MacLean Davis, Curtin Kimberley D, Barnabe Cheryl, Bill Lea, Healy Bonnie, Holroyd Brian R, Khangura Jaspreet K, McLane Patrick
Department of Medicine, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada.
Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
Acad Emerg Med. 2025 Jan;32(1):6-19. doi: 10.1111/acem.14987. Epub 2024 Jul 25.
Disparities in health outcomes, including increased chronic disease prevalence and decreased life expectancy for Indigenous people, have been shown across settings affected by white settler colonialism including Canada, the United States, Australia, and New Zealand. Emergency departments (EDs) represent a unique setting in which urgent patient need and provider strain interact to amplify inequities within society. The aim of this scoping review was to map the ED-based interventions aimed at improving equity in care for Indigenous patients in EDs.
This scoping review was conducted using the procedures outlined by Arksey and O'Malley and guidance on conducting scoping reviews from the Joanna Briggs Institute. A systematic search of MEDLINE, CINAHL, SCOPUS, and EMBASE was conducted.
A total of 3636 articles were screened by title and abstract, of which 32 were screened in full-text review and nine articles describing seven interventions were included in this review. Three intervention approaches were identified: the introduction of novel clinical roles, implementation of chronic disease screening programs in EDs, and systems/organizational-level interventions.
Relatively few interventions for improving equity in care were identified. We found that a minority of interventions are aimed at creating organizational-level change and suggest that future interventions could benefit from targeting system-level changes as opposed to or in addition to incorporating new roles in EDs.
在包括加拿大、美国、澳大利亚和新西兰等受白人定居者殖民主义影响的地区，健康结果方面存在差异，包括原住民慢性病患病率上升和预期寿命下降。急诊科是一个独特的场所，紧急的患者需求和医护人员的压力相互作用，加剧了社会内部的不平等。本范围综述的目的是梳理旨在改善急诊科原住民患者护理公平性的基于急诊科的干预措施。
本范围综述采用阿克西和奥马利概述的程序以及乔安娜·布里格斯研究所关于进行范围综述的指南进行。对MEDLINE、CINAHL、SCOPUS和EMBASE进行了系统检索。
通过标题和摘要共筛选出3636篇文章，其中32篇进行了全文审查，9篇描述了7种干预措施的文章纳入了本综述。确定了三种干预方法：引入新的临床角色、在急诊科实施慢性病筛查项目以及系统/组织层面的干预措施。
发现改善护理公平性的干预措施相对较少。我们发现少数干预措施旨在实现组织层面的变革，并建议未来的干预措施可能受益于针对系统层面的变革，而不是或除了在急诊科纳入新角色之外。
