Emergency department care experiences among 2SLGBTQQIA+ patients: a mixed methods study.

BACKGROUND

Equity-deserving groups (EDG), including those who identify as two-spirit, lesbian, gay, bisexual, transgender, queer, questioning, intersex, and/or asexual (2SLGBTQQIA+), are disproportionately treated in the Emergency Department (ED). This study aimed to understand ED care experiences of 2SLGBTQQIA+ individuals compared to those who do not identify with an equity-deserving group in Kingston, Canada, ultimately aiming to enhance inclusivity and better meet healthcare needs.

METHODS

Data were collected through a mixed qualitative/quantitative cross-sectional study using a novel electronic survey tool (Spryng.io), which purposely integrates qualitative and quantitative data, while minimising researcher bias. A community-based participatory approach was employed to involve community stakeholders. Participants were recruited from the Kingston Health Sciences Centre's ED, Urgent Care Centre, and at community-based organisations. Quantitative data were analysed using chi-squared tests, while qualitative data underwent thematic analysis. Results were triangulated. Focus group discussions with community partners were then undertaken to contextualise findings.

RESULTS

Compared to persons who did not identify as belonging to an EDG (n = 949), 2SLGBTQQIA+ individuals (n = 118) felt their identity had a more negative impact on their care (p < 0.0001) and experienced more judgment and disrespect from healthcare providers (HCPs) (p < 0.0001). Four themes emerged from triangulation of qualitative and quantitative data: (1) mixed emotions regarding ED care; (2) transgender and non-binary health care considerations; (3) unmet mental health needs; and (4) lack of patient-centred care for 2SLGBTQQIA+ patients.

CONCLUSIONS

2SLGBTQQIA+ individuals often face unmet mental health care needs, requiring tailored mental health care provision in the ED. Intersectionality within the 2SLGBTQQIA+ population underscores the importance of trauma-informed care. Strategies to improve 2SLGBTQQIA+ healthcare include implementing safer spaces, clear feedback mechanisms, referrals to gender-affirming specialists, and privacy in triage. Further research should assess the impact of educational interventions on HCP knowledge and patient experiences in the ED.