在阿尔伯塔省的第一民族和非第一民族患者中,离开急诊室未完成治疗:一项混合方法研究
Patrick McLane1, Lea Bill2, Bonnie Healy2
1Alberta 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. mclane@ualberta.ca.
原住民患者离开急诊室的可能性几乎是医生没有看过或违背医疗建议的两倍. 在控制其他因素后,这种差异仍然存在,突出了土著人民紧急护理获取的系统性问题.
科学领域:
- 土著健康土著健康
- 医疗保健服务研究 医疗服务研究
- 紧急医疗 紧急医疗
背景情况:
- 以前的研究表明,在加拿大阿尔伯塔省的第一民族患者中,患者离开急诊室而不见或违背医疗建议的比例较高.
- 这些离开与非第一民族患者的访问进行了比较.
研究的目的:
- 为了确定是否在人口统计和访问特征考虑后,对第一民族患者的急诊诊所访问结果存在差异.
- 探索导致第一民族患者过早离开护理的根本原因.
主要方法:
- 采用混合方法方法,将基于人口的回顾性队列研究 (2012年4月至2017年3月) 与定性数据相结合.
- 多变量后勤回归模型对人口统计学,访问特征和设施类型进行控制.
- 通过分享圈子,重点小组和与患者和医疗保健提供者的采访,收集了定性数据.
主要成果:
- 这项研究分析了11,686,287次紧急诊所访问,其中1,099,424 (9.4%) 是第一民族患者.
- 原住民患者在没有被看过或违背医疗建议的情况下离开的可能性显著增加 (OR 1.96).
- 定性调查发现,种族主义,刻板印象,沟通障碍,交通问题和长时间等待是出境的主要原因.
结论:
- 与非第一民族患者相比,第一民族患者的离急诊室提前离开率明显高.
- 这些差异并非由人口统计或特定访问因素来解释.
- 医疗保健提供者和部门必须与原住民社区合作,实施旨在改善患者保留和护理连续性的战略.
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