Moradinia Mehdi, Yarahmadi Sajad, Birjandi Mehdi, Gholami Mohammad
Student Research Committee, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran.
Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran.
Int J Equity Health. 2025 May 12;24(1):133. doi: 10.1186/s12939-025-02496-1.
Patients with acute coronary syndrome (ACS) who belong to marginalized groups often do not receive equitable treatment and care when they are referred to emergency departments (ED), and this can have negative consequences for these patients. Therefore, this study aimed to evaluate the impact of a disparity-reduction intervention on outcomes of patients with ACS in the ED.
This randomized clinical trial included 264 ACS patients, randomly allocated into intervention (n = 132) and control group (n = 132). The intervention involved improving the triage process by (1) welcoming nurses and (2) conducting specialized triage. Also, a patient navigation (PN) program was implemented, comprising (1) emergency care comprehensive management, (2) supportive education and counseling, and (3) clinical actions with follow-up care. In the control group, standard triage and routine care were provided. Outcomes assessed included pain intensity, patient opinion of pain management, illness perception, threat perception, and short and long-term outcomes.
The results showed that after the intervention, pain intensity and threat perception decreased significantly in the intervention group compared to the control group (P < 0.001). Moreover, the opinion of pain management-assessed only post-intervention-was significantly more favorable in the intervention group than in the control group (P < 0.001). Illness perception scores also increased more prominently in the intervention group than in the control group (P < 0.001). Short-term outcomes showed improvement in the intervention group compared to the control group (P < 0.05). Long-term outcomes revealed that the intervention group experienced better results than the control group in specialist visits, exercise stress tests, echocardiography, and readmissions (P < 0.05).
Interventions such as improving the triage process and the PN are important in reducing disparities and improving patient outcomes. These findings underscore the effectiveness of tailored strategies in promoting equitable care in ED.
属于边缘化群体的急性冠状动脉综合征（ACS）患者在被送往急诊科（ED）时，往往无法获得公平的治疗和护理，这可能会给这些患者带来负面后果。因此，本研究旨在评估一项减少差距干预措施对急诊科ACS患者治疗结果的影响。
这项随机临床试验纳入了264例ACS患者，随机分为干预组（n = 132）和对照组（n = 132）。干预措施包括通过（1）热情接待护士和（2）进行专业分诊来改善分诊流程。此外，还实施了患者导航（PN）计划，包括（1）急诊综合管理、（2）支持性教育和咨询以及（3）后续护理的临床行动。对照组则提供标准分诊和常规护理。评估的结果包括疼痛强度、患者对疼痛管理的看法、疾病认知、威胁认知以及短期和长期结果。
结果显示，与对照组相比，干预组在干预后疼痛强度和威胁认知显著降低（P < 0.001）。此外，仅在干预后评估的疼痛管理看法方面，干预组明显优于对照组（P < 0.001）。干预组的疾病认知得分也比对照组有更显著的提高（P < 0.001）。短期结果显示，干预组比对照组有所改善（P < 0.05）。长期结果表明，干预组在专科就诊、运动压力测试、超声心动图和再入院方面的结果优于对照组（P < 0.05）。
改善分诊流程和患者导航等干预措施对于减少差距和改善患者治疗结果很重要。这些发现强调了量身定制策略在促进急诊科公平护理方面的有效性。
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