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Kolakowska A, Marshall E, Krastinova E, Cros A, Duvivier C, Leroy P, Caby F, Zucman D, Maka A, Salmon D, Chéret A. Insufficient vaccine coverage and vaccine hesitancy in people living with HIV: A prospective study in outpatient clinics in the Paris region. Vaccine 2024; 42:3655-3663. [PMID: 38714445 DOI: 10.1016/j.vaccine.2024.04.077] [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: 02/16/2024] [Revised: 04/18/2024] [Accepted: 04/25/2024] [Indexed: 05/09/2024]
Abstract
Vaccine prevention strategies play a crucial role in the management of people living with HIV (PLWH). The aim of this study was to assess vaccination coverage and identify barriers to vaccine uptake in PLWH in the Paris region. A cross-sectional survey was conducted in PLWH in 16 hospitals in the Paris region. The vaccination status, characteristics, opinions, and behaviors of participants were collected using a face-to-face questionnaire and from medical records. A total of 338 PLWH were included (response rate 99.7 %). The median age of participants was 51 years (IQR: 41-58). Vaccination coverage was 77.3 % for hepatitis B (95 % CI: 72.3-81.8 %), 62.7 % for hepatitis A (57.3-67.9 %), 61.2 % for pneumococcal vaccines (55.8-66.5 %), 56.5 % for diphtheria/tetanus/poliomyelitis (DTP) (51.0-61.9 %), 44.7 % for seasonal influenza (39.3-50.1 %), 31.4 % for measles/mumps/rubella (26.4-36.6 %) and 38.5 % for meningococcal vaccine (13.9-68.4 %). The main reason for vaccine reluctance was related to the lack of vaccination proposals/reminders. The overall willingness to get vaccinated was 71.0 % (65.9-75.8 %). In the multivariable analysis, several factors were associated with a higher vaccine uptake; for DTP vaccine: higher education level, having vaccination records, being registered with a general practitioner; for seasonal influenza vaccine: age > 60 years, higher education level, being employed. The overall vaccination coverage was suboptimal. Development of strategies reducing missed opportunity to offer vaccines is needed.
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Affiliation(s)
| | - Esaïe Marshall
- COREVIH Île-de-France Sud, Paris, France; Pierre Louis Institute of Epidemiology and Public Health, University of Paris Sorbonne, INSERM U1136, Paris, France
| | - Evguenia Krastinova
- Pierre Louis Institute of Epidemiology and Public Health, University of Paris Sorbonne, INSERM U1136, Paris, France; Prevention and Community Health, Creteil Hospital, France
| | - Agnès Cros
- COREVIH Île-de-France Sud, Paris, France
| | - Claudine Duvivier
- Paris Cité University, Necker Hospital, AP-HP, Infectious Diseases Department, Necker-Pasteur Infectiology Center, Paris, France; Inserm U1016, CNRS UMR 8104, Université Paris Descartes, Institut Cochin, Paris, France
| | - Pierre Leroy
- Department of Infectious Diseases, Public Health Unit, Groupe Hospitalier Sud Île-de-France, Melun, France
| | - Fabienne Caby
- HIV and STI department, Victor-Dupouy Hospital, Argenteuil, France
| | - David Zucman
- Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Arthur Maka
- Departement of Infectious Diseases, Bastia Hospital, France
| | - Dominique Salmon
- Department of Infectious Diseases, Hôtel Dieu Hospital, Paris, France; Department of Infectious Diseases, Institut Fournier, Paris, France
| | - Antoine Chéret
- Service de Plateforme de Diagnostic et Thérapeutique pluridisciplinaires, CHU, Guadeloupe; Inserm U1016, CNRS UMR 8104, Université Paris Descartes, Institut Cochin, Paris, France; INSERM-CIC-1424, CHU, Guadeloupe.
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Doetsch JN, Schlösser C, Barros H, Shaw D, Krafft T, Pilot E. A scoping review on the impact of austerity on healthcare access in the European Union: rethinking austerity for the most vulnerable. Int J Equity Health 2023; 22:3. [PMID: 36604705 PMCID: PMC9815671 DOI: 10.1186/s12939-022-01806-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND There is consensus that the 2008 financial and economic crisis and related austerity measures adversely impacted access to healthcare. In light of the growing debt caused by the COVID-19 crisis, it is uncertain whether a period of austerity will return. OBJECTIVE This study aims to provide a structured overview of the impact of austerity policies in the EU-28 zone, applied in response to the Great Recession, on access to health care for the adult population, using the five access dimensions by Levesque et al. (2013). METHODS This study followed the PRISMA extension for Scoping Reviews guideline. Medline (PubMed) and Web of Science were searched between February 2021 and June 2021. Primary studies in the English language published after the 1st of January 2008 reporting on the possible change in access to the healthcare system for the adult population induced by austerity in an EU28 country were included. RESULTS The final search strategy resulted in 525 articles, of which 75 studies were reviewed for full-text analysis, and a total of 21 studies were included. Results revealed that austerity policy has been primarily associated with a reduction in access to healthcare, described through four main categories: i) Increase in rates of reported unmet needs (86%); ii) Affordability (38%); iii) Appropriateness (38%); iv) and Availability and Accommodation (19%). Vulnerable populations were more affected by austerity measures than the general population when specific safeguards were not in place. The main affected adult vulnerable population groups were: patients with chronic diseases, elderly people, (undocumented) migrants, unemployed, economically inactive people and individuals with lower levels of education or socioeconomic status. CONCLUSION Austerity measures have led to a deterioration in access to healthcare in the vast majority of the countries studied in the EU-28 zone. Findings should prompt policymakers to rethink the fiscal agenda across all policies in times of economic crisis and focus on the needs of the most vulnerable populations from the health perspective.
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Affiliation(s)
- Julia Nadine Doetsch
- grid.5808.50000 0001 1503 7226EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal ,grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Clara Schlösser
- grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Henrique Barros
- grid.5808.50000 0001 1503 7226EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal ,grid.5808.50000 0001 1503 7226Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
| | - David Shaw
- grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands ,grid.6612.30000 0004 1937 0642Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Thomas Krafft
- grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Eva Pilot
- grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Fleming P, Caffrey L, Belle SV, Barry S, Burke S, Conway J, Siersbaek R, Mockler D, Thomas S. How International Health System Austerity Responses to the 2008 Financial Crisis Impacted Health System and Workforce Resilience - A Realist Review. Int J Health Policy Manag 2022; 12:7420. [PMID: 37579453 PMCID: PMC10125082 DOI: 10.34172/ijhpm.2022.7420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/19/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND The Great Recession, following the 2008 financial crisis, led many governments to adopt programmes of austerity. This had a lasting impact on health system functionality, resources, staff (numbers, motivation and morale) and patient outcomes. This study aimed to understand how health system resilience was impacted and how this affects readiness for subsequent shocks. METHODS A realist review identified legacies associated with austerity (proximal outcomes) and how these impact the distal outcome of health system resilience. EMBASE, CINAHL, MEDLINE, EconLit and Web of Science were searched (2007-May 2021), resulting in 1081 articles. Further theory-driven searches resulted in an additional 60 studies. Descriptive, inductive, deductive and retroductive realist analysis (utilising excel and Nvivo) aided the development of context-mechanism-outcome configurations (CMOCs), alongside stakeholder engagement to confirm or refute emerging results. Causal pathways, and the interplay between context and mechanisms that led to proximal and distal outcomes, were revealed. The refined CMOCs and policy recommendations focused primarily on workforce resilience. RESULTS Five CMOCs demonstrated how austerity-driven policy decisions can impact health systems when driven by the priorities of external agents. This created a real or perceived shift away from the values and interests of health professionals, a distrust in decision-making processes and resistance to change. Their values were at odds with the realities of implementing such policy decisions within sustained restrictive working conditions (rationing of staff, consumables, treatment options). A diminished view of the profession and an inability to provide high-quality, equitable, and needs-led care, alongside stagnant or degraded working conditions, led to moral distress. This can forge legacies that may adversely impact resilience when faced with future shocks. CONCLUSION This review reveals the importance of transparent, open communication, in addition to co-produced policies in order to avoid scenarios that can be detrimental to workforce and health system resilience.
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Affiliation(s)
- Padraic Fleming
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Louise Caffrey
- School of Social Work and Social Policy, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
| | | | - Sarah Barry
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Jacki Conway
- Everlake, 5 Marine Terrace, Dun Laoghaire, Dublin, Ireland
| | - Rikke Siersbaek
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - David Mockler
- Library Reader Services, Trinity College Dublin, The University of Dublin, St James Hospital, Dublin 8, Ireland
| | - Steve Thomas
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
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Prats-Uribe A, Brugueras S, Comet D, Álamo-Junquera D, Ortega Gutiérrez LL, Orcau À, Caylà JA, Millet JP. Evidences supporting the inclusion of immigrants in the universal healthcare coverage. Eur J Public Health 2021; 30:785-787. [PMID: 32044956 DOI: 10.1093/eurpub/ckaa020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In 2012, the Spanish government enforced a healthcare exclusion policy against undocumented immigrants. The newly elected government has recently derogated this policy. To analyze how this decree could have affected population health, we looked at primary health patients who would have been excluded and compared with a matched sample of non-excluded patients. Potentially excluded patients had decreased odds of: depression, chronic obstructive pulmonary disease, dyslipidaemia, heart failure and hypertension while diabetes mellitus rates were similar to non-excluded. Infectious diseases were more frequent in potentially excluded population (HIV, tuberculosis and syphilis). The exclusion of patients impedes the control of infectious diseases at a community level.
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Affiliation(s)
- Albert Prats-Uribe
- Epidemiology Service, Public Health Agency of Barcelona (ASPB), Barcelona, Spain.,Preventive Medicine and Public Health Training Unit, PSMar-ASPB, Barcelona, Spain.,Centre for Statistics in Medicine, Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK
| | - Sílvia Brugueras
- Epidemiology Service, Public Health Agency of Barcelona (ASPB), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain.,Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Dolors Comet
- Departament de Salut, Subdirecció General d'Avaluacions Mèdiques, Direcció General d'ordenació i Regulació Sanitària del, Barcelona, Spain
| | | | | | - Àngels Orcau
- Epidemiology Service, Public Health Agency of Barcelona (ASPB), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - Joan A Caylà
- Foundation of Tuberculosis Research Unit of Barcelona (fuiTB), Barcelona, Spain
| | - Joan-Pau Millet
- Epidemiology Service, Public Health Agency of Barcelona (ASPB), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
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Lostao L, Ronda E, Pascual C, Cea-Soriano L, Moreno A, Regidor E. Erosion of universal health coverage and trend in the frequency of physician consultations in Spain. Int J Equity Health 2020; 19:121. [PMID: 32660616 PMCID: PMC7359494 DOI: 10.1186/s12939-020-01234-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/02/2020] [Indexed: 11/15/2022] Open
Abstract
Background We studied the frequency of physician visits in the native and immigrant populations in Spain before and after implementation of a governmental measure to restrict the use of public healthcare services by undocumented immigrants beginning in 2012. Methods Data were taken from the 2009 and 2014 European Health Surveys carried out in Spain. We investigated any physician consultation in the last 4 weeks before the interview, as well as visits to a family physician, public specialist physician and private specialist physician. We estimated the frequency of visits in 2009 and in 2014 in the native and immigrant populations and the difference in the frequency between the two populations, by calculating the percentage ratio estimated by binomial regression and adjusted for different confounders that are indicators of the need for assistance. Results The percentage of persons who consulted any physician in 2009 and 2014 was 31.7 and 32.9% in the native population, and 25.6 and 30.1% in the immigrant population, respectively. In the immigrant population, the frequency of visits to the general practitioner and public specialist physician increased, whereas in the native population only public specialist physician visits increased. The frequency of private specialist visits remained stable in both populations. After adjusting for the indicators of need for healthcare, no significant differences between the immigrant and native populations were seen in the frequency of visits, except for private specialist consultations, which were less frequent among immigrants. Conclusion The restriction of universal healthcare coverage in Spain did not reduce the frequency of physician visits between 2009 and 2014, as the frequency of these consultations was seen to increase in both the native and immigrant populations.
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Affiliation(s)
- Lourdes Lostao
- Department of Sociology, Medical Sociology, Universidad Pública de Navarra, Pamplona, Spain. .,I-COMMUNITAS-Institute for Advanced Social Research, Universidad Pública de Navarra, Pamplona, Spain.
| | - Elena Ronda
- Department of Preventive Medicine and Public Health, Universidad de Alicante, Alicante, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Cruz Pascual
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain
| | - Lucía Cea-Soriano
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Almudena Moreno
- Department of Sociology, Medical Sociology, Universidad Pública de Navarra, Pamplona, Spain.,I-COMMUNITAS-Institute for Advanced Social Research, Universidad Pública de Navarra, Pamplona, Spain
| | - Enrique Regidor
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Kentikelenis A. Intersecting crises: migration, the economy and the right to health in Europe. Eur J Public Health 2019; 28:61-62. [PMID: 30476091 DOI: 10.1093/eurpub/cky224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Jordão NM, Freitas CD, García Ramírez M. Efeitos da crise económica e das políticas de austeridade na saúde e no acesso aos cuidados de saúde da população migrante em países do sul da Europa: revisão scoping. REMHU: REVISTA INTERDISCIPLINAR DA MOBILIDADE HUMANA 2018. [DOI: 10.1590/1980-85852503880005411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo O objectivo deste artigo é reunir e sintetizar o conhecimento existente sobre o impacto da crise económica e das consequentes políticas de austeridade no estado de saúde e no acesso aos cuidados de saúde das populações migrantes em países do sul da Europa, nomeadamente Portugal, Espanha, Itália e Grécia. Os resultados analisados indicam que a crise económica e as políticas de austeridade tiveram um impacto negativo na saúde e no acesso aos cuidados de saúde dos migrantes em três países, já que não se encontraram dados relativos a Portugal. Os seus efeitos negativos espelham-se na saúde mental, saúde ocupacional, doenças transmissíveis e não transmissíveis, saúde infantil e na perceção subjetiva de saúde. A acessibilidade dos cuidados de saúde tornou-se mais limitada em Espanha, especialmente para a população de imigrantes em situação irregular.
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Peralta-Gallego L, Gené-Badia J, Gallo P. Effects of undocumented immigrants exclusion from health care coverage in Spain. Health Policy 2018; 122:1155-1160. [PMID: 30193979 DOI: 10.1016/j.healthpol.2018.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 08/02/2018] [Accepted: 08/22/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND In 2012 the Spanish government passed Royal Decree-Law 16/2012 (RDL) aimed at containing public expenditure in response to the economic crisis. This RDL redefined just who would be entitled to public health care. As a result, a large proportion of undocumented immigrants in Spain were excluded from basic publicly financed health care with access only being granted under particular circumstances (emergency care, maternal care, children under 18, asylum seekers and victims of human trafficking). AIM The aims of this paper are to identify the specific traits of this policy, review its impact on health and health care access, and to evaluate its economic impact. RESULTS Most political parties and health professional groups opposed the RDL, and a large number of Spanish regions either declined to apply it or opted to apply it partially. To date, the RDL has had a considerable impact on the access of undocumented immigrants to public health care, with evidence suggesting that approximately 870,000 people have been excluded. A slight increase in infectious diseases has been reported, albeit not as high as originally predicted, and recent evidence points to an increase in mortality among this population subgroup. CONCLUSIONS Regional legislation favouring the coverage of undocumented immigrants might have acted as a counterweight and thus contained the negative health effects in this population subgroup. But the Constitutional Court invalidated all regional arrangements obliging regions to comply with the RDL.
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Affiliation(s)
| | | | - Pedro Gallo
- Department of Sociology, University of Barcelona, Spain
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