scholarly journals Homeless Patients Associate Clinician Bias With Suboptimal Care for Mental Illness, Addictions, and Chronic Pain

2020 ◽  
Vol 11 ◽  
pp. 215013272091028
Author(s):  
Cyndi Gilmer ◽  
Kristy Buccieri
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Chronic Pain ◽  
Mental Illness ◽  
Care Provider ◽  
Primary Care Provider ◽  
Quality Care ◽  
Emergency Department Visits ◽  
Clinician Bias ◽  
Housing Status

Objective: To determine how accessible health care services are for people who are experiencing homelessness and to understand from their perspectives what impact clinician bias has on the treatment they receive. Methods: Narrative interviews were conducted with 53 homeless/vulnerably housed individuals in Ontario, Canada. Visit history records were subsequently reviewed at 2 local hospitals, for 52 of the interview participants. Results: Of the 53 participants only 28% had a primary care provider in town, an additional 40% had a provider in another town, and 32% had no access to a primary care provider at all. A subset of the individuals were frequent emergency department users, with 15% accounting for 75% of the identified hospital visits, primarily seeking treatment for mental illness, pain, and addictions. When seeking primary care for these 3 issues participants felt medication was overprescribed. Conversely, in emergency care settings participants felt prejudged by clinicians as being drug-seekers. Participants believed they received poor quality care or were denied care for mental illness, chronic pain, and addictions when clinicians were aware of their housing status. Conclusion: Mental illness, chronic pain, and addictions issues were believed by participants to be poorly treated due to clinician bias at the primary, emergency, and acute care levels. Increased access to primary care in the community could better serve this marginalized population and decrease emergency department visits but must be implemented in a way that respects the rights and dignity of this patient population.

scholarly journals EMERGENCY DEPARTMENT VISITS BY CHILD REFUGEE CLAIMANTS AT A PEDIATRIC TERTIARY CARE CENTER

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e7-e7 ◽  
Author(s):  
Andrea Evans ◽  
Savithiri Ratnapalan
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Care Provider ◽  
Primary Care Provider ◽  
Tertiary Care ◽  
Emergency Department Visits ◽  
Refugee Children ◽  
Care Hospital ◽  
Clinical Presentations ◽  
Refugee Claimants

Abstract BACKGROUND The Canadian government has announced the resettlement of 50 000 refugees from the Middle East by 2018. The proportion of refugees that are below 18 years of age have increased from 20% to almost 40% from 2005 to 2014 and is expected to increase further with new refugee influxes. Barriers to timely health care can worsen clinical presentations and outcomes, especially in vulnerable children such as refugees. This study aims to provide an overview of the epidemiology, clinical presentations, hospital stay metrics, and non-clinical support needs for child refugee claimants presenting to the emergency department at a large tertiary care hospital in Canada. OBJECTIVES To describe the emergency department visits by refugee claimants with IFH, including demographics, primary care access, immunization status, acuity of presentation, repeat visits, and admission rates. DESIGN/METHODS A retrospective chart review of all refugee children presenting to the emergency department at this tertiary care hospital from April 1 2014 to March 31st 2017. A case was defined as a child who presented to the hospital with Interim Federal Health (IFH) which is the federal health insurance program covers newly arrived refugee claimants in Canada. Descriptive statistics and chi square test for categorical data was used. Data was analyzed using SPSS v21 IBM 2012. Ethics was approved by the Ethics Review Board of the hospital. RESULTS In total, there were 646 visits to the emergency department by 388 patients with IFH. The average age was 6.4 years (IQR 2.9–9.3), of which 58% were females. Travel history was documented in 65% of cases. The majority of patients arrived from Southeast Asia and the Middle East. The average time spent in Canada was 217 days (IQR 78–205). Sixty percent of patients did not have an identified primary care provider. Those with an identified primary care provider had more non-acute (CTAS 4–5) visits than those without an identified primary care provider (p<0.05). Immunizations were not up-to-date per Canadian standard in 25% of those who had an immunization history documented. Translation services was used in 11% of visits. Admission rate was 12%, with average length of stay 3.4 days (std 4). Top three reasons for admission were febrile neutropenia, respiratory distress, and blood per rectum. One fifth (20%) of admissions occurred on the same day as the arrival of the patient to Canada. CONCLUSION A significant number of refugee children are needing emergency care and admission to hospital on the day they arrive to Canada. Most child refugees presenting to the emergency department did not have an identified primary care provider, and a quarter did not have up-to-date immunizations. Association with primary care provider suggests that linkage to primary care in this population should be a priority.

scholarly journals Community Primary Care Provider Preferences for Emergency Department Follow-up Recommendations

2017 ◽  
Vol 33 (10) ◽  
pp. 690-693
Author(s):  
Marissa A. Hendrickson ◽  
Eta Obeya ◽  
Andrew R. Wey ◽  
Philippe R. Gaillard
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Care Provider ◽  
Primary Care Provider

Reach Out Behavioral Intervention for Hypertension Initiated in the Emergency Department Connecting Multiple Health Systems: Study Protocol for a Randomized Control Trial

2020 ◽  
Author(s):  
William Meurer ◽  
Mackenzie Dinh ◽  
Kelley Kidwell ◽  
Adam Flood ◽  
Emily Champoux ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Emergency Department ◽  
Care Provider ◽  
Primary Care Provider ◽  
Chronic Disease Management ◽  
Emergency Department Patient ◽  
Safety Net ◽  
Health Records ◽  
Electronic Health

Abstract Background: Hypertension is the most important modifiable risk factor for cardiovascular disease, the leading cause of mortality in the United States. The Emergency Department represents an underutilized opportunity to impact difficult-to-reach populations. There are 136 million visits to the Emergency Department each year and nearly all have at least one blood pressure measured and recorded. Additionally, an increasing number of African Americans and socioeconomically disadvantaged patients are overrepresented in the Emergency Department patient population. In the age of electronic health records and mobile health, the Emergency Department has the potential to become an integral partner in chronic disease management. The electronic health records in conjunction with mobile health behavior interventions can be leveraged to identify hypertensive patients to impact otherwise unreached populations. Methods: Reach Out is a factorial trial studying multicomponent, behavioral interventions to reduce blood pressure in the Emergency Department patient population. Potential participants are identified by automated alerts from the electronic health record and, following consent, receive a blood pressure cuff to take home. During the initial screening phase, they are prompted to submit weekly blood pressure readings. Responders with persistent hypertension are then randomized into one of three component arms, consisting of varying intensity levels: (1) healthy behavior text messaging (daily vs. none), (2) blood pressure self-monitoring (daily vs. weekly), and (3) facilitated primary care provider appointment scheduling and transportation (yes vs. no). If participants are randomized to receive facilitated primary care provider appointment scheduling and are not established with a primary care provider, care will be established at a local Federally Qualified Health Center. Participants are followed for twelve-months. Discussion: The Reach Out study is designed to determine which behavioral intervention components or ‘dose’ of components contributes to a reduction in systolic blood pressure after one year (Aim 1). The study will also assess the effect of primary care provider appointment assistance on total primary care follow-up visits of hypertensive patients treated in an urban, safety net Emergency Department (Aim 2). Ideally, the Reach Out system will contribute to hypertension management, serving as a model for safety net hospitals and Federally Qualified Health Centers to improve chronic disease management in underserved communities. Trial Registration: This study was registered at clinicaltrials.gov, identifier NCT03422718. The record was first available to the public on 01/30/2018 prior to the enrollment of patients on 03/25/2019. KEYWORDS Hypertension, Emergency Medicine, Randomized Clinical Trial, Multiphase Optimization Strategy

scholarly journals Exploring the Experiences of Transgender and Gender Diverse Adults in Accessing a Trans Knowledgeable Primary Care Physician

2021 ◽  
Vol 18 (24) ◽  
pp. 13057
Author(s):  
Shanna K. Kattari ◽  
Jarrod Call ◽  
Brendon T. Holloway ◽  
Leonardo Kattari ◽  
Kristie L. Seelman
Keyword(s):  
Primary Care ◽  
Care Provider ◽  
Primary Care Provider ◽  
Insurance Coverage ◽  
Healthcare Providers ◽  
Care Physician ◽  
Housing Status ◽  
Gender Diverse ◽  
Disability Status ◽  
And Gender

Transgender and gender diverse individuals face a variety of barriers when attempting to access healthcare, from discrimination to lack of access to lack of knowledgeable providers. Using data from the 2015 United States Trans Survey (N = 27,715), this study looks at the differences within the TGD population regarding having seen a doctor in the past year, having a primary care provider, and having a primary care provider who is knowledgeable about trans health. Logistic regressions indicate that even within an all transgender and gender diverse sample, a variety of identities and experiences are related to increased or decreased likelihood of each of these outcomes, with significant differences across gender, race/ethnicity, age, sexual orientation, disability status, educational attainment, annual income, disability status, religiosity, military status, overall health, housing status, and insurance coverage. Not only should there be an effort to support transgender and gender diverse individuals in accessing care, but there is a clearly indicated need for additional education for healthcare providers, especially those doing primary care, on how to offer knowledgeable, affirming, and intersectional care to their patients.

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