EQUIP emergency: can interventions to reduce racism, discrimination and stigma in EDs improve outcomes?
Abstract 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-in...
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| Format: | Article |
| Language: | English |
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BMC
2022-09-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-022-08475-4 |
| _version_ | 1828114402319007744 |
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| author | Colleen Varcoe Annette J. Browne Nancy Perrin Erin Wilson Vicky Bungay David Byres Nadine Wathen Cheyanne Stones Catherine Liao Elder Roberta Price |
| author_facet | Colleen Varcoe Annette J. Browne Nancy Perrin Erin Wilson Vicky Bungay David Byres Nadine Wathen Cheyanne Stones Catherine Liao Elder Roberta Price |
| author_sort | Colleen Varcoe |
| collection | DOAJ |
| description | Abstract 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). |
| first_indexed | 2024-04-11T12:23:58Z |
| format | Article |
| id | doaj.art-ab58413bb74045a8af1b720694e5cba6 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-11T12:23:58Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-ab58413bb74045a8af1b720694e5cba62022-12-22T04:24:00ZengBMCBMC Health Services Research1472-69632022-09-0122111410.1186/s12913-022-08475-4EQUIP emergency: can interventions to reduce racism, discrimination and stigma in EDs improve outcomes?Colleen Varcoe0Annette J. Browne1Nancy Perrin2Erin Wilson3Vicky Bungay4David Byres5Nadine Wathen6Cheyanne Stones7Catherine Liao8Elder Roberta Price9Critical Research in Health and Healthcare Inequities Research Unit, School of Nursing, The University of British ColumbiaCritical Research in Health and Healthcare Inequities Research Unit, School of Nursing, The University of British ColumbiaJohns Hopkins University School of NursingSchool of Nursing, University of Northern British ColumbiaCritical Research in Health and Healthcare Inequities Research Unit, School of Nursing, The University of British ColumbiaProvincial Health Services AuthorityArthur Labatt Family School of Nursing, Western UniversityCritical Research in Health and Healthcare Inequities Research Unit, School of Nursing, The University of British ColumbiaCritical Research in Health and Healthcare Inequities Research Unit, School of Nursing, The University of British ColumbiaCritical Research in Health and Healthcare Inequities Research Unit, School of Nursing, The University of British ColumbiaAbstract 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).https://doi.org/10.1186/s12913-022-08475-4Health inequityHealth disparitiesStigmaDiscriminationRacismEmergency |
| spellingShingle | Colleen Varcoe Annette J. Browne Nancy Perrin Erin Wilson Vicky Bungay David Byres Nadine Wathen Cheyanne Stones Catherine Liao Elder Roberta Price EQUIP emergency: can interventions to reduce racism, discrimination and stigma in EDs improve outcomes? BMC Health Services Research Health inequity Health disparities Stigma Discrimination Racism Emergency |
| title | EQUIP emergency: can interventions to reduce racism, discrimination and stigma in EDs improve outcomes? |
| title_full | EQUIP emergency: can interventions to reduce racism, discrimination and stigma in EDs improve outcomes? |
| title_fullStr | EQUIP emergency: can interventions to reduce racism, discrimination and stigma in EDs improve outcomes? |
| title_full_unstemmed | EQUIP emergency: can interventions to reduce racism, discrimination and stigma in EDs improve outcomes? |
| title_short | EQUIP emergency: can interventions to reduce racism, discrimination and stigma in EDs improve outcomes? |
| title_sort | equip emergency can interventions to reduce racism discrimination and stigma in eds improve outcomes |
| topic | Health inequity Health disparities Stigma Discrimination Racism Emergency |
| url | https://doi.org/10.1186/s12913-022-08475-4 |
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