Table 2 Barriers to care and provider mitigation efforts
Barriers to Healthcare for First Nations Patients | Examples of Provider Efforts to Mitigate Barriers |
|---|---|
Transportation | • Arranging transportation for the patient (e.g. through providing resources or connecting with transportation services).(P4, N5, N8, N10, P11, P13, P14, P15) • Arranging for patients and their families to stay overnight in ED, where appropriate.(N5, N8) • Advocating for specialists to book patients with long travel distances later in the day.(P7) • Arranging inter-facility transport.(P8) • Advocating for a patient to be admitted when follow up is difficult, or to be admitted to a hospital closer to their home, when this is the patient’s preference.(N2, N5, P17) |
Communication | • Taking more time or having more conversations with First Nations patients.(N2, P3, P4, P6, P7, P9, N10, P15) • Updating contact information at each visit.(P13, P14) • Calling family members to leave messages if the patient has no phone.(P13) • Building relationships with clinics in First Nations communities. (N5, N8, N10) |
Resources | • Writing notes for patients to access coverage for transportation costs.(P7) • Educating themselves on what resources are available for First Nations patients and referring patients to these resources.(P3, P7) |
Access to primary care | • Communication about follow up care needs with staff at the First Nation Health Centre (e.g. a Nurse Practitioner), who are often more available and consistent than physicians (who may rotate into and out of communities).(N5, P7) • Arranging for patients to come back to ED for follow up where primary care is not readily accessible.(P7, N10) • Writing longer prescriptions for patients who lack access to primary care.(P7) • Communication with family physician or outpatient clinic to encourage continuity of care.(P15) |
Discrimination | • Taking additional time and effort with patients who have had negative experiences with the healthcare system.(N2, P7, N8, P9, P11, P14) • Not relying on past providers’ potentially biased diagnoses.(P7) • Sensitivity in how questions about substance use are framed.(P6, P14) • Challenging negative comments and use of racial slurs by colleagues.(P3, P7) |