The association between ethnicity and the delay time in seeking medical care for chest pain: a systematic review

Made available in accordance with the Publisher's Author's Permissions policyBackground: Acute coronary syndrome (ACS) is a leading cause of mortality and morbidity worldwide, and chest pain is one of the most common symptoms of ACSs. A rapid response to chest pain by patients and appropriate management by health professionals are vital to improve survival rates. People from different ethnic groups are likely to have different perceptions of chest pain, its severity and the need for urgent treatment. These differences in perception may contribute to differences in response to chests pain and precipitate unique coping strategies. Delay in seeking medical care for chest pain in the general population has been well documented; however, limited studies have focused on delay times within ethnic groups. There is little research to date as to whether ethnicity is associated with the time taken to seek medical care for chest pain. Consequently, addressing this gap in knowledge will play a crucial role in improving the health outcomes of culturally and linguistically diverse (CALD) patients suffering from chest pain and for developing appropriate clinical practice and public awareness for these populations. Objectives: The current review aimed to determine if there is an association between ethnicity and delay in seeking medical care for chest pain among CALD populations. Inclusion criteria Types of participants: Patients from different ethnic minority groups presenting to emergency departments (EDs) with chest pain. Types of exposure: The current review will examine studies that evaluate the association between ethnicity and delay in seeking medical care for chest pain among CALD populations. Types of studies: The current review will consider quantitative studies including randomized controlled trials (RCTs), non-RCTs, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies. Outcomes: The current review will consider studies that measure delay time as the main outcome. The time will be measured as the interval between the time of symptom onset and time to reach an ED. Search strategy: A comprehensive search was undertaken for relevant published and unpublished studies written in English with no date restriction. All searches were conducted in October 2014. We searched the following databases: MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest (health databases only), Informit, Sociological Abstracts, Scopus and Web of Science. The search for unpublished studies included a wide range of ‘gray literature’ sources including national libraries, digital theses repositories and clinical trial registries. We also targeted specific health research, specialist cardiac, migrant health, and emergency medicine organizational websites and/or conferences. We also checked the reference lists of included studies and contacted authors when further details about reported data was required to make a decision about eligibility. Methodological quality: Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to being included in the review. Validity was assessed using standardized critical appraisal instruments from the Joanna Briggs Institute. Adjudication was produced by the third reviewer. Data extraction: Data were extracted from included articles by two independent reviewers using the standardized data extraction tool from the Joanna Briggs Institute. Data synthesis: The extracted data were synthesized into a narrative summary. Meta-analysis could not be performed due to the heterogeneity of study protocols and methods used to measure outcomes. Results: A total of 10 studies, with a total of 1,511,382 participants, investigating the association between ethnicity and delay met the inclusion criteria. Delay times varied across ethnic groups, including Black, Hispanic, Asian, South Asian, Southeast Asian and Chinese. Seven studies reported delay in hours and ranged from 1.90 to 3.10 h. Delay times were longer among CALD populations than the majority population. The other three studies reported delay time in categories of time (e.g. <1, <4 and <6 h) and found larger proportions of later presentations to the EDs among ethnic groups compared with the majority groups. Conclusion: There is evidence of an association between ethnicity and time taken in seeking medical care for chest pain, with patients from some ethnic minorities (e.g. Black, Asian, Hispanic and South Asian) taking longer than those of the majority population. Health promotions and health campaigns focusing on these populations are indicated

Variation in Seeking Care for Cardiovascular Disease and Ambulance Utilization among Migrants in Australia: Time, Ethnicity, and Delay (TED) Study III

Insight into differences in seeking medical care for chest pain among migrant populations is limited. This study aimed to determine ethnic differences in seeking care behaviors and using ambulances among migrants compared to an Australian-born group. A total of 607 patients presenting with chest pain to a tertiary hospital between 1 July 2012 and 30 June 2014 were randomly selected. Data from the emergency department dataset and medical record reviews were collected and linked for analysis. The migrant group was stratified into nine ethnic groups for analysis based on the Australian Standard Classification of Cultural and Ethnic Groups. The overall median prehospital delay time was 3.7 (1.5, 10.7) h, which ranged from 2.5 (1.0, 10.7) (Southern and Eastern European group) to 6.0 (2.3, 20.6) (Sub-Saharan African group). The median decision time was 2.0 (0.8, 7.9) h, which ranged from 1.5 (Australian-born group) to 4.5 h (Sub-Saharan African group). Five ethnic groups had significantly longer decision times compared to the Australian-born group. Decision time accounted for 58.4% of pre-hospital delay time. Migrant patients were 60% less likely to seek care for chest pain within one hour (odds ratio 0.40, (0.23&ndash;0.68), p = 0.001). There was no significant difference in ambulance utilization between migrant and Australian-born groups. In conclusion, ethnic differences in seeking care for chest pain do exist, and ethnicity plays a vital role in a longer delay in seeking care. To reduce the delays and improve patient outcomes, appropriate health campaigns focusing on ethnic differences among migrant populations and normalizing cultural competency into practice are recommended

Pharmacy practice in emergency response during the COVID-19 pandemic : lessons from Australia

The purpose of this paper is to provide an overview of the pharmacy practice and initiatives taken by the Australian federal government to ensure the continued supply of essential medicines under the conditions of an emergency response plan for COVID-19. During the pandemic, Australian pharmacists have been working collaboratively with multidisciplinary teams at the frontline to manage the equitable and safe supply of medicines despite the unprecedented situation. Although these presented problems for small pharmacies, social distancing policies were implemented widely to maintain personal and environmental hygiene and reduce the number of face-to-face patient visits. In collaboration with various pharmaceutical stakeholders, the Australian government responded rapidly to ensure equitable and sufficient supply with continued access to therapeutic goods during the pandemic. Additionally, vital policies and practices have been implemented, including supplying regular medicines at government-subsidized prices, a maximum one-month supply of some prescription medicines and purchase limits on over-the-counter medicines (one unit per purchase), medication management reviews through telehealth, electronic and digital prescribing, home delivery of medicines to vulnerable people and those in home isolation and the provision of serious shortage medicine substitution rights to pharmacists. Pharmacists were encouraged to communicate and collaborate with other local pharmacies to ensure that essential pharmacy services met community needs (e.g., opening hours). However, there has been a shortage of some medicines due to supply chain disruption and increased demand due to the pandemic. Higher demand for flu vaccinations, increased work pressure in pharmacies, and severe frustration and anxiety in pharmacy customers were also reported. Vigilance is required to monitor foreseeable shortages of therapeutics goods, particularly in regional pharmacies. There is an opportunity for long-term change to retain certain rights and roles based on the competence shown by pharmacists in this challenging period, such as telephone medication reviews, telehealth for MedsCheck and Diabetes MedsCheck, digital prescription handling and therapeutic substitution

PM318 Variation in care between English speaking and culturally and linguistically diverse patients in SNAPSHOT ACS

Author version made available in accordance with the publisher's policy for non-mandated open access submission. Under Elsevier's copyright, non-mandated authors are permitted to make work available in an institutional repository. NOTICE: this is the author’s version of a work that was accepted for publication in Global Heart. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in GLOBAL HEART, [VOL9, ISSUE1, (2014)] DOI:10.1016/j.gheart.2014.03.1677

Is there inequity amongst patients with acute coronary syndrome who are proficient and not proficient in English language in terms of their in-hospital care: Analysis of the SNAPSHOT ACS Study

Posted in accordance with Publisher's copyright policy.Background: The provision of equitable acute coronary syndrome (ACS) care in Australia and New Zealand requires an understanding of the sources of variation in the provision of this care. Objective: The aim of this study was to compare the variation in care and outcomes between ACS patients with limited English proficiency (LEP) and English proficiency (EP) admitted to Australian and NZ hospitals. Methods: Data were collected from 4387 suspected/confirmed ACS patients from 286 hospitals between May 14 and 27, 2012, who were followed for 18 months. We compared hospital care and outcomes according to the proficiency of English using logistic regressions. Results: The 294 LEP patients were older (70.9 vs 66.3 years; P < .001) and had higher prevalenc