Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee.
J Emerg Med. 2023 Apr;64(4):481-487. doi: 10.1016/j.jemermed.2023.02.015. Epub 2023 Mar 21.
Substance use-related morbidity and mortality rates are at an all-time high in the United States, yet there remains significant stigma and discrimination in emergency medicine about patients with this condition.
The purpose of this study was to determine whether there are racial and ethnic differences in emergency department (ED) wait times among patients with substance use disorder.
The study uses pooled data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2016 to 2018. The dependent variable is length of time the patient with a diagnosis of substance use disorder waited in the ED before being admitted for care. The independent variable is patient race and ethnicity. Adjusted analyses were conducted using a generalized linear model.
There were a total of 3995 reported ED events among patients reporting a substance use disorder in the NHAMCS sample between 2016 and 2018. After adjusting for covariates, Black patients with substance use disorder were significantly more likely to wait longer in the ED (35% longer) than White patients with substance use disorder (p < 0.01).
The findings showed that Black patients with substance use disorder are waiting 35% longer, on average, than White patients with the same condition. This is concerning, given that emergency medicine is a critical frontline of care, and often the only source of care, for these patients. Furthermore, longer wait times can increase the likelihood of leaving the ED without being seen. Programs and policies should address potential stigma and discrimination among providers, and EDs should consider adding people with lived experiences to the staff to serve as peer recovery specialists and bridge the gap for care.
在美国，与物质使用相关的发病率和死亡率达到历史最高水平，但在急诊医学中，患者仍然存在着严重的污名化和歧视。
本研究旨在确定在患有物质使用障碍的患者中，急诊部（ED）等待时间是否存在种族和民族差异。
本研究使用了 2016 年至 2018 年国家医院门诊医疗调查（NHAMCS）的汇总数据。因变量是被诊断为物质使用障碍的患者在接受护理前在 ED 等待的时间长度。自变量是患者的种族和民族。使用广义线性模型进行了调整分析。
在 2016 年至 2018 年期间，NHAMCS 样本中报告有物质使用障碍的患者共有 3995 例报告 ED 事件。在调整了协变量后，患有物质使用障碍的黑人患者比患有物质使用障碍的白人患者在 ED 中等待的时间明显更长（长 35%）（p<0.01）。
研究结果表明，患有物质使用障碍的黑人患者平均比患有相同疾病的白人患者多等待 35%。这令人担忧，因为急诊医学是这些患者的关键一线治疗，而且通常是唯一的治疗来源。此外，较长的等待时间会增加患者在未接受治疗的情况下离开 ED 的可能性。应针对提供者之间潜在的污名化和歧视问题制定方案和政策，ED 应考虑在员工中增加有经验的人，以担任同伴康复专家，并为护理提供帮助。
