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Acquadro-Pacera G, Valente M, Facci G, Molla Kiros B, Della Corte F, Barone-Adesi F, Ragazzoni L, Trentin M. Exploring differences in the utilization of the emergency department between migrant and non-migrant populations: a systematic review. BMC Public Health 2024; 24:963. [PMID: 38580984 PMCID: PMC10996100 DOI: 10.1186/s12889-024-18472-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/28/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Migrants face several barriers when accessing care and tend to rely on emergency services to a greater extent than primary care. Comparing emergency department (ED) utilization by migrants and non-migrants can unveil inequalities affecting the migrant population and pave the way for public health strategies aimed at improving health outcomes. This systematic review aims to investigate differences in ED utilization between migrant and non-migrant populations to ultimately advance research on migrants' access to care and inform health policies addressing health inequalities. METHODS A systematic literature search was conducted in March 2023 on the Pubmed, Scopus, and Web of Science databases. The included studies were limited to those relying on data collected from 2012 and written in English or Italian. Data extracted included information on the migrant population and the ED visit, the differences in ED utilization between migrants and non-migrants, and the challenges faced by migrants prior to, during, and after the ED visit. The findings of this systematic review are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. RESULTS After full-text review, 23 articles met the inclusion criteria. All but one adopted a quantitative methodology. Some studies reported a higher frequency of ED visits among migrants, while others a higher frequency among non-migrants. Migrants tend to leave the hospital against medical advice more frequently than the native population and present at the ED without consulting a general practitioner (GP). They are also less likely to access the ED via ambulance. Admissions for ambulatory care-sensitive conditions, namely health conditions for which adequate, timely, and effective outpatient care can prevent hospitalization, were higher for migrants, while still being significant for the non-migrant population. CONCLUSIONS The comparison between migrants' and non-migrants' utilization of the ED did not suggest a clear pattern. There is no consensus on whether migrants access EDs more or less than non-migrants and on whether migrants are hospitalized at a higher or lower extent. However, migrants tend to access EDs for less urgent conditions, lack a referral from a GP and access the ED as walk-ins more frequently. Migrants are also discharged against medical advice more often compared to non-migrants. Findings of this systematic review suggest that migrants' access to care is hindered by language barriers, poor insurance coverage, lack of entitlement to a GP, and lack of knowledge of the local healthcare system.
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Affiliation(s)
- Giulia Acquadro-Pacera
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Universià del Piemonte Orientale, Novara, 28100, Italy
| | - Martina Valente
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Universià del Piemonte Orientale, Novara, 28100, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, 13100, Italy
| | - Giulia Facci
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Universià del Piemonte Orientale, Novara, 28100, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, 28100, Italy
| | | | - Francesco Della Corte
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Universià del Piemonte Orientale, Novara, 28100, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, 28100, Italy
| | - Francesco Barone-Adesi
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Universià del Piemonte Orientale, Novara, 28100, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, 28100, Italy
| | - Luca Ragazzoni
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Universià del Piemonte Orientale, Novara, 28100, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, 13100, Italy
| | - Monica Trentin
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Universià del Piemonte Orientale, Novara, 28100, Italy.
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, 28100, Italy.
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Li K, Thaweesee N, Kimmel A, Dorward E, Dam A. Barriers and facilitators to utilizing HIV prevention and treatment services among migrant youth globally: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002851. [PMID: 38354206 PMCID: PMC10866458 DOI: 10.1371/journal.pgph.0002851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/04/2024] [Indexed: 02/16/2024]
Abstract
Both migrants and young people experience disproportionately high rates of HIV acquisition and poor access to HIV prevention and treatment services. To develop effective interventions and reach epidemic control, it is necessary to understand the barriers and facilitators to accessing HIV services among migrant youth. We conducted a scoping review to identify these factors for migrant youth ages 15-24, globally. We conducted a PRISMA-concordant scoping review using keyword searches in PUBMED and Web of Science for peer-reviewed primary literature published between January 2012 and October 2022. We included studies that investigated barriers and facilitators to accessing services for migrant youth participants. We used the Socio-Ecological Model as an analytical framework. The 20 studies meeting the inclusion criteria spanned 10 countries, of which 80% (n = 16) were low- and middle-income countries. Study methods included were quantitative (40%), qualitative (55%), and mixed methods (5%). Six studies included refugee youth (30%), 6 included migrant worker youth (30%), 3 included immigrant youth (15%), 2 included rural migrant youth (10%), and 1 included immigrants and refugees. The remainder represented unspecified migrant youth populations (10%). At the individual level, education level and fear of infection acted as barriers and facilitators to HIV services. At the relationship level, social support and power in relationships acted as barriers and facilitators to HIV services. At the community level, barriers to HIV services included discrimination and stigma, while community and religious outreach efforts facilitated access to HIV services. At the structural level, barriers to HIV services included stigmatizing social norms, lack of health insurance, and legal barriers. Migrant youth face significant, unique barriers to accessing HIV services. However, facilitators exist that can be leveraged to enable access. Future implementation science research, enabling policies, and adapted programmatic interventions should prioritize migrant youth as a distinctive sub-population to receive targeted HIV services.
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Affiliation(s)
- Kevin Li
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- STAR, Public Health Institute, Washington, District of Columbia, United States of America
| | - Natasha Thaweesee
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, United States of America
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, United States of America
- GHTASC, Credence LLC, Washington, District of Columbia, United States of America
| | - Allison Kimmel
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, United States of America
- STAR, Public Health Institute, Washington, District of Columbia, United States of America
| | - Emily Dorward
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, United States of America
| | - Anita Dam
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, United States of America
- GHTASC, Credence LLC, Washington, District of Columbia, United States of America
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Eick F, Vallersnes OM, Fjeld HE, Sørbye IK, Ruud SE, Dahl C. Use of emergency primary care among pregnant undocumented migrants over ten years: an observational study from Oslo, Norway. Scand J Prim Health Care 2023; 41:317-325. [PMID: 37485974 PMCID: PMC10478594 DOI: 10.1080/02813432.2023.2237074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 07/11/2023] [Indexed: 07/25/2023] Open
Abstract
OBJECTIVE To compare consultations with pregnant undocumented migrants at emergency primary health care to consultations with pregnant residents of Norway. DESIGN A cross-sectional study of consultations at several time points. SETTING The study was conducted at the Oslo Accident and Emergency Outpatient Clinic (OAEOC), the main emergency primary care service in Oslo, Norway. SUBJECTS Consultations with pregnant patients without a Norwegian identity number seeking care at the Department of Emergency General Practice at the OAEOC were identified through a manual search of registration lists from 2009 to 2019. The consultations were categorized by women's residency status as 'probably documented migrant', 'uncertain migrant status', or 'probably undocumented migrant'. We also extracted aggregated data for women with a Norwegian identity number (i.e. residents) presenting in consultations with pregnancy-related (ICPC-2 chapter W) conditions. MAIN OUTCOME MEASURES Manchester Triage System urgency level at presentation, and hospitalization. RESULTS Among 829 consultations with female patients categorized as probably undocumented migrants, we found 27.1% (225/829) with pregnant women. About half of the pregnant women (54.6% (123/225)) presented with a pregnancy-related condition. Pregnant women that were probably undocumented migrants had an increased risk of being triaged with a high level of urgency at presentation (relative risk (RR) 1.86, 95% CI 1.14-3.04) and being hospitalized (RR 1.68, 95% CI 1.21-2.34), compared to pregnant residents. CONCLUSION Pregnant undocumented migrants were more severely sick when presenting to emergency primary care services than pregnant residents. Increased access to primary care and emergency primary care services for pregnant undocumented migrants is urgently needed.
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Affiliation(s)
- Frode Eick
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Odd Martin Vallersnes
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Oslo Accident and Emergency Outpatient Clinic, Department of Emergency General Practice, City of Oslo Health Agency, Oslo, Norway
| | - Heidi E. Fjeld
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ingvil Krarup Sørbye
- Department of Obstetrics, Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Sven Eirik Ruud
- Oslo Accident and Emergency Outpatient Clinic, Department of Emergency General Practice, City of Oslo Health Agency, Oslo, Norway
| | - Cecilie Dahl
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Koh VTJ, Ong RHS, Chow WL, Tiah L, Oh HC, Yow WQ, Sharma S, Huat Yap JC. Understanding patients' health-seeking behaviour for non-emergency conditions: a qualitative study. Singapore Med J 2023:384043. [PMID: 37675670 DOI: 10.4103/singaporemedj.smj-2020-494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Affiliation(s)
| | | | - Wai Leng Chow
- Epidemiology and Disease Control, Ministry of Health, Singapore
| | - Ling Tiah
- Accident and Emergency Department, Changi General Hospital, Singapore
| | - Hong Choon Oh
- Health Services Research, Changi General Hospital, Singapore
| | - Wei Quin Yow
- Humanities Arts and Social Sciences, Singapore University of Technology and Design, Singapore
| | - Shrutivandana Sharma
- Engineering Systems and Design, Singapore University of Technology and Design, Singapore
| | - Jason Chin Huat Yap
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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McIntyre A, Janzen S, Shepherd L, Kerr M, Booth R. An integrative review of adult patient-reported reasons for non-urgent use of the emergency department. BMC Nurs 2023; 22:85. [PMID: 36991388 DOI: 10.1186/s12912-023-01251-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE To conduct an integrative review of the scientific literature to explore adult patient-reported reasons for using the emergency department (ED) non-urgently. METHOD A literature search of CINAHL, Cochrane, Embase, PsycINFO, and MEDLINE was conducted with filters for humans, published January 1, 1990-September 1, 2021, and English language. Methodological quality was assessed using Critical Appraisal Skills Programme Qualitative Checklist for qualitative and National Institutes Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies for quantitative studies. Data was abstracted on study and sample characteristics, and themes/reasons for ED use. Cited reasons were coded using thematic analysis. RESULTS Ninety-three studies met inclusion criteria. Seven themes were found: need to be risk averse with respect to the health issue; knowledge and awareness of alternative sources of care; dissatisfaction with primary care provider; satisfaction with ED; ED accessibility and convenience resulting in low access burden; referred to the ED by others; and relationships between patients and health care providers. DISCUSSION This integrative review examined patient-reported reasons for attending the ED on a non-urgent basis. The results suggest that ED patients are heterogenous and many factors influence their decision-making. Considering the complexity with which patients live, treating them as a single entity may be problematic. Limiting excessive non-urgent visits likely requires a multi-pronged approach. CONCLUSION For many ED patients, they have a very clear problem which needed to be addressed. Future studies should explore psychosocial factors driving decision-making (e.g., health literacy, health-related personal beliefs, stress and coping ability).
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Affiliation(s)
- Amanda McIntyre
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, Canada.
- Department of Emergency Medicine, University Hospital, London Health Sciences Centre, London, Canada.
| | | | - Lisa Shepherd
- Department of Emergency Medicine, University Hospital, London Health Sciences Centre, London, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Mickey Kerr
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, Canada
| | - Richard Booth
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, Canada
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Kalanlar B, Öner M. Emergency calls from migrants to an emergency call centre: A retrospective epidemiological study. Int J Health Plann Manage 2023. [PMID: 36965121 DOI: 10.1002/hpm.3638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 02/25/2023] [Accepted: 03/17/2023] [Indexed: 03/27/2023] Open
Abstract
OBJECTIVE The study aims to evaluate migrants' inclination to call emergency call centres. Records of calls made to an emergency call centre by migrants of different age groups and nationalities were reviewed retrospectively. MATERIALS AND METHODS A total of 4481 emergency call records from migrants of 33 different nationalities was evaluated between 2017 and 2021. RESULTS Migrants called the emergency call centres mostly for medical reasons, and most of their calls resulted in referrals to hospitals. Pain, fever, nausea, and vomiting were among the most common medical reasons for emergency calls. The majority of the calls were in the green triage category, and the calls spread over the week. CONCLUSION The results showed that migrants use emergency call services in non-emergency situations. The study recommended enhancing migrants' knowledge of when and how to utilise emergency call centres and making health planning to meet their specific needs.
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Affiliation(s)
- Bilge Kalanlar
- Department of Public Health Nursing, Hacettepe University Faculty of Nursing, Ankara, Turkey
| | - Mücahide Öner
- Department of Public Health Nursing, Hacettepe University Faculty of Nursing, Ankara, Turkey
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Loer AKM, Koschollek C, Hövener C. Investigating associated factors of primary and specialist health care utilization among people with selected nationalities: results of a multilingual survey in two German federal states. BMC Health Serv Res 2022; 22:1050. [PMID: 35978356 PMCID: PMC9382615 DOI: 10.1186/s12913-022-08419-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately every fourth person in Germany has a migration background. Health research on the use of primary and specialist health care in this group is still scarce. Few studies have suggested a difference in the use of primary and specialist health care among people with a migration background. Potential resources and barriers to health care access should be investigated as they are critical to health equity. This study investigates associated sociodemographic, migration-sensitive, and health-related factors of primary and specialist health care utilization among people with a migration background as defined by nationality. METHODS Analyses are based on data from a feasibility study of the project "Improving Health Monitoring in Migrant Populations" (IMIRA), conducted by the Robert Koch Institute. The sample (n = 1055) included persons with Croatian, Polish, Romanian, Syrian, and Turkish nationalities living in the federal states of Berlin and Brandenburg, Germany. Descriptive and bivariate analyses as well as multiple binary logistic regression analyses were carried out to assess sociodemographic (sex, age, socioeconomic position), health-related (self-rated health), and migration-sensitive factors (duration of residence in Germany, residence status, German language proficiency) associated with the use of primary and specialist health care services in the past 12 months. RESULTS Of the total study population, 79.62% visited a general practitioner and 59.53% a specialized physician in the past 12 months. Participants who were female sex, aged 65 and older, and with moderate/poor/very poor self-rated health had higher odds of visiting a general practitioner and a specialized physician, with the strongest impact from self-rated health. After controlling for sociodemographic and health-related factors, duration of residence in Germany and residence status were associated with primary but not with specialist health care utilization. CONCLUSIONS Our results suggest that migration-sensitive characteristics, such as duration of residence, should be considered in a differentiated manner in health services research to gain detailed insights into health care utilization and its potential barriers among the heterogenous group of people with a migration background. Further research needs to be done to evaluate how to get people into contact with a general practitioner.
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Affiliation(s)
- Anne-Kathrin M Loer
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany.
| | - Carmen Koschollek
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany
| | - Claudia Hövener
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany
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Di Napoli A, Ventura M, Spadea T, Giorgi Rossi P, Bartolini L, Battisti L, Cacciani L, Caranci N, Cernigliaro A, De Giorgi M, Fanolla A, Lazzeretti M, Mininni M, Mirisola C, Petrelli A. Barriers to Accessing Primary Care and Appropriateness of Healthcare Among Immigrants in Italy. Front Public Health 2022; 10:817696. [PMID: 35223739 PMCID: PMC8864157 DOI: 10.3389/fpubh.2022.817696] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The health status and health care needs of immigrant populations must be assessed. The aim of this study was to evaluate barriers to accessing primary care and the appropriateness of health care among resident immigrants in Italy, using indicators regarding maternal health, avoidable hospitalization, and emergency care. METHODS Cross-sectional study using some indicators of the National Monitoring System of Health Status and Healthcare of the Immigrant Population (MSHIP), coordinated by the National Institute for Health, Migration and Poverty (INMP), calculated on perinatal care, hospital discharge, and emergency department databases for the years 2016-2017 in nine Italian regions (Piedmont, Trento, Bolzano, Emilia-Romagna, Tuscany, Umbria, Latium, Basilicata, Sicily). The analyses were conducted comparing immigrant and Italian residents. RESULTS Compared to Italian women, immigrant women had fewer than five gynecological examinations (8.5 vs. 16.3%), fewer first examinations after the 12th week of gestational age (3.8 vs. 12.5%), and fewer than two ultrasounds (1.0 vs. 3.8%). Compared to Italians, immigrants had higher standardized rates (× 1,000 residents) of avoidable hospitalizations (males: 2.1 vs. 1.4; females: 0.9 vs. 0.7) and of access to emergency departments for non-urgent conditions (males: 62.0 vs. 32.7; females: 52.9 vs. 31.4). CONCLUSIONS In Italy, there appear to be major issues regarding accessing services and care for the immigrant population. Policies aimed at improving socioeconomic conditions and promoting integration can promote healthy lifestyles and appropriate access to health care, counteracting the emergence of health inequities in the immigrant population.
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Affiliation(s)
- Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), Roma, Italy
| | - Martina Ventura
- National Institute for Health, Migration and Poverty (INMP), Roma, Italy
| | - Teresa Spadea
- Epidemiology Unit, Local Health Unit TO3 Piedmont Region, Grugliasco, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Reggio Emilia, Italy
| | - Letizia Bartolini
- Epidemiology Unit, Azienda Unità Sanitaria Locale - Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Reggio Emilia, Italy
| | - Laura Battisti
- Epidemiological Observatory, Public Health Department - Local Health Unit, Trento, Italy
| | - Laura Cacciani
- Department of Epidemiology of the Lazio Regional Health Service, Roma, Italy
| | | | - Achille Cernigliaro
- Health Authority Sicily Region and Local Authority Trapani Province, Palermo, Italy
| | - Marcello De Giorgi
- Umbria Digitale - Health Information and Communication Technology Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Antonio Fanolla
- Provincial Government South Tyrol, Observatory for Health, Bolzano, Italy
| | | | | | - Concetta Mirisola
- National Institute for Health, Migration and Poverty (INMP), Roma, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Roma, Italy
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Explaining variation in health information seeking behaviour - Insights from a multilingual survey. Health Policy 2021; 125:618-626. [PMID: 33579562 DOI: 10.1016/j.healthpol.2021.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/04/2021] [Accepted: 01/19/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE How best to provide an increasingly diverse population with health information has become a major concern for health policy makers in Europe and beyond. Our study aims to investigate factors explaining variation in people's health information seeking behaviour. Our findings can be used to identify target groups for policy interventions that aim to provide health information efficiently. METHODS Cross-sectional, paper-based, multilingual survey of a random sample of enrolees of two statutory health insurers in Hamburg, Germany. Data were collected from September to December 2017. Multivariable logistic regression was used to examine sociodemographic and health-related individual characteristics and their associations with participants' choice of ten sources of health information. FINDINGS Participants' choice of information sources differed significantly across the following sociodemographic and health-related characteristics: age, gender, immigration status, education, employment status, marital status and general state of health. Immigrants and individuals with low educational attainment were most likely to use emergency departments as sources of health information. CONCLUSION Policy interventions aiming to manage the use of health information sources should focus on immigrants and individuals with low educational attainment. Providing multilingual, low-threshold counselling and information services could be an efficient way to reduce short-term costs of health information seeking behaviour to health insurers or other payers of care while improving patient empowerment.
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Evaluation of winter pressures on general practice in Manchester: a cross-sectional analysis of nine GP practices. BJGP Open 2020; 5:bjgpopen20X101138. [PMID: 33199311 PMCID: PMC7960527 DOI: 10.3399/bjgpopen20x101138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/28/2020] [Indexed: 12/30/2022] Open
Abstract
Background The Nuffield Trust’s report on NHS winter pressures highlights a lack of data for primary care, with a consequential focus on secondary care. An increase in data is required on the scale of the winter demand on primary care, so the need for investment in this area can be clearly seen. Aim To quantify seasonal variation in workload in primary and secondary care. Design & setting Analysis of data for nine GP practices in Greater Manchester with a patient population of 75 421. Method Descriptive and comparative analyses were performed for winter and summer periods in 2018–2019. Data were obtained from the North of England Clinical Support Unit (NECSU) via the Rapid Actionable Insight Driving Reform (RAIDR) toolkit, and EMIS Enterprise clinical audit tools. Results Accident and emergency (A&E) attendances increased by 4% (P = 0.035) during winter with no difference in the number of hospital admissions (P = 0.668). The number of problems (defined as separate diagnoses or causes for a GP consultation, for example, chest infection or medication request) seen in general practice increased by 61% (P<0.001) in winter compared to summer, as did the number of GP consultations, which was also 61% (P<0.001). Respiratory diagnoses saw the greatest seasonal variation accounting for 10% in winter compared with 4% in summer (P<0.001). Self-referral accounted for 66% of all A&E attendance and increased by 16% in winter. GP referral accounted for 7% in winter and 6% in summer (P = 0.002). Conclusion General practice observed a greater seasonal increase in presenting patients compared with secondary care. Any winter pressures strategy should target both respiratory illness and patients who self-refer to A&E. Transferring 50% of self-referrals in Manchester to GP appointments would achieve a £2.3 million cost saving. Increasing provision in primary care requires funding and increased appointments, but more importantly improved patient opportunities to easily access timely advice and assistance.
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Ohm E, Holvik K, Kjøllesdal MKR, Madsen C. Health care utilisation for treatment of injuries among immigrants in Norway: a nationwide register linkage study. Inj Epidemiol 2020; 7:60. [PMID: 33190634 PMCID: PMC7667780 DOI: 10.1186/s40621-020-00286-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/01/2020] [Indexed: 11/25/2022] Open
Abstract
Background Previous research has generally found lower rates of injury incidence in immigrant populations than in native-born populations. Most of this literature relies on mortality statistics or hospital data, and we know less about injuries treated in primary health care. The aim of the present study was to assess use of primary and secondary care for treatment of injuries among immigrants in Norway according to geographic origin and type of injury. Methods We conducted a nationwide register-based cohort study of all individuals aged 25–64 years who resided in Norway as of January 1st 2008. This cohort was followed through 2014 by linking sociodemographic information and injury data from primary and secondary care. We grouped immigrants into six world regions of origin and identified immigrants from the ten most frequently represented countries of origin. Six categories of injury were defined: fractures, superficial injuries, open wounds, dislocations/sprains/strains, burns and poisoning. Poisson regression models were fitted to estimate incidence rate ratios separately for injuries treated in primary and secondary care according to immigrant status, geographic origin and type of injury, with adjustment for sex, age, county of residence, marital status and socioeconomic status. Results Immigrants had a 16% lower incidence of injury in primary care than non-immigrants (adjusted IRR = 0.84, 95% CI 0.83–0.84), and a 10% lower incidence of injury in secondary care (adjusted IRR = 0.90, 95% CI 0.90–0.91). Immigrants from Asia, Africa and European countries outside EU/EEA had lower rates than non-immigrants for injuries treated in both primary and secondary care. Rates were lower in immigrants for most injury types, and in particular for fractures and poisoning. For a subset of injuries treated in secondary care, we found that immigrants had lower rates than non-immigrants for treatment of self-harm, falls, sports injuries and home injuries, but higher rates for treatment of assault, traffic injuries and occupational injuries. Conclusions Health care utilisation for treatment of injuries in primary and secondary care in Norway was lower for immigrants compared to non-immigrants. Incidence rates were especially low for immigrants originating from Asia, Africa and European countries outside EU/EEA, and for treatment of fractures, poisoning, self-harm and sports injuries.
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Affiliation(s)
- Eyvind Ohm
- Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway.
| | - Kristin Holvik
- Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway
| | | | - Christian Madsen
- Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway
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de Montgomery CJ, Petersen JH, Jervelund SS. Psychiatric healthcare utilisation among refugee adolescents and their peers in Denmark. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1457-1468. [PMID: 32409884 DOI: 10.1007/s00127-020-01878-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 05/02/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the psychiatric healthcare utilisation of refugees vis-à-vis their peers in Denmark during the ages 15-22. METHODS This paper utilises comprehensive full-population registry data from 1995 to 2016 to explore the psychiatric healthcare utilisation during the transition from childhood to adulthood for refugees (N = 13,027), a comparison group of children of labour migrants from Morocco, Pakistan, and Turkey (N = 13,413), and the majority population (N = 693,043) in Denmark. To test for population differences in types of admission for particular types of disorders, odds ratios for a first contact during ages 15-22 were calculated using logistic regression. For those with at least one diagnosis-specific hospital contact, differences in the amount and type of treatment were tested using negative binomial regression to estimate means ratios of days hospitalised, days in outpatient care, number of outpatient contacts, consultations with psychiatrists in private practice, and prescribed medicine purchases. RESULTS Refugees and the comparison group were generally less likely than the majority population to have a first contact for most disorders (adjusted ORs 0.03-0.88), but not for schizophrenia for boys (adjusted ORs 0.92-2.13). Among those who did have a first contact, youths from the ethnic minority groups tended to have more or similar inpatient and emergency room contacts (MRs 0.89-2.10), hospitalisations of refugee girls being an exception (MR 0.46; CI [0.23-0.94]), but fewer outpatient contacts, consultations with psychiatrists in private practice, and prescribed medicine purchases (MRs 0.23-0.94). CONCLUSIONS The results suggest that refugee and other ethnic minority groups may face barriers both to initial contact and to completing adequate treatment beyond the first contact.
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Affiliation(s)
- Christopher J de Montgomery
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.
| | - J H Petersen
- Section of Bio-Statistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - S S Jervelund
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
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Klingberg K, Stoller A, Müller M, Jegerlehner S, Brown AD, Exadaktylos A, Jachmann A, Srivastava D. Asylum Seekers and Swiss Nationals with Low-Acuity Complaints: Disparities in the Perceived level of Urgency, Health Literacy and Ability to Communicate-A Cross-Sectional Survey at a Tertiary Emergency Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082769. [PMID: 32316445 PMCID: PMC7215914 DOI: 10.3390/ijerph17082769] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 12/28/2022]
Abstract
Background: Emergency departments (EDs) are being increasingly used for low-acuity conditions and as primary care providers. Research indicates that patients with the status of asylum seeker (AS) may be seeking care in EDs at higher levels than nationals. The aim of this study was to identify disparities in the use of emergency care between AS and Swiss nationals (SN) with non-urgent complaints. Methods: Data were obtained from a survey in the period 01/12/2016–31/07/2017 of walk-in low-acuity patients attending the ED of the University Hospital Bern (Switzerland). AS and a gender, age-matched control group of SN of ≥16 years of age were included. Sociodemographic and survey data comprised information about health-seeking behavior in the home and reception country, knowledge of health care systems (HCSs), barriers to care and perceived acuity of the visit. Furthermore, attending physicians assessed the level of urgency of each case. Results: Among AS patients, 30.2% reported that they had no knowledge of the Swiss HCS. In total, 14.2% considered that their medical needs were non-urgent. On the other hand, 43.4% of the attending physicians in the ER considered that the medical needs were non-urgent. This contrast was less pronounced in SN patients. The majority of AS (63.2%) and SN (67.6%) patients sought care from the ED without first contacting a GP. In 53.8% of cases, an interpreter was needed during the ED consultation. Conclusions: Several factors associated with health-seeking behavior in the ED differed between AS and SN patients. Measures to increase health literacy, provision of easily accessible primary care services and intercultural-trained staff could improve quality of care and reduce the usage of EDs as primary care providers.
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Affiliation(s)
- Karsten Klingberg
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
| | - Adrian Stoller
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
| | - Martin Müller
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
| | - Sabrina Jegerlehner
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
- Accident & Emergency, Barts Health NHS Trust, London EC1A 7BE, UK
| | - Adam D. Brown
- Department of Psychology, New School of Social Research, New York, NY 10011, USA;
| | - Aristomenis Exadaktylos
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
| | - Anne Jachmann
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
| | - David Srivastava
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
- Correspondence:
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Paediatric emergency department utilisation rates and maternal migration status in the Born in Bradford cohort: A cross-sectional study. PLoS Med 2020; 17:e1003043. [PMID: 32126079 PMCID: PMC7053707 DOI: 10.1371/journal.pmed.1003043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/29/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Globally, international migration is increasing. Population growth, along with other demographic changes, may be expected to put new pressures on healthcare systems. Some studies across Europe suggest that emergency departments (EDs) are used more, and differently, by migrants compared to non-migrant populations, which may be a result of unfamiliarity with the healthcare systems and difficulties accessing primary healthcare. However, little evidence exists to understand how migrant parents, who are typically young and of childbearing age, utilise EDs for their children. This study aimed to examine the association between paediatric ED utilisation in the first 5 years of life and maternal migration status in the Born in Bradford (BiB) cohort study. METHODS AND FINDINGS We analysed linked data from the BiB study-an ongoing, multi-ethnic prospective birth cohort study in Bradford. Bradford is a large, ethnically diverse city in the north of England. In 2017, more than a third of births in Bradford were to mothers who were born outside the UK. Between March 2007 and December 2010, pregnant women were recruited to BiB during routine antenatal care, and the children born to these mothers have been, and continue to be, followed over time to assess how social, genetic, environmental, and behavioural factors impact on health from childhood to adulthood. Data analysed in this study included baseline questionnaire data from BiB mothers, and Bradford Royal Infirmary ED episode data for their children. Main outcomes were likelihood of paediatric ED use (no visits versus at least 1 ED visit in the first 5 years of life) and ED utilisation rates (number and frequency of ED visits) for children who have accessed the ED. The main explanatory variable was mother's migrant status (foreign-born versus UK/Irish-born). Multivariable analyses (logistic and zero-truncated negative binomial regression) were conducted adjusting for socio-demographic and socio-economic factors. The final dataset included 10,168 children born between April 2007 and June 2011, of whom 35.6% were born to migrant mothers. Foreign-born mothers originated from South Asia (28.6%), Europe/Central Asia (3.2%), Africa (2.1%), East Asia/Pacific (1.1%), and the Middle East (0.6%). At recruitment the mothers ranged in age from 15 to 49 years old. Overall, 3,104 (30.5%) children had at least 1 ED visit in the first 5 years of life, with the highest proportion of visits being in the first year of life (36.7%). The proportion of children who visited the ED at least once was lower for children of migrant mothers as compared to children of non-migrant mothers (29.4% versus 31.2%). Children of migrant mothers were found to be less likely to visit the ED (odds ratio 0.88 [95% CI 0.80 to 0.97], p = 0.012). However, among children who visited the ED, the utilisation rate was significantly higher for children of migrant mothers (incidence rate ratio [IRR] 1.19 [95% CI 1.01 to 1.40], p = 0.040). Utilisation rates were higher for children born to mothers from Europe (IRR 1.71 [95% CI 1.07 to 2.71], p = 0.024) and established migrants (≥5 years living in UK) (IRR 1.24 [95% CI 1.02 to 1.51], p = 0.032) compared to UK/Irish-born mothers. Important limitations include being unable to measure children's underlying health status and the urgency of ED attendance, as well as the analysis being limited by missing data. CONCLUSIONS In this study we observed that there is no higher likelihood of first paediatric ED attendance in the first 5 years of life for children in the BiB cohort for migrant mothers. However, among ED users, children of migrant mothers attend the service more frequently than children of UK/Irish-born mothers. Our findings show that patterns of ED utilisation differ by mother's region of origin and time since arrival in the UK.
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Lichtl C, Bozorgmehr K. Effects of introducing a walk-in clinic on ambulatory care sensitive hospitalisations among asylum seekers in Germany: a single-centre pre-post intervention study using medical records. BMJ Open 2019; 9:e027945. [PMID: 31806604 PMCID: PMC6924737 DOI: 10.1136/bmjopen-2018-027945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Measuring the effect of introducing a walk-in clinic on ambulatory care sensitive (ACS) hospitalisations among asylum seekers in a large state reception- and registration centre. DESIGN AND SETTING Pre-post intervention study using anonymous account data from a university hospital functioning as referral facility for a state reception- and registration centre in the third largest German federal state. PARTICIPANTS We included all asylum seekers residing in the reception centre and admitted to the referral hospital between 2015 to 2017. INTERVENTIONS Establishment of an interdisciplinary walk-in clinic in the reception centre (02/2016). MAIN OUTCOME MEASURES International lists for ACS conditions for both adults and children were adapted and used to calculate the prevalence of ACS conditions among the population (primary outcome measure). The impact of the intervention on the outcome was analysed using a segmented Poisson regression to calculate incidence-rate ratios with respective 95% CIs, adjusted for age, sex and admission. RESULTS The prevalence of ACS hospitalisations changed over time, as did the effect of age, sex and quarter of admission. Introducing the walk-in clinic reduced the prevalence of ACS hospitalisations among asylum seekers compared with the period before establishment of the clinic (incidence-rate ratios (IRR)=0.80 (0.65 to 1.00), p=0.054), but the effect was attenuated after adjustment for time trends. The average difference in prevalence of ACS hospitalisations compared with the period before establishment of the clinic, corrected for pre-existing time trends, age and sex of asylum seekers was IRR=1.03 ((0.69 to 1.55), p=0.876). CONCLUSIONS A walk-in clinic in reception centres may be effective to reduce ACS hospitalisations, but our study could not prove evidence for a measurable effect after full adjustment for time trends. Further research, ideally with parallel control groups, is required to establish evidence for the effectiveness of walk-in clinics in reception centres on reducing ACS hospitalisations.
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Affiliation(s)
- Celina Lichtl
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
- Institute of General Practice and Family Medicine, Ludwig Maximilians University Munich, Munich, Germany
| | - Kayvan Bozorgmehr
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
- Department of Population Medicine and Health Services Research, School of Publilc Health, Bielefeld University, Bielefeld, Germany
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Profile and Motivation of Patients Consulting in Emergency Departments While not Requiring Such a Level of Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224431. [PMID: 31726697 PMCID: PMC6888183 DOI: 10.3390/ijerph16224431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/02/2019] [Accepted: 11/04/2019] [Indexed: 01/18/2023]
Abstract
Consultations that do not require an emergency department (ED) level of care have increased. We explored attitudes of non-urgent patients in two academic hospitals in France with a similar fast track organization. One of them is a Parisian hospital with 90,000 patients/year who are admitted to the ED, while the other admits 40,000 patients/year in a smaller city. During one month in 2018, the triage nurse handed out a survey to patients coming for non-urgent consultations. It was given back to the fast track physician at the end of the visit; 598 patients agreed to answer. They were mostly young males with adequate social coverage, consulting for osteo-articular pathologies, without any significant difference between the two sites (p = 0.32). They were equally satisfied with the care they received (p = 0.38). Satisfaction was inversely correlated to waiting time (p < 0.0001). Convenience, accessibility of emergency facilities, and geographic proximity were motivation factors. These results suggest that primary care providers who can access testing facilities in accordance with patient needs might be a solution to help reduce overcrowding in EDs.
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Fernández-Niño JA, Vásquez-Rodríguez AB, Flórez-García VA, Rojas-Botero ML, Luna-Orozco K, Navarro-Lechuga E, Acosta-Reyes JL, Rodríguez Pérez DA. [Lifestyles and health status of migrants in a settlement of Barranquilla, Colombia, 2018]. ACTA ACUST UNITED AC 2019; 20:530-538. [PMID: 30843992 DOI: 10.15446/rsap.v20n4.75773] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/10/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the lifestyles and health status of returning Venezuelan and Colombian migrants in Villa Caracas, Barranquilla, in 2018. METHODS Descriptive, cross-sectional study with systematic sampling of dwellings. 229 people over 15 years of age from 90 homes were included. RESULTS Differences were found in the routes to arrive, commuting times and stay in the settlement between Venezuelan and returning Colombian migrants. Housing conditions and access to public services are limited: less than half of the dwellings have access to aqueduct, sewerage and bathrooms. In general, self-reported health status of migrants is very good or good and the prevalence of noncommunicable diseases was relatively low, with the exception of high blood pressure. Most of the people who consulted the emergency department reported effective access. Clinically significant depressive symptoms were found in 20% of the surveyed population. CONCLUSIONS The migrants of Villa Caracas are under high social vulnerability conditions given their economic and environmental conditions. Despite their lack of enrollment in the Colombian health system, they reported access to emergency care.
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Affiliation(s)
- Julián A Fernández-Niño
- JF: MD. M. Sc. Salud Pública; M. Sc. Bioestadística Ph. D. Epidemiología. Departamento de Salud Pública, Universidad del Norte. Barranquilla, Colombia.
| | - Ana B Vásquez-Rodríguez
- AV: Enfermería. M. Sc. Infecciones y Salud en el Trópico. Facultad de Medicina, Universidad Nacional de Colombia. Bogotá, Colombia.
| | - Víctor A Flórez-García
- VF: Biología. M. Sc. Epidemiología. Departamento de Salud Pública, Universidad del Norte. Barranquilla, Colombia.
| | - Maylen L Rojas-Botero
- MR: Gerencia en Sistemas de Información en Salud. M. Sc. Epidemiología; Ph. D.(c) Epidemiología. Facultad Nacional de Salud Pública, Universidad de Antioquia. Medellín, Colombia.
| | - Karen Luna-Orozco
- KL: MD. Esp. Medicina Interna. Departamento de Salud Pública, Universidad del Norte. Barranquilla, Colombia.
| | - Edgar Navarro-Lechuga
- EN: MD. M. Sc. Epidemiología. Departamento de Salud Pública, Universidad del Norte. Barranquilla, Colombia.
| | - Jorge L Acosta-Reyes
- JA: MD. M. Sc. Epidemiología Clínica. Departamento de Salud Pública, Universidad del Norte. Barranquilla, Colombia.
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Credé SH, Such E, Mason S. International migrants' use of emergency departments in Europe compared with non-migrants' use: a systematic review. Eur J Public Health 2019; 28:61-73. [PMID: 28510652 DOI: 10.1093/eurpub/ckx057] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background International migration across Europe is increasing. High rates of net migration may be expected to increase pressure on healthcare services, including emergency services. However, the extent to which immigration creates additional pressure on emergency departments (EDs) is widely debated. This review synthesizes the evidence relating to international migrants' use of EDs in European Economic Area (EEA) countries as compared with that of non-migrants. Methods MEDLINE, EMBASE, CINAHL, The Cochrane Library and The Web of Science were searched for the years 2000-16. Studies reporting on ED service utilization by international immigrants, as compared with non-migrants, were eligible for inclusion. Included studies were restricted to those conducted in EEA countries and English language publications only. Results Twenty-two articles (from six host countries) were included. Thirteen of 18 articles reported higher volume of ED service use by immigrants, or some immigrant sub-groups. Migrants were seen to be significantly more likely to present to the ED during unsocial hours and more likely than non-migrants to use the ED for low-acuity presentations. Differences in presenting conditions were seen in 4/7 articles; notably a higher rate of obstetric and gynaecology presentations among migrant women. Conclusions The principal finding of this review is that migrants utilize the ED more, and differently, to the native populations in EEA countries. The higher use of the ED for low-acuity presentations and the use of the ED during unsocial hours suggest that barriers to primary healthcare may be driving the higher use of these emergency services although further research is needed.
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Affiliation(s)
- Sarah H Credé
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Elizabeth Such
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Suzanne Mason
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Ellbrant J, Åkeson J, Eckner J, Karlsland Åkeson P. Influence of social characteristics on use of paediatric emergency care in Sweden - a questionnaire based study. BMC Emerg Med 2018; 18:59. [PMID: 30587134 PMCID: PMC6307227 DOI: 10.1186/s12873-018-0210-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 12/06/2018] [Indexed: 11/28/2022] Open
Abstract
Background Parental social characteristics influence the use of emergency departments (ED) in the USA, but less is known about paediatric ED care-seeking in countries with national health insurance. This prospective study was designed to evaluate associations between parental care-seeking and social characteristics, with emphasis on impact of non-native origin, at a paediatric ED in Sweden, a European country providing paediatric healthcare free of charge. Methods Parents attending a paediatric ED at a large urban university hospital filled out a questionnaire on social characteristics and reasons for care-seeking. Information on patient characteristics and initial management was obtained from ED registers and patient records. Paediatric ED physicians assessed the medical appropriateness of each patient visit triaged for ED care. Results In total, 962 patient visits were included. Telephone healthline service before the paediatric ED visit was less often used by non-native parents (63/345 vs. 249/544, p < 0.001). Low-aquity visits, triaged away from the ED, were more common among non-native parents (80/368 vs. 67/555, OR = 1.66; p = 0.018), and among those reporting lower abilities in the Swedish language (23/82 vs. 120/837, OR = 2.66; p = 0.003). Children of non-native parents were more often assessed by physicians not to require ED care (122/335 vs. 261/512, OR = 0.70; p = 0.028). Conclusions This study confirms more direct and less urgent use of paediatric ED care by parents of non-native origin or with limited abilities in the Swedish language, proposing that parental social characteristics influence paediatric ED care-seeking, also in a country with healthcare free of charge, and that specific needs of these groups should be better met by prehospital medical services. Electronic supplementary material The online version of this article (10.1186/s12873-018-0210-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Ellbrant
- Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, SE-20502, Malmö, Sweden. .,Department of Clinical Sciences Malmö, Surgery, Lund University, Skåne University Hospital, Jan Waldenströms gata 11 A, SE-20502, Malmö, Sweden.
| | - Jonas Åkeson
- Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, SE-20502, Malmö, Sweden
| | - Jenny Eckner
- Department of Clinical Sciences Malmö, Surgery, Lund University, Skåne University Hospital, Jan Waldenströms gata 11 A, SE-20502, Malmö, Sweden
| | - Pia Karlsland Åkeson
- Department of Clinical Sciences Malmö, Paediatrics, Lund University, Skåne University Hospital, SE-20502, Malmö, Sweden
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Tillmann J, Puth MT, Frank L, Weckbecker K, Klaschik M, Münster E. Determinants of having no general practitioner in Germany and the influence of a migration background: results of the German health interview and examination survey for adults (DEGS1). BMC Health Serv Res 2018; 18:755. [PMID: 30285753 PMCID: PMC6171288 DOI: 10.1186/s12913-018-3571-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is aspired in the German healthcare system that general practitioners (GPs) act as initial contact for patients and guide through at all steps of medical treatment. This study aims at identifying factors associated with the odds of having no GP within the general population and especially among people with migration background. METHODS This cross-sectional analysis was based on the "German Health Interview and Examination Survey for Adults" (DEGS1) conducted by the Robert Koch Institute. Descriptive analyses as well as multiple logistic regression models were performed to analyse the impact of a migration background, age, gender, residential area, socioeconomic status (SES) and other factors on having no GP among 7755 participants. RESULTS 9.5% of the total study population and 14.8% of people with a migration background had no GP, especially men, adults living in big cities and without chronic diseases. The odds of not having a GP were higher for people with a two-sided migration background (aOR: 1.90, 95% CI: 1.42-2.55). Among the population with a migration background, particularly young adults, men, people living in big cities and having a private health insurance showed higher odds to have no GP. CONCLUSIONS It is necessary to investigate the causes of the differing utilization of healthcare of people with a migration background and, if necessary, to take measures for an equal access to healthcare for all population groups. Further research needs to be done to evaluate how to get young people into contact with a GP.
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Affiliation(s)
- Judith Tillmann
- Institute of General Practice and Family Medicine, University of Bonn, 53127 Bonn, Germany
| | - Marie-Therese Puth
- Institute of General Practice and Family Medicine, University of Bonn, 53127 Bonn, Germany
- Department of Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital of Bonn, 53127 Bonn, Germany
| | - Laura Frank
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, 13353 Berlin, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Family Medicine, University of Bonn, 53127 Bonn, Germany
| | - Manuela Klaschik
- Institute of General Practice and Family Medicine, University of Bonn, 53127 Bonn, Germany
| | - Eva Münster
- Institute of General Practice and Family Medicine, University of Bonn, 53127 Bonn, Germany
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Keidar O, Jegerlehner SN, Ziegenhorn S, Brown AD, Müller M, Exadaktylos AK, Srivastava DS. Emergency Department Discharge Outcome and Psychiatric Consultation in North African Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15092033. [PMID: 30227686 PMCID: PMC6163756 DOI: 10.3390/ijerph15092033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/02/2018] [Accepted: 09/12/2018] [Indexed: 12/27/2022]
Abstract
Studies in Europe have found that immigrants, compared to the local population, are more likely to seek out medical care in Emergency Departments (EDs). In addition, studies show that immigrants utilize medical services provided by EDs for less acute issues. Despite these observed differences, little is known about the characteristics of ED use by North African (NA) immigrants. The main objective of this study was to examine whether there were differences in ED discharge outcomes and psychiatric referrals between NA immigrants and Swiss nationals. A retrospective analysis was conducted using patient records from NA and Swiss adults who were admitted to the ED of the University Hospital in Bern (Switzerland) from 2013–2016. Measures included demographic information as well as data on types of admission. Outcome variables included discharge type and psychiatric referral. A total of 77,619 patients generated 116,859 consultations to the ED, of which 1.1 per cent (n = 1338) were consultations by NA patients. Compared to Swiss national patients, NA patients were younger, with a median age of 38.0 (IQR 28–51 years vs. 52.0 (IQR 32–52) for Swiss and predominantly male (74.4% vs. 55.6% in the Swiss). NA patient admission type was more likely to be “walk-in” or legal admission (7.5% vs 0.8 in Swiss,). Logistic regressions indicated that NA patients had 1.2 times higher odds (95% CI 1.07–1.40, p < 0.003) of receiving ambulatory care. An effect modification by age group and sex was observed for the primary outcome “seen by a psychiatrist”, especially for men in the 16–25 years age group, whereby male NA patients had 3.45 times higher odds (95% CI: 2.22–5.38) of having being seen by a psychiatrist. In conclusion differences were observed between NA and Swiss national patients in ED consultations referrals and outcomes, in which NA had more ambulatory discharges and NA males, especially young, were more likely to have been seen by psychiatrist. Future studies would benefit from identifying those factors underlying these differences in ED utilization.
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Affiliation(s)
- Osnat Keidar
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
| | - Sabrina N Jegerlehner
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
| | - Stephan Ziegenhorn
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
| | - Adam D Brown
- Department of Psychology, New School for Social Research, New York, NY 10011, USA.
- Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA.
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, 50935 Cologne, Germany.
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
| | - David S Srivastava
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
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Klukowska-Röetzler J, Eracleous M, Müller M, Srivastava DS, Krummrey G, Keidar O, Exadaktylos AK. Increased Urgent Care Center Visits by Southeast European Migrants: A Retrospective, Controlled Trial from Switzerland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091857. [PMID: 30154317 PMCID: PMC6164677 DOI: 10.3390/ijerph15091857] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/25/2018] [Accepted: 08/26/2018] [Indexed: 01/10/2023]
Abstract
We investigated whether immigrants from Southeast Europe (SE) and Swiss patients have different reasons for visiting the emergency department (ED). Our retrospective data analysis for the years 2013–2017 describes the pattern of ED consultations for immigrants from SE living in Switzerland (Canton Bern), in comparison with Swiss nationals, with a focus on type of referral and reason for admission. A total of 153,320 Swiss citizens and 12,852 immigrants from SE were included in the study. The mean age was 51.30 (SD = 21.13) years for the Swiss patients and 39.70 (SD = 15.87) years for the SE patients. For some countries of origin (Albania, Bosnia and Herzegovina, and Turkey), there were highly statistically significant differences in sex distribution, with a predominance of males. SE immigrants had a greater proportion of patients in the lower triage level (level 3: SE: 67.3% vs. Swiss: 56.0%) and a greater proportion of patients in the high triage level than the Swiss population (level 1: SE: 3.4% vs. Swiss: 8.8%). SE patients of working age (16–65 years) were six times more often admitted by ambulance than older (≥65 years) SE patients, whereas this ratio was similar in the Swiss population. In both groups, the fast track service was primarily used for patients of working age (<65) and more than three times more often in the SE than the Swiss group (SE: 39.1%, Swiss: 12.6%). We identified some indications for access to primary care in emergency departments for immigrants and highlighted the need for attention to the role of organizational characteristics of primary health care in Switzerland. We highlighted the need for professional support to improve the quality of healthcare for immigrants. In the future, we will need more primary care services and general practitioners with a migrant background.
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Affiliation(s)
| | - Maria Eracleous
- Department of Rheumatology, Immunology and Allergology, University Hospital, 3010 Bern, Switzerland.
| | - Martin Müller
- Department of Emergency Medicine, University Hospital, 3010 Berne, Switzerland.
- Institute of Health Economics and Clinical Epidemiology, University Hospital, 50935 Cologne, Germany.
| | - David S Srivastava
- Department of Emergency Medicine, University Hospital, 3010 Berne, Switzerland.
| | - Gert Krummrey
- Department of Emergency Medicine, University Hospital, 3010 Berne, Switzerland.
| | - Osnat Keidar
- Department of Emergency Medicine, University Hospital, 3010 Berne, Switzerland.
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Emergency Department and Primary Care Use by Refugees Compared to Non-refugee Controls. J Immigr Minor Health 2018; 21:793-800. [DOI: 10.1007/s10903-018-0795-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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24
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Jervelund SS, Maltesen T, Wimmelmann CL, Petersen JH, Krasnik A. Know where to go: evidence from a controlled trial of a healthcare system information intervention among immigrants. BMC Public Health 2018; 18:863. [PMID: 29996799 PMCID: PMC6042399 DOI: 10.1186/s12889-018-5741-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immigrants may face problems with accessing the Danish healthcare system due to, for example, lack of knowledge of how to navigate it, which may cause inappropriate healthcare-seeking. Danish municipalities provide a mandatory introduction and language programme for newly arrived immigrants, but no information on the healthcare system is offered. This study investigated what effects information about the Danish healthcare system may have on the hypothetical healthcare-seeking behaviour of newly arrived immigrants and their actual healthcare use. METHODS A prospective intervention study of 1572 adult immigrants attending two language schools in Copenhagen was carried out. Two intervention groups received either a course or written information on the Danish healthcare system, respectively, while the control group received neither. Survey data included three case vignettes on healthcare-seeking behaviour (flu-like symptoms, chest pain and depression) and were linked to registry data on sociodemographic characteristics and healthcare use in the year to follow. Logistic regression and binomial regression analyses were performed. RESULTS Appropriate hypothetical healthcare-seeking behaviour was reported by 61.8-78.8% depending on the vignette. Written information showed no effect on immigrants' hypothetical healthcare-seeking behaviour, while the course showed a positive effect on hypothetical healthcare-seeking behaviour for flu-like symptoms (adjusted odds ratio [AOR] = 1.71, 95% confidence interval [CI] = 1.01-2.91, p-value = 0.0467), but not on chest pain or depression. The interventions did not affect immigrants' actual healthcare use; all groups made lower use of health care services in the following year compared with the year where the study took place, except for the use of dental care which remained stable. CONCLUSIONS Information on the healthcare system embedded in the language school programme has the potential to facilitate immigrants' access to healthcare. Yet, the results underscore the need for further refinement and development of educational interventions, as well as ensuring adequate utilisation of healthcare services by other means. Multi-dimensional and multi-sectional efforts are important for integration issues within healthcare in Europe. TRIAL REGISTRATION Health-seeking behaviour among newly arrived immigrants in Denmark ISRCTN24905314 , May 1, 2015 (Retrospectively registered).
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Affiliation(s)
- Signe Smith Jervelund
- Department of Public Health, Section for Health Services Research, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Øster Farimagsgade 5A, DK-1014, Copenhagen K, Denmark.
| | - Thomas Maltesen
- Department of Public Health, Section for Biostatistics, University of Copenhagen, Øster Farimagsgade 5A, DK-1014, Copenhagen K, Denmark
| | - Camilla Lawaetz Wimmelmann
- Department of Public Health, Section for Health Services Research, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Øster Farimagsgade 5A, DK-1014, Copenhagen K, Denmark
| | - Jørgen Holm Petersen
- Department of Public Health, Section for Biostatistics, University of Copenhagen, Øster Farimagsgade 5A, DK-1014, Copenhagen K, Denmark
| | - Allan Krasnik
- Department of Public Health, Section for Health Services Research, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Øster Farimagsgade 5A, DK-1014, Copenhagen K, Denmark
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Gea-Sánchez M, Alconada-Romero Á, Briones-Vozmediano E, Pastells R, Gastaldo D, Molina F. Undocumented Immigrant Women in Spain: A Scoping Review on Access to and Utilization of Health and Social Services. J Immigr Minor Health 2017; 19:194-204. [PMID: 26880030 DOI: 10.1007/s10903-016-0356-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This scoping review summarizes and analyzes relevant studies related to the evidence published on undocumented immigrant women's access to and utilization of health and social services in Spain. Scientific literature was identified by entering search terms in seven electronic databases which combined retrieved health sciences peer-reviewed articles (Pubmed, Embase, CINAHL Plus and Scopus) and grey literature databases (Europa OpenGrey, DART-Europe and Google Scholar) published between 2004 and 2014 and written in Spanish or in English presenting data about Spain. Those that fulfill the inclusion criteria were selected after a blind peer reviewed process when pertinence and quality was debated. A total of 16 publications were included, the main topics being socio-cultural differences in the access and utilization of social and health services and barriers faced by immigrant women. None of the studies focused exclusively on undocumented women, hence further research is needed in this area.
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Affiliation(s)
- Montserrat Gea-Sánchez
- Department of Nursing, Faculty of Nursing and Physiotherapy, GESEC, University of Lleida, Street Rovira Roure 44, 25198, Lleida, Spain. .,Research Group in Health Care (GRECS), IRB Lleida, Lleida, Spain.
| | - Álvaro Alconada-Romero
- Department of Nursing, Faculty of Nursing and Physiotherapy, GESEC, University of Lleida, Street Rovira Roure 44, 25198, Lleida, Spain.,Council of Nurses of Lleida, Lleida, Spain
| | - Erica Briones-Vozmediano
- Department of Nursing, Faculty of Nursing and Physiotherapy, GESEC, University of Lleida, Street Rovira Roure 44, 25198, Lleida, Spain.,Public Health Research Group, University of Alicante, Alicante, Spain
| | - Roland Pastells
- Department of Nursing, Faculty of Nursing and Physiotherapy, GESEC, University of Lleida, Street Rovira Roure 44, 25198, Lleida, Spain.,Research Group in Health Care (GRECS), IRB Lleida, Lleida, Spain
| | - Denise Gastaldo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Fidel Molina
- Department of Geography and Sociology, GESEC, University of Lleida, Lleida, Spain
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Keizer E, Bakker P, Giesen P, Wensing M, Atsma F, Smits M, van den Muijsenbergh M. Migrants' motives and expectations for contacting out-of-hours primary care: a survey study. BMC FAMILY PRACTICE 2017; 18:92. [PMID: 29162044 PMCID: PMC5699192 DOI: 10.1186/s12875-017-0664-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/15/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Migrants are more likely to use out-of-hours primary care, especially for nonurgent problems. Their motives and expectations for help-seeking are as yet unknown. The objective of this study is to examine the motives and expectations of migrants for contacting out-of-hours primary care. METHODS We used data from a survey study of 11,483 patients who contacted a General Practitioner (GP) cooperative in the Netherlands between 2009 and 2014 (response rate 45.6%). Logistic regression analysis was used to test differences in motives and expectations between non-western and western migrants and native Dutch patients. RESULTS The main motives for contacting a GP cooperative for non-western and western migrants were an urgent need for contact with a GP (54.9%-52.4%), worry (49.3%-43.0%), and a need for medical information (21.3%-26.2%). These were also the most important motives for native Dutch patients. Compared to native Dutch patients, non-western migrants more often perceived an urgent need for a GP (OR 1.65; 99% CI 1.27-2.16), less often needed information (OR 0.59; 99% CI 0.43-0.81), and more often experienced problems contacting their own GP during office hours (OR 1.71; 99% CI 1.21-2.43). Western migrants also reported experiencing problems more often in contacting their own GP (OR 1.38; 99% CI 1.04-1.84). As well as for natives, most non-western and western migrants expected to see a doctor (46.2%-46.6%) or get advice (39.6%-41.5%). Non-western migrants expected more often to get physical examination (OR 1.53; 99% CI 1.14-2.04), and prescription (OR 1.37; 99% CI 1.00-1.88). We found no differences in expectations between western migrants and native Dutch patients. CONCLUSION The main motives and expectations of migrants are similar to native Dutch patients, yet non-western migrants more often wanted action from the GP, e.g. examination or prescription, and less often passive forms of assistance such as giving information. At the same time they experience problems accessing their own GP. We recommend stimulation of self-care, education about the purpose of a GP cooperative, and examination and improvement of accessibility of daytime primary care.
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Affiliation(s)
- Ellen Keizer
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Peter Bakker
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.,Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Paul Giesen
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Michel Wensing
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Femke Atsma
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Marleen Smits
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.,Pharos, Centre of Expertise of Health Disparities, P.O. Box 13318, 3507, LH, Utrecht, The Netherlands
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Lichtl C, Lutz T, Szecsenyi J, Bozorgmehr K. Differences in the prevalence of hospitalizations and utilization of emergency outpatient services for ambulatory care sensitive conditions between asylum-seeking children and children of the general population: a cross-sectional medical records study (2015). BMC Health Serv Res 2017; 17:731. [PMID: 29141614 PMCID: PMC5688672 DOI: 10.1186/s12913-017-2672-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 11/03/2017] [Indexed: 11/10/2022] Open
Abstract
Background Hospitalizations for ambulatory care sensitive (ACS) conditions are established indicators for the availability and quality of ambulatory care. We aimed to assess the differences between asylum-seeking children and children of the general population in a German city with respect to (i) the prevalence of ACS hospitalizations, and (ii) the utilization of emergency outpatient services for ACS conditions. Methods Using anonymous account data, all children admitted to the University Hospital Heidelberg in 2015 were included in our study. A unique cost unit distinguished asylum seekers residing in a nearby reception center (exposed) from the children of the general population. We adapted international lists of ACS conditions and calculated the prevalence of ACS hospitalizations and the utilization of emergency outpatient services for ACS conditions, attributable fractions among the exposed (Afe) and the population attributable fraction among total admissions (PAF) for each outcome. Differences in the prevalence of each outcome between exposed and controls were analyzed in logistic regression models adjusted for sex, age group and quarterly admission. Results Of the 32,015 admissions in 2015, 19.9% (6287) were from inpatient and 80.1% (25,638) from outpatient care. In inpatient care, 9.8% (622) of all admissions were hospitalizations for ACS conditions. The Afe of ACS hospitalizations was 46.57%, the PAF was 1.12%. Emergency service use for ACS conditions could be identified in 8.3% (3088) of all admissions (Afe: 79.57%, PAF: 5.08%). The odds ratio (OR) of asylum-seeking children being hospitalized for ACS conditions in comparison to the control group was 1.81 [95% confidence interval, CI: 1.02; 3.2]. The OR of the asylumseeking population compared to the general population for the utilization of emergency service use for ACS conditions was 4.93 [95% CI: 4.11; 5.91]. Conclusions Asylum-seeking children had significantly higher odds of ACS hospitalization and of utilization of emergency outpatient services for ACS conditions. Using the concept of ACS conditions allowed measuring the strength of primary care provided to this local asylum-seeking population. This approach could help to compare the strength of primary care provision in different locations, and allow an objective.
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Affiliation(s)
- Célina Lichtl
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Thomas Lutz
- Center for Child and Adolescent Medicine, Department of General Pediatrics, Metabolism, Gastroenterology, Nephrology, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Kayvan Bozorgmehr
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
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Coster JE, Turner JK, Bradbury D, Cantrell A. Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis. Acad Emerg Med 2017; 24:1137-1149. [PMID: 28493626 PMCID: PMC5599959 DOI: 10.1111/acem.13220] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/31/2017] [Accepted: 04/04/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Rising demand for emergency and urgent care services is well documented, as are the consequences, for example, emergency department (ED) crowding, increased costs, pressure on services, and waiting times. Multiple factors have been suggested to explain why demand is increasing, including an aging population, rising number of people with multiple chronic conditions, and behavioral changes relating to how people choose to access health services. The aim of this systematic mapping review was to bring together published research from urgent and emergency care settings to identify drivers that underpin patient decisions to access urgent and emergency care. METHODS Systematic searches were conducted across Medline (via Ovid SP), EMBASE (via Ovid), The Cochrane Library (via Wiley Online Library), Web of Science (via the Web of Knowledge), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; via EBSCOhost). Peer-reviewed studies written in English that reported reasons for accessing or choosing emergency or urgent care services and were published between 1995 and 2016 were included. Data were extracted and reasons for choosing emergency and urgent care were identified and mapped. Thematic analysis was used to identify themes and findings were reported qualitatively using framework-based narrative synthesis. RESULTS Thirty-eight studies were identified that met the inclusion criteria. Most studies were set in the United Kingdom (39.4%) or the United States (34.2%) and reported results relating to ED (68.4%). Thirty-nine percent of studies utilized qualitative or mixed research designs. Our thematic analysis identified six broad themes that summarized reasons why patients chose to access ED or urgent care. These were access to and confidence in primary care; perceived urgency, anxiety, and the value of reassurance from emergency-based services; views of family, friends, or healthcare professionals; convenience (location, not having to make appointment, and opening hours); individual patient factors (e.g., cost); and perceived need for emergency medical services or hospital care, treatment, or investigations. CONCLUSIONS We identified six distinct reasons explaining why patients choose to access emergency and urgent care services: limited access to or confidence in primary care; patient perceived urgency; convenience; views of family, friends, or other health professionals; and a belief that their condition required the resources and facilities offered by a particular healthcare provider. There is a need to examine demand from a whole system perspective to gain better understanding of demand for different parts of the emergency and urgent care system and the characteristics of patients within each sector.
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Affiliation(s)
- Joanne E. Coster
- School for Health and Related Research (ScHARR)University of SheffieldSheffield
| | - Janette K. Turner
- School for Health and Related Research (ScHARR)University of SheffieldSheffield
| | - Daniel Bradbury
- School for Health and Related Research (ScHARR)University of SheffieldSheffield
- Northampton General Hospital NHS TrustNorthamptonUK
| | - Anna Cantrell
- School for Health and Related Research (ScHARR)University of SheffieldSheffield
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Ruud SE, Hjortdahl P, Natvig B. Reasons for attending a general emergency outpatient clinic versus a regular general practitioner - a survey among immigrant and native walk-in patients in Oslo, Norway. Scand J Prim Health Care 2017; 35:35-45. [PMID: 28277057 PMCID: PMC5361418 DOI: 10.1080/02813432.2017.1288817] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To explore reasons for attending a general emergency outpatient clinic versus a regular general practitioner (RGP). DESIGN Cross-sectional study using a multilingual anonymous questionnaire. SETTING Native and immigrant walk-in patients attending a general emergency outpatient clinic in Oslo (Monday-Friday, 08:00-23:00) during 2 weeks in September 2009. SUBJECTS We included 1022 walk-in patients: 565 native Norwegians (55%) and 457 immigrants (45%). MAIN OUTCOME MEASURES Patients' reasons for attending an emergency outpatient clinic versus their RGP. RESULTS Among patients reporting an RGP affiliation, 49% tried to contact their RGP before this emergency encounter: 44% of native Norwegian and 58% of immigrant respondents. Immigrants from Africa [odds ratio (OR) = 2.55 (95% confidence interval [CI]: 1.46-4.46)] and Asia [OR = 2.32 (95% CI: 1.42-3.78)] were more likely to contact their RGP before attending the general emergency outpatient clinic compared with native Norwegians. The most frequent reason for attending the emergency clinic was difficulty making an immediate appointment with their RGP. A frequent reason for not contacting an RGP was lack of access: 21% of the native Norwegians versus 4% of the immigrants claimed their RGP was in another district/municipality, and 31% of the immigrants reported a lack of affiliation with the RGP scheme. CONCLUSIONS AND IMPLICATIONS Access to primary care provided by an RGP affects patients' use of emergency health care services. To facilitate continuity of health care, policymakers should emphasize initiatives to improve access to primary health care services. KEY POINTS Access to immediate primary health care provided by a regular general practitioner (RGP) can reduce patients' use of emergency health care services. The main reason for attending a general emergency outpatient clinic was difficulty obtaining an immediate appointment with an RGP. A frequent reason for native Norwegians attending a general emergency outpatient clinic during the daytime is having an RGP outside Oslo. Lack of affiliation with the RGP scheme is a frequent reason for attending a general emergency outpatient clinic among immigrants.
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Affiliation(s)
- Sven Eirik Ruud
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Emergency General Practice, City of Oslo Health Agency, Oslo, Norway
- CONTACT Sven Eirik Ruud Department of General Practice, Institute of Health and Society, University of Oslo, P.O. Box 1130 Blindern, N-0318 Oslo, Norway
| | - Per Hjortdahl
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Bård Natvig
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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30
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Jervelund SS, Maltesen T, Wimmelmann CL, Petersen JH, Krasnik A. Ignorance is not bliss: The effect of systematic information on immigrants' knowledge of and satisfaction with the Danish healthcare system. Scand J Public Health 2017; 45:161-174. [PMID: 28077059 DOI: 10.1177/1403494816685936] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Suboptimal healthcare utilisation and lower satisfaction with the patient-doctor encounter among immigrants has been documented. Immigrants' lack of familiarity with the healthcare system has been proposed as an explanation for this. This study investigated whether a systematic delivery of information affected immigrants' knowledge of and satisfaction with the Danish healthcare system. METHODS A prospective, randomised intervention study of 1158 adult immigrants attending two language schools in Copenhagen was conducted. Two intervention groups received written information or a 12-hour course on the Danish healthcare system, while a control group received nothing. Survey data included self-assessed knowledge, true/false questions on access and questions relating to satisfaction with the healthcare system. Data were linked to socioeconomic registry data. Logistic regression analyses were performed. RESULTS The course improved knowledge of who to contact in the event of an accident (odds ratio (OR) = 2.67, 95% confidence interval (CI) = 1.56-4.59) but not in the event of illness. Further, it positively affected correct answers for nine out of 11 questions on the healthcare system (varying from OR = 1.87, 95% CI = 1.08-3.24 to OR = 3.11, 95% CI = 1.58-6.11). Written information positively affected correct answers for three out of 11 questions, but negatively affected one out of 11 compared with the control group. Neither intervention affected immigrants' satisfaction with the healthcare system. CONCLUSIONS Knowledge of the healthcare system is necessary for optimal healthcare-seeking behaviour. The results may form the basis of national and international changes in immigrant reception and optimise immigrants' contact with the healthcare system.
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Affiliation(s)
- Signe Smith Jervelund
- 1 Department of Public Health, Section for Health Services Research, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen K, Denmark
| | - Thomas Maltesen
- 2 Department of Public Health, Section for Biostatistics, University of Copenhagen, Copenhagen K, Denmark
| | - Camilla Lawaetz Wimmelmann
- 1 Department of Public Health, Section for Health Services Research, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen K, Denmark
| | - Jørgen Holm Petersen
- 2 Department of Public Health, Section for Biostatistics, University of Copenhagen, Copenhagen K, Denmark
| | - Allan Krasnik
- 1 Department of Public Health, Section for Health Services Research, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen K, Denmark
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Kraaijvanger N, van Leeuwen H, Rijpsma D, Edwards M. Motives for self-referral to the emergency department: a systematic review of the literature. BMC Health Serv Res 2016; 16:685. [PMID: 27938366 PMCID: PMC5148909 DOI: 10.1186/s12913-016-1935-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/06/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In several western countries patients' use of Emergency Departments (EDs) is increasing. A substantial number of patients is self-referred, but does not need emergency care. In order to have more influence on unnecessary self-referral, it is essential to know why patients visit the ED without referral. The goal of this systematic review therefore is to explore what motivates self-referred patients in those countries to visit the ED. METHODS Recommendations from the PRISMA were used to search and analyze the literature. The following databases; PUBMED, MEDLINE, EMBASE, CINAHL and Cochrane Library, were systematically searched from inception up to the first of February 2015. The reference lists of the included articles were screened for additional relevant articles. All studies that reported on the motives of self-referred patients to visit an ED were selected. The reasons for self-referral were categorized into seven main themes: health concerns, expected investigations; convenience of the ED; lesser accessibility of primary care; no confidence in general practitioner/primary care; advice from others and financial considerations. A random-effects meta-analysis was performed. RESULTS Thirty publications were identified from the literature studied. The most reported themes for self-referral were 'health concerns' and 'expected investigations': 36% (95% Confidence Interval 23-50%) and 35% (95% CI 20-51%) respectively. Financial considerations most often played a role in the United States with a reported percentage of 33% versus 4% in other countries (p < 0.001). CONCLUSIONS Worldwide, the most important reasons to self-refer to an ED are health concerns and expected investigations. Financial considerations mainly play a role in the United States.
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Affiliation(s)
- Nicole Kraaijvanger
- Emergency Department, Rijnstate Hospital, Wagnerlaan 55, Arnhem, The Netherlands
| | - Henk van Leeuwen
- Department of Intensive Care / Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, The Netherlands
| | - Douwe Rijpsma
- Emergency Department, Rijnstate Hospital, Wagnerlaan 55, Arnhem, The Netherlands
| | - Michael Edwards
- Department of Surgery, Radboud University Medical Centre, Geert Grooteplein-Zuid 10, Nijmegen, The Netherlands
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Kietzmann D, Knuth D, Schmidt S. (Non-)utilization of pre-hospital emergency care by migrants and non-migrants in Germany. Int J Public Health 2016; 62:95-102. [PMID: 27658813 DOI: 10.1007/s00038-016-0904-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 09/10/2016] [Accepted: 09/16/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This study was designed to explore the utilization and non-utilization of pre-hospital emergency care by migrants and non-migrants, and the factors that influence this behaviour. METHODS A cross-sectional representative German survey was conducted in a sample of 2.175 people, 295 of whom had a migration background. An additional sample of 50 people with Turkish migration background was conducted, partially in the Turkish language. Apart from socio-demographics, the utilization of emergency services and the reasons for non-utilization were assessed. RESULTS Migrants had a higher utilization rate of pre-hospital emergency care (RR = 1.492) than non-migrants. Furthermore, migrants who were not born in Germany had a lower utilization rate (RR = 0.793) than migrants who were born in Germany. Regarding non-utilization, the most frequently stated reasons belonged to the categories initial misjudgment of the emergency situation and acting on one's own behalf, with the latter stated more frequently by migrants than by non-migrants. CONCLUSIONS To prevent over-, under-, and lack of supply, it is necessary to transfer knowledge about the functioning of the medical emergency services, including first aid knowledge.
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Affiliation(s)
- Diana Kietzmann
- Department Health and Prevention, Institute of Psychology, Ernst-Moritz-Arndt-University Greifswald, Robert-Blum-Str. 13, 17487, Greifswald, Germany.
| | - Daniela Knuth
- Department Health and Prevention, Institute of Psychology, Ernst-Moritz-Arndt-University Greifswald, Robert-Blum-Str. 13, 17487, Greifswald, Germany
| | - Silke Schmidt
- Department Health and Prevention, Institute of Psychology, Ernst-Moritz-Arndt-University Greifswald, Robert-Blum-Str. 13, 17487, Greifswald, Germany
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Barghadouch A, Kristiansen M, Jervelund SS, Hjern A, Montgomery E, Norredam M. Refugee children have fewer contacts to psychiatric healthcare services: an analysis of a subset of refugee children compared to Danish-born peers. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1125-36. [PMID: 27333980 DOI: 10.1007/s00127-016-1260-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 06/15/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Studies show a high level of mental health problems among refugee children. This study examined whether a subset of refugee children living in Denmark accessed psychiatric healthcare services more than those born in the country. METHODS This study compared 24,427 refugee children from Asia, The Middle East, Sub-Saharan Africa and former Yugoslavia, who obtained residency in Denmark between 1 January 1993 and 31 December 2010 with 146,562 Danish-born children, matched 1:6 on age and sex. The study looked at contacts with psychiatric hospitals as well as psychologists and psychiatrists in private practice. RESULTS Between 1 January 1996 and 30 June 2012, 3.5 % of the refugee children accessed psychiatric healthcare services compared to 7.7 % of the Danish-born children. The rate ratio of having any first-time psychiatric contact was 0.42 (95 % CI 0.40-0.45) among refugee boys and 0.35 (95 % CI 0.33-0.37) among refugee girls, compared to Danish-born children. Figures were similar for those accessing private psychologists or psychiatrists, emergency room, inpatient and outpatient services. CONCLUSIONS Refugee children used fewer psychiatric healthcare services than Danish-born children. This may indicate that refugee children experience barriers in accessing psychiatric healthcare systems and do not receive adequate assessment of their mental health and subsequent referral to specialist services.
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Affiliation(s)
- Amina Barghadouch
- Danish Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 10, 1014, Copenhagen K, Denmark.
| | - Maria Kristiansen
- Danish Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 10, 1014, Copenhagen K, Denmark
| | - Signe Smith Jervelund
- Danish Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 10, 1014, Copenhagen K, Denmark
| | - Anders Hjern
- Centre for Health Equity Studies (CHESS), Karolinska Institutet/Stockholm University, Stockholm, Sweden.,Clinical Epidemiology, Department of Medicine, Karolinska Institutet/Stockholm University, Stockholm, Sweden
| | | | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 10, 1014, Copenhagen K, Denmark.,Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
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Ruud SE, Hjortdahl P, Natvig B. Is it a matter of urgency? A survey of assessments by walk-in patients and doctors of the urgency level of their encounters at a general emergency outpatient clinic in Oslo, Norway. BMC Emerg Med 2016; 16:22. [PMID: 27378228 PMCID: PMC4932670 DOI: 10.1186/s12873-016-0086-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 06/08/2016] [Indexed: 11/16/2022] Open
Abstract
Background Emergency room (ER) use is increasing in several countries. Variability in the proportion of non-urgent ER visits was found to range from 5 to 90 % (median 32 %). Non-urgent emergency visits are considered an inappropriate and inefficient use of the health-care system because they may lead to higher expenses, crowding, treatment delays, and loss of continuity of health care provided by a general practitioner. Urgency levels of doctor–walk-in patient encounters were assessed based on their region of origin in a diverse Norwegian population. Methods An anonymous, multilingual questionnaire was distributed to all walk-in patients at a general emergency outpatient clinic in Oslo during two weeks in September 2009. We analysed demographic data, patient–doctor assessments of the level of urgency, and the results of the consultation. We used descriptive statistics to obtain frequencies with 95 % confidence interval (CI) for assessed levels of urgency and outcomes. Concordance between the patients’ and doctors’ assessments was analysed using a Kendall tau-b test. We used binary logistic regression modelling to quantify associations of explanatory variables and outcomes according to urgency level assessments. Results The analysis included 1821 walk-in patients. Twenty-four per cent of the patients considered their emergency consultation to be non-urgent, while the doctors considered 64 % of encounters to be non-urgent. The concordance between the assessments by the patient and by their doctor was positive but low, with a Kendall tau-b coefficient of 0.202 (p < 0.001). Adjusted logistic regression analysis showed that patients from Eastern Europe (odds ratio (OR) = 3.04; 95 % CI 1.60–5.78), Asia and Turkey (OR = 4.08; 95 % CI 2.43–6.84), and Africa (OR = 8.47; 95 % CI 3.87–18.5) reported significantly higher urgency levels compared with Norwegians. The doctors reported no significant difference in assessment of urgency based on the patient’s region of origin, except for Africans (OR = 0.64; 95 % CI 0.43–0.96). Conclusion This study reveals discrepancies between assessments by walk-in patients and doctors of the urgency level of their encounters at a general emergency clinic. The patients’ self-assessed perception of the urgency level was related to their region of origin. Electronic supplementary material The online version of this article (doi:10.1186/s12873-016-0086-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sven Eirik Ruud
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway. .,Department of Emergency General Practice, City of Oslo Health Agency, Oslo, Norway.
| | - Per Hjortdahl
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Bård Natvig
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Müller M, Klingberg K, Srivastava D, Exadaktylos AK. Consultations by Asylum Seekers: Recent Trends in the Emergency Department of a Swiss University Hospital. PLoS One 2016; 11:e0155423. [PMID: 27192154 PMCID: PMC4871557 DOI: 10.1371/journal.pone.0155423] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/28/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Large-scale war-related migration to Switzerland and other European countries is currently challenging European health systems. Little is known about recent patterns and trends in Emergency Department (ED) consultations by Asylum Seekers (AS). METHODS A retrospective single-centre analysis was performed of the data from all adult patients with the official status of "Asylum Seeker" or "Refugee" who consulted the ED of Bern University Hospital, Switzerland, between June 2012 and June 2015. Patient characteristics and clinical information, such as triage category, type of referral and discharge, violence-related injury and diagnostic group on discharge, were extracted from the computerised database or determined from the medical reports. Changes in categorical variables between the three studied years were described. RESULTS A total of 1,653 eligible adult patients were identified in the 3-year period. Between the first (06/12-06/13) and third periods (06/14-06/15), the number of presentations per year increased by about 45%. The AS came from 62 different nations, the most common countries being Eritrea (13%), Somalia (13%) and Syria (11%). The mean age was 33.3 years (SD 12.3) and two thirds (65.7%) were male. The proportion of women increased over time. Moreover the relative proportions shifted from patients between 20 and 50 years to patients of under 20 or over 60 years. Nearly two thirds of the patients were walk-in emergencies and this proportion increased over time. The mean triage score was 2.9 (SD 0.7), with more than 90% presenting as "urgent consultation". About half of the patients were treated for trauma (17.2%), infections (16.8%) or psychiatric problems (14.2%). Trauma was seen in a higher proportion of male than female patients. About 25% of the patients were admitted for in-hospital treatment. CONCLUSIONS The recent rise in AS in the population has lead to an increase in AS presenting to EDs. This changes the composition of ED patients and should raise awareness that changes in procedures may be needed. Infectious diseases and psychiatric problems remain a heavy burden for AS presenting in the ED. A trend towards an increasing proportion of walk-in patients to the ED could not be explained by this study. Further studies and surveillance are needed to investigate this trend.
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Affiliation(s)
- Martin Müller
- Emergency Department, Bern University Hospital, Bern, Switzerland
| | - Karsten Klingberg
- Emergency Department, Bern University Hospital, Bern, Switzerland
- * E-mail:
| | - David Srivastava
- Emergency Department, Bern University Hospital, Bern, Switzerland
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Turner J, Coster J, Chambers D, Cantrell A, Phung VH, Knowles E, Bradbury D, Goyder E. What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03430] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.
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Affiliation(s)
- Janette Turner
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Joanne Coster
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Viet-Hai Phung
- College of Social Science, University of Lincoln, Lincoln, UK
| | - Emma Knowles
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Bradbury
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Ruud SE, Aga R, Natvig B, Hjortdahl P. Use of emergency care services by immigrants—a survey of walk-in patients who attended the Oslo Accident and Emergency Outpatient Clinic. BMC Emerg Med 2015; 15:25. [PMID: 26446671 PMCID: PMC4596368 DOI: 10.1186/s12873-015-0055-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 10/05/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The Oslo Accident and Emergency Outpatient Clinic (OAEOC) experienced a 5-6% annual increase in patient visits between 2005 and 2011, which was significantly higher than the 2-3% annual increase among registered Oslo residents. This study explored immigrant walk-in patients' use of both the general emergency and trauma clinics of the OAEOC and their concomitant use of regular general practitioners (RGPs) in Oslo. METHODS A cross-sectional survey of walk-in patients attending the OAEOC during 2 weeks in September 2009. We analysed demographic data, patients' self-reported affiliation with the RGP scheme, self-reported number of OAEOC and RGP consultations during the preceding 12 months. The first approach used Poisson regression models to study visit frequency. The second approach compared the proportions of first- and second-generation immigrants and those from the four most frequently represented countries (Sweden, Pakistan, Somalia and Poland) among the patient population, with their respective proportions within the general Oslo population. RESULTS The analysis included 3864 patients: 1821 attended the Department of Emergency General Practice ("general emergency clinic"); 2043 attended the Section for Orthopaedic Emergency ("trauma clinic"). Both first- and second-generation immigrants reported a significantly higher OAEOC visit frequency compared with Norwegians. Norwegians, representing 73% of the city population accounted for 65% of OAEOC visits. In contrast, first- and second-generation immigrants made up 27% of the city population but accounted for 35% of OAEOC visits. This proportional increase in use was primarily observed in the general emergency clinic (42% of visits). Their proportional use of the trauma clinic (29%) was similar to their proportion in the city. Among first-generation immigrants only 71% were affiliated with the RGP system, in contrast to 96% of Norwegians. Similar finding were obtained when immigrants were grouped by nationality. Compared to Norwegians, immigrants from Sweden, Pakistan and Somalia reported using the OAEOC significantly more often. Immigrants from Sweden, Poland and Somalia were over-represented at both clinics. The least frequent RGP affiliation was among immigrants from Sweden (32%) and Poland (65%). CONCLUSIONS In Norway, immigrant subgroups use emergency health care services in different ways. Understanding these patterns of health-seeking behaviour may be important when designing emergency health services.
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Affiliation(s)
- Sven Eirik Ruud
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway. .,Department of Emergency General Practice, City of Oslo Health Agency, Oslo, Norway.
| | - Ruth Aga
- Section for Orthopaedic Emergency, Oslo University Hospital, Oslo, Norway.
| | - Bård Natvig
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Per Hjortdahl
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
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Mahmoud I, Eley R, Hou XY. Subjective reasons why immigrant patients attend the emergency department. BMC Emerg Med 2015; 15:4. [PMID: 25885860 PMCID: PMC4378552 DOI: 10.1186/s12873-015-0031-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 03/13/2015] [Indexed: 11/21/2022] Open
Abstract
Background Some patients visit a hospital’s emergency department (ED) for reasons other than an urgent medical condition. There is evidence that this practice may differ among patients from different backgrounds. The objective of this study was to examine the reasons why patients from a non-English speaking background (NESB) and patients with an English speaking background but not born in Australia (ESB-NBA) visit the ED, as compared to patients from English-speaking backgrounds but born in Australia (ESB-BA). Methods A cross-sectional survey was conducted at the ED of a tertiary hospital in metropolitan Brisbane, Queensland, Australia. Over a four-month period patients who were assigned an Australasian Triage Scale score of 3, 4 or 5 were surveyed. Pearson chi-square test and multivariate logistic regression analyses were performed to examine the differences between the ESB and NESB patients’ reported reasons for attending the ED. Results A total of 828 patients participated in this study. Compared to ESB-BA patients NESB patients were less likely to consider contacting a general practitioner (GP) before attending the ED (Odds Ratios (OR) 0.6 (95% Confidence Interval (CI) 0.4–0.8, p < .05) While ESB-NBA were more likely to consider contacting a GP 1.7 (1.1–2.5, p < .05). Both the NESB patients and the ESB-NBA patients were far more likely than ESB-BA patients to report that they had visited the ED either because they do not have a GP (OR 7.9, 95% CI 4.7–13.4, p < .001) and 2.2 (95% CI 1.1–4.4, p < .05) respectively and less likely to think that the ED could deal with their problem better than a GP (OR 0.5 (95% CI 0.3–0.8, p < .05) and 0.7 (0.3–0.9, p < .05) respectively. The NESB patients also thought it would take too long to make an appointment to consult a GP (OR 6.2, 95% CI 3.7–10.4, p < 0.001). Conclusions NESB patients were the least likely to consider contacting a GP before attending hospital EDs. Educational interventions may help direct NESB people to the appropriate health services and therefore reduce the burden on tertiary hospitals ED. Electronic supplementary material The online version of this article (doi:10.1186/s12873-015-0031-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ibrahim Mahmoud
- Department of Emergency Medicine, Royal Brisbane & Women's Hospital - School of Medicine, The University of Queensland, and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
| | - Rob Eley
- School of Medicine and the Department of Emergency Medicine- Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia.
| | - Xiang-Yu Hou
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
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Mahmoud I, Hou XY, Chu K, Clark M. Language affects length of stay in emergency departments in Queensland public hospitals. World J Emerg Med 2014; 4:5-9. [PMID: 25215085 DOI: 10.5847/wjem.j.issn.1920-8642.2013.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 01/19/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A long length of stay (LOS) in the emergency department (ED) associated with overcrowding has been found to adversely affect the quality of ED care. The objective of this study is to determine whether patients who speak a language other than English at home have a longer LOS in EDs compared to those whose speak only English at home. METHODS A secondary data analysis of a Queensland state-wide hospital EDs dataset (Emergency Department Information System) was conducted for the period, 1 January 2008 to 31 December 2010. RESULTS The interpreter requirement was the highest among Vietnamese speakers (23.1%) followed by Chinese (19.8%) and Arabic speakers (18.7%). There were significant differences in the distributions of the departure statuses among the language groups (Chi-squared=3236.88, P<0.001). Compared with English speakers, the Beta coefficient for the LOS in the EDs measured in minutes was among Vietnamese, 26.3 (95%CI: 22.1-30.5); Arabic, 10.3 (95%CI: 7.3-13.2); Spanish, 9.4 (95%CI: 7.1-11.7); Chinese, 8.6 (95%CI: 2.6-14.6); Hindi, 4.0 (95%CI: 2.2-5.7); Italian, 3.5 (95%CI: 1.6-5.4); and German, 2.7 (95%CI: 1.0-4.4). The final regression model explained 17% of the variability in LOS. CONCLUSION There is a close relationship between the language spoken at home and the LOS at EDs, indicating that language could be an important predictor of prolonged LOS in EDs and improving language services might reduce LOS and ease overcrowding in EDs in Queensland's public hospitals.
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Affiliation(s)
- Ibrahim Mahmoud
- School of Public Health, Queensland University of Technology, Brisbane, Australia
| | - Xiang-Yu Hou
- School of Public Health, Queensland University of Technology, Brisbane, Australia ; Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Kevin Chu
- School of Public Health, Queensland University of Technology, Brisbane, Australia ; Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Michele Clark
- School of Public Health, Queensland University of Technology, Brisbane, Australia
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Mahmoud I, Hou XY. Immigrants and the utilization of hospital emergency departments. World J Emerg Med 2014; 3:245-50. [PMID: 25215071 DOI: 10.5847/wjem.j.issn.1920-8642.2012.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 10/07/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Immigrants with language barriers are at high risk of having poor access to health care services. However, several studies have indicated that immigrants tend to use emergency departments (EDs) as their primary source of care at the expense of primary care. This may place an additional burden on already overcrowded EDs and lead to a low level of patient satisfaction with ED care. The study was to review if immigrants utilize ED care differently from host populations and to assess immigrants' satisfaction with ED care. DATA SOURCES Studies about immigrants' utilization of EDs in Australia and worldwide were reviewed. RESULTS There are conflicting results in the literature about the pattern of ED care use among immigrants. Some studies have shown higher utilization by immigrants compared to host populations and others have shown lower utilization. Overall, immigrants use ED care heavily, make inappropriate visits to EDs, have a longer length of stay in EDs, and are less satisfied with ED care as compared to host populations. CONCLUSIONS Immigrants might use ED care differently from host populations due to language and cultural barriers. There is sparse Australian literature regarding immigrants' access to health care including ED care. To ensure equity, further research is needed to inform policy when planning health care provision to immigrants.
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Affiliation(s)
- Ibrahim Mahmoud
- School of Public Health, Queensland University of Technology, Queensland, Australia
| | - Xiang-Yu Hou
- School of Public Health, Queensland University of Technology, Queensland, Australia
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Mahmoud I, Hou XY, Chu K, Clark M, Eley R. Satisfaction with emergency department service among non-English-speaking background patients. Emerg Med Australas 2014; 26:256-61. [DOI: 10.1111/1742-6723.12214] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Ibrahim Mahmoud
- School of Public Health and Social Work; Queensland University of Technology; Brisbane Queensland Australia
| | - Xiang-Yu Hou
- School of Public Health and Social Work; Queensland University of Technology; Brisbane Queensland Australia
| | - Kevin Chu
- Department of Emergency Medicine; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Michele Clark
- School of Public Health and Social Work; Queensland University of Technology; Brisbane Queensland Australia
| | - Rob Eley
- Emergency Department; The University of Queensland - Princess Alexandra Hospital; Brisbane Queensland Australia
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Kiss V, Pim C, Hemmelgarn BR, Quan H. Building knowledge about health services utilization by refugees. J Immigr Minor Health 2013; 15:57-67. [PMID: 21959711 DOI: 10.1007/s10903-011-9528-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The objective of this study was to compare the utilization of outpatient physician, emergency department and hospital services between refugees and the general population in Calgary, Alberta. Data was collected on 2,280 refugees from a refugee clinic in Calgary and matched with 9,120 non-refugees. Both groups were linked to Alberta Health and Wellness administrative data to assess health services utilization over 2 years. After adjusting for age, sex and medical conditions, refugees utilized general practitioners, emergency departments and hospitals more than non-refugees. A similar proportion in the two groups had seen a general practitioner within 1 week prior to their emergency department visit; however, refugees were more likely to have been triaged for urgent conditions and female refugees seen for pregnancy-related conditions than non-refugees. Refugees were more likely to have had infectious and parasitic diseases. Refugees utilized health services more than non-refugees with no evidence of underutilization.
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Affiliation(s)
- Valerie Kiss
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
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Ballotari P, D’Angelo S, Bonvicini L, Broccoli S, Caranci N, Candela S, Rossi PG. Effects of immigrant status on Emergency Room (ER) utilisation by children under age one: a population-based study in the province of Reggio Emilia (Italy). BMC Health Serv Res 2013; 13:458. [PMID: 24176109 PMCID: PMC4228415 DOI: 10.1186/1472-6963-13-458] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 10/28/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The primary aim of this study was to assess the effect of immigrant status on Emergency Room (ER) utilisation by children under age one, considering all, non-urgent, very urgent, and followed by hospitalisation visits. The second aim was to investigate the role played by mother's educational level in the relationship between citizenship and ER utilisation. METHODS The cohort study included all healthy singleton live births in the years 2008-2009 and residing in the province of Reggio Emilia, followed for the first year of life in order to study their ER visits. The outcomes were the ER utilisation rate for all, non-urgent, very urgent, and followed by hospitalisation visits. The main explanatory variable was mother's citizenship. Other covariates were mother's educational level, maternal age, parity, and child gender. Multivariate analyses (negative binomial regression and zero inflated when appropriate) were performed. Adjusted utilisation Rate Ratios (RR) and their 95% Confidence Intervals (95% CI) were calculated. Trend for age in months by citizenship is depicted. RESULTS There were 3,191 children (36.4%) with at least one ER visit in the first year of life. Adjusted RR show a significantly greater risk of ER visit for immigrants than for Italians: (RR 1.51; 95% CI 1.39-1.63). Immigrants also had a higher risk of non-urgent visits (RR 1.72; 95% CI 1.48-2.00) and for visits followed by hospitalizations (RR 1.58; 95% CI 1.33-1.89). For very urgent visits, the immigrants had a slightly higher risk compared to Italians (RR 1.25; 95% CI 0.98-1.59).The risk of ER visits is higher in the first two months of life (RR(1st vs 3rd-12th) 2.08; 95% CI 1.93-2.24 and RR(2nd vs 3rd-12th) 1.45; 95% CI 1.33-1.58, respectively). Considering all visits, the ER utilisation rate was inversely related with maternal education only for Italians (low educational level 44.0 and high educational level 73.9 for 100 children; p value for trend test < 0.001). CONCLUSIONS Our study observed a higher use of ER services by immigrant children and, to a lesser extent, by children of less educated Italian mothers. In immigrants, the excess is mostly due to non-urgent visits and only slightly to high acute conditions.
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Affiliation(s)
- Paola Ballotari
- Servizio Interaziendale di Epidemiologia, ASL di Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy
| | - Stefania D’Angelo
- Servizio Interaziendale di Epidemiologia, ASL di Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy
| | - Laura Bonvicini
- Servizio Interaziendale di Epidemiologia, ASL di Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy
| | - Serena Broccoli
- Servizio Interaziendale di Epidemiologia, ASL di Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy
| | - Nicola Caranci
- Regional Agency for Health and Social Care Emilia-Romagna Region, Viale Aldo Moro 21, Bologna, Italy
| | - Silvia Candela
- Servizio Interaziendale di Epidemiologia, ASL di Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Servizio Interaziendale di Epidemiologia, ASL di Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy
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Sandvik H, Hunskår S, Diaz E. Use of emergency medical services by patients encompassed by the Regular GP scheme. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013; 132:2272-6. [PMID: 23736193 DOI: 10.4045/tidsskr.12.0090] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Norwegian emergency medical services are used with frequency, often in relation to conditions that could wait until the next day to be handled by the patient's regular GP (RGP). We investigated whether there are characteristics of particular GPs that may help explain why patients on their list use the emergency medical services. MATERIAL AND METHODS We used data from the billing cards for 2008 from all emergency doctors, linked to information from the Regular GP database and Statistics Norway, for a total of 4,097 RGPs. For each RGP we estimated a contact rate: The total number of contacts reported for their list patients (identified by their personal ID numbers), divided by the length of the RGP's list. This rate was subsequently analysed with regard to characteristics of the RGP (bivariate analyses and multiple logistic regression). RESULTS The average contact rate amounted to 27.4 contacts per 100 list patients, with significant variation between the RGPs (the 25th percentile was 17.8 contacts and the 75th percentile 33.1). Patients of male RGPs, young RGPs and immigrant RGPs used the emergency medical services more frequently than patients of female RGPs, older RGPs and Norwegian RGPs. Patients from long lists, single-doctor practices and open lists used the emergency medical services less frequently than patients from short lists, group practices and closed lists. The contact rate was higher in rural municipalities than in urban areas. INTERPRETATION The large variations in the use of emergency medical services indicate that more RGPs should take measures to improve accessibility for emergency calls during the daytime.
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Affiliation(s)
- Hogne Sandvik
- National Centre for Emergency Primary Health Care, Uni Health, Uni Research, Bergen, Norway.
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Characteristics, processes, management and outcome of accesses to accident and emergency departments by citizenship. Int J Public Health 2013; 59:167-74. [DOI: 10.1007/s00038-013-0483-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 02/06/2013] [Accepted: 06/19/2013] [Indexed: 11/25/2022] Open
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Realizing good care within a context of cross-cultural diversity: an ethical guideline for healthcare organizations in Flanders, Belgium. Soc Sci Med 2013; 93:38-46. [PMID: 23906119 DOI: 10.1016/j.socscimed.2013.03.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 12/05/2012] [Accepted: 03/20/2013] [Indexed: 11/23/2022]
Abstract
In our globalizing world, health care professionals and organizations increasingly experience cross-cultural challenges in care relationships, which give rise to ethical questions regarding "the right thing to do" in such situations. For the time being, the international literature lacks examples of elaborated ethical guidelines for cross-cultural healthcare on the organizational level. As such, the ethical responsibility of healthcare organizations in realizing cross-cultural care remains underexposed. This paper aims to fill this gap by offering a case-study that illustrates the bioethical practice on a large-scale organizational level by presenting the ethical guideline developed in the period 2007-2011 by the Ethics Committee of Zorgnet Vlaanderen, a Christian-inspired umbrella organization for over 500 social profit healthcare organizations in Flanders, Belgium. The guideline offers an ethical framework within which fundamental ethical values are being analyzed within the context of cross-cultural care. The case study concludes with implications for healthcare practice on four different levels: (1) the level of the healthcare organization, (2) staff, (3) care receivers, and (4) the level of care supply. The study combines content-based ethics with process-based benchmarks.
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Haji Loueian E, Lange D, Borde T, David M, Babitsch B. Werden klinische Notfallambulanzen angemessen genutzt? Notf Rett Med 2012. [DOI: 10.1007/s10049-012-1603-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sandvik H, Hunskaar S, Diaz E. Immigrants' use of emergency primary health care in Norway: a registry-based observational study. BMC Health Serv Res 2012; 12:308. [PMID: 22958343 PMCID: PMC3471038 DOI: 10.1186/1472-6963-12-308] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 09/05/2012] [Indexed: 11/24/2022] Open
Abstract
Background Emigrants are often a selected sample and in good health, but migration can have deleterious effects on health. Many immigrant groups report poor health and increased use of health services, and it is often claimed that they tend to use emergency primary health care (EPHC) services for non-urgent purposes. The aim of the present study was to analyse immigrants’ use of EPHC, and to analyse variations according to country of origin, reason for immigration, and length of stay in Norway. Methods We conducted a registry based study of all immigrants to Norway, and a subsample of immigrants from Poland, Germany, Iraq and Somalia, and compared them with native Norwegians. The material comprised all electronic compensation claims for EPHC in Norway during 2008. We calculated total contact rates, contact rates for selected diagnostic groups and for services given during consultations. Adjustments for a series of socio-demographic and socio-economic variables were done by multiple logistic regression analyses. Results Immigrants as a whole had a lower contact rate than native Norwegians (23.7% versus 27.4%). Total contact rates for Polish and German immigrants (mostly work immigrants) were 11.9% and 7.0%, but for Somalis and Iraqis (mostly asylum seekers) 31.8% and 33.6%. Half of all contacts for Somalis and Iraqis were for non-specific pain, and they had relatively more of their contacts during night than other groups. Immigrants’ rates of psychiatric diagnoses were low, but increased with length of stay in Norway. Work immigrants suffered less from respiratory and gastrointestinal infections, but had more injuries and higher need for sickness certification. All immigrant groups, except Germans, were more often given a sickness certificate than native Norwegians. Use of interpreter was reduced with increasing length of stay. All immigrant groups had an increased need for long consultations, while laboratory tests were most often used for Somalis and Iraqis. Conclusions Immigrants use EPHC services less than native Norwegians, but there are large variations among immigrant groups. Work immigrants from Germany and Poland use EPHC considerably less, while asylum seekers from Somalia and Iraq use these services more than native Norwegians.
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Affiliation(s)
- Hogne Sandvik
- National Centre for Emergency Primary Health Care, Uni Health, Uni Research, Bergen, Norway.
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Do immigrants from Turkey, Pakistan and Ex-Yugoslavia with newly diagnosed type 2 diabetes initiate recommended statin therapy to the same extent as Danish-born residents? A nationwide register study. Eur J Clin Pharmacol 2012; 69:87-95. [PMID: 22648279 DOI: 10.1007/s00228-012-1306-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 05/02/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To explore whether newly diagnosed type 2 diabetes patients without previous cardiovascular disease (CVD) initiate preventive statin therapy regardless of ethnic background. METHODS Using nationwide individual-level registers, we followed a cohort of Danish-born residents and immigrants from Turkey, Pakistan and Ex-Yugoslavia, all without previous diabetes or CVD, during the period 2000-2008 for first dispensing of oral glucose-lowering medication (GLM), first dispensing of statins and register-markers of CVD (N = 3,764,620). Logistic regression analyses were used to test whether the odds ratios (ORs) of early statin therapy initiation (within 180 days after first GLM dispensing) are the same regardless of ethnic background. While age and gender were included as confounders in the basic model, income was included in the second model as a potential mediating variable. RESULTS Compared to native Danes, the ORs for early statin therapy were 0.68 (95 % confidence interval 0.50-0.92], 0.67 (0.56-0.81) and 0.56 (0.44-0.71) for Ex-Yugoslavians, Turks and Pakistanis, respectively. The differences remained largely unchanged after adjusting for income and tended to be accentuated when the threshold period was extended. The ORs of women initiating therapy (compared to native Danes) were 0.56 (0.35-0.90), 0.60 (0.46-0.78) and 0.48 (0.32-0.72) for Ex-Yugoslavians, Turks and Pakistanis, respectively, and those for men were 0.78 (0.52-1.17), 0.74 (0.58-0.95) and 0.60 (0.44-0.83), respectively. CONCLUSIONS Immigrants from Turkey, Pakistan and Ex-Yugoslavia with type 2 diabetes were less likely to initiate statin therapy than Danish-born residents-despite a similar or even higher risk of CVD. The treatment inequities associated with ethnicity were more pronounced in women than men.
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Headache in the emergency room: the role of immigrant background on the frequency of serious causes and diagnostic procedures. Neurol Sci 2011; 33:793-9. [PMID: 22044991 DOI: 10.1007/s10072-011-0830-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 10/20/2011] [Indexed: 10/15/2022]
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