Bruyère Research Institute, Ottawa, Ontario, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Int J Equity Health. 2023 May 19;22(1):97. doi: 10.1186/s12939-023-01900-y.
High rates of emergency department (ED) use by older adults persist despite attempts to improve accessibility of appropriate and comprehensive care. Understanding the drivers of ED visits from the perspective of older adults from historically marginalized groups could help reduce ED use by patients with needs that are preventable or could have been treated in a more appropriate setting. This interpretivist, feminist study aims to explore the unmet care needs of older adults (age 65 +) with high ED use and belonging to historically marginalized groups to better understand how social and structural inequities reinforced by neoliberalism; federal and provincial governance structures and policy frameworks; and regional processes and local institutional practices, shape the experiences of these older adults, particularly those at risk of poor health outcomes based on the social determinants of health (SDH).
METHODS/DESIGN: This mixed methods study will employ an integrated knowledge translation (iKT) approach, starting with a quantitative phase followed by a qualitative phase. Older adults self-identifying as belonging to a historically marginalized group, having visited an ED three or more times in the past 12 months, and living in a private dwelling, will be recruited using flyers posted at two emergency care sites and by an on-site research assistant. Data obtained through surveys, short answer questions, and chart review will be used to compile case profiles of patients from historically marginalized groups with potentially avoidable ED visits. Descriptive and inferential statistical analyses and inductive thematic analysis will be conducted. Findings will be interpreted using the Intersectionality-Based Policy Analysis Framework to identify the interconnections between unmet care needs, potentially avoidable ED admissions, structural inequalities, and the SDH. Semi-structured interviews will be conducted with a subset of older adults at risk of poor health outcomes based on SDH, family care partners, and health care professionals to validate preliminary findings and collect additional data on perceived facilitators and barriers to integrated and accessible care.
Exploring the linkages between potentially avoidable ED visits by older adults from marginalized groups and how their care experiences have been shaped by inequities in the systems, policies, and institutions that structure health and social care provision will enable researchers to offer recommendations for equity-focused policy and clinical practice reforms to improve patient outcomes and system integration.
尽管为改善适当和全面医疗服务的可及性做出了诸多努力，老年人仍大量前往急诊部（ED）就诊。从历史上处于边缘地位的老年人的角度出发，了解 ED 就诊的驱动因素，有助于减少因可预防或本可在更合适的环境中治疗的需求而前往 ED 的患者的就诊次数。这项解释主义、女性主义研究旨在探索高 ED 使用量的老年（年龄≥65 岁）患者的未满足护理需求，他们属于历史上处于边缘地位的群体，以便更好地了解新自由主义、联邦和省级治理结构和政策框架以及区域进程和当地机构实践所强化的社会和结构性不平等如何影响这些老年人的就诊经历，尤其是那些因健康决定因素（SDH）而处于不良健康结果风险中的老年人。
方法/设计：这项混合方法研究将采用综合知识转化（iKT）方法，首先进行定量阶段，然后进行定性阶段。将通过在两个急诊护理点张贴传单和由现场研究助理进行现场招聘，招募自我认定属于历史上处于边缘地位的群体、在过去 12 个月内去过 ED 三次或以上且居住在私人住宅中的老年人。通过调查、简短回答问题和图表审查获得的数据将用于编制来自历史上处于边缘地位的群体、可能存在可避免的 ED 就诊的患者的案例资料。将进行描述性和推断性统计分析以及归纳主题分析。将使用基于交叉性的政策分析框架来解释研究结果，以确定未满足的护理需求、潜在可避免的 ED 入院、结构性不平等和 SDH 之间的相互关系。将对基于 SDH 的健康结果较差风险的老年人、家庭护理伙伴和医疗保健专业人员进行半结构化访谈，以验证初步结果并收集有关综合和可及性护理的感知障碍和促进因素的额外数据。
探索边缘化群体的老年人因潜在可避免的 ED 就诊而就诊的情况，以及他们的护理体验如何受到卫生和社会保健服务提供系统、政策和机构中不平等现象的影响，将使研究人员能够提出以公平为重点的政策和临床实践改革建议，以改善患者结局和系统整合。
