CJEM最新文献

Objective: Patients from equity-deserving populations, such as those who are from racialized communities, the 2SLGBTQIA + community, who are refugees or immigrants, and/or who have a disability, may experience a unique set of challenges accessing and receiving care through virtual models. The objective of this qualitative study was to describe physician perspectives on their experiences providing care to patients from equity-deserving communities and their family members who received care from a Virtual Emergency Department (ED) in Toronto, Canada.

Methods: We interviewed 14 Virtual ED physicians from different sites across the Greater Toronto Area. Semi-structured interviews were conducted to explore ED physicians' experiences with treating patients from equity-deserving populations who used the Virtual ED. Inductive thematic analysis was used to identify themes from the interview data.

Results: Three themes were identified, which included: (1) Considerations for Virtual ED Inclusivity; (2) Beliefs about Compassionate Virtual ED Care Practices; and (3) Proposed Innovations for Advancing Equity through Virtual ED Care. An overarching and connecting theme was accessibility. Across these themes, providers highlighted factors that influenced Virtual ED accessibility for many equity-deserving populations.

Conclusions: The Virtual ED holds many promising applications for the delivery of equitable and compassionate care for equity-deserving populations. There are several patient, provider and system level issues that need to be considered to ensure its inclusivity and accessibility. One suggestion for innovation includes creating community hubs offering access to the Virtual ED to make it easier for equity-deserving populations who may face barriers to using it or need a safe space to do so.

Purpose: Patients living with dementia are complex and visit the emergency department (ED) more frequently than other populations. There is a knowledge gap regarding challenges in care delivery for these patients from the perspective of interdisciplinary healthcare providers. The aim of this study was to identify the barriers and facilitators to caring for people living with dementia in the ED as perceived by healthcare providers to gain a deeper understanding of current care gaps and inform best care practices.

Methods: Semi-structured interviews were conducted with healthcare providers to understand their experiences in caring for people living with dementia in the ED. Healthcare providers currently employed within in a Calgary zone ED and with experience in caring for people living with dementia in the ED were eligible for participation. The Framework Method based on the Theoretical Domains Framework and the Behavior Change Wheel was used in the analysis to inform change interventions by addressing key factors that influence behavior.

Results: A total of 11 providers participated. Key facilitators to care included collaborative team approaches; collateral information from care partners, EMS, and care homes; geriatric medicine staff; addressing non-medical needs; and person-centered care. Key barriers to care included the ED environment encompassing challenges with lack of resources, staff, and time constraints; deteriorating cognition and behavioral challenges; and a lack of dementia-specific guidance and training.

Conclusion: This study highlights key issues in emergency care delivery at the system, unit, provider, and patient levels for people living with dementia through the analysis of healthcare provider experiences. Environmental context and resources, skills, and social/professional role and identity were key domains correlating to the major barriers and facilitators in these findings. Key opportunities for change are identified through which targeted interventions and policies may address dementia-related care gaps within the ED context.