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Dubé E, Renaud MP, Lyonnais MC, Pelletier C, Fletcher C. "The needle is already ready to go": communities' and health care professionals' perceptions of routine vaccination in Nunavik, Canada. Int J Circumpolar Health 2024; 83:2295042. [PMID: 38105644 PMCID: PMC10732179 DOI: 10.1080/22423982.2023.2295042] [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: 07/19/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023] Open
Abstract
Inuit living in the northern region of Nunavik continue to experience significant health inequalities, which are rooted in colonialism that still have repercussions on their health-related perceptions and practices, including vaccination. This study aimed to explore the perceptions and determinants of routine vaccination among the Inuit of Nunavik by describing factors influencing vaccination decisions from the perspective of community members and health professionals. Semi-structured interviews focusing on the perception of vaccination and experience with vaccination and health services were conducted with 18 Inuit and 11 non-Inuit health professionals. Using the socio-ecological model, factors acting at the community and public policy (e.g. rumours and misinformation about vaccination, language barrier), organisational (e.g. complexity of the vaccination process, staff turnover, lack of specialised vaccination workers and interpreters), and intrapersonal and interpersonal (e.g. past experiences with vaccination, vaccine attitudes, social norms) levels were identified as having an impact on vaccination decisions. Improving vaccination coverage in Nunavik requires a more global reflection on how to improve and culturally adapt the health care and services offered to the Inuit population.
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Affiliation(s)
- Eve Dubé
- Direction des risques biologiques, Institut national de santé publique du Québec, Québec, Canada
- Département d’anthropologie, Université Laval, Québec, Canada
| | - Marie-Pierre Renaud
- École d’études autochtones, Université du Québec en Abitibi-Témiscamingue, Québec, Canada
| | | | - Catherine Pelletier
- Axe Maladies infectieuses et immunitaires, Centrre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Christopher Fletcher
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
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2
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O’Grady JR, Ferdus J, Leylachian S, Bolarinwa Y, Wagamese J, Ellison LK, Siedule C, Batista R, Sheppard AJ. Lung cancer in First Nations, Inuit, and Métis peoples in Canada - a scoping review. Int J Circumpolar Health 2024; 83:2381879. [PMID: 39074244 PMCID: PMC11288199 DOI: 10.1080/22423982.2024.2381879] [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: 03/07/2024] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024] Open
Abstract
Lung cancer is one of the most commonly diagnosed cancers in Canada and a leading cause of cancer mortality. Lung cancer also affects First Nations, Inuit and Métis peoples significantly in Canada, which deserves further investigation as there is a literature gap on this topic. We sought to develop a deeper understanding of lung cancer diagnosis, incidence, mortality, and survival in First Nations, Inuit, and Métis peoples in Canada. A systematic search was conducted in bibliographic databases to identify relevant studies published between January 2000 and March 2023. Articles were screened and assessed for relevance using the Population/ Concept/ Context (PCC) framework. A total of 22 articles were included in the final analysis, of which 13 were Inuit-specific, 7 were First Nations-specific, and 2 were Métis-specific. The literature suggests that comparative incidence, mortality, and relative risk of lung cancer is higher and survival is poorer in First Nations, Inuit and Métis peoples. Lung cancer also has varying impact on these population depending on sex, age, location and other factors. This review illustrates that more comprehensive quantitative and qualitative lung cancer research is essential to further identify the structural causes for the high incidence of the disease.
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Affiliation(s)
| | - Jannatul Ferdus
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Sayna Leylachian
- Indigenous Cancer Care Unit, Ontario Health, Toronto, Ontario, Canada
| | - Yinka Bolarinwa
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Joshua Wagamese
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Lisa K Ellison
- Indigenous Cancer Care Unit, Ontario Health, Toronto, Ontario, Canada
| | - Connie Siedule
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Ricardo Batista
- The Akausivik Inuit Family Health Team, Ottawa, Ontario, Canada
| | - Amanda J Sheppard
- Indigenous Cancer Care Unit, Ontario Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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3
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MacLean D, Curtin KD, Barnabe C, Bill L, Healy B, Holroyd BR, Khangura JK, McLane P. Interventions to improve equity in emergency departments for Indigenous people: A scoping review. Acad Emerg Med 2024. [PMID: 39054590 DOI: 10.1111/acem.14987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 06/18/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Disparities in health outcomes, including increased chronic disease prevalence and decreased life expectancy for Indigenous people, have been shown across settings affected by white settler colonialism including Canada, the United States, Australia, and New Zealand. Emergency departments (EDs) represent a unique setting in which urgent patient need and provider strain interact to amplify inequities within society. The aim of this scoping review was to map the ED-based interventions aimed at improving equity in care for Indigenous patients in EDs. METHODS This scoping review was conducted using the procedures outlined by Arksey and O'Malley and guidance on conducting scoping reviews from the Joanna Briggs Institute. A systematic search of MEDLINE, CINAHL, SCOPUS, and EMBASE was conducted. RESULTS A total of 3636 articles were screened by title and abstract, of which 32 were screened in full-text review and nine articles describing seven interventions were included in this review. Three intervention approaches were identified: the introduction of novel clinical roles, implementation of chronic disease screening programs in EDs, and systems/organizational-level interventions. CONCLUSIONS Relatively few interventions for improving equity in care were identified. We found that a minority of interventions are aimed at creating organizational-level change and suggest that future interventions could benefit from targeting system-level changes as opposed to or in addition to incorporating new roles in EDs.
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Affiliation(s)
- Davis MacLean
- Department of Medicine, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada
| | - Kimberley D Curtin
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Cheryl Barnabe
- Department of Medicine, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada
| | - Lea Bill
- Alberta First Nations Information Governance Centre, Calgary, Alberta, Canada
| | - Bonnie Healy
- Blackfoot Confederacy Tribal Council, Standoff, Alberta, Canada
| | - Brian R Holroyd
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
- Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jaspreet K Khangura
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick McLane
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
- Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada
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Boss H, MacInnis C, Simon R, Jackson J, Lahtinen M, Sinclair S. What role does compassion have on quality care ratings? A regression analysis and validation of the SCQ in emergency department patients. BMC Emerg Med 2024; 24:124. [PMID: 39026184 PMCID: PMC11264741 DOI: 10.1186/s12873-024-01040-8] [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: 05/27/2024] [Accepted: 07/05/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVE To examine the unique contribution of patient reported experiences of compassion to overall patient quality care ratings. Additionally, we assess whether patients' reported experiences of compassion in the emergency department differed between sociodemographic groups. METHODS Provincial data for this cross-sectional study were collected from 03/01/2022 to 09/05/2022 from 14 emergency departments in Alberta, Canada. Data from 4501 emergency department patients (53.6% women, 77.1% White/European) were analyzed. The primary outcome was patients' overall quality care ratings during their most recent ED visit. Measures included in the hierarchical stepwise regression included demographics, and those drawn from the Emergency Department Patient Experience of Care (EDPEC) questionnaire: single and multi-item measures of patient information (e.g., patient perceptions health) and patient experience (e.g., physician communication), and compassion (e.g., Sinclair Compassion Questionnaire; SCQ-ED). RESULTS Data from 4501 ED patients were analysed. Stepwise hierarchical linear multiple regression indicated that of 21 included variables, compassion most strongly predicted overall quality care ratings (b=1.61, 95% CI 1.53-1.69, p<.001, f2=.23), explaining 19% unique variance beyond all other measures. One-way ANOVAs indicated significant demographic differences in mean compassion scores, such that women (vs. men) reported lower compassion (MD=-.15, 95% CI=-.21, -.09, p<.001), and Indigenous (vs. White) patients reported lower compassion (MD=-.17, 95% CI =-.34, -.01, p=.03). CONCLUSIONS Compassion was identified as a key contributor to ED overall quality care ratings, and experiences of compassion varied as a function of demographics. Patient-reported compassion is an indicator of quality care that needs to be formally integrated into clinical care and quality care assessments.
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Affiliation(s)
- Harrison Boss
- Department of Psychology, University of Calgary, Calgary, Canada
- Compassion Research Lab, University of Calgary, Calgary, Canada
| | - Cara MacInnis
- Department of Psychology, Acadia University, Wolfville, Canada
- Compassion Research Lab, University of Calgary, Calgary, Canada
| | - Roland Simon
- Health Quality Council of Alberta, Calgary, Canada
| | | | | | - Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, Canada.
- Compassion Research Lab, University of Calgary, Calgary, Canada.
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Hamed S, Bradby H, Thapar-Björkert S, Ahlberg BM. Healthcare staff's racialized talk: The perpetuation of racism in healthcare. Soc Sci Med 2024; 355:117085. [PMID: 39032198 DOI: 10.1016/j.socscimed.2024.117085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/11/2024] [Accepted: 06/28/2024] [Indexed: 07/22/2024]
Abstract
Research points to the existence of racial bias and beliefs among healthcare staff but does not explicate accounts of racialization in healthcare and the day-to-day utterances that have racializing effects excluding minoritized users' right to care. This study understands racism as structural and embedded in societies and institutions, including healthcare, as well as in interactions and talk. Through excavating accounts of healthcare staff's talk that devalues minoritized users, this study posits talk as reflective and constitutive of the dominant structure of racism within which it is situated. Drawing on qualitative interviews with 58 staff in Sweden, the study delineates three categories through which racialized talk differentiates between minoritized and majoritized users. These are: Characterizing minoritized users as 'bad' users, Characterizing minoritized users' health complaints as unworthy and finally, Devaluing minoritized users as justification for suboptimal and differential care. Healthcare staff accounts show that continuous racialization of minoritized users maintains existing power-relations representing Western users as civilized and non-Western users as uncivilized and problematic. Through reiteration, these practices of exclusion become invisible, normalized, and assume the status quo. It is imperative to address racialization as it has implications for the core ethics of healthcare.
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Affiliation(s)
- Sarah Hamed
- Department of Sociology, Uppsala University, Uppsala, Sweden; Department of Ethnology, History of Religion and Gender Studies, Stockholm University, Stockholm, Sweden.
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | | | - Beth Maina Ahlberg
- Department of Sociology, Uppsala University, Uppsala, Sweden; Skaraborg Institute for Research and Development, Skövde, Sweden
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Hall JN, Vijayakumar A, Reis L, Alamgir A, Kokorelias KM, Hemphill J, Pattni N, Legere L, Halperin IJ, Di Prospero L, Elman D, Domb S, Arafeh D, Ledwos C, Sheppard CL, Hitzig SL. A qualitative study on the Virtual Emergency Department care experiences of equity-deserving populations. PLoS One 2024; 19:e0304618. [PMID: 38833484 PMCID: PMC11149852 DOI: 10.1371/journal.pone.0304618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/15/2024] [Indexed: 06/06/2024] Open
Abstract
Patients from equity-deserving populations, such as those who are from racialized communities, the 2SLGBTQI+ community, who are refugees or immigrants, and/or who have a disability, may experience a unique set of challenges accessing virtual models of care. The objective of this qualitative study was to describe the experiences of patients from equity-deserving communities and their family members who received care from a Virtual Emergency Department (ED) in Toronto, Canada. Forty-three participants (36 patients and 7 family caregivers) with different and intersecting identities who used the Virtual ED participated in the study. Semi-structured interviews were conducted to explore reasons for accessing the Virtual ED, barriers to access, and how the Virtual ED met their care needs and expectations, including ways their experience could have been improved. Thematic analysis was used to identify themes from the data. Patients from equity-deserving populations described negative past experiences with ED in-person care, which included recounts of discrimination or culturally insensitive care while waiting to see the ED physician or nurse. Conversely, participants found the Virtual ED to be a socially and culturally safe space since they could now by-pass the waiting room experience. However, virtual care could not replace in-person care for certain issues (e.g., physical exam), and there was a need for greater promotion of the service to specific communities that might benefit from having access to the Virtual ED. Targeted outreach to help raise awareness of the service to equity-deserving communities is an important future direction.
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Affiliation(s)
- Justin N. Hall
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Logan Reis
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Akm Alamgir
- Access Alliance Multicultural Health and Community Services, Toronto, Ontario, Canada
| | - Kristina M. Kokorelias
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sinai Health, University Health Network, Toronto, Ontario, Canada
| | | | - Noorin Pattni
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Laurie Legere
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ilana J. Halperin
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Lisa Di Prospero
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Debbie Elman
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Domb
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dana Arafeh
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Cliff Ledwos
- Access Alliance Multicultural Health and Community Services, Toronto, Ontario, Canada
| | - Christine L. Sheppard
- Wellesley Institute, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Sander L. Hitzig
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
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McLane P, Bill L, Healy B, Barnabe C, Plume TB, Bird A, Colquhoun A, Holroyd BR, Janvier K, Louis E, Rittenbach K, Curtin KD, Fitzpatrick KM, Mackey L, MacLean D, Rosychuk RJ. Leaving emergency departments without completing treatment among First Nations and non-First Nations patients in Alberta: a mixed-methods study. CMAJ 2024; 196:E510-E523. [PMID: 38649167 PMCID: PMC11045230 DOI: 10.1503/cmaj.231019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Our previous research showed that, in Alberta, Canada, a higher proportion of visits to emergency departments and urgent care centres by First Nations patients ended in the patient leaving without being seen or against medical advice, compared with visits by non-First Nations patients. We sought to analyze whether these differences persisted after controlling for patient demographic and visit characteristics, and to explore reasons for leaving care. METHODS We conducted a mixed-methods study, including a population-based retrospective cohort study for the period of April 2012 to March 2017 using provincial administrative data. We used multivariable logistic regression models to control for demographics, visit characteristics, and facility types. We evaluated models for subgroups of visits with pre-selected illnesses. We also conducted qualitative, in-person sharing circles, a focus group, and 1-on-1 telephone interviews with health directors, emergency care providers, and First Nations patients from 2019 to 2022, during which we reviewed the quantitative results of the cohort study and asked participants to comment on them. We descriptively categorized qualitative data related to reasons that First Nations patients leave care. RESULTS Our quantitative analysis included 11 686 287 emergency department visits, of which 1 099 424 (9.4%) were by First Nations patients. Visits by First Nations patients were more likely to end with them leaving without being seen or against medical advice than those by non-First Nations patients (odds ratio 1.96, 95% confidence interval 1.94-1.98). Factors such as diagnosis, visit acuity, geography, or patient demographics other than First Nations status did not explain this finding. First Nations status was associated with greater odds of leaving without being seen or against medical advice in 9 of 10 disease categories or specific diagnoses. In our qualitative analysis, 64 participants discussed First Nations patients' experiences of racism, stereotyping, communication issues, transportation barriers, long waits, and being made to wait longer than others as reasons for leaving. INTERPRETATION Emergency department visits by First Nations patients were more likely to end with them leaving without being seen or against medical advice than those by non-First Nations patients. As leaving early may delay needed care or interfere with continuity of care, providers and departments should work with local First Nations to develop and adopt strategies to retain First Nations patients in care.
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Affiliation(s)
- Patrick McLane
- Alberta Health Services, Strategic Clinical Networks (McLane, Holroyd); Departments of Emergency Medicine (McLane, Holroyd, Curtin, Fitzpatrick, Mackey, MacLean), and Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Alberta First Nations Information Governance Centre (Bill), Calgary, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Departments of Community Health Sciences (Barnabe), Medicine (Barnabe, MacLean), and Psychiatry (Rittenbach), University of Calgary, Calgary, Alta; Stoney Nakoda Tsuut'ina Tribal Council (Big Plume), Tsuut'ina, Alta.; Paul First Nation Health Services (Bird), Parkland County, Alta.; Analytics and Performance Reporting (Colquhoun), Alberta Health, Edmonton, Alta.; Kee Tas Kee Now Tribal Council (Janvier), Atikameg, Alta.; Maskwacis Health Services (Louis), Maskwacis Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta.
| | - Lea Bill
- Alberta Health Services, Strategic Clinical Networks (McLane, Holroyd); Departments of Emergency Medicine (McLane, Holroyd, Curtin, Fitzpatrick, Mackey, MacLean), and Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Alberta First Nations Information Governance Centre (Bill), Calgary, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Departments of Community Health Sciences (Barnabe), Medicine (Barnabe, MacLean), and Psychiatry (Rittenbach), University of Calgary, Calgary, Alta; Stoney Nakoda Tsuut'ina Tribal Council (Big Plume), Tsuut'ina, Alta.; Paul First Nation Health Services (Bird), Parkland County, Alta.; Analytics and Performance Reporting (Colquhoun), Alberta Health, Edmonton, Alta.; Kee Tas Kee Now Tribal Council (Janvier), Atikameg, Alta.; Maskwacis Health Services (Louis), Maskwacis Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Bonnie Healy
- Alberta Health Services, Strategic Clinical Networks (McLane, Holroyd); Departments of Emergency Medicine (McLane, Holroyd, Curtin, Fitzpatrick, Mackey, MacLean), and Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Alberta First Nations Information Governance Centre (Bill), Calgary, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Departments of Community Health Sciences (Barnabe), Medicine (Barnabe, MacLean), and Psychiatry (Rittenbach), University of Calgary, Calgary, Alta; Stoney Nakoda Tsuut'ina Tribal Council (Big Plume), Tsuut'ina, Alta.; Paul First Nation Health Services (Bird), Parkland County, Alta.; Analytics and Performance Reporting (Colquhoun), Alberta Health, Edmonton, Alta.; Kee Tas Kee Now Tribal Council (Janvier), Atikameg, Alta.; Maskwacis Health Services (Louis), Maskwacis Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Cheryl Barnabe
- Alberta Health Services, Strategic Clinical Networks (McLane, Holroyd); Departments of Emergency Medicine (McLane, Holroyd, Curtin, Fitzpatrick, Mackey, MacLean), and Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Alberta First Nations Information Governance Centre (Bill), Calgary, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Departments of Community Health Sciences (Barnabe), Medicine (Barnabe, MacLean), and Psychiatry (Rittenbach), University of Calgary, Calgary, Alta; Stoney Nakoda Tsuut'ina Tribal Council (Big Plume), Tsuut'ina, Alta.; Paul First Nation Health Services (Bird), Parkland County, Alta.; Analytics and Performance Reporting (Colquhoun), Alberta Health, Edmonton, Alta.; Kee Tas Kee Now Tribal Council (Janvier), Atikameg, Alta.; Maskwacis Health Services (Louis), Maskwacis Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Tessy Big Plume
- Alberta Health Services, Strategic Clinical Networks (McLane, Holroyd); Departments of Emergency Medicine (McLane, Holroyd, Curtin, Fitzpatrick, Mackey, MacLean), and Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Alberta First Nations Information Governance Centre (Bill), Calgary, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Departments of Community Health Sciences (Barnabe), Medicine (Barnabe, MacLean), and Psychiatry (Rittenbach), University of Calgary, Calgary, Alta; Stoney Nakoda Tsuut'ina Tribal Council (Big Plume), Tsuut'ina, Alta.; Paul First Nation Health Services (Bird), Parkland County, Alta.; Analytics and Performance Reporting (Colquhoun), Alberta Health, Edmonton, Alta.; Kee Tas Kee Now Tribal Council (Janvier), Atikameg, Alta.; Maskwacis Health Services (Louis), Maskwacis Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Anne Bird
- Alberta Health Services, Strategic Clinical Networks (McLane, Holroyd); Departments of Emergency Medicine (McLane, Holroyd, Curtin, Fitzpatrick, Mackey, MacLean), and Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Alberta First Nations Information Governance Centre (Bill), Calgary, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Departments of Community Health Sciences (Barnabe), Medicine (Barnabe, MacLean), and Psychiatry (Rittenbach), University of Calgary, Calgary, Alta; Stoney Nakoda Tsuut'ina Tribal Council (Big Plume), Tsuut'ina, Alta.; Paul First Nation Health Services (Bird), Parkland County, Alta.; Analytics and Performance Reporting (Colquhoun), Alberta Health, Edmonton, Alta.; Kee Tas Kee Now Tribal Council (Janvier), Atikameg, Alta.; Maskwacis Health Services (Louis), Maskwacis Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Amy Colquhoun
- Alberta Health Services, Strategic Clinical Networks (McLane, Holroyd); Departments of Emergency Medicine (McLane, Holroyd, Curtin, Fitzpatrick, Mackey, MacLean), and Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Alberta First Nations Information Governance Centre (Bill), Calgary, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Departments of Community Health Sciences (Barnabe), Medicine (Barnabe, MacLean), and Psychiatry (Rittenbach), University of Calgary, Calgary, Alta; Stoney Nakoda Tsuut'ina Tribal Council (Big Plume), Tsuut'ina, Alta.; Paul First Nation Health Services (Bird), Parkland County, Alta.; Analytics and Performance Reporting (Colquhoun), Alberta Health, Edmonton, Alta.; Kee Tas Kee Now Tribal Council (Janvier), Atikameg, Alta.; Maskwacis Health Services (Louis), Maskwacis Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Brian R Holroyd
- Alberta Health Services, Strategic Clinical Networks (McLane, Holroyd); Departments of Emergency Medicine (McLane, Holroyd, Curtin, Fitzpatrick, Mackey, MacLean), and Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Alberta First Nations Information Governance Centre (Bill), Calgary, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Departments of Community Health Sciences (Barnabe), Medicine (Barnabe, MacLean), and Psychiatry (Rittenbach), University of Calgary, Calgary, Alta; Stoney Nakoda Tsuut'ina Tribal Council (Big Plume), Tsuut'ina, Alta.; Paul First Nation Health Services (Bird), Parkland County, Alta.; Analytics and Performance Reporting (Colquhoun), Alberta Health, Edmonton, Alta.; Kee Tas Kee Now Tribal Council (Janvier), Atikameg, Alta.; Maskwacis Health Services (Louis), Maskwacis Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Kris Janvier
- Alberta Health Services, Strategic Clinical Networks (McLane, Holroyd); Departments of Emergency Medicine (McLane, Holroyd, Curtin, Fitzpatrick, Mackey, MacLean), and Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Alberta First Nations Information Governance Centre (Bill), Calgary, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Departments of Community Health Sciences (Barnabe), Medicine (Barnabe, MacLean), and Psychiatry (Rittenbach), University of Calgary, Calgary, Alta; Stoney Nakoda Tsuut'ina Tribal Council (Big Plume), Tsuut'ina, Alta.; Paul First Nation Health Services (Bird), Parkland County, Alta.; Analytics and Performance Reporting (Colquhoun), Alberta Health, Edmonton, Alta.; Kee Tas Kee Now Tribal Council (Janvier), Atikameg, Alta.; Maskwacis Health Services (Louis), Maskwacis Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Eunice Louis
- Alberta Health Services, Strategic Clinical Networks (McLane, Holroyd); Departments of Emergency Medicine (McLane, Holroyd, Curtin, Fitzpatrick, Mackey, MacLean), and Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Alberta First Nations Information Governance Centre (Bill), Calgary, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Departments of Community Health Sciences (Barnabe), Medicine (Barnabe, MacLean), and Psychiatry (Rittenbach), University of Calgary, Calgary, Alta; Stoney Nakoda Tsuut'ina Tribal Council (Big Plume), Tsuut'ina, Alta.; Paul First Nation Health Services (Bird), Parkland County, Alta.; Analytics and Performance Reporting (Colquhoun), Alberta Health, Edmonton, Alta.; Kee Tas Kee Now Tribal Council (Janvier), Atikameg, Alta.; Maskwacis Health Services (Louis), Maskwacis Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Katherine Rittenbach
- Alberta Health Services, Strategic Clinical Networks (McLane, Holroyd); Departments of Emergency Medicine (McLane, Holroyd, Curtin, Fitzpatrick, Mackey, MacLean), and Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Alberta First Nations Information Governance Centre (Bill), Calgary, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Departments of Community Health Sciences (Barnabe), Medicine (Barnabe, MacLean), and Psychiatry (Rittenbach), University of Calgary, Calgary, Alta; Stoney Nakoda Tsuut'ina Tribal Council (Big Plume), Tsuut'ina, Alta.; Paul First Nation Health Services (Bird), Parkland County, Alta.; Analytics and Performance Reporting (Colquhoun), Alberta Health, Edmonton, Alta.; Kee Tas Kee Now Tribal Council (Janvier), Atikameg, Alta.; Maskwacis Health Services (Louis), Maskwacis Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Kimberley D Curtin
- Alberta Health Services, Strategic Clinical Networks (McLane, Holroyd); Departments of Emergency Medicine (McLane, Holroyd, Curtin, Fitzpatrick, Mackey, MacLean), and Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Alberta First Nations Information Governance Centre (Bill), Calgary, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Departments of Community Health Sciences (Barnabe), Medicine (Barnabe, MacLean), and Psychiatry (Rittenbach), University of Calgary, Calgary, Alta; Stoney Nakoda Tsuut'ina Tribal Council (Big Plume), Tsuut'ina, Alta.; Paul First Nation Health Services (Bird), Parkland County, Alta.; Analytics and Performance Reporting (Colquhoun), Alberta Health, Edmonton, Alta.; Kee Tas Kee Now Tribal Council (Janvier), Atikameg, Alta.; Maskwacis Health Services (Louis), Maskwacis Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Kayla M Fitzpatrick
- Alberta Health Services, Strategic Clinical Networks (McLane, Holroyd); Departments of Emergency Medicine (McLane, Holroyd, Curtin, Fitzpatrick, Mackey, MacLean), and Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Alberta First Nations Information Governance Centre (Bill), Calgary, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Departments of Community Health Sciences (Barnabe), Medicine (Barnabe, MacLean), and Psychiatry (Rittenbach), University of Calgary, Calgary, Alta; Stoney Nakoda Tsuut'ina Tribal Council (Big Plume), Tsuut'ina, Alta.; Paul First Nation Health Services (Bird), Parkland County, Alta.; Analytics and Performance Reporting (Colquhoun), Alberta Health, Edmonton, Alta.; Kee Tas Kee Now Tribal Council (Janvier), Atikameg, Alta.; Maskwacis Health Services (Louis), Maskwacis Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Leslee Mackey
- Alberta Health Services, Strategic Clinical Networks (McLane, Holroyd); Departments of Emergency Medicine (McLane, Holroyd, Curtin, Fitzpatrick, Mackey, MacLean), and Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Alberta First Nations Information Governance Centre (Bill), Calgary, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Departments of Community Health Sciences (Barnabe), Medicine (Barnabe, MacLean), and Psychiatry (Rittenbach), University of Calgary, Calgary, Alta; Stoney Nakoda Tsuut'ina Tribal Council (Big Plume), Tsuut'ina, Alta.; Paul First Nation Health Services (Bird), Parkland County, Alta.; Analytics and Performance Reporting (Colquhoun), Alberta Health, Edmonton, Alta.; Kee Tas Kee Now Tribal Council (Janvier), Atikameg, Alta.; Maskwacis Health Services (Louis), Maskwacis Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Davis MacLean
- Alberta Health Services, Strategic Clinical Networks (McLane, Holroyd); Departments of Emergency Medicine (McLane, Holroyd, Curtin, Fitzpatrick, Mackey, MacLean), and Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Alberta First Nations Information Governance Centre (Bill), Calgary, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Departments of Community Health Sciences (Barnabe), Medicine (Barnabe, MacLean), and Psychiatry (Rittenbach), University of Calgary, Calgary, Alta; Stoney Nakoda Tsuut'ina Tribal Council (Big Plume), Tsuut'ina, Alta.; Paul First Nation Health Services (Bird), Parkland County, Alta.; Analytics and Performance Reporting (Colquhoun), Alberta Health, Edmonton, Alta.; Kee Tas Kee Now Tribal Council (Janvier), Atikameg, Alta.; Maskwacis Health Services (Louis), Maskwacis Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Rhonda J Rosychuk
- Alberta Health Services, Strategic Clinical Networks (McLane, Holroyd); Departments of Emergency Medicine (McLane, Holroyd, Curtin, Fitzpatrick, Mackey, MacLean), and Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Alberta First Nations Information Governance Centre (Bill), Calgary, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Departments of Community Health Sciences (Barnabe), Medicine (Barnabe, MacLean), and Psychiatry (Rittenbach), University of Calgary, Calgary, Alta; Stoney Nakoda Tsuut'ina Tribal Council (Big Plume), Tsuut'ina, Alta.; Paul First Nation Health Services (Bird), Parkland County, Alta.; Analytics and Performance Reporting (Colquhoun), Alberta Health, Edmonton, Alta.; Kee Tas Kee Now Tribal Council (Janvier), Atikameg, Alta.; Maskwacis Health Services (Louis), Maskwacis Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
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8
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Mackie AS, Bravo-Jaimes K, Keir M, Sillman C, Kovacs AH. Access to Specialized Care Across the Lifespan in Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:267-282. [PMID: 38161668 PMCID: PMC10755796 DOI: 10.1016/j.cjcpc.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/05/2023] [Indexed: 01/03/2024]
Abstract
Individuals living with tetralogy of Fallot require lifelong specialized congenital heart disease care to monitor for and manage potential late complications. However, access to cardiology care remains a challenge for many patients, as does access to mental health services, dental care, obstetrical care, and other specialties required by this population. Inequities in health care access were highlighted by the COVID-19 pandemic and continue to exist. Paradoxically, many social factors influence an individual's need for care, yet inadvertently restrict access to it. These include sex and gender, being a member of a racial or ethnic historically excluded group, lower educational attainment, lower socioeconomic status, living remotely from tertiary care centres, transportation difficulties, inadequate health insurance, occupational instability, and prior experiences with discrimination in the health care setting. These factors may coexist and have compounding effects. In addition, many patients believe that they are cured and unaware of the need for specialized follow-up. For these reasons, lapses in care are common, particularly around the time of transfer from paediatric to adult care. The lack of trained health care professionals for adults with congenital heart disease presents an additional barrier, even in higher income countries. This review summarizes challenges regarding access to multiple domains of specialized care for individuals with tetralogy of Fallot, with a focus on the impact of social determinants of health. Specific recommendations to improve access to care within Canadian and American systems are offered.
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Affiliation(s)
- Andrew S. Mackie
- Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Michelle Keir
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Christina Sillman
- Adult Congenital Heart Disease Program, Sutter Heart and Vascular Institute, Sacramento, California, USA
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Taplin JG, Bill L, Blanchard IE, Barnabe CM, Holroyd BR, Healy B, McLane P. Exploring paramedic care for First Nations in Alberta: a qualitative study. CMAJ Open 2023; 11:E1135-E1147. [PMID: 38086557 PMCID: PMC10721334 DOI: 10.9778/cmajo.20230039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Prior work has shown that a greater proportion of First Nations patients than non-First Nations patients arrive by ambulance to emergency departments in Alberta. The objective of this study was to understand First Nations perspectives on transitions in care involving paramedics, and paramedic perspectives on serving First Nations communities. METHODS Participants for this participatory qualitative study were selected by means of purposive sampling through author networks, established relationships and knowledge of the Alberta paramedicine system. First Nations research team members engaged First Nations community organizations to identify and invite First Nations participants. Four sharing circles were held virtually in July 2021 via Zoom by the Alberta First Nations Information Governance Centre. We analyzed the data from the sharing circles using a Western thematic approach. The data were reviewed by Indigenous researchers. RESULTS Forty-four participants attended the 4 sharing circles (8-14 participants per circle), which ranged from 68 to 88 minutes long. We identified 3 major themes: racism, system barriers and solutions. First Nations participants described being stereotyped as misusing paramedic systems and substance using, which led to racial discrimination by paramedics and emergency department staff. Discrimination and lack of options to return home after care sometimes led First Nations patients to avoid paramedic care, and lack of alternative care options drove patients to access paramedic care. First Nations providers described facing racism from colleagues and completing additional work to act as cultural mentors to non-First Nations providers. Paramedics expressed moral distress when called on to handle issues outside their scope of practice and when they observed discrimination that interfered with patient care. Proposed solutions included First Nations self-determination in paramedic service design, cultural training and education for paramedics, and new paramedicine service models. INTERPRETATION First Nations people face discrimination and systemic barriers when accessing paramedicine. Potential solutions include the integration of paramedics in expanded health care roles that incorporate First Nations perspectives and address local priorities, and First Nations should lead in the design of and priority setting for paramedic services in their communities.
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Affiliation(s)
- John G Taplin
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Lea Bill
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Ian E Blanchard
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Cheryl M Barnabe
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Brian R Holroyd
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Bonnie Healy
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Patrick McLane
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta.
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Wees T, Pandey M, Nicolay S, Windigo J, Bitternose A, Kopriva D. Identifying barriers to preventive care among First Nations people at risk of lower extremity amputation: a qualitative study. CMAJ Open 2023; 11:E906-E914. [PMID: 37816546 PMCID: PMC10569813 DOI: 10.9778/cmajo.20220150] [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] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND First Nations people in Canada are overrepresented among those who have undergone nontraumatic lower extremity amputation, and are more likely to be younger, have diabetic foot infections and have no previous revascularization procedures than non-First Nations populations who have undergone lower extremity amputations. We sought to identify access barriers for high-risk First Nations patients, explore patients' experiences with health care systems and identify solutions. METHODS Employing a community participatory research design, we engaged representatives from 2 communities. They assisted with research design and data analysis, and approved the final manuscript. Using a hermeneutic phenomenological approach and purposeful sampling, we conducted 5 semistructured focus groups between August and December 2021 with community health care teams and patients at risk for, or who had previously undergone, a nontraumatic lower extremity amputation. RESULTS Patients' (n = 10) and community health care providers' (n = 18) perspectives indicated that barriers to health care access led to delayed care and increased complications and risk for lower extremity amputations, leading to aggressive procedures upon receiving care. Barriers to care led to negative experiences at urban centres and aggressive procedures created further distrust, leading to care disengagement and poor outcomes. Patients and providers both suggested building stronger partnerships between urban and rural health care providers, improving education for patients and health care providers and identifying innovative strategies to improve patients' overall health. INTERPRETATION Systemic changes, health promotional program and reliable on-reserve primary care are needed to create equitable access for First Nation patients at risk for lower extremity amputations. The study results imply that health care delivery for First Nations patients at risk for lower extremity amputations can be improved through stronger partnership and communication between urban and community providers, and continued education and cultural competency training for urban health care providers.
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Affiliation(s)
- Tyrell Wees
- College of Medicine (Wees, Kopriva), University of Saskatchewan; Research (Pandey), Saskatchewan Health Authority; Wellness Wheel Medical Clinic (Nicolay), Regina, Sask.; Muskowekwan First Nation (Windigo), Lestock, Sask.; George Gordon First Nation (Bitternose), Regina, Sask
| | - Mamata Pandey
- College of Medicine (Wees, Kopriva), University of Saskatchewan; Research (Pandey), Saskatchewan Health Authority; Wellness Wheel Medical Clinic (Nicolay), Regina, Sask.; Muskowekwan First Nation (Windigo), Lestock, Sask.; George Gordon First Nation (Bitternose), Regina, Sask
| | - Susanne Nicolay
- College of Medicine (Wees, Kopriva), University of Saskatchewan; Research (Pandey), Saskatchewan Health Authority; Wellness Wheel Medical Clinic (Nicolay), Regina, Sask.; Muskowekwan First Nation (Windigo), Lestock, Sask.; George Gordon First Nation (Bitternose), Regina, Sask
| | - Juandell Windigo
- College of Medicine (Wees, Kopriva), University of Saskatchewan; Research (Pandey), Saskatchewan Health Authority; Wellness Wheel Medical Clinic (Nicolay), Regina, Sask.; Muskowekwan First Nation (Windigo), Lestock, Sask.; George Gordon First Nation (Bitternose), Regina, Sask
| | - Agnes Bitternose
- College of Medicine (Wees, Kopriva), University of Saskatchewan; Research (Pandey), Saskatchewan Health Authority; Wellness Wheel Medical Clinic (Nicolay), Regina, Sask.; Muskowekwan First Nation (Windigo), Lestock, Sask.; George Gordon First Nation (Bitternose), Regina, Sask
| | - David Kopriva
- College of Medicine (Wees, Kopriva), University of Saskatchewan; Research (Pandey), Saskatchewan Health Authority; Wellness Wheel Medical Clinic (Nicolay), Regina, Sask.; Muskowekwan First Nation (Windigo), Lestock, Sask.; George Gordon First Nation (Bitternose), Regina, Sask.
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Bowker SL, Williams K, Volk A, Auger L, Lafontaine A, Dumont P, Wingert A, Davis A, Bialy L, Wright E, Oster RT, Bagshaw SM. Incidence and outcomes of critical illness in indigenous peoples: a systematic review and meta-analysis. Crit Care 2023; 27:285. [PMID: 37443118 PMCID: PMC10339531 DOI: 10.1186/s13054-023-04570-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: 05/29/2023] [Accepted: 07/07/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Indigenous Peoples experience health inequities and racism across the continuum of health services. We performed a systematic review and meta-analysis of the incidence and outcomes of critical illness among Indigenous Peoples. METHODS We searched Ovid MEDLINE/PubMed, Ovid EMBASE, Google Scholar, and Cochrane Central Register of Controlled Trials (inception to October 2022). Observational studies, case series of > 100 patients, clinical trial arms, and grey literature reports of Indigenous adults were eligible. We assessed risk of bias using the Newcastle-Ottawa Scale and appraised research quality from an Indigenous perspective using the Aboriginal and Torres Strait Islander Quality Assessment Tool. ICU mortality, ICU length of stay, and invasive mechanical ventilation (IMV) were compared using risk ratios and mean difference (MD) for dichotomous and continuous outcomes, respectively. ICU admission was synthesized descriptively. RESULTS Fifteen studies (Australia and/or New Zealand [n = 12] and Canada [n = 3]) were included. Risk of bias was low in 10 studies and moderate in 5, and included studies had minimal incorporation of Indigenous perspectives or consultation. There was no difference in ICU mortality between Indigenous and non-Indigenous (RR 1.14, 95%CI 0.98 to 1.34, I2 = 87%). We observed a shorter ICU length of stay among Indigenous (MD - 0.25; 95%CI, - 0.49 to - 0.00; I2 = 95%) and a higher use for IMV among non-Indigenous (RR 1.10; 95%CI, 1.06 to 1.15; I2 = 81%). CONCLUSION Research on Indigenous Peoples experience with critical care is poorly characterized and has rarely included Indigenous perspectives. ICU mortality between Indigenous and non-Indigenous populations was similar, while there was a shorter ICU length of stay and less mechanical ventilation use among Indigenous patients. Systematic Review Registration PROSPERO CRD42021254661; Registered: 12 June, 2021.
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Affiliation(s)
- Samantha L. Bowker
- Critical Care Strategic Clinical Network™, Alberta Health Services, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, 2-124E Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
| | - Kienan Williams
- Indigenous Wellness Core, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB T2W 1S7 Canada
| | - Auriele Volk
- Indigenous Medical and Dental Students Association, Faculty of Medicine and Dentistry, University of Alberta, Katz Group Centre for Pharmacy and Health Research, 1-002, Edmonton, AB T6G 2E1 Canada
- Indigenous Peoples and Critical Care in Alberta Advisory Committee, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
| | - Leonard Auger
- Indigenous Peoples and Critical Care in Alberta Advisory Committee, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
| | - Alika Lafontaine
- Indigenous Peoples and Critical Care in Alberta Advisory Committee, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
| | - Paige Dumont
- Indigenous Peoples and Critical Care in Alberta Advisory Committee, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
| | - Aireen Wingert
- Alberta Research Centre for Health Evidence, University of Alberta, Room 4-496A, Edmonton Clinic Health Academic, 11405 – 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Amanda Davis
- Indigenous Wellness Core, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB T2W 1S7 Canada
| | - Liza Bialy
- Alberta Research Centre for Health Evidence, University of Alberta, Room 4-496A, Edmonton Clinic Health Academic, 11405 – 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Erica Wright
- Alberta Research Centre for Health Evidence, University of Alberta, Room 4-496A, Edmonton Clinic Health Academic, 11405 – 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Richard T. Oster
- Indigenous Wellness Core, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB T2W 1S7 Canada
| | - Sean M. Bagshaw
- Critical Care Strategic Clinical Network™, Alberta Health Services, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, 2-124E Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
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Montesanti S, MacKean G, Fitzpatrick KM, Fancott C. Family caregivers as essential partners in care: examining the impacts of restrictive acute care visiting policies during the COVID-19 pandemic in Canada. BMC Health Serv Res 2023; 23:320. [PMID: 37004050 PMCID: PMC10066017 DOI: 10.1186/s12913-023-09248-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/06/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION During the pandemic many Canadian hospitals made significant changes to their 'open family presence' and 'visitor policies' to reduce the spread of COVID-19 by instituting restrictive or 'zero visiting' policies in healthcare facilities. These policies have the potential to create great hardship, anxiety and stress for patients, families, caregivers and frontline healthcare providers (HCPs); along with concerns about the quality and safety of patient care. The presence of family members and other caregivers as essential partners in care is an explicit expression of the philosophy of patient- and family-centred care (PFCC) in action. The purpose of this study is to increase our understanding of how changes to family presence and visiting policies and practices during the COVID-19 pandemic have impacted patients, family caregivers and frontline healthcare providers (HCPs) in acute care hospitals. METHODS A total of 38 in-depth semi-structured interviews were conducted with patients, family caregivers and HCPs in Canadian provinces who had experience with visiting policies in acute care settings during the pandemic. COVID patients, and the caregivers of COVID patients, were excluded from this study. A maximum variation sampling strategy was used to guide the selection and recruitment of patients, family caregivers and HCPs, based on our interest in gaining a diversity of perspectives and experiences. RESULTS Many patients, family caregivers, and HCPs view family caregiver presence as integral to PFCC, describing the essential roles played by family caregivers prior to the pandemic. There were commonalities across all three groups with respect to their perspectives on the impacts of restrictive visiting policies on patients, family caregivers and HCPs. They fell into four broad integrated categories: (1) emotional and mental health; (2) communication and advocacy; (3) safety and quality of care; and (4) PFCC, trust in the healthcare system, and future decisions regarding accessing needed healthcare. Recommendations for pandemic visiting policies were also identified. CONCLUSIONS The findings from this study highlighted several impacts of restrictive family caregiver presence or visiting policies implemented during COVID-19 on patients, family caregivers and HCPs in acute healthcare settings across Canada. Participants emphasized that there is no "one-size-fits-all" caregiver presence policy that will address all patient needs. To be consistent with the practice of PFCC, patients and family caregivers are welcomed as part of the healthcare team in ways that work for them, demonstrating that flexibility in family presence and visiting policies is essential.
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Affiliation(s)
- Stephanie Montesanti
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Gail MacKean
- Imagine Citizens Network, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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