Through an equity lens: Illuminating the relationships among social inequities, stigma and discrimination, and patient experiences of emergency health care.
Open accessAbstract
People who experience the greatest social inequities often have poor experiences in emergency departments (EDs) so that they are deterred from seeking care, leave without care complete, receive inadequate care, and/or return repeatedly for unresolved problems. However, efforts to measure and monitor experiences of care rarely capture the experiences of people facing the greatest inequities, experiences of discrimination, or relationships among these variables. This analysis examined how patients' experiences, including self-reported ratings of care, experiences of discrimination, and repeat visits vary with social and economic circumstances. Every consecutive person presenting to three diverse EDs was invited if/when they were able to consent; 2424 provided demographic and contact information; and 1692 (70%) completed the survey. Latent class analysis (LCA) using sociodemographic variables: age, gender, financial strain, employment, housing stability, English as first language, born in Canada, and Indigenous identity, indicated a six-class solution. Classes differed significantly on having regular access to primary care, reasons for the visit, and acuity. Classes also differed on self-reported discrimination every day and during their ED visit, ratings of ED care, and number of ED visits within the past six months. ED care can be improved through attention to how intersecting forms of structural disadvantage and inequities affect patient experiences.
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There are few options for measuring patient experiences of care using an intersectional lens.
“there are few options for measuring patient experiences of care using an intersectional lens [10].”
From Using a health equity lens to measure patient experiences of care in diverse health care settings (2024) · cites this paper as [10]
People who have negative health care experiences or anticipate such experiences, including from stigma and discrimination, are deterred from accessing care.
“people who have negative health care experiences or who anticipate such experiences, including experiences arising from stigma and discrimination, are deterred from accessing care [4, 8–10].”
From Using a health equity lens to measure patient experiences of care in diverse health care settings (2024) · cites this paper as [10]
PHC settings and EDs are critical contexts for addressing health equity, particularly with reductions in community-level primary care and increasing pressures on EDs.
“PHC settings and EDs are critical contexts within which issues of health equity and inequities must be addressed, particularly in light of ongoing reductions in community-level primary care services in most jurisdictions in Canada, with concomitant and increasing pressures on EDs to bridge the gaps in care [5, 10, 24, 49].”
From Using a health equity lens to measure patient experiences of care in diverse health care settings (2024) · cites this paper as [10]
The EOHCS-Episodic allowed the authors to examine those aspects of care that people valued most highly in EDs.
“For example, the EOHCS–Episodic allowed us to examine those aspects of care that people valued most highly in EDs [10].”
From Using a health equity lens to measure patient experiences of care in diverse health care settings (2024) · cites this paper as [10]
Ratings of quality of care in the SMH sample were high, with an average of 8.11 (SD 2.14) on a 0-10 scale.
“ratings of quality of care in our sample were high, with an average of 8.11 (SD 2.14) on a scale of 0–10, as measured by an item from the British Columbia Emergency Department Patient Experiences of Care scale [10, 24, 36, 77].”
From Using a health equity lens to measure patient experiences of care in diverse health care settings (2024) · cites this paper as [10]
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“Additionally, as reported elsewhere [43], our pre-intervention sample was more diverse, particularly on demographic variables indicating structural disadvantage, than samples collected routinely by mail out surveys.”
BackgroundMethodResultInfluentialSelf-citationUsing a health equity lens to measure patient experiences of care in diverse health care settings
Browne, A. J., Varcoe, C., Ford-Gilboe, M., Wathen, C. N., Wilson, E., Bungay, V., & Perrin, N. (2024) · PLOS ONE · doi:10.1371/journal.pone.0297721 · Cited by 17 · see citing works
Self-citation
- Authors
- Varcoe, C., Browne, A. J., Bungay, V., Perrin, N., Wilson, E., Wathen, C. N., Byres, D., & Roberta Price, E.
- Affiliations
- University of British Columbia (CA)
- Johns Hopkins University (US)
- University of Northern British Columbia (CA)
- Western University (CA)
- Provincial Health Services Authority (CA)
- University of British Columbia (UBC), Vancouver BC, Canada
- Corresponding author
- Varcoe, Colleen
- Venue
- International Journal of Health Services
- Publisher
- SAGE Publications
- Published
- 2022-01-31
- Volume
- 52
- Issue
- 2
- Pages
- 246-260
- ISSN
- 0020-7314 (ISSN-L)
- 1541-4469
- PMC
- PMC8894974
- OpenAlex
- W4210544680
- Cited by
- 39
- References
- 54
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 10 · 2023: 7 · 2022: 4
- FWCI
- 9.11
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- International Journal of Health Services (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Scholarship@Western (Western University) (submittedVersion, cc-by)
- Scholarship@Western (Western University) (submittedVersion)
- Funders
- Canadian Institutes of Health Research (11R74386)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Health Professions › General Health Professions › Patient Satisfaction in Healthcare
- Keywords
- social inequities, stigma, discrimination, patient experience, emergency department, repeat emergency visits, structural disadvantage, health equity, primary care access, financial stress, housing stability, indigenous identity, English as a first language
- MeSH terms
- Delivery of Health Care, Emergency Service, Hospital, Gender Identity, Humans, Social Stigma, Patient Outcome Assessment
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