Application of health equity audit to emergency care for acute myocardial infarction
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Dipartimento di Epidemiologia del Servizio Sanitario Regionale del Lazio, Rome, Italy
Dipartimento di Epidemiologia del SSR del Lazio, ASL Roma 1, Rome, Italy
Servizio Sovrazonale di Epidemiologia ASL TO3, Regione Piemonte, Torino, Italy
Dipartimento di Epidemiologia del SSR del Lazio, ASL Roma 1,Rome, Italy
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A763
Background and Objective: Identifying and addressing health inequalities is a public health priority for Health Services to guarantee equitable access to effective care and health opportunities. Health Equity Audit (HEA) is a systematic methodology to evaluate inequalities in the distribution of health determinants, in the access to healthcare services and in the outcomes across the population, to define and implement actions to reduce them and to evaluate their impact. The objective of this work was to apply the HEA to in-hospital emergency care for Acute Myocardial Infarction(AMI) in Lazio Region, Italy. Methods: A multidisciplinary group of different professionals was identified and an equity profile was defined. A conceptual framework was elaborated, the entry points for possible inequalities were identified. According to the framework, indicators, health determinants and data sources were identified. After data elaboration, results were fed back to relevant professionals in the participating hospitals (cardiology, emergency, health management) with the invitation to organize audit meeting and to identify improving actions. Results: The identified entry points include risk for AMI, access to timely health procedure, access to diagnosis and/or treatment, adherence to post-acute treatment, outcomes. Health determinants included sex, education, socio-economic position, occupation, geographical area and country of origin. The sources of data were health information systems of the Lazio Region. Data firstly elaborated regard the inequalities in access to timely Percutaneous-Transluminal-Coronary-Angioplasty (PTCA) for patients with ST-elevation myocardial infarction(STEMI) and 30-days mortality after AMI, according to sex and education. The access to timely PTCA is lower in female while the 30-days mortality is higher in less educated patients. Conclusions: HEA allowed to identify possible mechanisms for inequalities generation. Returning results to professionals involved in the care-pathways we expect to increase their awareness about the problems and to stimulate the adoption of improving actions and finally to reduce the gaps.
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