First Nations patients less likely to be prioritized for urgent care in Alberta ERs: study

Lisa Johnson 3 minute read January 17, 2022

An ambulance is seen parked in the emergency entrance of the Foothills Medical Centre in Calgary on Dec. 9, 2020. Brendan Miller / Postmedia, file

First Nations patients who go to emergency departments are treated as less urgent compared to non–First Nations patients in Alberta, a new study shows.

A study published Monday in the Canadian Medical Association Journal, looked at data on more than 11 million emergency department visits over five years up to 2017, finding that status First Nations patients had lower odds of being triaged, or assessed, as high priorities for care.

The research found that 7.9 per cent of First Nations visits were triaged at more acute levels, compared to 11.8 per cent of non–First Nations visits, and authors of the study said that may reflect systemic racism and stereotyping.

Lea Bill, co-lead on the study and executive director of the Alberta First Nations Information Governance Centre, said in an interview she hopes the findings will help leadership and the general population form a better understanding of what’s happening, and that it leads to major changes in the health-care system.

“The stats are showing us that there is a gap there … it’s not a perception. This work provides the evidence that there definitely is,” said Bill.

The collaborative project went beyond collecting and analyzing data. Bill said it was Indigenous-designed, beginning in 2016 with conversations with First Nations leadership and then with engagement sessions with individuals directly affected by triage, a process that also offered reconciliation and healing for those who shared their stories.

“One of the questions that was raised by one of our participants was, ‘Why do they hate us so much?’ This is their perspective, when they’re going to access a service at a hospital, for example, and they’re met with, ‘Are you here to get drugs, or are you intoxicated?’ … rather than looking at the presenting issue,” said Bill.

Co-lead Patrick McLane, University of Alberta adjunct associate professor in emergency medicine, said the research gives weight to the discrepancies First Nations people and other researchers have highlighted. However, he said he was surprised the study also showed First Nations status was associated with lower odds of acute triage for three out of five diagnoses researchers looked at the data for, including broken arm or leg bones.

“I would have thought that a long bone fracture is relatively more visible than some other medical conditions and might cause more comparable triage,” said McLane, who added the study shows the need for change.

The paper points to a documented stereotype among many health-care providers that First Nations people misuse or overuse the health-care system, especially in emergency departments.

McLane said the team of researchers behind the study aimed to raise awareness about how that could be affecting triage in emergency departments, which are unique in the health-care system and have seen workers put under tremendous pressure.

“The triage system itself is equity-oriented. It is designed to make sure that people are seen based on their medical need and not on any other characteristics,” he said, adding patients should not be discouraged from visiting emergency rooms when they need to.

Bill, who has worked for decades as a nurse, said the negative experiences of many patients can come from an unconscious bias by care providers, lack of understanding about Canadian history, communication barriers, and the need for culturally-supportive care.

“I believe that this work has really opened up a lot of possibilities to really start talking about those things,” said Bill.

First Nations people rely on emergency care more than non–First Nations people in Alberta, especially in rural and remote areas.

Bill said she hopes to see First Nations communities get the type of primary health services that most non-Indigenous communities have so patients can get proper care before they reach emergency departments.


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