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Morisod K, Luta X, Marti J, Spycher J, Malebranche M, Bodenmann P. Measuring Health Equity in Emergency Care Using Routinely Collected Data: A Systematic Review. Health Equity 2022; 5:801-817. [PMID: 35018313 PMCID: PMC8742300 DOI: 10.1089/heq.2021.0035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Achieving equity in health care remains a challenge for health care systems worldwide and marked inequities in access and quality of care persist. Identifying health care equity indicators is an important first step in integrating the concept of equity into assessments of health care system performance, particularly in emergency care. Methods: We conducted a systematic review of administrative data-derived health care equity indicators and their association with socioeconomic determinants of health (SEDH) in emergency care settings. Following PRISMA-Equity reporting guidelines, Ovid MEDLINE, EMBASE, PubMed, and Web of Science were searched for relevant studies. The outcomes of interest were indicators of health care equity and the associated SEDH they examine. Results: Among 29 studies identified, 14 equity indicators were identified and grouped into four categories that reflect the patient emergency care pathway. Total emergency department (ED) visits and ambulatory care-sensitive condition-related ED visits were the two most frequently used equity indicators. The studies analyzed equity based on seven SEDH: social deprivation, income, education level, social class, insurance coverage, health literacy, and financial and nonfinancial barriers. Despite some conflicting results, all identified SEDH are associated with inequalities in access to and use of emergency care. Conclusion: The use of administrative data-derived indicators in combination with identified SEDH could improve the measurement of health care equity in emergency care settings across health care systems worldwide. Using a combination of indicators is likely to lead to a more comprehensive, well-rounded measurement of health care equity than using any one indicator in isolation. Although studies analyzed focused on emergency care settings, it seems possible to extrapolate these indicators to measure equity in other areas of the health care system. Further studies elucidating root causes of health inequities in and outside the health care system are needed.
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Affiliation(s)
- Kevin Morisod
- Department of Vulnerabilities and Social Medicine, Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Xhyljeta Luta
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Joachim Marti
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Jacques Spycher
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Mary Malebranche
- Department of Vulnerabilities and Social Medicine, Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Department of Medicine, University of Calgary, Calgary, Canada
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Kruse MI, Voloshin D, Wan M, Clarizio A, Bigham BL, Upadhye S. Care of Sexual and Gender Minorities in the Emergency Department: A Scoping Review. Ann Emerg Med 2021; 79:196-212. [PMID: 34785088 DOI: 10.1016/j.annemergmed.2021.09.422] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE This scoping review was conducted to collate and summarize the published research literature addressing sexual and gender minority care in the emergency department (ED). METHODS Using PRISMA-ScR criteria, an electronic search was conducted of CINAHL, Embase, Ovid Medline, and Web of Science for all studies that were published after 1995 involving sexual and gender minorities, throughout all life stages, presenting to an ED. We excluded non-US and Canadian studies and editorials. Titles and abstracts were screened, and full-text review was performed independently with 4 reviewers. Abstraction focused on study design, demographics, and outcomes, and the resulting data were analyzed using an ad hoc iterative thematic analysis. RESULTS We found 972 unique articles and excluded 743 after title and abstract screening. The remaining 229 articles underwent full-text review, and 160 articles were included. Themes identified were HIV in sexual and gender minorities (n=61), population health (n=46), provider training (n=29), ED avoidance or barriers (n=23), ED use (n=21), and sexual orientation/gender identity information collection (n=9). CONCLUSION The current literature encompassing ED sexual and gender minority care cluster into 6 themes. There are considerable gaps to be addressed in optimizing culturally competent and equitable care in the ED for this population. Future research to address these gaps should include substantial patient stakeholder engagement in all aspects of the research process to ensure patient-focused outcomes congruent with sexual and gender minority values and preferences.
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Affiliation(s)
- Michael I Kruse
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Daniel Voloshin
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Wan
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alexandra Clarizio
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Blair L Bigham
- Division of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Suneel Upadhye
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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Ng R, Kendall CE, Burchell AN, Bayoumi AM, Loutfy MR, Raboud J, Glazier RH, Rourke S, Antoniou T. Emergency department use by people with HIV in Ontario: a population-based cohort study. CMAJ Open 2016; 4:E240-8. [PMID: 27398370 PMCID: PMC4933601 DOI: 10.9778/cmajo.20150087] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Emergency department use may reflect poor access to primary care. Our objective was to compare rates and causes of emergency department use between adults living with and without HIV. METHODS We conducted a population-based study involving Ontario residents living with and without HIV between Apr. 1, 2011, and Mar. 31, 2012. We frequency matched adults with HIV to 4 HIV-negative people by age, sex and census division, and used random-effects negative binomial regression to compare rates of emergency department use. We classified visits as low urgency or high urgency, and also examined visits for ambulatory care sensitive conditions. Hospital admission following an emergency department visit was a secondary outcome. RESULTS We identified 14 534 people with HIV and 58 136 HIV-negative individuals. Rates of emergency department use were higher among people with HIV (67.3 v. 31.2 visits per 100 person-years; adjusted rate ratio 1.58, 95% confidence interval [CI] 1.51-1.65). Similar results were observed for low-urgency visits. With the exception of hypertension, visit rates for ambulatory care sensitive conditions were higher among people with HIV. People with HIV were also more likely than HIV-negative individuals to be admitted to hospital following an emergency department visit (adjusted odds ratio 1.55, 95% CI 1.43-1.69). INTERPRETATION Compared with HIV-negative individuals, people with HIV had high rates of emergency department use, including potentially avoidable visits. These findings strongly support the need for comprehensive care for people with HIV.
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Affiliation(s)
- Ryan Ng
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Claire E Kendall
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Ann N Burchell
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Ahmed M Bayoumi
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Mona R Loutfy
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Janet Raboud
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Richard H Glazier
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Sean Rourke
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Tony Antoniou
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
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