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Publication Date
5-2021
Keywords
oregon; portland; psvmc; diversity/inclusion
Disciplines
Emergency Medicine
Abstract
Background
• Health disparity is a sum of differences in healthcare seen in underserved populations of the United States. 1 • Differences include incidence, prevalence, mortality, burden of disease, and other adverse health conditions • According to ASHP, health disparities continue to be a major public health problem confronting the U.S. health care systems. 2 • Evidence suggests that health disparities can be in part due to differences in the quality of care for different racial and ethnic groups. 2 • All the different disparity factors have been shown to lead to different health outcomes that do not favor Black, Latinx, and Native American populations. • ASHP believes health-system pharmacists have both a professional and moral obligation to take part in initiatives that work towards erasing any racial and ethnic disparities in healthcare. 2 • Examples of ways pharmacists can make an impact are: • Increase awareness among fellow caregivers • Ensure effective communication by volunteering for leadership roles • Enforce consistency of using evidence-based therapy for all patients • Analyze data for outcomes sorted by racial minorities • Per ASHP there are three general principles that serve as guides for pharmacist to help erase healthcare disparities: 2 1. All patients have the right to high-quality care, by taking leadership roles pharmacists can partake in initiatives to increase access to care. 2. Medication-use practices should reflect knowledge of, sensitivity to, and respect for the race and culture of the patient. 3. Health-system pharmacists have a vital role to play in eliminating racial and ethnic disparities in health care.
Purpose
Evaluate and compare how two large tertiary hospitals have provided prompt evidence based medical therapy to Blacks, Latinx, and Natives, in comparison to Caucasians pertaining to hypertensive emergency, non- ST segment elevation myocardial infarction (NSTEMI), and cerebrovascular accident (CVA)
Objective
Determine what differences there may be in providing various non-medication/medication interventions and time-to-intervention order placement after arrival to the emergency department (ED)
Methodology
• Institutional Review Board (IRB) – approved • Double center, observational, descriptive-analysis, retrospective review, spanning 51 months (January 1st, 2017, to March 31st, 2021), of adults presenting to ED at either of the two large tertiary hospitals. • Inclusion criteria • Black, Latinx, Native American, and Caucasian adults (> 18 years old) presenting to the ED with primary diagnosis of NSTEMI, hypertensive emergency, or CVA. • Exclusion criteria • < 18 years old; patients not meeting the pre-specified race/ethnicity criteria; primary diagnosis outside of hypertensive emergency, NSTEMI, or CVA
Discussion
Patient Population • The total number of patients in the study was 4,308. • Breakdown of primary clinical diagnosis categories by order of most prevalent: CVA (n=1,858), NSTEMI (1,695), hypertensive emergency (n=8) • Total population heavily consisted of White or Caucasian (n=3,359) which was 94% of the racial groups. • Total Hispanic or Latino population (n=207) was 4.8% of ethnicity groups. Primary and Secondary Outcomes: NSTEMI: • Similar ordering rates of ECG 12 lead and troponin, (98- 100%). American Indian/Alaska Native group had longest time elapse before ordering either. • Aspirin ordering rates were 18% for American Indian/Alaska Native, 43% for Black/African American, 50-51% for the remaining three groups . Hypertensive Emergency: • No data for either Black/African American or American Indian/Alaska Native groups. • Emergent anti-hypertensive agent ordering rates were 100% for all groups, with White/Caucasian and Not Hispanic/Latino groups having shortest time-to antihypertensive agent being ordered. • Achieving average BP <160/110 mmHg in the first 24 hours favored the Not Hispanic/Latino group with the highest rate of 25%, followed by 13% for White/Caucasian and 0% for Hispanic/Latino. CVA: • Alteplase ordering rates were lowest in the American Indian/Alaska Native group (6%) followed by the Black/African American group (11%) which also had the longest time elapse before ordering (76 minutes). • American Indian/Alaska Native population had lowest ordering rates for brain non-contrast CT or MRI at 41% and the lowest ordering rates of key labs/diagnostics outside of brain imaging at 6%. Limitations: • Descriptive study – no statistical analysis performed • Racial and ethnic identification inaccuracy cannot be ruled out as data was pulled from Epic. • Unidentified variables may have altered the choice of therapy from providers (e.g., formulary changes)
Conclusions
• Differences in care were present, with more unfavorable trends seen in the American Indian/Alaska Native group. • Data inconsistencies made reliability of results uncertain. This also made statical analysis challenging.
Specialty/Research Institute
Emergency Medicine
Specialty/Research Institute
Pharmacy
Specialty/Research Institute
Graduate Medical Education
Conference / Event Name
Academic Achievement Day, 2021
Location
Providence St. Vincent Medical Center
