Systematic review: the barriers and facilitators for minority ethnic groups in accessing urgent and prehospital care

Phung, Viet-Hai and Windle, Karen and Asghar, Zahid and Ortega, Marishona and Essam, Nadya and Barot, Mukesh and Kai, Joe and Johnson, Mark and Siriwardena, A. Niroshan (2014) Systematic review: the barriers and facilitators for minority ethnic groups in accessing urgent and prehospital care. In: Meeting challenges in emergency care, 19 February 2013, Halifax Hall, University of Sheffield.

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Systematic review: the barriers and facilitators for minority ethnic groups in accessing urgent and prehospital care
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Abstract

Introduction
Research addressing inequalities has focused predominantly on primary and community care; few initiatives relate to the prehospital environment. We aimed to identify in the literature barriers or facilitators experienced by patients from black and minority ethnic (BME) communities in accessing prehospital care and to explore the causes and consequences of any differences in delivery.
Methods
We conducted a systematic literature review and narrative synthesis. Electronic and journal hand searches from 2003 through 2013 identified relevant evaluative studies (systematic reviews, randomised controlled trials, quasi-experimental, case and observational studies). A researcher extracted data to determine characteristics, results and quality, each checked by a second reviewer. The main outcome measures were delays in patient calls, mortality rates and 30-days survival post discharge.
Results
Eighteen studies met criteria for the review: two concerned services in England and Wales and 15 were United States based. Reported barriers to accessing care were generic (and well-known) given the heterogeneity of BME groups: difficulties in communication where English was the patient’s second language; new migrants’ lack of knowledge of the health care system leading to inappropriate emergency calls; and cultural assumptions among clinical staff resulting in inappropriate diagnoses and treatment. There were limited reported facilitators to improvement, such as the need for translation services and staff education, but the latter were poorly described or developed. Where outcomes were discussed, there was evidence for race-related disparity in mortality and survival rates. This could reflect differences in condition severity, delays between onset and initiation of calls, or the scope of response and assistance.
Conclusion
The paucity of literature and difficulties of transferring findings from US to UK context identified an important research gap. Further studies should be undertaken to investigate UK differences in prehospital care and outcomes for BME groups, followed by qualitative approaches to understand barriers and enablers to equitable access.

Keywords:Emergency Medical Systems, ambulance services, systematic review, ethnic minority groups, access, outcomes
Subjects:B Subjects allied to Medicine > B990 Subjects Allied to Medicine not elsewhere classified
A Medicine and Dentistry > A300 Clinical Medicine
Divisions:College of Social Science > School of Health & Social Care
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ID Code:13446
Deposited On:02 Mar 2014 21:57

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