Inequitable care delivery for COVID-19 positive people of color and people with disabilities

Research Objectives: To explore provider observations of inequitable care delivery towards COVID-19 positive patients who are Black, Indigenous, and People of Color (BIPOC) and/or have disabilities and to identify ways health providers may be contributing to and compounding inequitable care.

Design: Qualitative research design using thematic analysis of data collected via individual semi-structured interviews between April and November 2021.

Setting: Hospitalized and ambulatory care

Participants: A total of 19 pandemic frontline health care providers including nine physicians, five nurses, three rehabilitation professionals, and two nurse practitioners from Washington, Florida, Illinois, and New York were recruited through convenience and snowball sampling. The majority of participants were female (n=12) and White (n=11).

Interventions: Not applicable

Main Outcome Measures: A semi-structured interview guide included questions regarding equity in treatments among COVID-19 patients who are BIPOC or have disabilities and perceptions around stigma related to COVID-19.

Results: Discriminatory treatment included decreased care (i.e., less explanation due to communication barriers, less interaction with health care providers, no access to telehealth follow-ups), delayed care, and fewer options for care. Health care providers’ bias and stigma (racism, ableism, and ageism), patient mistrust and provider-patient disconnect , lack of resources (e.g., staff, interpreter services, funding, or collaboration across health systems), fear of transmission, and burnout were mentioned as drivers for discriminatory treatment. COVID-19 related health system policies such as visitor restrictions and telehealth follow-ups also inadvertently resulted in discriminatory practices towards BIPOC patients and patients with disabilities.

Conclusions: BIPOC patients and patients with disabilities may experience lower quality of healthcare related to COVID-19 due to factors such as providers’ biases, fear, burnout, and lack of needed resources in their work settings. In addition, COVID-19-related restrictions and policies compounded existing inequitable care for these populations.

Author(s) Disclosures: Authors do not have conflicts to disclose.