• Patrick McLane, Lea Bill, Bonnie Healy, Cheryl Barnabe, Tessy Big Plume, Anne Bird, Amy Colquhoun, Brian R Holroyd, Kris Janvier, Eunice Louis, Katherine Rittenbach, Kimberley D Curtin, Kayla M Fitzpatrick, Leslee Mackey, Davis MacLean, and Rhonda J Rosychuk.
• Alberta Health Services, Strategic Clinical Networks (McLane, Holroyd); Departments of Emergency Medicine (McLane, Holroyd, Curtin, Fitzpatrick, Mackey, MacLean), and Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Alberta First Nations Information Governance Centre (Bill), Calgary, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Departments of Community Health Sciences (Barnabe), Medicine (Barnabe, MacLean), and Psychiatry (Rittenbach), University of Calgary, Calgary, Alta; Stoney Nakoda Tsuut'ina Tribal Council (Big Plume), Tsuut'ina, Alta.; Paul First Nation Health Services (Bird), Parkland County, Alta.; Analytics and Performance Reporting (Colquhoun), Alberta Health, Edmonton, Alta.; Kee Tas Kee Now Tribal Council (Janvier), Atikameg, Alta.; Maskwacis Health Services (Louis), Maskwacis Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta. mclane@ualberta.ca.
• CMAJ. 2024 Apr 21; 196 (15): E510E523E510-E523.

BackgroundOur previous research showed that, in Alberta, Canada, a higher proportion of visits to emergency departments and urgent care centres by First Nations patients ended in the patient leaving without being seen or against medical advice, compared with visits by non-First Nations patients. We sought to analyze whether these differences persisted after controlling for patient demographic and visit characteristics, and to explore reasons for leaving care.MethodsWe conducted a mixed-methods study, including a population-based retrospective cohort study for the period of April 2012 to March 2017 using provincial administrative data. We used multivariable logistic regression models to control for demographics, visit characteristics, and facility types. We evaluated models for subgroups of visits with pre-selected illnesses. We also conducted qualitative, in-person sharing circles, a focus group, and 1-on-1 telephone interviews with health directors, emergency care providers, and First Nations patients from 2019 to 2022, during which we reviewed the quantitative results of the cohort study and asked participants to comment on them. We descriptively categorized qualitative data related to reasons that First Nations patients leave care.ResultsOur quantitative analysis included 11 686 287 emergency department visits, of which 1 099 424 (9.4%) were by First Nations patients. Visits by First Nations patients were more likely to end with them leaving without being seen or against medical advice than those by non-First Nations patients (odds ratio 1.96, 95% confidence interval 1.94-1.98). Factors such as diagnosis, visit acuity, geography, or patient demographics other than First Nations status did not explain this finding. First Nations status was associated with greater odds of leaving without being seen or against medical advice in 9 of 10 disease categories or specific diagnoses. In our qualitative analysis, 64 participants discussed First Nations patients' experiences of racism, stereotyping, communication issues, transportation barriers, long waits, and being made to wait longer than others as reasons for leaving.InterpretationEmergency department visits by First Nations patients were more likely to end with them leaving without being seen or against medical advice than those by non-First Nations patients. As leaving early may delay needed care or interfere with continuity of care, providers and departments should work with local First Nations to develop and adopt strategies to retain First Nations patients in care.© 2024 CMA Impact Inc. or its licensors.

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