Systematic review: barriers and facilitators for minority ethnic groups accessing urgent and prehospital care

BackgroundResearch addressing inequalities has focussed predominantly on primary and acute care. We aimed to identify barriers or facilitators to people from minority ethnic groups accessing prehospital care and to explore the causes and consequences of any differences in delivery.Methodology We conducted a systematic literature review and narrative synthesis. Electronic searches from 2003 through to 2013 identified studies; systematic reviews, randomised controlled trials, quasi-experimental, case and observational studies. A researcher extracted data to determine characteristics, results and quality, each checked by a second reviewer. Outcome measures were delays in patient calls, mortality rates and survival to 30 days post-discharge.ResultsSixteen studies met criteria for the review, two from the UK and 14 from the United States. Barriers to accessing care included difficulties in communication where English was the patient’s second language, new migrants’ lack of knowledge of the healthcare system leading to inappropriate calls and cultural assumptions among clinical staff resulting in inappropriate treatment. There were limited facilitators to access including translation services and staff education, but the latter were poorly described or developed. Where outcomes were discussed, there was evidence for ethnicity-related disparity in mortality and survival rates. This could reflect differences in condition severity, delays between onset and initiation of calls, or the scope of response and assistance.ImplicationsThe paucity of literature and difficulties of transferring findings from US to UK context identified an important research gap. Further studies should be undertaken to investigate UK differences in prehospital care and outcomes for minority ethnic groups.