Newport Rochelle, Grey Corina, Dicker Bridget, Ameratunga Shanthi, Harwood Matire
Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Section of Epidemiology & Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.
JMIR Res Protoc. 2023 Jul 12;12:e40557. doi: 10.2196/40557.
Substantial inequities in cardiovascular disease occur between and within countries, driving much of the current burden of global health inequities. Despite well-established treatment protocols and clinical interventions, the extent to which the prehospital care pathway for people who have experienced an out-of-hospital cardiac event (OHCE) varies by ethnicity and race is inconsistently documented. Timely access to care in this context is important for good outcomes. Therefore, identifying any barriers and enablers that influence timely prehospital care can inform equity-focused interventions.
This systematic review aims to answer the question: Among adults who experience an OHCE, to what extent and why might the care pathways in the community and outcomes differ for minoritized ethnic populations compared to nonminoritized populations? In addition, we will investigate the barriers and enablers that could influence variations in the access to care for minoritized ethnic populations.
This review will use Kaupapa Māori theory to underpin the process and analysis, thus prioritizing Indigenous knowledge and experiences. A comprehensive search of the CINAHL, Embase, MEDLINE (OVID), PubMed, Scopus, Google Scholar, and Cochrane Library databases will be done using Medical Subject Headings terms themed to the 3 domains of context, health condition, and setting. All identified articles will be managed using an Endnote library. To be included in the research, papers must be published in English; have adult study populations; have an acute, nontraumatic cardiac condition as the primary health condition of interest; and be in the prehospital setting. Studies must also include comparisons by ethnicity or race to be eligible. Those studies considered suitable for inclusion will be critically appraised by multiple authors using the Mixed Methods Appraisal Tool and CONSIDER (Consolidated Criteria for Strengthening the Reporting of Health Research Involving Indigenous Peoples) framework. Risk of bias will be assessed using the Graphic Appraisal Tool for Epidemiology. Disagreements on inclusion or exclusion will be settled by a discussion with all reviewers. Data extraction will be done independently by 2 authors and collated in a Microsoft Excel spreadsheet. The outcomes of interest will include (1) symptom recognition, (2) patient decision-making, (3) health care professional decision-making, (4) the provision of cardiopulmonary resuscitation, (5) access to automated external defibrillator, and (6) witnessed status. Data will be extracted and categorized under key domains. A narrative review of these domains will be conducted using Indigenous data sovereignty approaches as a guide. Findings will be reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines.
Our research is in progress. We anticipate the systematic review will be completed and submitted for publication in October 2023.
The review findings will inform researchers and health care professionals on the experience of minoritized populations when accessing the OHCE care pathway.
PROSPERO CRD42022279082; https://tinyurl.com/bdf6s4h2.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40557.
心血管疾病在不同国家之间以及国家内部存在显著的不平等现象，这也是当前全球健康不平等负担的主要原因之一。尽管已经有完善的治疗方案和临床干预措施，但院外心脏事件（OHCE）患者的院前护理途径因种族和民族而异的程度，相关记录并不一致。在这种情况下，及时获得护理对于取得良好治疗效果至关重要。因此，识别影响及时院前护理的任何障碍和促进因素，可以为以公平为重点的干预措施提供依据。
本系统评价旨在回答以下问题：在经历OHCE的成年人中，与非少数族裔人群相比，少数族裔人群在社区中的护理途径和治疗结果在何种程度上存在差异，原因是什么？此外，我们将调查可能影响少数族裔人群获得护理差异的障碍和促进因素。
本评价将采用毛利人健康理论（Kaupapa Māori theory）来支撑整个过程和分析，从而优先考虑本土知识和经验。将使用与背景、健康状况和环境这三个领域相关的医学主题词，全面检索CINAHL、Embase、MEDLINE（OVID）、PubMed、Scopus、谷歌学术和Cochrane图书馆数据库。所有识别出的文章将使用Endnote库进行管理。要纳入本研究，论文必须以英文发表；研究对象为成年人；主要关注的健康状况为急性、非创伤性心脏疾病；且研究场景为院前。研究还必须包括按种族或民族进行的比较，才有资格入选。那些被认为适合纳入的研究将由多位作者使用混合方法评价工具和CONSIDER（加强涉及原住民的健康研究报告的综合标准）框架进行严格评价。将使用流行病学图形评价工具评估偏倚风险。关于纳入或排除的分歧将通过与所有评审人员讨论来解决。数据提取将由两位作者独立完成，并整理到Microsoft Excel电子表格中。感兴趣的结果将包括：（1）症状识别；（2）患者决策；（3）医护人员决策；（4）心肺复苏的实施；（5）自动体外除颤器的使用；（6）是否有人目睹。数据将在关键领域下进行提取和分类。将以本土数据主权方法为指导，对这些领域进行叙述性综述。研究结果将根据PRISMA（系统评价和Meta分析的首选报告项目）2020指南进行报告。
我们的研究正在进行中。预计系统评价将于2023年10月完成并提交发表。
该评价结果将为研究人员和医护人员提供有关少数族裔人群在获得OHCE护理途径方面的经验信息。
PROSPERO CRD42022279082；https://tinyurl.com/bdf6s4h2。
国际注册报告识别码（IRRID）：PRR1-10.2196/40557。
