Through An Equity Lens: Illuminating The Relationships Among Social Inequities, Stigma And Discrimination, And Patient Experiences of Emergency Health Care

Abstract

People who experience the greatest social inequities often have poor experiences in emergency departments (EDs) so that they are deterred from seeking care, leave without care complete, receive inadequate care, and/or return repeatedly for unresolved problems. However, efforts to measure and monitor experiences of care rarely capture the experiences of people facing the greatest inequities, experiences of discrimination, or relationships among these variables. This analysis examined how patients’ experiences, including self-reported ratings of care, experiences of discrimination, and repeat visits vary with social and economic circumstances. Every consecutive person presenting to three diverse EDs was invited if/when they were able to consent; 2424 provided demographic and contact information; and 1692 (70%) completed the survey. Latent class analysis (LCA) using sociodemographic variables: age, gender, financial strain, employment, housing stability, English as first language, born in Canada, and Indigenous identity, indicated a six-class solution. Classes differed significantly on having regular access to primary care, reasons for the visit, and acuity. Classes also differed on self-reported discrimination every day and during their ED visit, ratings of ED care, and number of ED visits within the past six months. ED care can be improved through attention to how intersecting forms of structural disadvantage and inequities affect patient experiences.

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

“…This study offers concrete direction for organizations to improve care and outcomes for people who are least well served in EDs, including, but not limited to, Indigenous people. An intersectional analysis of pre-intervention baseline data from this study, published elsewhere [43], showed some of the complex social circumstances associated with perceptions of poor care and discrimination in EDs. Specifically, those reporting the lowest perceptions of care were those most severely socially and economically disadvantaged, including a high proportion of Indigenous people.…”

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

“…Similar to the ndings by Chiu et al (62), which compared the BCEDPEC sample to a sample collected in-person, our sample was more diverse in terms of having greater representation from Indigenous people and those less likely to have a primary care home. Additionally, as reported elsewhere (43), our pre-intervention sample was more diverse, particularly on demographic variables indicating structural disadvantage, than samples collected routinely by mail out surveys. Across all waves, comparisons between those consenting and enrolling, and those completing showed that those who completed were less likely to identify as Indigenous, have precarious housing, or have accessed a shelter in the past 6 months, signaling a less disadvantaged nal sample than those presenting to the EDs.…”

“…Across all waves, comparisons between those consenting and enrolling, and those completing showed that those who completed were less likely to identify as Indigenous, have precarious housing, or have accessed a shelter in the past 6 months, signaling a less disadvantaged nal sample than those presenting to the EDs. They were also more likely to be over age 65; given that our prior analysis (43) showed intersections among being over 65, low nancial strain and stable housing, this may also signal that those completing the full survey experienced less structural disadvantage than the overall population presenting for care.…”

“…This study offers concrete direction for organizations to improve care and outcomes for people who are least well served in EDs, including, but not limited to, Indigenous people. An intersectional analysis of pre-intervention baseline data from this study, published elsewhere (43), showed some of the complex social circumstances associated with perceptions of poor care and discrimination in EDs. Speci cally, those reporting the lowest perceptions of care were those most severely socially and economically disadvantaged, including a high proportion of Indigenous people.…”

Toward equity-oriented cancer care: a Strategy for Patient-Oriented Research (SPOR) protocol to promote equitable access to lung cancer screening

“…This was achieved by enhancing patients’ comfort and confidence in their care and their own confidence in preventing and managing health problems [ 33 ]. Interventions to improve the delivery of EOHC based on this understanding are currently undergoing evaluation in emergency department settings [ 34 , 35 ]. As a person-led and -centred approach that encourages providers to actively listen and build on a person’s strengths, needs and agency to determine best next steps in care [ 36 ], these approaches have shown promise as a way to shift individual practice, and organizational policies, towards safer and more equitable care [ 37 , 38 ].…”