel's National Health Insurance Law as a point of entry, in this article I probe how notions of equality and citizenship, secularism, and religion become entangled in the experience of Negev/Naqab Bedouins, who are Palestinian citizens of Israel. Drawing on ethnographic and archival research, I show how Jewish citizens have come to represent the secular and modern citizens in the region, while Bedouins, although mandated and claimed by policy and providers to be the 'same' and 'equal,' are always already imagined and characterized as other. Universal health care and the daily manner in which biomedicine is practiced in southern Israel provides an avenue for examining the Jewish valences medicine carries in southern Israel, Israel's boundaries of inclusion, and the connection between biomedicine and secularism.
- Published
- 2016
24. The construction and meaning of race within hypertension guidelines: a scoping review.
- Author
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Razon, Na'amah, Gottlieb, Laura, Hahn, Monica, Jones, Danielle Hessler, El-Sabrout, Hannah, and Awolope, Anna
- Subjects
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RACE , *RACISM in medicine , *ESSENTIAL hypertension , *HYPERTENSION , *RESEARCH personnel - Abstract
Context: Professional society guidelines are evidence-based recommendations intended to promote standardized care and improve health outcomes. In the context of increased recognition of the role racism has played in shaping medical practices, many healthcare researchers and practitioners have critiqued existing guidelines, particularly those that include race-based recommendations. These critiques question how implicit--and sometimes explicit--racism has influenced both the evidence that guidelines are based on and the interpretation of that evidence. Objective and study design: In this study, we conducted a scoping review of all professional guidelines focused on the treatment and management of essential hypertension published between 1977 and 2020 and examined how race and ethnicity influenced guideline recommendations. Results: We found that authors largely focused on Black and White categories, with few references to other groups. Guideline authors described race as a distinct, preestablished category with biological underpinnings (for example, recommended specific medication classes to a predefined racial group). No guideline discussed the history of racism and the role it has played in perpetuating hypertension (or other health) disparities or inequities. The characterizations of race in essential hypertension guidelines normalize race as a biological rather than social construct. Conclusion: As the health system grapples with how to address racism in medicine, exploring how professional care guidelines reflect an outdated understanding of race can help us understand both the social origins of and treatments for hypertension inequities. [ABSTRACT FROM AUTHOR]
- Published
- 2023
25. Adjusting Clinical Plans Based on Social Context.
- Author
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De Marchis EH, Aceves B, Razon N, Chang Weir R, Jester M, and Gottlieb LM
- Subjects
- Humans, Texas, Female, Community Health Centers organization & administration, Male, Surveys and Questionnaires, Risk Factors, Attitude of Health Personnel, Social Determinants of Health, Social Environment, Adult, Middle Aged, Interviews as Topic, Patient Care Planning
- Abstract
Background: Social risk data collection is expanding in community health centers (CHCs). We explored clinicians' practices of adjusting medical care based on their awareness of patients' social risk factors-that is, changes they make to care plans to mitigate the potential impacts of social risk factors on their patients' care and health outcomes-in a set of Texas CHCs., Methods: Convergent mixed methods. Surveys/interviews explored clinician perspectives on adjusting medical care based on patient social risk factors. Survey data were analyzed with descriptive statistics; interviews were analyzed using thematic analysis and inductive coding., Results: Across 4 CHCs, we conducted 15 clinician interviews and collected 97 surveys. Interviews and surveys overall indicated support for adjustment activities. Two main themes emerged: 1) clinicians reported making frequent adjustments to patient care plans based on their awareness of patients' social contexts, while simultaneously expressing concerns about adjustment; and 2) awareness of patients' social risk factors, and clinician time, training, and experience all influenced clinician adjustments., Conclusions: Clinicians at participating CHCs described routinely adjusting patient care plans based on their patients' social contexts. These adjustments were being made without specific guidelines or training. Standardization of adjustments may facilitate the contextualization of patient care through shared decision making to improve outcomes., Competing Interests: Conflict of interest: None., (© Copyright 2024 by the American Board of Family Medicine.)
- Published
- 2024
- Full Text
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