Ethnic differences in pre-hospital ambulance care in the UK: a mixed method study

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BackgroundThe Equality Act 2010 ensures fair access to healthcare services by eliminating discrimination. Previous research indicates that ethnic minority communities are more likely to face significant disparities in prehospital ambulance care. The aim of this study was to identify barriers and facilitators associated with ambulance response in ethnic minority communities in the East Midlands region in the UK. MethodsWe used an explanatory sequential mixed methods design. First, in a cross-sectional design, we analysed retrospective electronic clinical data from East Midlands Ambulance Service NHS Trust (EMAS). Multivariable logistic regression analysis was used to identify ethnic differences in ambulance transportation whilst accounting for confounders including age, gender, ethnicity, NEWS2 score, socio-economic deprivation, and urban or rural place of attendance. Second, a qualitative study used online semi-structured interviews with purposive sample of ethnic minority patients who used EMAS. Thematic analysis was used to explore barriers and facilitators. FindingsThe observational study included 2 324 439 clinical records from Jan 1, 2018 to Dec 31, 2021. After adjusting for confounders, Asian (odds ratio [OR] 0·81, 95% confidence interval [CI] 0·80, 0·82), Black (OR 0·90, 95% CI 0·88, 0·93), and Mixed ethnicity patients (OR 0·92, 95% CI 0·89, 0·95) were significantly less likely than White British patients to be conveyed to hospital. The qualitative study included 11 individuals from mainland European countries, Asian, Black, and Mixed ethnicities. We identified five main barriers including delays in ambulance arrival, high costs for uninsured, language barriers, racism, and trust issues with ambulance staff. We also found that cultural and communication training for ambulance staff, and better-equipped ambulances were key facilitators for ensuring effective ambulance care. InterpretationProviding financial support and promoting awareness of available resources for transportation costs, along with implementing cultural competency training for ambulance staff, are steps that will help to eliminate ethnic minority disparities. Further research is needed given the varying requirements of heterogeneous and diverse ethnic minority communities. FundingThe Türkiye Ministry of National Education supported this research.