(HEA1a) Sociology of Medicine, Health, and Illness I: Social Inequalities in Health

This session focuses on the theoretical, methodological, and empirical issues pertaining to the sociology of health and health care. Papers explore health inequities, individuals’ experiences of illness and/or interactions with health care services, intersections between work and health, health care professions, and organization of the health care system. Tags: Égalité et Inégalité, Politique, Santé et soin

Organizers: Elena Neiterman, University of Waterloo, Michael Halpin, Dalhousie University

Presentations

Anders Holm, Western University

Some evidence on the effectiveness of universal health care Medicare, socio-economic status, and self-reported health in Canada

Canada’s Medicare system is a universal health care system (UHC) with the explicit goal to improve overall health and reduce differences in health related to socio-economic status (SES). Using a natural experiment research design, we explore the extent to which these objectives have been achieved. Linear probability models are fitted to data from two waves of the General Social Survey of Canada. Accounting for general changes over time, we assess the relationship between years of exposure to Medicare and the self-reported health of Canadians born between 1922 and 1972. Medicare has had a positive, though modest, impact on self-reported health. It has not decreased socio-economic differences in health, however. In fact, exposure to Medicare is associated with a widening difference in self-reported health between those with a university degree and those without one. We argue that this growing difference reflects social and cultural capital factors.

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Non-presenting authors: Robert Andersen, Western University; Kamma Andersen, Western University; Anders hjort-trolle, Rockwool foundation

Nahid Rahimipour Anaraki, Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland

Strategies to Overcome Barriers and Leverage Facilitators in Implementation of a Quality Improvement Program in Emergency Departments

The implementation of effective quality improvement eHealth interventions in emergency departments (EDs) is challenging. Prior research has identified barriers and facilitators to the implementation of such interventions in the ED (i.e., management strategies, availability of key resources, the obvious need for change, etc.). However, prior research has often overlooked how to develop strategies to address these factors when implementing large-scale interventions in EDs. This study identifies a set of management strategies to guide the implementation of SurgeCon, an eHealth quality improvement program, in the dynamic environment of two rural and two urban EDs in Newfoundland and Labrador, Canada. SurgeCon aims to improve ED wait times and ED efficiency while ensuring high-quality patient care and enhancing clearer communication among healthcare providers. The implementation of SurgeCon involved changes throughout the ED, including: the installation of eHealth system, organizational restructuring, and the establishment of a patient-centered environment. We utilized semi-structured, in-depth interviews with 33 healthcare providers (e.g., physicians, nurses, managers), discussions with the implementation team involved throughout the implementation of SurgeCon in the four EDs and in the implementation at a pilot site, and structured observations of the EDs. An interpretive description approach was utilized to analyze the data. A set of seven management strategies to overcome barriers and leverage facilitators emerged from our analysis. 1- Train staff to cultivate engagement in the intervention. The SurgeCon implementation team developed a 4-hour FLOW Course to foster a holistic approach —an interactive simulation module to provide practical insights into connecting software to process improvement, an eHealth platform module to familiarize staff with the digital whiteboard application, and a patient centeredness module to reinforce core values related to patient care. 2- Appoint and train a dedicated frontline champion by ED management to act as a crucial liaison between staff and the implementation team, ensuring effective communication and ongoing support. 3- Continuously measure and report performance to improve the operational efficiency of EDs by offering meaningful data. Prominently displaying department-level data in the ED and providing individual performance reports to physicians, focusing on key performance indicators (KPIs) such as time to physician initial assessment (PIA), length of stay (LOS), and the rate of patients leaving without being seen (LWBS). However, post-COVID staffing shortages prompted changes in reporting protocols, as KPIs do not reflect staffing allocations and are inappropriately assuming ideal operating conditions. Providing individual physicians with performance reports may not offer a fair assessment in the presence of staff shortages, leading the implementation team to opt for aggregated department-level reports. The primary goal is to boost physician motivation to use SurgeCon. 4- Highlight successes. To motivate physicians, the research team highlighted the success of SurgeCons implementation in the pilot site, presenting it as a model for other sites. 5- Encourage engagement in the intervention. Executing interventions is a collaborative effort requiring dedication from all members. To encourage engagement, compensation, including full payment for attendance, travel, and meals, was provided for participation in training sessions and interviews. Additionally, refreshments in the form of snacks and beverages were offered at every training session. 6- Assign a clinical or non-clinical staff member to manually enter department-level data into SurgeCons cloud-based application to assess the level of busyness in the ED based on patient demand and availability of resources. The SurgeCon score that is calculated once an algorithm has analyzed all the inputted data provides a set of actions the ED team can carry out to improve patient flow. The data entry process takes less than a minute and collects information related to the number of patients, the level of acuity assigned to those patients, the number of patients with special care requirements, bed availability, staff shortages, among other relevant variables. 7- Employ demand and capacity analysis to optimize staffing models. The information collected through SurgeCon’s eHealth platform can be used to advocate for improved staffing levels during peak times of the day and week. This could come in the form of double physician coverage, the addition of a nurse practitioner to the team, or an increase in the number of registered nurses. This study expands upon current knowledge providing comprehensive management strategies to overcome obstacles and leverage facilitators when implementing quality improvement eHealth interventions in the ED.

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Non-presenting authors: Holly Etchegary, Memorial University ; Meghraj Mukhopadhyay, Memorial University; Jennifer Jewer, Memorial University; Christopher Patey, Memorial University; Paul Norman, Eastern Health, Carbonear Institute for Rural Reach and Innovation by the Sea, Carbonear General Hospital; Oliver Hurley, Centre for Rural Health Studies, Faculty of Medicine, Memorial University; Shabnam Asghari, Centre for Rural Health Studies, Faculty of Medicine, Memorial University

Jalal Uddin, Dalhousie University

Impact of childhood adversity on cardiovascular disease among middle-aged and older Canadians: Differential protective role of social support across sex and nativity statuses

It is now well established that childhood toxic stress is associated with morbidity and mortality decades later. Research has also demonstrated differential exposure to and impact of adverse childhood experiences (ACE) for different population groups. Although research to date has clearly outlined the causal effects of ACE on adult health outcomes, fewer studies have explicitly examined how resilience resources in adult life may guard against childhood stressors that impact cardiovascular disease risk. This study examines the associations of ACEs with cardiovascular disease among middle-aged and older Canadians. Further, we examine how social support availability buffers against childhood stressors in shaping the risk of cardiovascular disease (CVD) and test whether the buffering process differs by sex and nativity status. Guided by the sociological framework of the stress process, we hypothesize that protective resources, such as social support, buffer ACE’s harmful impacts on CVD risk, and social stratification factors, such as sex and nativity, may modify the buffering process. This is a secondary analysis of the Canadian Longitudinal Study on Aging (CLSA). The CLSA is a nationally representative prospective longitudinal study that collects psychosocial, clinical, and biomarker data from a cohort of approximately 50,000 individuals aged 45 or above. The current analysis is based on an analytic sample of 32,688 participants aged 45-89 from the baseline (2011-2015). The outcome is a binary measure of any CVD event self-reported in the baseline tracking and comprehensive cohorts of the CLSA. The exposure is the number of ACEs experienced in childhood. The ACE module consists of retrospectively reported 14 items on household dysfunctions, economic hardship, and physical and emotional abuse. Perceived social support is measured using the 19-item Medical Outcomes Study (MOS) questionnaire. The analysis uses logistic regression to estimate ACEs’ associations with CVD in sequentially adjusted models controlling for sociodemographic (e.g., age, sex, marital status, nativity, education, income, and home ownership), CVD risk factors (e.g., smoking, alcohol drinking, physical exercise, and BMI), and perceived social support. The analysis examined whether ACEs’ effect on CVD risk differs by social support, sex, and nativity status by employing statistical interactions. Overall, 13% of participants reported any CVD. The prevalence of CVD was higher among males (14.5%) versus females (10.7%) and slightly higher among those born in Canada (12.6%) versus foreign-born participants (11.9%). We found a consistent association of ACE categories with any CVD outcome. Across models with sequential adjustment of covariates, participants with a higher number of ACEs were more likely to have any CVD. The magnitude of the association of 3 or more ACEs with any CVD was higher in males (Odds ratio: 1.43, CI: 1.08-1.89) than in females (Odds ratio: 1.24, CI: 0.94-1.63) and among participants born in Canada (Odds ratio: 1.33, CI: 1.08-1.66) than those were foreign-born (Odds ratio: 1.29, CI: 0.80-2.08). Further, we observed significant effect modification by perceived social support, broadly suggesting buffering of the harmful associations of ACEs with CVD outcome at higher social support scores. The buffering processes of social support further differ by sex and nativity categories, suggesting a stronger protective role of social support for females and foreign-born participants. This study finds differential associations of ACE with CVD outcomes among population subgroups in a nationally representative sample of middle-aged and older Canadians. Social support strongly buffers the impact of ACE on CVD risk and may differ for males and females and by nativity status. Our findings have policy implications for investing in social interventions that help develop nurturing, resilient, and protective communities in Canada.

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Non-presenting authors: Emran Hasan, School of Health Administration, Dalhousie University; Mario Ulises Pérez-Zepeda, Dalhousie University; Melissa Andrew, Dalhousie University; Susan Kirkland, Dalhousie University