Department of General Practice and Rural Health, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand.
Department of Preventive and Social Medicine, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand.
Int J Equity Health. 2021 May 11;20(1):119. doi: 10.1186/s12939-021-01461-y.
Despite an overt commitment to equity, health inequities are evident throughout Aotearoa New Zealand. A general practice electronic alert system was developed to notify clinicians about their patient's risk of harm due to their pre-existing medical conditions or current medication. We aimed to determine whether there were any disparities in clinician action taken on the alert based on patient ethnicity or other demographic factors.
Sixty-six New Zealand general practices from throughout New Zealand participated. Data were available for 1611 alerts detected for 1582 patients between 1 and 2018 and 1 July 2019. The primary outcome was whether action was taken following an alert or not. Logistic regression was used to assess if patients of one ethnicity group were more or less likely to have action taken. Potential confounders considered in the analyses include patient age, gender, ethnicity, socio-economic deprivation, number of long term diagnoses and number of long term medications.
No evidence of a difference was found in the odds of having action taken amongst ethnicity groups, however the estimated odds for Māori and Pasifika patients were lower compared to the European group (Māori OR 0.88, 95 %CI 0.63-1.22; Pasifika OR 0.88, 95 %CI 0.52-1.49). Females had significantly lower odds of having action taken compared to males (OR 0.76, 95 %CI 0.59-0.96).
This analysis of data arising from a general practice electronic alert system in New Zealand found clinicians typically took action on those alerts. However, clinicians appear to take less action for women and Māori and Pasifika patients. Use of a targeted alert system has the potential to mitigate risk from medication-related harm. Recognising clinician biases may improve the equitability of health care provision.
尽管新西兰公开承诺公平，但健康不平等现象在全国各地都很明显。开发了一个全科医生电子警报系统，以通知临床医生其患者因现有医疗条件或当前用药而面临伤害的风险。我们旨在确定基于患者的种族或其他人口统计学因素，临床医生对警报采取的行动是否存在差异。
新西兰各地的 66 家普通实践参与了研究。19 年 7 月 1 日至 2018 年 1 月期间，为 1582 名患者的 1611 次警报检测到数据。主要结果是是否根据警报采取了行动。使用逻辑回归来评估一个种族群体的患者是否更有可能或不太可能采取行动。在分析中考虑了潜在的混杂因素，包括患者年龄、性别、种族、社会经济贫困程度、长期诊断数量和长期用药数量。
在种族群体中，采取行动的可能性没有发现差异的证据，但是毛利人和太平洋岛民患者的估计几率低于欧洲群体（毛利人 OR 0.88，95%CI 0.63-1.22；太平洋岛民 OR 0.88，95%CI 0.52-1.49）。与男性相比，女性采取行动的可能性显著降低（OR 0.76，95%CI 0.59-0.96）。
对新西兰普通实践电子警报系统产生的数据进行的分析发现，临床医生通常会对这些警报采取行动。然而，临床医生似乎对女性、毛利人和太平洋岛民患者的行动较少。使用有针对性的警报系统有可能减轻药物相关伤害的风险。认识到临床医生的偏见可能会提高医疗保健提供的公平性。
