Delay and inequality in treatment of the elderly with suspected acute coronary syndrome

Libungan, Berglind; Karlsson, Thomas; Hirlekar, Geir; Albertsson, Per; Herlítz, Johan; Ravn-Fischer, Annica

doi:10.1016/j.ijcard.2014.08.109

Cited by 14 publications

(8 citation statements)

References 25 publications

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“…There is no direct explanation as to why low SES, marital status as single and non-Western ethnicity are associated with high DOW. However, it could be speculated, whether the association between these socioeconomic variables and high DOW is caused by the general social gradient in health care both in detection as well as treatment of illness [35][36][37]. DOW was rated as high by 38.2% of the participants.…”

Section: Implications Of the Findings In Context Of Existing Researchmentioning

confidence: 99%

Possible associations between callers’ degree-of-worry and their socioeconomic status when contacting out-of-hours services: a prospective cohort study

et al. 2021

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Background Telephone triage within out-of-hours (OOH) services aims to ascertain the urgency of a caller’s medical condition in order to determine the correct type of health care needed, ensuring patient safety. To improve the triage process by increasing patient-centred communication, a triage tool has been developed, whereby callers are asked to rate their degree-of-worry (DOW) as a measure of self-evaluated urgency. Studies show that low socioeconomic status (SES), being single and non-Western ethnicity are associated to low self-rated health and high morbidity and these factors may also be associated with high DOW. The aim of this paper was to examine if low SES, being single and non-Western ethnicity were associated to high DOW of callers contacting OOH services. Methods A prospective cohort study design, at the OOH services for the Capital Region of Denmark. Over 2 weeks, 6869 of 38,787 callers met the inclusion criteria: ≥18 years, patients themselves or close relative/friend, reported DOW, had a valid personal identification number and gave informed consent. Callers were asked to report their DOW (1 = minimal worry to 5 = maximal worry), which was dichotomized into low (1–3) and high (4, 5) DOW and linked to data from electronical medical records and Statistics Denmark. Socioeconomic factors (education and annual household income), marital status and ethnicity were assessed in relation to DOW by logistic regression. Results High DOW was reported by 38.2% of the participants. Low SES (low educational level; OR 1.5, 95% CI 1.3–1.7 and low annual household income; 1.5, 1.3–1.6) was associated with high DOW and so too was being single; 1.2, 1.1–1.3 and of non-Western ethnicity; 2.9, 2.5–3.4. Conclusions Knowledge of the association of low SES, marital status as single and non-Western ethnicity with high DOW among callers to OOH services may give call handlers a better understanding of callers’ DOW. If this does not correspond to the call handler’s perception of urgency, this knowledge may further encourage patient-centred communication, aid the triage process and increase patient safety. A better understanding of socioeconomic variables and their relation to callers’ DOW gives direction for future research to improve telephone triage of OOH services.

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Section: Implications Of the Findings In Context Of Existing Researchmentioning

confidence: 99%

Possible associations between callers’ degree-of-worry and their socioeconomic status when contacting out-of-hours services: a prospective cohort study

et al. 2021

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“…This political goal is visible in decades of effort that includes establishing formal clinical guidelines and ongoing monitoring of healthcare provision. However, numerous examples show the system failing to ensure equality as patient characteristics are repeatedly linked to differences in the healthcare services actually attained (Morris, Sutton and Gravelle, 2005;Siciliani and Verzulli, 2009;Kjellén, Von Euler-Chelpin and von Euler-Chilpin, 2010;Starr et al, 2013;Libungan et al, 2014;Carlsen and Martin, 2015). The underlying mechanisms of these inequalities are unclear and may include controversial phenomena.…”

Section: Introductionmentioning

confidence: 99%

“…According to Grossman's theory, this production of health is most efficient among individuals with higher educational levels and consequently better health literacy, which leads to socioeconomic inequality. However, such explanations are mainly relevant for elective and longstanding pathways; but disparities are also found in the field of acute care where the patients' health literacy is arguably less crucial to access and quality of care (Eden et al, 2008;Vassileva et al, 2013;Libungan et al, 2014). Focusing on acute care, a continuum of possible explanations on the part of the system might include stigmatization -if patients who have exerted objective responsibility by not smoking, not being obese or not over-drinking are favoured over patients not showing such objective responsibility.…”

Section: Introductionmentioning

confidence: 99%

Does the responsibility patients exert determine their opportunities for best clinical practice in the healthcare system?

Hyldgård¹,

Støvring²,

Albertsen³

et al. 2021

Nordic J Health Eco

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Many consider inequality in health unfair if it is caused by inequality within the healthcare system but less unfair when caused by individuals’ health behaviour. However, healthcare systems are challenged when it comes to ensuring equal care for equal need. In Roemer’s equality of opportunity theory, people have equal opportunity for obtaining something if obtaining it reflects their effort instead of their circumstances. Very little is known about how responsibility exerted by patients prior to illness affects the healthcare they are provided by the healthcare system. We aimed to apply Roemer’s theory to an acute care setting where healthcare is most directly in the hands of the healthcare system in order to study the role of patient-exerted responsibility for their opportunities in the healthcare system. We operationalised the responsibility patients exert as Body Mass Index (BMI), smoking and alcohol habits, and their circumstances as demographics, socioeconomics, prognostic factors and year of discharge. Opportunity in healthcare was defined as patients’ attainment of clinical guideline-recommended acute hospital care. In Roemer’s theory, we detected inequality of opportunity as restricted attainment of healthcare was mainly associated with patients’ circumstances, such as lower education, old age or living alone. We also identified a strong association with BMI; being underweight negatively affected patients’ opportunities as it led to suboptimal healthcare, while the opposite was found for being overweight and, in particular, obese. Hence, patient-exerted responsibility affected patients’ opportunities in healthcare, though perhaps in an unexpected way. This improved understanding of inequality may help to focus future research and, in the long term, support clinical and political efforts to achieve equal care for equal needs. Published: Online March 2021.

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“…1,2 Among the sociodemographic factors, age is often, but not always associated with increased pre-hospital delay. 1–7…”

Section: Introductionmentioning

confidence: 99%

A cluster and inferential analysis of myocardial infarction symptom presentation by age

McKee

Mooney

O’Donnell

et al. 2018

European Journal of Cardiovascular Nursing

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Delay and inequality in treatment of the elderly with suspected acute coronary syndrome

Cited by 14 publications

References 25 publications

Possible associations between callers’ degree-of-worry and their socioeconomic status when contacting out-of-hours services: a prospective cohort study

Possible associations between callers’ degree-of-worry and their socioeconomic status when contacting out-of-hours services: a prospective cohort study

Does the responsibility patients exert determine their opportunities for best clinical practice in the healthcare system?

A cluster and inferential analysis of myocardial infarction symptom presentation by age

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