First Nations emergency care in Alberta: descriptive results of a retrospective cohort study

McLane, Patrick; Barnabé, Cheryl; Holroyd, Brian R.; Colquhoun, Amy; Bill, Lea; Fitzpatrick, Kayla; Rittenbach, Katherine; Healy, Chyloe; Healy, Bonnie; Rosychuk, Rhonda J.

doi:10.1186/s12913-021-06415-2

Cited by 21 publications

(28 citation statements)

References 40 publications

(10 reference statements)

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“…Each of the PHC clinics identified that those they served often faced poor treatment when accessing care at local EDs. These findings aligned with historical and ongoing evidence of inequitable treatment in EDs for Indigenous people [4,7,33,34], people experiencing violence [35,36], and those presenting with histories of mental illness [37], substance use and/or homelessness [38,39].…”

Section: Introductionsupporting

confidence: 68%

EQUIP emergency: can interventions to reduce racism, discrimination and stigma in EDs improve outcomes?

Varcoe

Browne

Perrin

et al. 2022

BMC Health Serv Res

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Background Despite a publicly funded system, health care in Canada has been shown to be deeply inequitable, particularly toward Indigenous people. Based on research identifying key dimensions of equity-oriented health care as being cultural safety, harm reduction and trauma- and violence-informed care, an intervention to promote equity at the organizational level was tested in primary health care, refined and adapted, and tested in Emergency Departments (EDs). Methods In partnership with clinical, community and Indigenous leaders in three diverse EDs in one Canadian province, we supported direct care staff to tailor and implement the intervention. Intervention activities varied in type and intensity at each site. Survey data were collected pre- and post-intervention from every consecutive patient over age 18 presenting to the EDs (n = 4771) with 3315 completing post-visit questions in 4 waves at two sites and 3 waves (due to pandemic constraints) at the third. Administrative data were collected for 12 months pre- and 12 months post-intervention. Results Throughout the study period, the participating EDs were dealing with a worsening epidemic of overdoses and deaths related to a toxic drug supply, and the COVID 19 pandemic curtailed both intervention activities and data collection. Despite these constraints, staff at two of the EDs mounted equity-oriented intervention strategies; the other site was experiencing continued, significant staff shortages and leadership changeover. Longitudinal analysis using multiple regression showed non-significant but encouraging trends in patient perceptions of quality of care and patient experiences of discrimination in the ED. Subgroup analysis showed that specific groups of patients experienced care in significantly different ways at each site. An interrupted time series of administrative data showed no significant change in staff sick time, but showed a significant decrease in the percentage of patients who left without care being completed at the site with the most robust intervention activities. Conclusions The trends in patient perceptions and the significant decrease in the percentage of patients who left without care being completed suggest potential for impact. Realization of this potential will depend on readiness, commitment and resources at the organizational and systems levels. Trial registration Clinical Trials.gov #NCT03369678 (registration date November 18, 2017).

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Section: Introductionsupporting

confidence: 68%

EQUIP emergency: can interventions to reduce racism, discrimination and stigma in EDs improve outcomes?

Varcoe

Browne

Perrin

et al. 2022

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Each of the PHC clinics identi ed that those they served often faced poor treatment when accessing care at local EDs. These ndings aligned with historical and ongoing evidence of inequitable treatment in EDs for Indigenous people (4,7,33,34), people experiencing violence (35,36), and those presenting with histories of mental illness (37), substance use and/or homelessness (38,39).…”

Section: Introductionsupporting

confidence: 66%

“…Research to date has not studied equity-oriented interventions in Emergency settings. However, the consequences of inequitable treatment of Indigenous people in EDs have been described (4,7,33,34,40), as have efforts to integrate cultural safety in EDs (41). Building on such research, and the lessons learned in our primary health care research, we modi ed the intervention, tailored it to and tested it in EDs (42).…”

Section: Introductionmentioning

confidence: 99%

EQUIP Emergency: Can interventions to reduce racism, discrimination and stigma in EDs improve outcomes?

Varcoe

Browne

Perrin

et al. 2022

Preprint

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BackgroundDespite a publicly funded system, health care in Canada has been shown to be deeply inequitable, particularly toward Indigenous people. Based on research identifying key dimensions of equity-oriented health care as being cultural safety, harm reduction and trauma- and violence-informed care, an intervention to promote equity at the organizational level was tested in primary health care, refined and adapted, and tested in Emergency Departments (EDs).MethodsIn partnership with clinical, community and Indigenous leaders in three diverse EDs in one Canadian province, we supported direct care staff to tailor and implement the intervention. Intervention activities varied in type and intensity at each site. Survey data were collected pre- and post-intervention from every consecutive patient over age 18 presenting to the EDs (n= 4771) with 3315 completing post-visit questions in 4 waves at two sites and 3 waves (due to pandemic constraints) at the third. Administrative data were collected for 12 months pre- and 12 months post-intervention.ResultsThroughout the study period, the participating EDs were dealing with a worsening epidemic of overdoses and deaths related to a toxic drug supply, and the COVID 19 pandemic curtailed both intervention activities and data collection. Despite these constraints, staff at two of the EDs mounted equity-oriented intervention strategies; the other site was experiencing continued, significant staff shortages and leadership changeover. Longitudinal analysis using multiple regression showed non-significant but encouraging trends in patient perceptions of quality of care and patient experiences of discrimination in the ED. Subgroup analysis showed that specific groups of patients experienced care in significantly different ways at each site. An interrupted time series of administrative data showed no significant change in staff sick time, but showed a significant decrease in the percentage of patients who left without care being completed at the site with the most robust intervention activities. ConclusionsThe trends in patient perceptions and the significant decrease in the percentage of patients who left without care being completed suggest potential for impact. Realization of this potential will depend on readiness, commitment and resources at the organizational and systems levels.Trial registrationClinical Trials.gov #NCT03369678 (registration date 12/12/2017.).

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“…An article studying visits to the emergency department by Indigenous patients in 2004-2005 arrived to the same conclusion but also found that Indigenous patients were more likely to leave the emergency department before being seen by a health care practitioner [134]. A study with the same aim has recently been published in Canada and the results are very similar to those found in Australia [135]. Another study published in Australia about intensive care unit admissions also obtained similar results.…”

Section: Discussionmentioning

confidence: 61%

Acute health care among Indigenous patients in Canada: a scoping review

Vigneault

Diendéré

Sohier-Poirier

et al. 2021

International Journal of Circumpolar Health

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A recent report by the Chief Public Health Officer of Canada demonstrates the inferior health status of Indigenous Peoples in Canada when compared to non-Indigenous populations. This scoping review maps out the available literature concerning acute health care for Indigenous Peoples in Canada in order to better understand the health care issues they face. All existing articles concerning health care provided to Indigenous Peoples in Canada in acute settings were included in this review. The targeted studied outcomes were access to care, health care satisfaction, hospital visit rates, mortality, quality of care, length of stay and cost per hospitalisation. 114 articles were identified. The most studied outcomes were hospitalisation rates (58.8%), length of stay (28.0%), mortality (25.4%) and quality of care (24.6%) Frequently studied topics included pulmonary disease, injuries, cardiovascular disease and mental illness. Indigenous Peoples presented lower levels of satisfaction and access to care although they tend to be over-represented in hospitalisation rates for acute care. Greater inclusion of Indigenous Peoples in the health care system and in the training of health care providers is necessary to ensure a better quality of care that is culturally safe for Indigenous Peoples.

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First Nations emergency care in Alberta: descriptive results of a retrospective cohort study

Cited by 21 publications

References 40 publications

EQUIP emergency: can interventions to reduce racism, discrimination and stigma in EDs improve outcomes?

EQUIP emergency: can interventions to reduce racism, discrimination and stigma in EDs improve outcomes?

EQUIP Emergency: Can interventions to reduce racism, discrimination and stigma in EDs improve outcomes?

Acute health care among Indigenous patients in Canada: a scoping review

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