Date of Award

12-2023

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr. Uzma Rahim Khan

Second Advisor

Dr. Nadeemullah Khan

Third Advisor

Dr. Farhala Baloch

Department

Community Health Sciences

Abstract

Introduction: There are substantial delays in emergency access and care for women compared to men, as per the global literature. Our aim was to investigate the potential influence of gender on delays in access to emergency care and subsequent management for individuals presenting with chest pain in the emergency departments. This research seeks to shed light on disparities in the timely provision of emergency services, with a particular focus on understanding how gender may contribute to variations in access and management within the Emergency departments.
Methods: This investigation employs a cross-sectional research design, conducted within the emergency departments of Aga Khan University Hospital (AKUH) and Indus Hospital and Health Network (IHHN) in Karachi, Pakistan. The overall sample comprised n=414 participants, with a distribution of 43% females and 57% males. The study spans from September 18, 2023, to October 22, 2023. In the emergency departments, eligible chest pain patients who consented to participate were recruited by data collectors. Some information in questionnaire was collected from patient while two-thirds of variables were taken from electronic health records of hospitals. Descriptive analysis of time variables was done as mean ± standard deviation, median and interquartile range (IQR) were computed.
Results: The findings suggest that female patients exhibited a shorter time from symptom onset to the first medical contact of 12.16 hours as compared to 19.04 hours in male patients (p=0.031*). The time from triage to registration time was 7 minutes in females compared to male patients, who have an average of 9 minutes (p = 0.008*). The remaining findings revealed a contrasting pattern. Significant gender differences emerged in the time from triage to ECG, indicating that male patients had a shorter average time of 25 minutes compared to female patients, who have an average of 34.5 minutes (p= 0.012*). On average, it took 106.2 minutes to administer aspirin to male patients, while the administration time for females was 160.2 minutes. The emergency department length of stay in female patients was 301.5 minutes, while male patients had an average of 272 minutes (p= 0.008*). Similarly, the time from triage to hospital admission also showed significant differences, where female patients had a longer average duration of 311 minutes compared to male patients, who had an average of 244 minutes (p = 0.020*). Discharged female patients had a longer hospital stay (119.6 hours on average) compared to males (51.3 hours on average), and this difference was also statistically significant (p = 0.013*). Lastly, among male STEMI patients the mean door to balloon time was of 67.56 minutes, in contrast to female patients who experienced a significantly longer mean door to balloon time of 179.0 minutes (p = 0.009).
Conclusion: This study has highlighted crucial time intervals that contribute to morbidity and mortality among chest pain patients. The differences suggest an inequitable care in the emergency management based on gender. However, the research in this area is scarce, especially in context of a LMIC. This serves as a snapshot and calls for greater attention and research on the topic. These findings prompt urgent considerations for enhancing patient-centric care to gender equity, emphasizing the imperative for tailored strategies to address disparities and optimize outcomes for individuals seeking emergency cardiac care, regardless of their gender.

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