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Coisy F, Olivier G, Ageron FX, Guillermou H, Roussel M, Balen F, Grau-Mercier L, Bobbia X. Do emergency medicine health care workers rate triage level of chest pain differently based upon appearance in simulated patients? Eur J Emerg Med 2024; 31:188-194. [PMID: 38100643 DOI: 10.1097/mej.0000000000001113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND IMPORTANCE There seems to be evidence of gender and ethnic bias in the early management of acute coronary syndrome. However, whether these differences are related to less severe severity assessment or to less intensive management despite the same severity assessment has not yet been established. OBJECTIVE To show whether viewing an image with characters of different gender appearance or ethnic background changes the prioritization decision in the emergency triage area. METHODS The responders were offered a standardized clinical case in an emergency triage area. The associated image was randomized among eight standardized images of people presenting with chest pain and differing in gender and ethnic appearance (White, Black, North African and southeast Asian appearance). OUTCOME MEASURES AND ANALYSIS Each person was asked to respond to a single clinical case, in which the priority level [from 1 (requiring immediate treatment) to 5 (able to wait up to 2 h)] was assessed visually. Priority classes 1 and 2 for vital emergencies and classes 3-5 for nonvital emergencies were grouped together for analysis. RESULTS Among the 1563 respondents [mean age, 36 ± 10 years; 867 (55%) women], 777 (50%) were emergency physicians, 180 (11%) emergency medicine residents and 606 (39%) nurses. The priority levels for all responses were 1-5 : 180 (11%), 686 (44%), 539 (34%), 131 (9%) and 27 (2%). There was a higher reported priority in male compared to female [62% vs. 49%, difference 13% (95% confidence interval; CI 8-18%)]. Compared to White people, there was a lower reported priority for Black simulated patients [47% vs. 58%, difference -11% (95% CI -18% to -4%)] but not people of southeast Asian [55% vs. 58%, difference -3% (95% CI -10-5%)] and North African [61% vs. 58%, difference 3% (95% CI -4-10%)] appearance. CONCLUSION In this study, the visualization of simulated patients with different characteristics modified the prioritization decision. Compared to White patients, Black patients were less likely to receive emergency treatment. The same was true for women compared with men.
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Affiliation(s)
- Fabien Coisy
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, CHU de Nimes, University of Montpellier, Nimes, France
| | - Guillaume Olivier
- Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
| | | | - Hugo Guillermou
- IDESP, University of Montpellier and INSERM, Montpellier, France
| | - Mélanie Roussel
- Emergency Department, Rouen University Hospital, Rouen, France
| | - Frédéric Balen
- Emergency Department, Toulouse University Hospital, Toulouse, France
| | - Laura Grau-Mercier
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, CHU de Nimes, University of Montpellier, Nimes, France
| | - Xavier Bobbia
- Montpellier University, UR UM 103 (IMAGINE), Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
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Kodali S, He CH, Patel S, Tao A, Szlechter M, Parsikia A, Mbekeani JN. Characteristics of ocular injuries associated with mortality in patients admitted with major trauma. BMC Ophthalmol 2024; 24:125. [PMID: 38504178 PMCID: PMC10949718 DOI: 10.1186/s12886-024-03392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Few ocular trauma studies have addressed mortality outcomes. We sought to determine characteristics of mortality-related ocular trauma admissions and compared them with non-fatal injuries. METHODS A retrospective study was conducted using de-identified data of patients admitted with major trauma from the National Trauma Data Bank (2008-2014). Patients with ocular injury were identified using ICD- 9CM codes. Demographics, intention and mechanism, types of ocular and head injuries, and injury severity were documented. Mortality was determined using post-admission disposition. Statistical analysis using student t-test, chi-square, and odds ratios (OR) calculations were performed with STATA-17 software. Significance was set at P < 0.05. RESULTS Of 316,485 patients admitted with ocular trauma, 12,233 (3.86%) were mortality related. Expired patients were older than survivors: mean (SD) of 50.1(25.5) vs. 41.5(22.8) years. White (OR = 1.32; P < 0.001), ≥ 65years old (OR = 2.25; P < 0.001), and male (OR = 1.05; P = 0.029) patients were most likely to expire than their counterparts. Common mechanisms of injury in survivors were falls (25.3%), motor vehicle traffic-occupant, MVTO (21.8%) and struck by/against (18.1%) and for fatal injuries, falls (29.7%), MVTO (21.9%) and firearms (11.5%). Traumatic brain injury (TBI) was documented in 88.2% of mortality-related admissions. Very severe injury severity scores (ISS > 24) (OR = 19.19; P < 0.001) and severe Glasgow Coma Score (GCS < 8) (OR = 19.22; P < 0.001) were most associated with mortality than survival. Firearms were most associated with very severe ISS (OR = 3.73; P < 0.001), severe GCS (OR = 4.68; P < 0.001) and mortality (OR = 5.21; P < 0.001) than other mechanisms. Patients with cut/pierce injuries had the greatest odds of survival (OR = 13.48; P < 0.001). Optic nerve/visual pathways injuries (3.1%) had the highest association with very severe ISS (OR = 2.51; P < 0.001), severe GCS (OR = 3.64; P < 0.001) and mortality (OR = 2.58; P < 0.001) than other ocular injuries. Black patients with very severe ISS (OR = 32.14; P < 0.001) and severe GCS (OR = 31.89; P < 0.001) were more likely to expire than other race/ethnicities with similar injury severity. CONCLUSIONS Mortality-related admissions were older, male, and mostly of White race than ocular trauma admissions of survivors. Firearms were the deadliest mechanism. TBI was commonly associated and patients with optic nerve/pathway injuries, very severe ISS and severe GCS had higher mortality rates. Characteristics and demographic variations identified in this study may be useful in developing focused measures aimed at preventing trauma-related deaths.
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Affiliation(s)
- Sruthi Kodali
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Catherine H He
- Department of Ophthalmology & Visual Sciences, Yale School of Medicine, New Haven, Conn, USA
| | - Sheel Patel
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Alice Tao
- Department of Ophthalmology, Jamaica Hospital Medical Center, New York Medical College, Queens, NY, USA
| | - Moshe Szlechter
- Department of Surgery (Ophthalmology), Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY, 10461, USA
- Department of Ophthalmology & Visual Sciences, Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY, USA
| | - Afshin Parsikia
- Department of Research Services, University of Pennsylvania, Philadelphia, PA, USA
| | - Joyce N Mbekeani
- Department of Surgery (Ophthalmology), Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY, 10461, USA.
- Department of Ophthalmology & Visual Sciences, Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY, USA.
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Hayba N, Cheek C, Austin E, Testa L, Richardson L, Safi M, Ransolin N, Carrigan A, Harrison R, Francis-Auton E, Clay-Williams R. Strategies to Improve Care in the Emergency Department for Culturally and Linguistically Diverse Adults: a Systematic Review. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01876-z. [PMID: 38117444 DOI: 10.1007/s40615-023-01876-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/01/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The emergency department (ED) is an important gateway into the health system for people from culturally and linguistically diverse (CALD) backgrounds; their experience in the ED is likely to impact the way they access care in the future. Our review aimed to describe interventions used to improve ED health care delivery for adults from a CALD background. METHODS An electronic search of four databases was conducted to identify empirical studies that reported interventions with a primary focus of improving ED care for CALD adults (aged ≥ 18 years), with measures relating to ED system performance, patient outcomes, patient experience, or staff experience. Studies published from inception to November 2022 were included. We excluded non-empirical studies, studies where an intervention was not provided in ED, papers where the full text was unavailable, or papers published in a language other than English. The intervention strategies were categorised thematically, and measures were tabulated. RESULTS Following the screening of 3654 abstracts, 89 articles underwent full text review; 16 articles met the inclusion criteria. Four clear strategies for targeting action tailored to the CALD population of interest were identified: improving self-management of health issues, improving communication between patients and providers, adhering to good clinical practice, and building health workforce capacity. CONCLUSIONS The four strategies identified provide a useful framework for targeted action tailored to the population and outcome of interest. These detailed examples show how intervention design must consider intersecting socio-economic barriers, so as not to perpetuate existing disparity. REGISTRATION PROSPERO registration number: CRD42022379584.
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Affiliation(s)
- Nematullah Hayba
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Colleen Cheek
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia.
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Luke Testa
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Lieke Richardson
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Mariam Safi
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Internal Medicine Research Unit, Department of Regional Health Research, University Hospital of Southern Denmark, Aabenraa, University of Southern Denmark, Odense, Denmark
| | - Natália Ransolin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Construction Management and Infrastructure Post-Graduation Program (PPGCI), Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Emilie Francis-Auton
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Robyn Clay-Williams
- Construction Management and Infrastructure Post-Graduation Program (PPGCI), Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
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Loftin MC, Zynda AJ, Pollard-McGrandy A, Eke R, Covassin T, Wallace J. Racial differences in concussion diagnosis and mechanism of injury among adults presenting to emergency departments across the United States. Brain Inj 2023; 37:1326-1333. [PMID: 37607067 DOI: 10.1080/02699052.2023.2248581] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/20/2023] [Accepted: 08/13/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES The purpose of this study was to examine the association between race and concussion diagnosis as well as the association between race and mechanism of injury (MOI) for concussion diagnoses in adult patients (>19 years old) visiting the emergency department (ED). METHODS A retrospective analysis of patient visits to the ED for concussion between 2010 and 2018, using the National Hospital Ambulatory Medical Care Survey, was conducted. Outcome measures included concussion diagnosis and MOI. Multivariable and multinomial logistic regression analyses were conducted to assess associations between race and outcome variables. The results were weighted to reflect population estimates with a significance set at p < 0.05. RESULTS Overall, 714 patient visits for concussions were identified, representing an estimated 4.3 million visits nationwide. Black adults had lower odds of receiving a concussion diagnosis [p < 0.05, Odds Ratio (OR), 0.54; 95% Confidence Interval (CI), 0.38-0.76] compared to White adults in the ED. There were no significant differences in MOI for a concussion diagnosis by race. CONCLUSION Racial differences were found in the ED for concussion diagnosis. Disparities in concussion diagnosis for Black or other minoritized racial groups could have significant repercussions that may prolong recovery or lead to long-term morbidity.
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Affiliation(s)
- Megan C Loftin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Aaron J Zynda
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | | | - Ransome Eke
- Department of Community Medicine, School of Medicine, Mercer University, Columbus, Georgia
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Jessica Wallace
- Department of Health Science, The University of Alabama, Tuscaloosa, Alabama, USA
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Hayes M, Hutchinson A, Kerr D. Gender-based differences in assessment and management of acute abdominal pain in the emergency department: A retrospective audit. Australas Emerg Care 2023; 26:290-295. [PMID: 36914504 DOI: 10.1016/j.auec.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Previous research has identified gender-based differences in acute pain management in the emergency department [ED]. The aim of this study was to compare pharmacological management of acute abdominal pain in the ED by gender. METHODS A retrospective chart audit was conducted at one private metropolitan ED including adult patients (18-80 years) who presented with acute abdominal pain in 2019. Exclusion criteria included: pregnancy, repeat presentation within the study period, pain-free at initial medical review or documented refusal of analgesia, and oligo-analgesia. Comparisons by gender included: (1) analgesia type and (2) time to analgesia. Bivariate analysis was undertaken using SPSS. RESULTS There were 192 participants: 61 (31.6 %) men and 131 (67.9 %) women. Men were more likely to get combined opioid and non-opioid medication as first line analgesia (men: 26.2 % n = 16; women: 14.5 % n = 19, p = .049). Median time from ED presentation to analgesia was 80 min for men (IQR: 60) versus 94 min for women (IQR: 58), (p = .119). Women (25.2 % n = 33) were more likely to receive their first analgesic after 90 min from ED presentation compared to men versus men (11.5 %, n = 7 p = .029). In addition, women waited longer before receiving second analgesia (women: 94, men: 30 min, p = .032). CONCLUSION Findings confirm there are differences in pharmacological management of acute abdominal pain in the ED. Larger studies are required to further explore differences observed in this study.
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Affiliation(s)
- Megan Hayes
- Cabrini Health, The Patricia Peck Education and Research Precinct, Australia; Epworth HealthCare, Emergency Department, Richmond, Victoria, Australia.
| | - Ana Hutchinson
- Deakin University, Institute of Health Transformation, Centre for Quality and Safety Research, Epworth HealthCare, Deakin University Partnership, Australia; Deakin University, School of Nursing & Midwifery, Burwood, Victoria, Australia.
| | - Debra Kerr
- Deakin University, School of Nursing & Midwifery, Burwood, Victoria, Australia; Deakin University, Institute of Health Transformation, Centre for Quality and Safety Research, Australia.
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Crowe RP, Kennel J, Fernandez AR, Burton BA, Wang HE, Van Vleet L, Bourn SS, Myers JB. Racial, Ethnic, and Socioeconomic Disparities in Out-of-Hospital Pain Management for Patients With Long Bone Fractures. Ann Emerg Med 2023; 82:535-545. [PMID: 37178100 DOI: 10.1016/j.annemergmed.2023.03.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/20/2023] [Accepted: 03/30/2023] [Indexed: 05/15/2023]
Abstract
STUDY OBJECTIVE To evaluate racial and ethnic disparities in out-of-hospital analgesic administration, accounting for the influence of clinical characteristics and community socioeconomic vulnerability, among a national cohort of patients with long bone fractures. METHODS Using the 2019-2020 ESO Data Collaborative, we retrospectively analyzed emergency medical services (EMS) records for 9-1-1 advanced life support transport of adult patients diagnosed with long bone fractures at the emergency department. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for out-of-hospital analgesic administration by race and ethnicity, accounting for age, sex, insurance, fracture location, transport time, pain severity, and scene Social Vulnerability Index. We reviewed a random sample of EMS narratives without analgesic administration to identify whether other clinical factors or patient preferences could explain differences in analgesic administration by race and ethnicity. RESULTS Among 35,711 patients transported by 400 EMS agencies, 81% were White, non-Hispanic, 10% were Black, non-Hispanic, and 7% were Hispanic. In crude analyses, Black, non-Hispanic patients with severe pain were less likely to receive analgesics compared with White, non-Hispanic patients (59% versus 72%; Risk Difference: -12.5%, 95% CI: -15.8% to -9.9%). After adjustment, Black, non-Hispanic patients remained less likely to receive analgesics compared with White, non-Hispanic patients (aOR:0.65, 95% CI:0.53 to 0.79). Narrative review identified similar rates of patients declining analgesics offered by EMS and analgesic contraindications across racial and ethnic groups. CONCLUSIONS Among EMS patients with long bone fractures, Black, non-Hispanic patients were substantially less likely to receive out-of-hospital analgesics compared with White, non-Hispanic patients. These disparities were not explained by differences in clinical presentations, patient preferences, or community socioeconomic conditions.
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Affiliation(s)
| | - Jamie Kennel
- Oregon Health and Science University, Portland, OR; Oregon Institute of Technology, Wilsonville, OR
| | | | | | - Henry E Wang
- Department of Emergency Medicine, The Ohio State University, Columbus, OH
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Curran J, Wozney L, Tavender E, Wilson C, Ritchie KC, Wong H, Gallant A, Somerville M, Archambault PM, Cassidy C, Jabbour M, Mackay R, Plint AC. Implementing Electronic Discharge Communication Tools in Pediatric Emergency Departments: Multicountry, Cross-Sectional Readiness Survey of Nurses and Physicians. JMIR Hum Factors 2023; 10:e46379. [PMID: 37819696 PMCID: PMC10600642 DOI: 10.2196/46379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Pediatric emergency departments (ED) in many countries are implementing electronic tools such as kiosks, mobile apps, and electronic patient portals, to improve the effectiveness of discharge communication. OBJECTIVE This study aimed to survey nurse and physician readiness to adopt these tools. METHODS An electronic, cross-sectional survey was distributed to a convenience sample of currently practicing ED nurses and physicians affiliated with national pediatric research organizations in Canada, Australia, and New Zealand. Survey development was informed by the nonadoption, abandonment, scale-up, spread, sustainability framework. Measures of central tendency, and parametric and nonparametric tests were used to describe and compare nurse and physician responses. RESULTS Out of the 270 participants, the majority were physicians (61%, 164/270), female (65%, 176/270), and had 5 or more years of ED experience (76%, 205/270). There were high levels of consensus related to the value proposition of electronic discharge communication tools (EDCTs) with 82% (221/270) of them agreeing that they help parents and patients with comprehension and recall. Lower levels of consensus were observed for organizational factors with only 37% (100/270) agreeing that their staff is equipped to handle challenges with communication technologies. Nurses and physicians showed significant differences on 3 out of 21 readiness factors. Compared to physicians, nurses were significantly more likely to report that EDs have a responsibility to integrate EDCTs as part of a modern system (P<.001) and that policies are in place to guide safe and secure electronic communication (P=.02). Physicians were more likely to agree that using an EDCT would change their routine tasks (P=.04). One third (33%, 89/270) of participants indicated that they use or have used EDCT. CONCLUSIONS Despite low levels of uptake, both nurses and physicians in multiple countries view EDCTs as a valuable support to families visiting pediatric ED. Leadership for technology change, unclear impact on workflow, and disparities in digital literacy skills require focused research effort.
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Affiliation(s)
- Janet Curran
- IWK Health Centre, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Pediatric Emergency Research Canada, Alberta Children's Hospital, Calgary, AB, Canada
| | - Lori Wozney
- IWK Health Centre, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Emma Tavender
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Critical Care, University of Melbourne, Victoria, Australia
- Paediatric Research in Emergency Departments International Collaborative, Murdoch Children's Research Institute, Melbourne, Australia
| | - Catherine Wilson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Paediatric Research in Emergency Departments International Collaborative, Murdoch Children's Research Institute, Melbourne, Australia
| | - Krista C Ritchie
- Faculty of Education, Mount Saint Vincent University, Halifax, NS, Canada
| | - Helen Wong
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Allyson Gallant
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | | | - Patrick M Archambault
- Département de médecine familiale et médecine d'urgence, Université Laval, Québec City, QC, Canada
| | | | - Mona Jabbour
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | | | - Amy C Plint
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
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Asakawa S, Takeda Y, Henker R. Barriers encountered by nurses in the care of walk-in international patients in an emergency department in Japan. Int Emerg Nurs 2023; 70:101337. [PMID: 37657133 DOI: 10.1016/j.ienj.2023.101337] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/05/2023] [Accepted: 07/16/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND An increasing number of international patients continue to visit emergency departments (EDs) in Japanese hospitals. However, nurses in Japan perceive challenges when caring for patients from other countries. This study explored ED nurses' perceptions of barriers when caring for walk-in international patients. METHODS Five semi-structured online focus group interviews involving 15 registered nurses with experience in caring for patients in an ED at a university referral hospital located in the center of Tokyo were conducted. Thematic analysis was used to identify patterns from the interviews. RESULTS The themes that emerged were as follows: (1) hesitation to engage with patients due to ambiguity, (2) loss of harmony in the ED, (3) difficulty with mutual goal settings, and (4) decreased professional self-efficacy. CONCLUSION The findings provide an understanding of the challenges faced when caring for walk-in international patients. Educational interventions for ED nurses and other strategies, such as the use of interpreters, can enhance nurses' abilities to improve patient safety and maintain equality.
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Affiliation(s)
- Shoko Asakawa
- Graduate School of Health Management, Keio University, Tokyo, Japan; Faculty of Nursing and Medical Care, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan.
| | - Yuko Takeda
- Graduate School of Health Management, Keio University, Tokyo, Japan; Faculty of Nursing and Medical Care, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan.
| | - Richard Henker
- Department of Nurse Anesthesia, School of Nursing, University of Pittsburgh, 360 Victoria Building 3500 Victoria Street, Pittsburgh, PA 15261, United States.
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Moynihan KM, Dorste A, Alizadeh F, Phelps K, Barreto JA, Kolwaite AR, Merlocco A, Barbaro RP, Chan T, Thiagarajan RR. Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature. Crit Care Med 2023; 51:843-860. [PMID: 36975216 DOI: 10.1097/ccm.0000000000005866] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
OBJECTIVES To map the scope, methodological rigor, quality, and direction of associations between social determinants of health (SDoH) and extracorporeal membrane oxygenation (ECMO) utilization or outcomes. DATA SOURCES PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched for citations from January 2000 to January 2023, examining socioeconomic status (SES), race, ethnicity, hospital and ECMO program characteristics, transport, and geographic location (context) with utilization and outcomes (concept) in ECMO patients (population). STUDY SELECTION Methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review extension. Two reviewers independently evaluated abstracts and full text of identified publications. Exclusion criteria included non-English, unavailable, less than 40 patients, and periprocedural or mixed mechanical support. DATA EXTRACTION Content analysis used a standardized data extraction tool and inductive thematic analysis for author-proposed mediators of disparities. Risk of bias was assessed using the Quality in Prognosis Studies tool. DATA SYNTHESIS Of 8,214 citations screened, 219 studies were identified. Primary analysis focuses on 148 (68%) including race/ethnicity/SES/payer variables including investigation of ECMO outcomes 114 (77%) and utilization 43 (29%). SDoH were the primary predictor in 15 (10%). Overall quality and methodologic rigor was poor with advanced statistics in 7%. Direction of associations between ECMO outcomes or utilization according to race, ethnicity, SES, or payer varied. In 38% adverse outcomes or lower use was reported in underrepresented, under-resourced or diverse populations, while improved outcomes or greater use were observed in these populations in 7%, and 55% had no statistically significant result. Only 26 studies (18%) discussed mechanistic drivers of disparities, primarily focusing on individual- and hospital-level rather than systemic/structural factors. CONCLUSIONS Associations between ECMO utilization and outcomes with SDoH are inconsistent, complicated by population heterogeneity and analytic shortcomings with limited consideration of systemic contributors. Findings and research gaps have implications for measuring, analyzing, and interpreting SDoH in ECMO research and healthcare.
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Affiliation(s)
- Katie M Moynihan
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Anna Dorste
- Medical Library, Boston Children's Hospital, Boston, MA
| | - Faraz Alizadeh
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Kayla Phelps
- Department of Pediatrics, Children's Hospital New Orleans, Louisiana State University, New Orleans, LA
| | - Jessica A Barreto
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Amy R Kolwaite
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Anthony Merlocco
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Ryan P Barbaro
- Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Titus Chan
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Ravi R Thiagarajan
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA
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10
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Johnson LW, Diaz I. Exploring the Social Determinants of Health and Health Disparities in Traumatic Brain Injury: A Scoping Review. Brain Sci 2023; 13:brainsci13050707. [PMID: 37239178 DOI: 10.3390/brainsci13050707] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/09/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Traumatic brain injury (TBI) is a global health concern, that can leave lasting physical, cognitive, and/or behavioral changes for many who sustain this type of injury. Because of the heterogeneity of this population, development of appropriate intervention tools can be difficult. Social determinants of health (SDoH) are factors that may impact TBI incidence, recovery, and outcome. The purpose of this study is to describe and analyze the existing literature regarding the prevailing SDoH and health disparities (HDs) associated with TBI in adults. A scoping review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was used to explore three electronic databases-PubMed, Medline, and CINAHL. Searches identified peer-reviewed empirical literature addressing aspects of SDoH and HDs related to TBI. A total of 123 records were identified and reduced to 27 studies based on inclusion criteria. Results revealed race/ethnicity was the most commonly reported SDoH impacting TBI, followed by an individual's insurance status. Health disparities were noted to occur across the continuum of TBI, including TBI risk, acute hospitalization, rehabilitation, and recovery. The most frequently reported HD was that Whites are more likely to be discharged to inpatient rehabilitation compared to racial/ethnic minorities. Health disparities associated with TBI are most commonly associated with the race/ethnicity SDoH, though insurance status and socioeconomic status commonly influence health inequities as well. The additional need for evidence related to the impact of other, lesser researched, SDoH is discussed, as well as clinical implications that can be used to target intervention for at-risk groups using an individual's known SDoH.
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Affiliation(s)
- Leslie W Johnson
- Department of Communication Sciences and Disorders, North Carolina Central University, Durham, NC 27707, USA
| | - Isabella Diaz
- Department of Communication Sciences and Disorders, North Carolina Central University, Durham, NC 27707, USA
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11
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Orthopaedic Diagnoses in the Black Pediatric Population. J Am Acad Orthop Surg 2023; 31:274-282. [PMID: 36800541 DOI: 10.5435/jaaos-d-22-00535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/04/2022] [Indexed: 02/19/2023] Open
Abstract
The Black pediatric population is one that has been historically underserved and continues to have unmet needs. Factors including lack of diversity in orthopaedic studies and in historical standards, such as bone age, may inadvertently lead to inferior care. There are certain conditions in this population for which the practicing orthopaedic surgeon should have a higher degree of suspicion, including slipped capital femoral epiphysis, Blount disease, and postaxial polydactyly. Systemic diseases with higher rates in this population have orthopaedic manifestations, including sickle cell disease, vitamin D deficiency, and obesity. Racial discrepancies in access to prenatal care can have orthopaedic consequences for babies, especially cerebral palsy and myelodysplasia. Racial discrepancy exists in evaluation for nonaccidental trauma. Increased awareness of these issues better prepares practitioners to provide equitable care.
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12
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Mercado SH. An outpatient pain plan and ED pain pathway for adults with sickle cell disease. JAAPA 2023; 36:20-23. [PMID: 36752670 DOI: 10.1097/01.jaa.0000920956.33631.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
ABSTRACT Sickle cell disease (SCD), one of the most common inherited diseases, is associated with lifetime morbidity and reduced life expectancy. In the United States, SCD primarily affects Black patients and, to a lesser degree, those of Hispanic descent. These populations are known to have healthcare disparities related to lower socioeconomic status, limited access to healthcare, and racial bias. The quality-adjusted life expectancy of patients with SCD is less than 35 years, because of progressive complications of the disease. The most common complication is severe episodic pain related to vaso-occlusive ischemic events. Despite guidelines, pain management often is delayed as patients struggle with resistance from clinicians based on concerns over opioid use or abuse, overdose, or drug-seeking behavior. Effective pain management can be accomplished with collaboration between clinicians and patients, a documented outpatient pain management plan, and when necessary, an ED clinical pain pathway for acute SCD pain management.
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Affiliation(s)
- Stephanie Harris Mercado
- Stephanie Harris Mercado practices in the University of California San Francisco's Community Cancer Institute, Sickle Cell Disease clinic in Fresno, Calif. The author has disclosed no potential conflicts of interest, financial or otherwise
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13
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Hutton J, Gunatillake T, Barnes D, Phillips G, Maplesden J, Chan A, Shanahan P, Zordan R, Sundararajan V, Arabena K, Quigley A, Pynor-Greedy T, Mason T. Characteristics of First Nations patients who take their own leave from an inner-city emergency department, 2016-2020. Emerg Med Australas 2023; 35:74-81. [PMID: 36041727 PMCID: PMC10087393 DOI: 10.1111/1742-6723.14057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/29/2022] [Accepted: 07/26/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Using a strength-based framework, we aimed to describe and compare First Nations patients who completed care in an ED to those who took their own leave. METHODS Routinely collected adult patient data from a metropolitan ED collected over a 5-year period were analysed. RESULTS A total of 6446 presentations of First Nations patients occurred from 2016 to 2020, constituting 3% of ED presentations. Of these, 5589 (87%) patients waited to be seen and 857 (13%) took their own leave. Among patients who took their own leave, 624 (73%) left not seen and 233 (27%) left at own risk after starting treatment. Patients who were assigned a triage category of 4-5 were significantly more likely to take their own leave (adjusted odds ratio [OR] 3.17, 95% confidence interval [CI] 2.67-3.77, P < 0.001). Patients were significantly less likely to take their own leave if they were >60 years (adjusted OR 0.69, 95% CI 1.01-1.36, P = 0.014) and had private health insurance (adjusted OR 0.61, 95% CI 0.45-0.84, P < 0.001). Patients were more likely to leave if they were women (adjusted OR 1.17, 95% CI 1.01-1.36, P = 0.04), had an unknown housing status (adjusted OR 1.76, 95% CI 1.44-2.15, P < 0.001), were homeless (adjusted OR 1.50, 95% CI 1.22-1.93, P < 0.001) or had a safety alert (adjusted OR 1.60, 95% CI 1.35-1.90, P < 0.001). CONCLUSION A lower triage category is a strong predictor of First Nations patients taking their own leave. It has been documented that First Nations patients are under-triaged. One proposed intervention in the metropolitan setting is to introduce practices which expediate the care of First Nations patients. Further qualitative studies with First Nations patients should be undertaken to determine successful approaches to create equitable access to emergency healthcare for this population.
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Affiliation(s)
- Jennie Hutton
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tilini Gunatillake
- Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Barnes
- Aboriginal Health Unit, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Georgina Phillips
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jacqueline Maplesden
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Andrew Chan
- Complex Care Services, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Prudence Shanahan
- Department of Psychiatry, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Rachel Zordan
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Education and Learning, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Vijaya Sundararajan
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kerry Arabena
- Karabena Consulting, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alyssa Quigley
- St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - T'ia Pynor-Greedy
- Aboriginal Health Unit, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Toni Mason
- Aboriginal Health Unit, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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14
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Tom JE, Eckhoff MD, Tadlock JC, Garcia ESJ. A 10-Year National Analysis of Pediatric Elbow Fractures. Clin Pediatr (Phila) 2022; 62:433-440. [PMID: 36345146 DOI: 10.1177/00099228221135525] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Elbow fractures comprise 15% of all fractures in children. Our study identifies risk factors and consumer products that contribute to pediatric elbow fractures. The National Electronic Injury Surveillance System was used to collect demographic and consumer product information between 2010 and 2019 for patients younger than 17 years who presented to the emergency department with elbow fractures. Of the 458,433 elbow fractures, the average age of the patients was 7.4 ± 4.1 years and 55.6% were male children. The most common consumer product was sports and recreation equipment, followed by home furnishings. Male patients (P < .0001) and patients 8 years and older (79.2% vs 51.1%, P < .0001) experienced significantly greater rates of injury with sports and recreation equipment. This study evaluates the products associated with pediatric elbow fractures and highlights the importance of safe sports and recreation equipment use and the role of parental counseling in preventing falls from furniture.
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Affiliation(s)
- Jessica E Tom
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Michael D Eckhoff
- Department of Orthopedics, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Joshua C Tadlock
- Department of Orthopedics, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - EStephan J Garcia
- Department of Orthopedics, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
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15
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Nelson R, Kittel J, Mahoui I, Thornberry D, Dunkman A, Sams M, Adler D, Jones CMC. Racial differences in treatment among patients with acute headache treated in the emergency department and discharged home. Am J Emerg Med 2022; 60:45-49. [DOI: 10.1016/j.ajem.2022.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/10/2022] [Accepted: 05/21/2022] [Indexed: 11/16/2022] Open
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16
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Tate K, McLane P, Reid C, Rowe BH, Cummings G, Estabrooks CA, Cummings G. Assessing quality of older persons' emergency transitions between long-term and acute care settings: a proof-of-concept study. BMJ Open Qual 2022; 11:bmjoq-2021-001639. [PMID: 35264332 PMCID: PMC8915308 DOI: 10.1136/bmjoq-2021-001639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 02/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background Long-term care (LTC) residents frequently experience transitions in the location of more advanced care delivery, including receiving emergency department (ED) care. In this proof-of-concept study, we aimed to determine if we could identify measures in quality of care across transitions from LTC to the ED, via emergency medical services and back, by applying Institute of Medicine (IOM) Quality of Care Domains to an existing dataset. Methods In the Older Persons’ Transitions in Care (OPTIC) study, we collected information on residents’ transitions in two Western Canadian cities. We applied the IOM’s Quality of Care Domains to the OPTIC data to create binary measures of transition quality. We report the median (MED) per cent and IQR of measures met within each domain of quality. Results We tracked 637 transitions over a 12-month period, with data collected from each setting. We developed 19 safety measures, 20 measures of resident-centred care, 3 measures of timely care and 5 measures of effective care. We were unable to develop measures for equitable care at an individual transfer level. Domain scores varied across individual transitions, with the highest scores in safety (MED 79%, IQR: 63–95), efficiency (66%; IQR: 66–99), and resident-centred (45%; IQR: 25–65), followed by effectiveness (36%; IQR: 16–56), and timeliness (0%; IQR: 0–50). Conclusions Our results show variation in scores across the domains of quality suggesting that it is possible to track quality of transitions for individuals across all settings, and not only within settings. We recommend that future work in tracking quality of care be performed at several levels (LTC, region, health authority, province). Such tracking is necessary to evaluate and improve overall quality of care.
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Affiliation(s)
- Kaitlyn Tate
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick McLane
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.,Alberta Health Services, Edmonton, Alberta, Canada
| | - Colin Reid
- School of Health and Exercise Science, The University of British Columbia, Kelowna, British Columbia, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Garnet Cummings
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Greta Cummings
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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17
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First Nations emergency care in Alberta: descriptive results of a retrospective cohort study. BMC Health Serv Res 2021; 21:423. [PMID: 33947385 PMCID: PMC8096356 DOI: 10.1186/s12913-021-06415-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background Worse health outcomes are consistently reported for First Nations people in Canada. Social, political and economic inequities as well as inequities in health care are major contributing factors to these health disparities. Emergency care is an important health services resource for First Nations people. First Nations partners, academic researchers, and health authority staff are collaborating to examine emergency care visit characteristics for First Nations and non-First Nations people in the province of Alberta. Methods We conducted a population-based retrospective cohort study examining all Alberta emergency care visits from April 1, 2012 to March 31, 2017 by linking administrative data. Patient demographics and emergency care visit characteristics for status First Nations persons in Alberta, and non-First Nations persons, are reported. Frequencies and percentages (%) describe patients and visits by categorical variables (e.g., Canadian Triage and Acuity Scale). Means, medians, standard deviations and interquartile ranges describe continuous variables (e.g., age). Results The dataset contains 11,686,288 emergency care visits by 3,024,491 unique persons. First Nations people make up 4% of the provincial population and 9.4% of provincial emergency visits. The population rate of emergency visits is nearly 3 times higher for First Nations persons than non-First Nations persons. First Nations women utilize emergency care more than non-First Nations women (54.2% of First Nations visits are by women compared to 50.9% of non-First Nations visits). More First Nations visits end in leaving without completing treatment (6.7% v. 3.6%). Conclusions Further research is needed on the impact of First Nations identity on emergency care drivers and outcomes, and on emergency care for First Nations women. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06415-2.
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18
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Johnston JN, Ridgway L, Cary-Barnard S, Allen J, Sanchez-Lafuente CL, Reive B, Kalynchuk LE, Caruncho HJ. Patient oriented research in mental health: matching laboratory to life and beyond in Canada. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:21. [PMID: 33902751 PMCID: PMC8074277 DOI: 10.1186/s40900-021-00266-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/30/2021] [Indexed: 05/19/2023]
Abstract
As patient-oriented research gains popularity in clinical research, the lack of patient input in foundational science grows more evident. Research has shown great utility in active partnerships between patient partners and scientists, yet many researchers are still hesitant about listening to the voices of those with lived experience guide and shape their experiments. Mental health has been a leading area for patient movements such as survivor-led research, however the stigma experienced by these patients creates difficulties not present in other health disciplines. The emergence of COVID-19 has also created unique circumstances that need to be addressed. Through this lens, we have taken experiences from our patient partners, students, and primary investigator to create recommendations for the better facilitation of patient-oriented research in foundational science in Canada. With these guidelines, from initial recruitment and leading to sustaining meaningful partnerships, we hope to encourage other researchers that patient-oriented research is necessary for the future of mental health research and foundational science.
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Affiliation(s)
- Jenessa N Johnston
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Lisa Ridgway
- Patient Partner, BC SUPPORT Unit, Victoria, BC, Canada
| | | | - Josh Allen
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | | | - Brady Reive
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Lisa E Kalynchuk
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Hector J Caruncho
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada.
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19
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Saadi A, Bannon S, Watson E, Vranceanu AM. Racial and Ethnic Disparities Associated with Traumatic Brain Injury Across the Continuum of Care: a Narrative Review and Directions for Future Research. J Racial Ethn Health Disparities 2021; 9:786-799. [DOI: 10.1007/s40615-021-01017-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/20/2021] [Accepted: 02/28/2021] [Indexed: 10/21/2022]
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20
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Quigley A, Hutton J, Phillips G, Dreise D, Mason T, Garvey G, Paradies Y. Review article: Implicit bias towards Aboriginal and Torres Strait Islander patients within Australian emergency departments. Emerg Med Australas 2020; 33:9-18. [PMID: 33248447 DOI: 10.1111/1742-6723.13691] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 12/24/2022]
Abstract
Aboriginal and Torres Strait Islander peoples continue to suffer adverse experiences in healthcare, with inequitable care prevalent in emergency settings. Individual, institutional and systemic factors play a significant part in these persisting healthcare disparities, with biases remaining entrenched in healthcare institutions. This includes implicit racial bias which can result in stereotyping of racial minorities and premature diagnostic closure. Furthermore, it may contribute to distrust of medical professionals resulting in higher rates of leave events and hinder racial minorities from seeking care or following treatment recommendations. The aim of this review is to analyse the effect of implicit bias on patient outcomes in the ED in international literature and explore how these studies correlate to an Australian context.
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Affiliation(s)
- Alyssa Quigley
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennie Hutton
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Georgina Phillips
- Emergency Department, St Vincent's Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Darlene Dreise
- Reconciliation Action Plan (RAP) Steering Committee, St Vincent's Health Australia, Brisbane, Queensland, Australia
| | - Toni Mason
- Aboriginal Health Unit, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Gail Garvey
- Menzies School of Health Research, Brisbane, Queensland, Australia.,Aboriginal Health, St Vincent's Health Australia, Brisbane, Queensland, Australia
| | - Yin Paradies
- Faculty of Arts and Education, Deakin University, Melbourne, Victoria, Australia
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21
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Mills SEE, Geneen LJ, Buchanan D, Guthrie B, Smith BH. Factors associated with unscheduled care use by cancer decedents: a systematic review with narrative synthesis. BMJ Support Palliat Care 2020:bmjspcare-2020-002410. [PMID: 33051311 DOI: 10.1136/bmjspcare-2020-002410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/09/2020] [Accepted: 09/20/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND People who die from cancer (cancer decedents) may experience unpleasant and distressing symptoms which cause them to present to unscheduled care. Unscheduled care is unplanned care delivered by general practitioner out-of-hours and emergency departments. Use of unscheduled care can disrupt treatment plans, leading to a disjointed patient care and suboptimal outcomes. OBJECTIVES This systematic review aimed to identify factors associated with unscheduled care use by cancer decedents. METHOD Systematic review with narrative synthesis of seven electronic databases (PubMed; Medline; Embase; Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; Web of Science; Cumulative Index to Nursing and Allied Health Literature) from inception until 01 January 2020. All observational and experimental studies were included, irrespective of their research design. RESULTS The search yielded 238 publications included at full-text, of which 47 were included in the final review and synthesis. Unscheduled care use by cancer decedents was influenced by multiple factors, synthesised into themes: demography, clinical and patient, temporal, prescribing and systems. Cancer decedents who were older, men, had comorbidities, or lung cancer, were most likely to use unscheduled care. Unscheduled care presentations were commonly due to pain, breathlessness and gastrointestinal symptoms. Low continuity of care, and oncology-led care were associated with greater unscheduled care use. Access to palliative care, having an up-to-date palliative care plan, and carer education were associated with less unscheduled care use. CONCLUSION The review identifies multiple factors associated with unscheduled care use by cancer decedents. Understanding these factors can inform future practice and policy developments, in order to appropriately target future interventions, optimise service delivery and improve the patient journey. PROSPERO REGISTRATION NUMBER CRD42016047231.
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Affiliation(s)
- Sarah E E Mills
- Division of Population Health and Genomics, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Louise J Geneen
- Systematic Review Initiative, NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
| | - Deans Buchanan
- Palliative Medicine & Supportive Care, NHS Tayside, Dundee, UK
| | - Bruce Guthrie
- College of Medicine and Veterinary Medicine, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Blair H Smith
- Division of Population Health and Genomics, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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