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Rada I, Cabieses B. Challenges for the prevention of hypertension among international migrants in Latin America: prioritizing the health of migrants in healthcare systems. Front Public Health 2024; 11:1125090. [PMID: 38274523 PMCID: PMC10809178 DOI: 10.3389/fpubh.2023.1125090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/29/2023] [Indexed: 01/27/2024] Open
Abstract
Among the health priorities of international migrants, non-communicable diseases such as hypertension are of major interest due to their increasing prevalence, mainly in low- and middle-income countries. Previous evidence has reported a significant risk of hypertension in international migrants derived from multiple exposures during the migration process and at the destination, such as living conditions, health literacy and access to preventive services. Also, poorer disease control has been found compared to the local population. Considering existing deficiencies in access and use of healthcare services related to hypertension prevention and continuity of care of migrants globally, we aimed to offer a Latin American perspective of the challenges faced by international migrants residing in Latin America in accessing hypertension preventive care from a human rights, equity, and universal primary healthcare approaches. From a health systems perspective, we conducted a scoping review of scientific literature on hypertension prevention and control among international migrants in Latin America and the Caribbean. Based on the findings, we discuss the potential influence of migration and health policies on healthcare systems and individual and structural barriers to healthcare access, including lack of insurance, linguistic barriers, limited intercultural competence, and geographical and financial barriers. From existing evidence related to hypertension, we highlight the particular healthcare needs of migrants and their implications for regional public health goals. This aligns with promoting culturally tailored interventions considering the migration process, lifestyle patterns, structural vulnerabilities, and gender particularities in hypertension prevention, diagnosis, and treatment. We advocate for developing universal, voluntary, and systemic regional screening and disease control initiatives in Latin America for hypertension and other chronic conditions.
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Affiliation(s)
- Isabel Rada
- Centro de Salud Global Intercultural (CeSGI), Facultad de Medicina Clínica Alemana, Facultad de Psicología, Universidad del Desarrollo, Santiago, Chile
- Programa de Doctorado en Ciencias e Innovación en Medicina, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Baltica Cabieses
- Centro de Salud Global Intercultural (CeSGI), Facultad de Medicina Clínica Alemana, Facultad de Psicología, Universidad del Desarrollo, Santiago, Chile
- Department of Health Sciences, University of York, York, United Kingdom
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Jaeger FN, Pellaud N, Laville B, Klauser P. Barriers to and solutions for addressing insufficient professional interpreter use in primary healthcare. BMC Health Serv Res 2019; 19:753. [PMID: 31653211 PMCID: PMC6815061 DOI: 10.1186/s12913-019-4628-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/11/2019] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this nationwide study was to investigate barriers to adequate professional interpreter use and to describe existing initiatives and identify key factors for successful interpreter policies in primary care, using Switzerland as a case study. Methods Adult and paediatric primary care providers were invited to participate in an online cross-sectional questionnaire-based study. All accredited regional interpreter agencies were contacted first by email and, in the absence of a reply, by mail and then by phone. Local as well as the national health authorities were asked about existing policies. Results 599 primary care physicians participated. Among other reasons, physicians identified cumbersome organization (58.7%), absent financial coverage (53.7%) and lack of knowledge on how to arrange interpreter interventions (44%) as main barriers. The odds of organising professional interpreters were 6.6-times higher with full financial coverage. Some agencies confirmed difficulties providing professional interpreters for certain languages at a timely manner. Degrees of coverage of professional interpreter costs (full coverage to none) and organization varied between regions resulting in different levels of unmet needs. Conclusions Professional interpreter use can be improved through the following points: increase awareness and knowledge of primary care providers on interpreter use and organization, ensure financial coverage, as well as address organizational aspects. Examples of successful interventions exist.
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Affiliation(s)
- Fabienne N Jaeger
- Kollegium für Hausarztmedizin, Rue de l'Hôpital 15, CH-1701, Berne, Fribourg, Switzerland. .,Swiss Tropical and Public Health Institut, Socinstrasse 57, CH-4002, Basel, Switzerland. .,University of Basel, CH-4003, Basel, Switzerland.
| | - Nicole Pellaud
- Kollegium für Hausarztmedizin, Rue de l'Hôpital 15, CH-1701, Berne, Fribourg, Switzerland.,Swiss Society of Paediatrics, Rue de l'Hôpital 15, CH-1700, Fribourg, Switzerland
| | - Bénédicte Laville
- Kollegium für Hausarztmedizin, Rue de l'Hôpital 15, CH-1701, Berne, Fribourg, Switzerland
| | - Pierre Klauser
- Kollegium für Hausarztmedizin, Rue de l'Hôpital 15, CH-1701, Berne, Fribourg, Switzerland
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Jackson Y, Courvoisier DS, Duvoisin A, Ferro-Luzzi G, Bodenmann P, Chauvin P, Guessous I, Wolff H, Cullati S, Burton-Jeangros C. Impact of legal status change on undocumented migrants' health and well-being (Parchemins): protocol of a 4-year, prospective, mixed-methods study. BMJ Open 2019; 9:e028336. [PMID: 31154311 PMCID: PMC6549650 DOI: 10.1136/bmjopen-2018-028336] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/08/2019] [Accepted: 05/02/2019] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Migrants without residency permit, known as undocumented, tend to live in precarious conditions and be exposed to an accumulation of adverse determinants of health. Only scarce evidence exists on the social, economic and living conditions-related factors influencing their health status and well-being. No study has assessed the impact of legal status regularisation. The Parchemins study is the first prospective, mixed-methods study aiming at measuring the impact on health and well-being of a regularisation policy on undocumented migrants in Europe. METHODS AND ANALYSIS The Parchemins study will compare self-rated health and satisfaction with life in a group of adult undocumented migrants who qualify for applying for a residency permit (intervention group) with a group of undocumented migrants who lack one or more eligibility criteria for regularisation (control group) in Geneva Canton, Switzerland. Asylum seekers are not included in this study. The total sample will include 400 participants. Data collection will consist of standardised questionnaires complemented by semidirected interviews in a subsample (n=38) of migrants qualifying for regularisation. The baseline data will be collected just before or during the regularisation, and participants will subsequently be followed up yearly for 3 years. The quantitative part will explore variables about health (ie, health status, occupational health, health-seeking behaviours, access to care, healthcare utilisation), well-being (measured by satisfaction with different dimensions of life), living conditions (ie, employment, accommodation, social support) and economic situation (income, expenditures). Several confounders including sociodemographic characteristics and migration history will be collected. The qualitative part will explore longitudinally the experience of change in legal status at individual and family levels. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of Geneva, Switzerland. All participants provided informed consent. Results will be shared with undocumented migrants and disseminated in scientific journals and conferences. Fully anonymised data will be available to researchers.
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Affiliation(s)
- Yves Jackson
- Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Delphine S Courvoisier
- Department of General Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Aline Duvoisin
- Institute of sociological research, University of Geneva, Geneva, Switzerland
| | - Giovanni Ferro-Luzzi
- Haute Ecole de Gestion, University of applied sciences of Western Switzerland, Carouge, Switzerland
- Geneva School of Economics and Management, Universite de Geneve, Geneva, Switzerland
| | - Patrick Bodenmann
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Pierre Chauvin
- Department of Social Epidemiology, Inserm, UMRS 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
- UMRS 1136, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Idris Guessous
- Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Institute of sociological research, University of Geneva, Geneva, Switzerland
- Swiss NCCR LIVES, Universite de Geneve, Geneva, Switzerland
| | - Claudine Burton-Jeangros
- Institute of sociological research, University of Geneva, Geneva, Switzerland
- Swiss NCCR LIVES, Universite de Geneve, Geneva, Switzerland
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Jackson Y, Paignon A, Wolff H, Delicado N. Health of undocumented migrants in primary care in Switzerland. PLoS One 2018; 13:e0201313. [PMID: 30052674 PMCID: PMC6063438 DOI: 10.1371/journal.pone.0201313] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 07/12/2018] [Indexed: 12/15/2022] Open
Abstract
Background Undocumented migrants endure adverse living conditions while facing barriers to access healthcare. Evidence is lacking regarding their healthcare needs, notably in regards to chronic diseases. Our goal was to investigate health conditions in undocumented migrants attended in primary care setting. Methods This study was conducted at the primary care outpatient clinic, Geneva University Hospitals, Switzerland. We retrospectively recorded and coded all medical conditions of a random sample of 731 undocumented migrants using the International Classification of Primary Care, 2nd version (ICPC-2). We dichotomized conditions as chronic or non-chronic and considered multimorbidity in the presence of three or more chronic conditions. Results Participants originated from 72 countries and were mainly female (65.5%) with a mean age of 42.4 (standard deviation [SD]: 11.4) years. They presented a mean of 2.9 (SD: 2.1; range: 1–17) health conditions. In multivariable analysis, the number of conditions was associated with female gender (p = 0.011) and older age (p <0.001), but not with origin (p = 0.373). The body systems most frequently affected were endocrine, metabolic and nutritional (n = 386; 18.4%), musculoskeletal (n = 308, 14.7%) and digestive (n = 266, 12.8%). Hypertension (17.9%; 95% CI: 15.2%, 29.9%), obesity or overweight (16%; 95% CI: 13.4%, 18.9%) and gastric problems (14.1%; 95% CI: 11.6%, 16.8%) were most prevalent. Overall, 71.8% (95% CI: 68.5%, 75%) participants had at least one chronic condition while 20% (95% CI: 17.2%, 23.1%) had three or more. In multivariable analysis, age (p <0.001) was the only predictor of presenting at least one or three or more chronic conditions. Conclusions Undocumented migrants present multiple health problems in primary care settings and bear an important burden of chronic diseases. The extent of multimorbidity highlights the need to provide and facilitate the access to comprehensive and long-term primary healthcare services.
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Affiliation(s)
- Yves Jackson
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Global Health Institute, University of Geneva, Geneva, Switzerland
- * E-mail:
| | - Adeline Paignon
- HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Sciences, Geneva, Switzerland
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Noelia Delicado
- HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Sciences, Geneva, Switzerland
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Dodd N, Mansfield E, Carey M, Oldmeadow C, Sanson-Fisher R. Have we increased our efforts to identify strategies which encourage colorectal cancer screening in primary care patients? A review of research outputs over time. Prev Med Rep 2018; 11:100-104. [PMID: 29963366 PMCID: PMC6022456 DOI: 10.1016/j.pmedr.2018.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/16/2018] [Accepted: 05/18/2018] [Indexed: 02/07/2023] Open
Abstract
Globally, colorectal cancer (CRC) screening rates remain suboptimal. Primary care practitioners are supported by clinical practice guidelines which recommend they provide routine CRC screening advice. Published research can provide evidence to improve CRC screening in primary care, however this is dependent on the type and quality of evidence being produced. This review aimed to provide a snapshot of trends in the type and design quality of research reporting CRC screening among primary care patients across three time points: 1993-1995, 2003-2005 and 2013-2015. Four databases were searched using MeSH headings and keywords. Publications in peer-reviewed journals which reported primary data on CRC screening uptake among primary care patients were eligible for inclusion. Studies meeting eligibility criteria were coded as observational or intervention. Intervention studies were further coded to indicate whether or not they met Effective Practice and Organisation of Care (EPOC) study design criteria. A total of 102 publications were included. Of these, 65 reported intervention studies and 37 reported observational studies. The proportion of each study type did not change significantly over time. The majority of intervention studies met EPOC design criteria at each time point. The majority of research in this field has focused on testing strategies to increase CRC screening in primary care patients, as compared to research describing rates of CRC screening in this population. Further research is needed to determine which effective interventions are most likely to be adopted into primary care.
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Affiliation(s)
- Natalie Dodd
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Elise Mansfield
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Clinical Research Design, IT and Statistical Support (CReDITSS), Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Dodd N, Carey ML, Mansfield E, Oldmeadow C. Testing the Effectiveness of a Primary Care Intervention to Improve Uptake of Colorectal Cancer Screening: A Randomized Controlled Trial Protocol. JMIR Res Protoc 2017; 6:e86. [PMID: 28490420 PMCID: PMC5443911 DOI: 10.2196/resprot.7432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/02/2017] [Accepted: 04/02/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Screening for colorectal cancer (CRC) significantly reduces mortality associated with this disease. In Australia, the National Bowel Cancer Screening Program provides regular fecal occult blood tests (FOBT) for those aged 50 to 74 years, however, participation rates in the program have plateaued at 36%. Given low uptake in the National Bowel Cancer Screening Program, it is necessary to explore alternate methods to increase CRC screening rates. Primary care is a promising adjunct setting to test methods to increase CRC screening participation. Primary care guidelines support the recommendation and provision of CRC screening to primary care patients. Those in the National Bowel Cancer Screening Program target age range frequently present to their primary care provider. OBJECTIVE This study tests the effect that a multicomponent primary care-based intervention has on CRC screening uptake when compared to usual care. METHODS Primary care patients presenting for an appointment with their primary care provider complete a touchscreen survey to determine eligibility for the trial. Those aged 50 to 74 years, at average risk of CRC, with no history of CRC or inflammatory bowel disease, who have not had an FOBT in the past 2 years or a colonoscopy in the past 5 years are eligible to participate in the trial. Trial participants are randomized to the intervention or usual care group by day of attendance at the practice. The intervention consists of provision of an FOBT, printed information sheet, and primary care provider endorsement to complete the FOBT. The usual care group receives no additional care. RESULTS The primary outcome is completion of CRC screening 6 weeks after recruitment. The proportion of patients completing CRC screening will be compared between trial groups using a logistic regression model. CONCLUSIONS CRC screening rates in Australia are suboptimal and interventions to increase screening participation are urgently required. This protocol describes the process of implementing a multicomponent intervention designed to increase CRC screening uptake in a primary care setting. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12616001299493; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371136&isReview=true (Archived by WebCite at http://www.webcitation.org/6pL0VYIj6). Universal Trial Number U1111-1185-6120.
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Affiliation(s)
- Natalie Dodd
- University of Newcastle, School of Medicine and Public Health, Faculty of Health and Medicine, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Mariko Leanne Carey
- University of Newcastle, School of Medicine and Public Health, Faculty of Health and Medicine, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Elise Mansfield
- University of Newcastle, School of Medicine and Public Health, Faculty of Health and Medicine, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Christopher Oldmeadow
- University of Newcastle, School of Medicine and Public Health, Faculty of Health and Medicine, Callaghan, Australia
- Hunter Medical Research Institute, Clinical Research Design, Information Technology and Statistical Support, New Lambton Heights, Australia
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Jackson Y, Lozano Becerra JC, Carpentier M. Quality of diabetes care and health insurance coverage: a retrospective study in an outpatient academic public hospital in Switzerland. BMC Health Serv Res 2016; 16:540. [PMID: 27716186 PMCID: PMC5048692 DOI: 10.1186/s12913-016-1801-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 09/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Socioeconomic disadvantage is associated with an increased risk of adverse diabetes outcomes. In Switzerland, a country with theoretical universal healthcare coverage, people without health insurance face barriers in accessing to and in receiving standard quality care. The Geneva University Hospitals (HUG) have implemented policies aiming at reducing these gaps. We compared quality of diabetes care and ambulatory healthcare services utilization among insured and uninsured diabetic patients. METHODS This retrospective study linked health and administrative data of type 2 diabetic outpatients with at least one HbA1c test performed in 2012-2013 at HUG. Quality of care evaluation relied on processes (annual serum HbA1c, cholesterol and microalbuminuria tesing) and outcomes (HbA1c) assessment. Healthcare utilization was assessed by the number of ambulatory clinical and laboratory visits. Results were stratified by disease course (newly diagnosed versus prevalent diabetes). RESULTS Of the 198 patients included, 80 (40.4 %) were uninsured. Both groups underwent annual testing of HbA1c, cholesterol, kidney function and microalbuminuria at comparably high rates and numbers of ambulatory visits did not significantly differ. After adjustments for age and sex, there were no significant differences in serum HbA1c between groups both in those with prevalent or with newly diagnosed diabetes. Initial medical intervention entailed comparable glycaemic improvement after 6 months in incident diabetes among insured and uninsured patients. CONCLUSIONS This study did not find any difference in quality of diabetes care between insured and uninsured patients in a public hospital enforcing health-equity policies for access to and for delivery of standard diabetes care. It highlights the frontline role of public hospitals in contributing to care delivery equity even in countries with theoretical universal healthcare coverage.
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Affiliation(s)
- Yves Jackson
- Division of primary care medicine, Department of community medicine, primary care and emergency medicine, Geneva University Hospitals, Geneva, Switzerland. .,Global health institute, University of Geneva, Geneva, Switzerland.
| | - Juan Carlos Lozano Becerra
- Division of primary care medicine, Department of community medicine, primary care and emergency medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marc Carpentier
- Division of clinical epidemiology, Geneva University Hospitals, Geneva, Switzerland
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Montesi L, Caletti MT, Marchesini G. Diabetes in migrants and ethnic minorities in a changing World. World J Diabetes 2016; 7:34-44. [PMID: 26862371 PMCID: PMC4733447 DOI: 10.4239/wjd.v7.i3.34] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/19/2015] [Accepted: 01/04/2016] [Indexed: 02/05/2023] Open
Abstract
On a worldwide scale, the total number of migrants exceeds 200 million and is not expected to reduce, fuelled by the economic crisis, terrorism and wars, generating increasing clinical and administrative problems to National Health Systems. Chronic non-communicable diseases (NCD), and specifically diabetes, are on the front-line, due to the high number of cases at risk, duration and cost of diseases, and availability of effective measures of prevention and treatment. We reviewed the documents of International Agencies on migration and performed a PubMed search of existing literature, focusing on the differences in the prevalence of diabetes between migrants and native people, the prevalence of NCD in migrants vs rates in the countries of origin, diabetes convergence, risk of diabetes progression and standard of care in migrants. Even in universalistic healthcare systems, differences in socioeconomic status and barriers generated by the present culture of biomedicine make high-risk ethnic minorities under-treated and not protected against inequalities. Underutilization of drugs and primary care services in specific ethnic groups are far from being money-saving, and might produce higher hospitalization rates due to disease progression and complications. Efforts should be made to favor screening and treatment programs, to adapt education programs to specific cultures, and to develop community partnerships.
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Streit S, da Costa BR, Bauer DC, Collet TH, Weiler S, Zimmerli L, Frey P, Cornuz J, Gaspoz JM, Battegay E, Kerr E, Aujesky D, Rodondi N. Multimorbidity and quality of preventive care in Swiss university primary care cohorts. PLoS One 2014; 9:e96142. [PMID: 24760077 PMCID: PMC3997570 DOI: 10.1371/journal.pone.0096142] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 04/03/2014] [Indexed: 12/27/2022] Open
Abstract
Background Caring for patients with multimorbidity is common for generalists, although such patients are often excluded from clinical trials, and thus such trials lack of generalizability. Data on the association between multimorbidity and preventive care are limited. We aimed to assess whether comorbidity number, severity and type were associated with preventive care among patients receiving care in Swiss University primary care settings. Methods We examined a retrospective cohort composed of a random sample of 1,002 patients aged 50–80 years attending four Swiss university primary care settings. Multimorbidity was defined according to the literature and the Charlson index. We assessed the quality of preventive care and cardiovascular preventive care with RAND’s Quality Assessment Tool indicators. Aggregate scores of quality of provided care were calculated by taking into account the number of eligible patients for each indicator. Results Participants (mean age 63.5 years, 44% women) had a mean of 2.6 (SD 1.9) comorbidities and 67.5% had 2 or more comorbidities. The mean Charlson index was 1.8 (SD 1.9). Overall, participants received 69% of recommended preventive care and 84% of cardiovascular preventive care. Quality of care was not associated with higher numbers of comorbidities, both for preventive care and for cardiovascular preventive care. Results were similar in analyses using the Charlson index and after adjusting for age, gender, occupation, center and number of visits. Some patients may receive less preventive care including those with dementia (47%) and those with schizophrenia (35%). Conclusions In Swiss university primary care settings, two thirds of patients had 2 or more comorbidities. The receipt of preventive and cardiovascular preventive care was not affected by comorbidity count or severity, although patients with certain comorbidities may receive lower levels of preventive care.
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Affiliation(s)
- Sven Streit
- Insitute of General Practice BIHAM, Faculty of Medicine, University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
| | - Bruno R. da Costa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Clinical Trials Unit, Department of Clinical Research, Bern University Hospital, Bern, Switzerland
| | - Douglas C. Bauer
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Tinh-Hai Collet
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
- Service of Endocrinology, Diabetes, and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Stefan Weiler
- Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
| | - Lukas Zimmerli
- Division of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Peter Frey
- Insitute of General Practice BIHAM, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Jacques Cornuz
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jean-Michel Gaspoz
- Department of Community Medicine and Primary Care, University Hospitals of Geneva, and Faculty of Medicine, Geneva, Switzerland
| | - Edouard Battegay
- Division of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Eve Kerr
- Veterans Affairs Center for Clinical Management Research, HSR&D Center of Excellence; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Drahomir Aujesky
- Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
- * E-mail:
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