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Wiessner C, Licaj S, Klein J, Bohn B, Brand T, Castell S, Führer A, Harth V, Heier M, Heise JK, Holleczek B, Jaskulski S, Jochem C, Koch-Gallenkamp L, Krist L, Leitzmann M, Lieb W, Meinke-Franze C, Mikolajczyk R, Moreno Velásquez I, Obi N, Pischon T, Schipf S, Thierry S, Willich SN, Zeeb H, Becher H. Health Service Use Among Migrants in the German National Cohort-The Role of Birth Region and Language Skills. Int J Public Health 2024; 69:1606377. [PMID: 38510525 PMCID: PMC10952844 DOI: 10.3389/ijph.2024.1606377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 02/14/2024] [Indexed: 03/22/2024] Open
Abstract
Objective: To compare health service use (HSU) between migrants and non-migrants in Germany. Methods: Using data from the population-based German National Cohort (NAKO), we compared the HSU of general practitioners, medical specialists, and psychologists/psychiatrists between six migrant groups of different origins with the utilization of non-migrants. A latent profile analysis (LPA) with a subsequent multinomial regression analysis was conducted to characterize the HSU of different groups. Additionally, separate regression models were calculated. Both analyses aimed to estimate the direct effect of migration background on HSU. Results: In the LPA, the migrant groups showed no relevant differences compared to non-migrants regarding HSU. In separate analyses, general practitioners and medical specialists were used comparably to slightly more often by first-generation migrants from Eastern Europe, Turkey, and resettlers. In contrast, the use of psychologists/psychiatrists was substantially lower among those groups. Second-generation migrants and migrants from Western countries showed no differences in their HSU compared to non-migrants. Conclusion: We observed a low mental HSU among specific migrant groups in Germany. This indicates the existence of barriers among those groups that need to be addressed.
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Affiliation(s)
- Christian Wiessner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sara Licaj
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Klein
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Tilman Brand
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Center for Infection Research, Brunswick, Germany
| | - Amand Führer
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- KORA Study Centre, University Hospital Augsburg, Augsburg, Germany
| | - Jana-Kristin Heise
- Department of Epidemiology, Helmholtz Center for Infection Research, Brunswick, Germany
| | | | - Stefanie Jaskulski
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Carmen Jochem
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Lena Koch-Gallenkamp
- Department of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Faculty of Medicine, University of Kiel, Kiel, Germany
| | - Claudia Meinke-Franze
- Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Ilais Moreno Velásquez
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
| | - Nadia Obi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Occupational and Maritime Medicine Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Pischon
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sabine Schipf
- Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Germany
| | - Sigrid Thierry
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Augsburg University Hospital, Augsburg, Germany
| | - Stefan N. Willich
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Heiko Becher
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, 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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Westrick AC, Vazquez V, De La Rosa M, Romano E, Rojas P, Sanchez M. Prescription Drug and Cannabis Use among Recent Latinx Immigrants Pre- and Post-Immigration to the US. Subst Use Misuse 2022; 57:175-184. [PMID: 34898352 PMCID: PMC8813903 DOI: 10.1080/10826084.2021.1990342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction: Shifts in the sociopolitical context of Latin America have led to steep increases in recent Latinx immigrants (RLI) arriving in the US within the context of forced migration. Yet, little is known about how adverse experiences of RLIs before and after immigration may impact their health including drug use. The purpose of this study was to examine prescription drug and cannabis use before and just after immigration among RLIs and how this drug use is influenced by pre-and post-immigration factors. Methods: This study utilized baseline data from a study examining pre- to post-immigration drinking and driving trajectories among RLI in the United States (US). Baseline criteria included: self-identifying as a Latinx immigrant, 18 - 34 years old, who recently immigrated from a Latin American country. Multivariate logistic regression was conducted to determine predictors of drug use both prior to and after immigrating. Results: There were 540 RLI, 50.2% male and 47.8% subjected to forced migration. Prescription and illicit drug use decreased post-immigration with sedatives being the most common. Higher levels of education was associated with increased odds of pre-immigration prescription drug use and cannabis use. Those experiencing forced migration were more likely to engage in prescription drug use before and after immigration, while no associations were found for cannabis use. Conclusion: Findings suggest a need for increased substance use and mental health services among RLIs arriving within the context of forced migration. More research is needed to understand the trajectories of drug use among RLI as their time in the US increases.
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Affiliation(s)
- Ashly C Westrick
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Vicky Vazquez
- Center for Research on US Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, Florida, USA
| | - Mario De La Rosa
- Center for Research on US Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, Florida, USA
| | - Eduardo Romano
- Pacific Institute for Research and Evaluation (P.I.R.E.), Calverton, Maryland, USA
| | - Patria Rojas
- Center for Research on US Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, Florida, USA.,Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Mariana Sanchez
- Center for Research on US Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, Florida, USA.,Pacific Institute for Research and Evaluation (P.I.R.E.), Calverton, Maryland, USA
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The Meaning of Physical Activity: A Qualitative Study on the Perspective of South American Immigrant Parents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207500. [PMID: 33076326 PMCID: PMC7602638 DOI: 10.3390/ijerph17207500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022]
Abstract
Physical activity facilitates the acquisition of healthy habits from childhood to adulthood. There are differences in the practice of physical activity between immigrant children and native Spanish children. The aim was to describe physical activity in children, from the perspective of South American immigrant parents. A qualitative case study was conducted. Parents were recruited using purposeful sampling. Data were collected from 12 participants by means of unstructured interviews together with researcher notes. A thematic analysis was applied. The following topics were identified: (a) physical activity and health, (b) socialization, (c) the need for movement, (d) gender, (e) barriers, (f) educational burden, (g) community living, and (h) reason for immigrating. Parents described how physical activity is fundamental and has benefits for health, and for the relationship between children. They perceived that physical activity should not be limited by gender. The time dedicated to other school activities, the norms related to community living, and financial limitations were especially relevant as barriers for the performance of physical activity. These results can be used to revise the curriculum in schools, promote equal opportunities for physical activity and support family participation.
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Trappolini E, Marino C, Agabiti N, Giudici C, Davoli M, Cacciani L. Disparities in emergency department use between Italians and migrants residing in Rome, Italy: the Rome Dynamic Longitudinal Study from 2005 to 2015. BMC Public Health 2020; 20:1548. [PMID: 33059671 PMCID: PMC7559990 DOI: 10.1186/s12889-020-09280-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/20/2020] [Indexed: 01/01/2023] Open
Abstract
Background The Emergency Department (ED) can be considered an indicator of accessibility and quality and can be influenced in period of economic downturns. In the last fifteen years, the number of migrants in Italy has doubled (from 2.4 million in 2005 to 5.2 in 2019, 4.1 and 8.7% of the total population, respectively). However, evidence about migrants’ healthcare use is poor, and no studies focused on the ED utilisation rate during the Great Recession are available. This study aims to analyse trends in all-cause and cause-specific ED utilisation among migrants and Italians residing in Rome, Italy, before and after 2008. Methods Longitudinal study based on data from the Municipal Register of Rome linked to the Emergency Department Register from 2005 to 2015. We analysed 2,184,467 individuals, aged 25–64 in each year. We applied a Hurdle model to estimate the propensity to use the ED and to model how often individuals accessed the ED. Results Migrants were less likely to be ED users than Italians, except for Africans (RR = 1.46, 95%CI 1.40–1.52) and Latin Americans (RR = 1.04, 95%CI 1.00–1.08) who had higher all-cause utilisation rates than non-migrants. Compared to the pre-2008 period, in the post-2008 we found an increase in the likelihood of being an ED user (OR = 1.34, 95%CI 1.34–1.35), and a decrease in ED utilisation rates (RR = 0.96, 95%CI 0.96–0.97) for the whole population, with differences among migrant subgroups, regardless of cause. Conclusions This study shows differences in the ED utilisation between migrants and Italians, and within the migrant population, during the Great Recession. The findings may reflect differentials in the health status, and barriers to access primary and secondary care among migrants. In this regard, health policies and cuts in health spending measures may have played a key role, and interventions to tackle health and access disparities should include policy measures addressing the underlying factors, adopting a Health in All Policies perspective. Further researches focusing on specific groups of migrants, and on the causes and diagnoses related to the ED utilisation, may help to explain the differences observed.
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Affiliation(s)
| | - Claudia Marino
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Laura Cacciani
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
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Alonso Moreno FJ, Micó Pérez RM, Segura Fragoso A, Ahmed de Prado H, Guerrero Muñoz M, Palomino Cobo I, Leiva-Cepas F, Llisterri Caro JL. [Skills perceived by general practitioners for providing care to immigrant patients]. Semergen 2020; 46:448-456. [PMID: 32178934 DOI: 10.1016/j.semerg.2019.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/29/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the skills perceived by general practitioners for providing competent care to immigrants MATERIAL AND METHODS: Observational, descriptive and cross-sectional study with data collection using a 21-item questionnaire completed electronically by the general practitioners and validated by the National Validation Commission of SEMERGEN. It was structured with closed-ended, multiple-choice test questions, including variables related to the doctor and variables related to the immigrant patient. The level of professional competence was assessed using a 1 to 10 Likert scale. RESULTS A total 610 family physicians with a mean age of 47.5±12.3 years responded and 64.1% were women. Of these, 112 (18.4%) were residents. The response rate was 4.9%. A large majority (72.6%) had not taken part in continuing education courses on caring for immigrants in the last 5years. Participants reported difficulties in the clinic: 73% of the cases with the language, 38.7% with the allotted time, and 32.3% due to knowledge of the culture. Most (96.9%) of patients attended the clinic due to a common illness. The cause in 14.4% was related to the migratory process (infectious disease acquired in the country of origin), and in 26.4% with the health conditions in the host country (lack of stable housing, overcrowding, and conditions of work). The perceived level of competence was 6.2±1.9. CONCLUSIONS The competence perceived by general practitioners in providing care to immigrants is moderate. The most important barriers for these professionals are ignorance of the language, lack of time allocated for consultation, and ignorance of the patient's culture.
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Affiliation(s)
| | - R M Micó Pérez
- Medicina Familiar, Centro de Salud Fontanars dels Alforins, EAP Ontinyent, Ontinyent, Valencia, España
| | - A Segura Fragoso
- Servicio de Investigación, Instituto de Ciencias de la Salud, Talavera de la Reina, España
| | - H Ahmed de Prado
- R3 de Medicina Familiar y Comunitaria, C. Salud Dobra, Hospital Sierrallana, Torrelavega, Cantabria, España
| | - M Guerrero Muñoz
- R4 año de Medicina Familiar y Comunitaria, Centro de Atención Primaria Santa Eulalia Sud. Hospital de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - I Palomino Cobo
- Medicina Familiar, Centro de Salud Mijas, Fuengirola, Málaga, España
| | - F Leiva-Cepas
- Medicina Familiar, Departamento de Ciencias Morfológicas, Facultad de Medicina y Enfermería, Universidad de Córdoba, Grupo de Investigación Epidemiológica en Atención Primaria, Instituto Maimónides de Investigación Biomédica Traslacional (IMIBIC), Córdoba, España
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Leveau E. [Providing nursing care for migrants: feedback from experience in Greece]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2020; 65:34-36. [PMID: 32563505 DOI: 10.1016/s0038-0814(20)30051-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
During the 2015 migration crisis in Europe, medical NGOs played a key role in caring for migrant people. Nursing practice during humanitarian crises is characterized by many challenges. Shared experience of a primary care nurse with migrants in Greece.
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Affiliation(s)
- Enzo Leveau
- Infirmier en pratique avancée diplômé d'État, spécialisé en pathologies chroniques stabilisées et prévention des polypathologies en soins primaires, certificat de médecine tropicale, diplôme universitaire de soins infirmiers en médecine d'urgence , 65 rue Camille-Desmoulins, 92442 Issy-les-Moulineaux cedex, France.
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Pinilla J, Negrín MA, Abásolo I. Trends in horizontal inequity in access to public health care services by immigrant condition in Spain (2006-2017). Int J Equity Health 2019; 18:185. [PMID: 31783864 PMCID: PMC6883664 DOI: 10.1186/s12939-019-1092-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background The objective of this research is to analyse trends in horizontal inequity in access to public health services by immigration condition in Spain throughout the period 2006–2017. We focus on “economic immigrants” because they are potentially the most vulnerable group amongst immigrants. Methods Based on the National Health Surveys of 2006–07 (N = 29,478), 2011–12 (N = 20,884) and 2016–17 (N = 22,903), hierarchical logistic regressions with random effects in Spain’s autonomous communities are estimated to explain the probability of using publicly-financed health care services by immigrant condition, controlling by health care need and other socioeconomic and demographic variables. Results Our results indicate that there are several horizontal inequities, though they changed throughout the decade studied. Regarding primary care services, the period starts (2006–07) with no global evidence of horizontal inequity in access (although the analysis by continent shows inequity that is detrimental to Eastern Europeans and Asians), giving way to inequity favouring economic immigrants (particularly Latin Americans and Africans) in 2011–12 and 2016–17. An opposite trend happens with specialist care, as the period starts (2006–07) with evidence of inequity that is detrimental to economic immigrants (particularly those from North of Africa) but this inequity disappears with the economic crisis and after it (with the only exception of Eastern Europeans in 2011–12, whose probability to visit a specialist is lower than for natives). Regarding emergency care, our evidence indicates horizontal inequity in access that favours economic immigrants (particularly Latin Americans and North Africans) that remains throughout the period. In general, there is no inequity in hospitalisations, with the exception of 2011–12, where inequity in favour of economic immigrants (particularly those from Latin America) takes place. Conclusions The results obtained here may serve, firstly, to prevent alarm about negative discrimination of economic immigrants in their access to public health services, even after the implementation of the Royal Decree RD Law 16/2012. Conversely, our results suggest that the horizontal inequity in access to specialist care that was found to be detrimental to economic immigrants in 2006–07, disappeared in global terms in 2011–12 and also by continent of origin in 2016–17.
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Affiliation(s)
- Jaime Pinilla
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Miguel A Negrín
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Ignacio Abásolo
- Departamento de Economía Aplicada y Métodos Cuantitativos, Instituto Universitario de Desarrollo Regional, Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, Spain. .,Facultad de Economía, Empresa y Turismo, Campus de Guajara, 38071, La Laguna, Santa Cruz de Tenerife, Spain.
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Dattoli VCC, Lucio DDS, Chaves ITDS. A utilização da atenção primária à saúde por imigrantes em Florianópolis. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2019. [DOI: 10.5712/rbmfc14(41)1786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Conhecer o perfil do imigrante que utiliza a atenção primária de Florianópolis. Métodos: Estudo transversal de base populacional com dados cadastrais de estrangeiros moradores de Florianópolis, que utilizaram a Atenção Primária à Saúde entre os anos de 2014 e 2016. As variáveis utilizadas foram: nacionalidade, sexo, idade, nível de escolaridade, raça, endereço de moradia e tipos de serviços utilizados. Resultados: Um total de 10.108 estrangeiros utilizaram a atenção básica em Florianópolis no período do estudo, com predomínio de adultos, brancos, com ensino médio ou superior, predominância de argentinos, uruguaios e haitianos, utilizando predominantemente serviços da farmácia e consultas médicas, distribuídos em todas unidades de saúde da capital. Houve maior nível de escolaridade e maior proporção de crianças e idosos na população provinda de países desenvolvidos, além de uma menor utilização dos serviços. Discussão: Estudo pioneiro no Brasil. O perfil dos imigrantes estudados é comparável à população de estudos europeus, com predomínio de latino-americanos e caribenhos, com faixa etária prevalecendo população economicamente ativa, utilizando consultas médicas e com alta escolaridade entre imigrantes de países desenvolvidos.
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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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Abstract
This study aims to analyze the differences in the use of primary care (PC), hospital, and emergency services between people born in Spain and immigrants. Data were obtained from the 2006 Spanish National Health Survey. The sample was composed of individuals aged 16-64 years from Spain and the seven countries with most immigrants in Spain (n = 22,224). Hierarchical multiple logistic regression models were fitted. Romanian men were less likely to use health care at all levels compared to men from other countries. Women from Argentina, Bolivia and Ecuador reported a lower use of PC. Among women, there were no differences in emergency visits or hospitalizations between countries. Bolivian men reported more hospitalizations than Spanish men, whereas Argentinean men reported more emergency visits than their Spanish counterparts. In Spain, most immigrants made less than, or about the same use of health care services as the native Spanish population.
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Graetz V, Rechel B, Groot W, Norredam M, Pavlova M. Utilization of health care services by migrants in Europe-a systematic literature review. Br Med Bull 2017; 121:5-18. [PMID: 28108435 DOI: 10.1093/bmb/ldw057] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/25/2016] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Our study reviewed the empirical evidence on the utilization of health care services by migrants in Europe, and on differences in health service utilization between migrants and non-migrants across European countries. SOURCES OF DATA A systematic literature review was performed, searching the databases Medline, Cinahl and Embase and covering the period from January 2009 to April 2016. The final number of articles included was 39. AREAS OF AGREEMENT Utilization of accident and emergency services and hospitalizations were higher among migrants compared with non-migrants in most countries for which evidence was available. In contrast, screening and outpatient visits for specialized care were generally used less often by migrants. AREAS OF CONTROVERSY Utilization of general practitioner services among migrants compared with non-migrants presents a diverging picture. GROWING POINTS Compared with previous systematic reviews, the results indicate a clearer picture of the differences in health service utilization between migrants and non-migrants in Europe. AREAS TIMELY FOR DEVELOPING RESEARCH A comprehensive comparison across European countries is impossible because the number of studies is still limited. Further research should also help to identify barriers regarding the utilization of health care services by migrants.
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Affiliation(s)
- V Graetz
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - B Rechel
- European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London, UK
| | - W Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
| | - M Norredam
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark
| | - M Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Gimeno-Feliu LA, Calderón-Larrañaga A, Prados-Torres A, Revilla-López C, Diaz E. Patterns of pharmaceutical use for immigrants to Spain and Norway: a comparative study of prescription databases in two European countries. Int J Equity Health 2016; 15:32. [PMID: 26912255 PMCID: PMC4765128 DOI: 10.1186/s12939-016-0317-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 02/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although equity in health care is theoretically a cornerstone in Western societies, several studies show that services do not always provide equitable care for immigrants. Differences in pharmaceutical consumption between immigrants and natives are explained by variances in predisposing factors, enabling factors and needs across populations, and can be used as a proxy of disparities in health care use. By comparing the relative differences in pharmacological use between natives and immigrants from the same four countries of origin living in Spain and Norway respectively, this article presents a new approach to the study of inequity in health care. METHODS All purchased drug prescriptions classified according to the Anatomical Therapeutic Chemical (ATC) system in Aragon (Spain) and Norway for a total of 5 million natives and nearly 100,000 immigrants for one calendar year were included in this cross-sectional study. Age and gender adjusted relative purchase rates for immigrants from Poland, China, Colombia and Morocco compared to native populations in each of the host countries were calculated. Direct standardisation was performed based on the 2009 population structure of the OECD countries. RESULTS Overall, a significantly lower proportion of immigrants in Aragon (Spain) and Norway purchased pharmacological drugs compared to natives. Patterns of use across the different immigrant groups were consistent in both host countries, despite potential disparities between the Spanish and Norwegian health care systems. Immigrants from Morocco showed the highest drug use rates in relation to natives, especially for antidepressants, "pain killers" and drugs for peptic ulcer. Immigrants from China and Poland showed the lowest use rates, while Colombians where more similar to host countries. CONCLUSIONS The similarities found between the two European countries in relation to immigrants' pharmaceutical use disregarding their host country emphasises the need to consider specific immigrant-related features when planning and providing healthcare services to this part of the population. These results somehow remove the focus on inequity as the main reason to explain differences in purchase between immigrants and natives.
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Affiliation(s)
- Luis Andres Gimeno-Feliu
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009, Zaragoza, Spain. .,San Pablo Health Centre, C/Aguadores 7, 50003, Zaragoza, Spain. .,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, C/Domingo Miral s/n, 50009, Zaragoza, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/Sinesio Delgado 4, 28029, Madrid, Spain.
| | - Amaia Calderón-Larrañaga
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009, Zaragoza, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/Sinesio Delgado 4, 28029, Madrid, Spain.
| | - Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009, Zaragoza, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/Sinesio Delgado 4, 28029, Madrid, Spain. .,Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, C/Domingo Miral s/n, 50009, Zaragoza, Spain.
| | - Concha Revilla-López
- Teaching Unit of Preventive Medicine and Public Health, Aragon Health Sciences Institute (IACS), Avda. San Juan Bosco 13, 50009, Zaragoza, Spain.
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018, Bergen, Norway. .,Norwegian Centre for Minority Health Research, Gullhaugveien 1-3, 0484, Oslo, Norway.
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Velasco C, Vinasco AM, Trilla A. [Immigrant perceptions of the Spanish National Healthcare System and its services]. Aten Primaria 2015; 48:149-58. [PMID: 26388468 PMCID: PMC6877837 DOI: 10.1016/j.aprim.2015.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 01/13/2015] [Accepted: 01/22/2015] [Indexed: 12/03/2022] Open
Abstract
Objetivo Conocer la percepción, la utilización y la satisfacción en relación con los servicios sanitarios de un grupo de inmigrantes residentes en Barcelona en relación con su género, procedencia y clase social. Diseño Estudio descriptivo transversal. Emplazamiento Ciudad de Barcelona, España. Participantes Doscientos veinticinco inmigrantes usuarios de servicios sociosanitarios residentes en la ciudad de Barcelona, de junio a julio del 2012. Mediciones principales Se analizaron el nivel de acceso y la relación de los inmigrantes residentes con el sistema sanitario público, a partir de una encuesta realizada en población inmigrante. Las respuestas obtenidas fueron analizadas en relación con los ejes: género, edad, clase social, salud autopercibida, país de origen, tiempo desde la llegada y estado civil. Resultados El 89% de la población encuestada dijo «haber sido tratada con respeto» al acudir a los servicios de salud, siendo considerado este el aspecto más importante. Sin embargo, el 59,4% refirió una percepción de «discriminación hacia los inmigrantes» y el 68,4% manifestó que las diferencias culturales afectan «total o parcialmente» la calidad de la atención recibida. Para el 66,7% la atención sanitaria recibida en Barcelona es mejor que la recibida en su país de origen, principalmente por su calidad científico-técnica y por el acceso universal. Conclusiones Pese a la buena valoración del sistema sanitario público universal este estudio mostró deficiencias del sistema en cuanto a los aspectos psicosociales de la atención sanitaria a inmigrantes en Barcelona. Es necesario profundizar en el estudio de los conocimientos y percepciones de colectivos minoritarios en el contexto actual.
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Affiliation(s)
- César Velasco
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic de Barcelona, Barcelona, España/ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic, Barcelona, España.
| | - Ana Maria Vinasco
- Universidad Barcelona, Máster de Gestión Hospitalaria y de Centros Sanitarios, Barcelona, España
| | - Antoni Trilla
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic de Barcelona, Barcelona, España/ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic, Barcelona, España
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Song IG, Lee H, Yi J, Kim MS, Park SM. Influenza Vaccination Coverage and Its Associated Factors among North Korean Defectors Living in the Republic of Korea. J Korean Med Sci 2015; 30:1226-31. [PMID: 26339160 PMCID: PMC4553667 DOI: 10.3346/jkms.2015.30.9.1226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/13/2015] [Indexed: 11/20/2022] Open
Abstract
This study aimed to examine influenza vaccination coverage of North Korean defectors (NKD) in the Republic of Korea (Korea) and explore the factors affected the vaccination coverage. Total 378 NKD were analyzed. Four Korean control subjects were randomly matched by age and gender from the Korea National Health and Nutrition Examination Survey V (n = 1,500). The adjusted vaccination coverage revealed no statistical difference between the defectors group and indigenous group (29.1% vs. 29.5%, P = 0.915). In the aged under 50 group, the vaccination coverage of NKD was higher than that of Korean natives (37.8% vs. 25.8%, P = 0.016). However in the aged 50 yr and over group, the vaccination coverage of North Korean defectors was lower than that of the natives (28.0% vs. 37.6%, P = 0.189). Even the gap was wider in the aged 65 yr and over group (36.4% vs. 77.8%, P = 0.007). Gender and medical check-up experience within 2 yr showed association with the vaccination coverage of NKD. Influenza vaccination coverage of aged defectors' group (aged 50 yr and over) was lower than indigenous people though overall vaccination coverage was similar. Further efforts to increase influenza vaccination coverage of this group are needed.
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Affiliation(s)
- In Gyu Song
- Department of Pediatrics, Hana Medical Center, Settlement Support Center for North Korean Refugees, Anseong, Korea
- Center for Medicine and Korean Reunification, Seoul National University College of Medicine, Seoul, Korea
| | - Haewon Lee
- Center for Medicine and Korean Reunification, Seoul National University College of Medicine, Seoul, Korea
| | - Jinseon Yi
- Center for Medicine and Korean Reunification, Seoul National University College of Medicine, Seoul, Korea
| | - Min Sun Kim
- Public Health Medical Service, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
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Gil-González D, Carrasco-Portiño M, Vives-Cases C, Agudelo-Suárez AA, Castejón Bolea R, Ronda-Pérez E. Is health a right for all? An umbrella review of the barriers to health care access faced by migrants. ETHNICITY & HEALTH 2014; 20:523-541. [PMID: 25117877 DOI: 10.1080/13557858.2014.946473] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To synthesise the scientific evidence concerning barriers to health care access faced by migrants. We sought to critically analyse this evidence with a view to guiding policies. DESIGN A systematic review methodology was used to identify systematic and scoping reviews which quantitatively or qualitatively analysed data from primary studies. The main variables analysed were structural and contextual barriers (health system organisation) as well as individual (patients and providers). The quality of evidence from the systematic reviews was critically appraised. From 2674 reviews, 79 were retained for further scrutiny, and finally 9 met the inclusion criteria. RESULTS The structural barriers identified were the lack of health insurance and the high cost of drugs (non-universal health system) and organisational aspects of health system (social insurance system and national health system). The individual barriers were linguistic and cultural. None of the reviews provided a quality appraisal of the studies. CONCLUSIONS Barriers to health care for migrants range from entitlement in non-universal health systems to accessibility in universal ones, and determinants of access to the respective health services should be analysed within the corresponding national context. Generate social and institutional changes that eliminate barriers to access to health services is essential to ensure health for all.
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Affiliation(s)
- Diana Gil-González
- a Department of Community Nursing, Preventive Medicine and Public Health, and History of Science , University of Alicante , Alicante , Spain
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Health Status Sensed by the Adult Latin American Immigrant Population in the City of Seville, Spain. J Immigr Minor Health 2013; 17:820-5. [DOI: 10.1007/s10903-013-9963-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Ramos JM, Navarrete-Muñoz EM, Pinargote H, Sastre J, Seguí JM, Rugero MJ. Hospital admissions in Alicante (Spain): a comparative analysis of foreign citizens from high-income countries, immigrants from low-income countries, and Spanish citizens. BMC Health Serv Res 2013; 13:510. [PMID: 24321628 PMCID: PMC3893374 DOI: 10.1186/1472-6963-13-510] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 11/14/2013] [Indexed: 11/11/2022] Open
Abstract
Background Over the last decade, the number of foreign citizens (FCs) in Spain has increased. There is no doubt that their health has become a relevant subject from the point of view of public healthcare. Our study aimed to describe hospital admission rates, diagnoses at hospital discharge, and mortality during hospital admissions in FCs from high-income countries (FCHICs), FCs from low-income countries (FCLICs), and autochthonous citizens (ACs). Methods A cross-sectional study was performed at two public hospitals in the city of Alicante (Spain) and its surrounding area. Utilization rates were estimated. Multivariate analysis adjusting for age and sex was performed on hospital admission rates, diagnoses at hospital discharge, service of admission, and mortality during hospital admission in FCHICs and FCLICs compared with ACs (adjusted odds ratio [AOR] with 95% confidence intervals [CI]). Results 42,839 patients ≥15 years were discharged from the hospitals. The utilization rate was lower in FCs than ACs, whose crude rate ratio was 0.676 (95% CI: 0.656-0.696). FCHICs had more risk of being diagnosed at discharge in the categories of the circulatory system (AOR: 1.55; 95% CI: 1.35-1.77), neoplasms (AOR: 1.21; 95% CI: 1.03-1.42), and injury and poisoning (AOR: 1.33; 95% CI: 1.11-1.58). FCLICs had more risk of being diagnosed in the categories of pregnancy, childbirth & puerperium (AOR: 1.33; 95% CI: 1.29-1.59), and injury and poisoning (AOR: 1.19; 95% CI: 1.03-1.36), and less risk in the mental disorder category (AOR: 0.32; 95% CI: 0.22-0.45). The length of hospitalization (in days) was lower in FCLICs (median: 3; IQR: 2–6) than both ACs (median: 4; IQR: 2–8) and FCHICs (median: 4; IQR: 2–8) (p < 0.001). The mortality rates on admission of ACs, FCHICs, and FCLICs were 4.2%, 3.3%, and 1.3%, respectively, but after adjusting for age and sex, the mortality rate risks were similar in FCHICs and FCLICs. Conclusion First, FCs utilized hospitalization less when compared with ACs. Second, the hospitalization profile for FCHICs was similar to ACs, with more problems in the circulatory system, and the hospitalization profile for FCLICs was different compared with ACs, with more admissions for pregnancy, childbirth & puerperium.
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Affiliation(s)
- José M Ramos
- Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain.
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González-López JR, Lomas-Campos MDLM, Rodríguez-Gázquez MDLÁ. [Risk factors and cardiovascular events in adult Latin American immigrants in the Macarena District, Seville, Spain: a pilot study]. Rev Esc Enferm USP 2013; 47:328-34. [PMID: 23743897 DOI: 10.1590/s0080-62342013000200008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 07/16/2012] [Indexed: 11/22/2022] Open
Abstract
In order to estimate the prevalence of self-reported risk factors and cardiovascular events in an adult immigrant Latin American population of District 2 (Macarena) in Seville, we conducted a pilot study using cross-sectional descriptive research. We used an anonymous questionnaire with self-reported risk factors and cardiovascular events. 34 people participated (18% of the sample); mean age: 31.8 years, mean residence: 6.5 years, women: 52.9%. Prevalence of risk factors: diabetes 8.8%, high cholesterol 14.7% and high blood pressure 23.5%. Prevalence of coronary events was 8.8%; angina pectoris, myocardial infarction and stroke, 2.9% each. The conclusion is that self-reported prevalence of cardiovascular events was higher than in the literature, this issue deserving the attention of health agencies. This knowledge should be considered by nurses to develop culturally appropriate care plans of the context of immigrants.
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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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Gimeno-Feliu LA, Magallón-Botaya R, Macipe-Costa RM, Luzón-Oliver L, Cañada-Millan JL, Lasheras-Barrio M. Differences in the use of primary care services between Spanish national and immigrant patients. J Immigr Minor Health 2013; 15:584-90. [PMID: 22618356 PMCID: PMC3632716 DOI: 10.1007/s10903-012-9647-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
UNLABELLED Knowing what real use is made of health services by immigrant population is of great interest. The objectives are to analyze the use of primary care services by immigrants compared to Spanish nationals and to analyze these differences in relation to geographic origin. Retrospective observational study of all primary care visits made in 26 urban health centers. Main variable: total number of health centre visits/year. DEPENDENT VARIABLES type of clinician requested; type of attention, and origin of immigrants. The independent variable was nationality. Statistics were obtained from the electronic medical records. The 4,933,521 appointments made in 2007 were analyzed for a reference population of 594,145 people (11.15% immigrants). The adjusted annual frequency for nationals was 8.3, versus whereas 4.6 for immigrants. The immigrant population makes less use of primary care services than national population. This is evident for all age groups and regardless of the immigrants' countries of origin. This result is important when planning health care resources for immigrant population.
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Davidovitch N, Filc D, Novack L, Balicer RD. Immigrating to a universal health care system: Utilization of hospital services by immigrants in Israel. Health Place 2013; 20:13-8. [DOI: 10.1016/j.healthplace.2012.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 11/15/2012] [Accepted: 11/17/2012] [Indexed: 11/30/2022]
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Agudelo-Suárez AA, Gil-González D, Vives-Cases C, Love JG, Wimpenny P, Ronda-Pérez E. A metasynthesis of qualitative studies regarding opinions and perceptions about barriers and determinants of health services' accessibility in economic migrants. BMC Health Serv Res 2012; 12:461. [PMID: 23245431 PMCID: PMC3565901 DOI: 10.1186/1472-6963-12-461] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 11/23/2012] [Indexed: 11/30/2022] Open
Abstract
Background Access to health services is an important health determinant. New research in health equity is required, especially amongst economic migrants from developing countries. Studies conducted on the use of health services by migrant populations highlight existing gaps in understanding which factors affect access to these services from a qualitative perspective. We aim to describe the views of the migrants regarding barriers and determinants of access to health services in the international literature (1997–2011). Methods A systematic review was conducted for Qualitative research papers (English/Spanish) published in 13 electronic databases. A selection of articles that accomplished the inclusion criteria and a quality evaluation of the studies were carried out. The findings of the selected studies were synthesised by means of metasynthesis using different analysis categories according to Andersen’s conceptual framework of access and use of health services and by incorporating other emergent categories. Results We located 3,025 titles, 36 studies achieved the inclusion criteria. After quality evaluation, 28 articles were definitively synthesised. 12 studies (46.2%) were carried out in the U.S and 11 studies (42.3%) dealt with primary care services. The participating population varied depending mainly on type of host country. Barriers were described, such as the lack of communication between health services providers and migrants, due to idiomatic difficulties and cultural differences. Other barriers were linked to the economic system, the health service characteristics and the legislation in each country. This situation has consequences for the lack of health control by migrants and their social vulnerability. Conclusions Economic migrants faced individual and structural barriers to the health services in host countries, especially those with undocumented situation and those experimented idiomatic difficulties. Strategies to improve the structures of health systems and social policies are needed.
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Affiliation(s)
- Andrés A Agudelo-Suárez
- Faculty of Dentistry, University of Antioquia, Calle 64 N° 52-59, Medellín, Antioquia, Colombia.
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Tay CY, Windsor HM, Thirriot F, Lu W, Conway C, Perkins TT, Marshall BJ. Helicobacter pylori eradication in Western Australia using novel quadruple therapy combinations. Aliment Pharmacol Ther 2012; 36:1076-83. [PMID: 23072648 DOI: 10.1111/apt.12089] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 06/05/2012] [Accepted: 09/26/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Helicobacter pylori eradication rates with standard triple therapy are declining worldwide. The optimal management of H. pylori is evolving and new treatment combinations for antibiotic resistant H. pylori strains are required, especially for patients with penicillin allergy. AIM To review the effectiveness of alternative antibiotic combinations and necessity of pre-antibiotic sensitivity testing. METHODS A total of 310 consecutive patients who had failed at least one course of standard 7-day triple therapy initially prescribed by their physicians were included in this study between year 2007 and 2011. Antibiotics were prescribed based on pre-antibiotic sensitivity tests and, if any, patient's allergy to penicillin. RESULTS In 98.7% of the patients' samples, H. pylori was successfully cultured. The proportion resistant to clarithromycin and metronidazole was 94.1% and 67.6% respectively, with 65% resistant to both. For the in-house primary quadruple therapy, with Proton pump inhibitor, Amoxicillin, Rifabutin and Ciprofloxacin (PARC), H. pylori was successfully eradicated in 95.2% of patients. For patients allergic to amoxicillin, an alternative quadruple therapy using Proton pump inhibitor, Bismuth subcitrate, Rifabutin and Ciprofloxacin (PBRC) gave an eradication rate of 94.2%. Patients needing alternative salvage therapy were given novel personalised combinations consisting of bismuth, rifabutin, tetracycline or furazolidone; the eradication rate was 73.8%. CONCLUSIONS Patients who present with antibiotic resistant H. pylori can be confidently treated with PARC, PBRC or other personalised salvage therapies. These regimens can be used when treatment options are limited by penicillin allergy. Pre-treatment H. pylori antibiotic sensitivity tests contributed to the high eradication rate in this study.
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Affiliation(s)
- C Y Tay
- School of Pathology and Laboratory Medicine M502, University of Western Australia, Nedlands, WA, Australia.
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Villarroel N, Artazcoz L. Heterogeneous patterns of health status among immigrants in Spain. Health Place 2012; 18:1282-91. [DOI: 10.1016/j.healthplace.2012.09.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 09/12/2012] [Accepted: 09/14/2012] [Indexed: 11/17/2022]
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Salinero-Fort MÁ, Jiménez-García R, del Otero-Sanz L, de Burgos-Lunar C, Chico-Moraleja RM, Martín-Madrazo C, Gómez-Campelo P. Self-reported health status in primary health care: the influence of immigration and other associated factors. PLoS One 2012; 7:e38462. [PMID: 22675564 PMCID: PMC3366977 DOI: 10.1371/journal.pone.0038462] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 05/05/2012] [Indexed: 11/30/2022] Open
Abstract
Objective The aims of this study are to compare self-reported health status between Spanish-born and Latin American-born Spanish residents, adjusted by length of residence in the host country; and additionally, to analyse sociodemographic and psychosocial variables associated with a better health status. Design This is a cross-sectional population based study of Latin American-born (n = 691) and Spanish-born (n = 903) in 15 urban primary health care centres in Madrid (Spain), carried out between 2007 and 2009. The participants provided information, through an interview, about self-reported health status, socioeconomic characteristics, psychosocial factors and migration conditions. Descriptive and multiple logistic regression analyses were conducted. Results The Spanish-born participants reported a better health status than the Latin America-born participants (79.8% versus 69.3%, p<0.001). Different patterns of self-reported health status were observed depending on the length of residence in the host country. The proportion of immigrants with a better health status is greater in those who have been in Spain for less than five years compared to those who have stayed longer. Better health status is significantly associated with being men, under 34 years old, being Spanish-born, having a monthly incomes of over 1000 euros, and having considerable social support and low stress. Conclusions Better self-reported health status is associated with being Spanish-born, men, under 34 years old, having an uppermiddle-socioeconomic status, adequate social support, and low stress. Additionally, length of residence in the host country is seen as a related factor in the self-reported health status of immigrants.
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Affiliation(s)
- Miguel Á Salinero-Fort
- Fundación de Investigación Biomédica, Hospital Carlos III, Servicio Madrileño de Salud, Madrid, Spain.
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Borkan J, Eaton CB, Novillo-Ortiz D, Rivero Corte P, Jadad AR. Renewing primary care: lessons learned from the Spanish health care system. Health Aff (Millwood) 2012; 29:1432-41. [PMID: 20679646 DOI: 10.1377/hlthaff.2010.0023] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
From 1978 on, Spain rapidly expanded and strengthened its primary health care system, offering a lesson in how to improve health outcomes in a cost-effective manner. The nation moved to a tax-based system of universal access for the entire population and, at the local level, instituted primary care teams coordinating prevention, health promotion, treatment, and community care. Gains included increases in life expectancy and reductions in infant mortality, with outcomes superior to those in the United States. In 2007 Spain spent $2,671 per person, or 8.5 percent of its gross domestic product on health care, versus 16 percent in the United States. Despite concerns familiar to Americans--about future shortages of primary care physicians and relatively low status and pay for these physicians--the principles underlying the Spanish reforms offer lessons for the United States.
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Affiliation(s)
- Jeffrey Borkan
- Department of Family Medicine at the Alpert Medical School, Brown University, in Providence, Rhode Island, USA.
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Gallegos-Juárez IG, Ponce-Samaniego YY, Sempere-Selva MT, Ramos-Rincón JM. [Life-style and self-rated health status, and the use of health services by an immigrant population from Paraguay and Bolivia in city of Elche (Alicante, Spain)]. Semergen 2012; 38:432-8. [PMID: 23021575 DOI: 10.1016/j.semerg.2012.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 02/13/2012] [Accepted: 02/15/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To study the lifestyle, use of health services, self-perceived health status and health services evaluations of immigrants from Paraguay and Bolivia in the city of Elche, and to establish and/or adapt prevention health services strategies to the needs of this population. METHODS A cross-sectional study, using a health questionnaire, was conducted between November 2009 and April 2010, using a convenience sample selected from the Paraguay and Bolivia Citizens Association. RESULTS A total of 49 Paraguayans and 35 Bolivians over 15 years old were interviewed of whom 42 (50%) were male; 33% of respondents did not perform any physical activity, and 14.3% were smokers (males [23.8%] vs female [4.8%], P=.03). The assessment of health was good or very good in 59.5% (Paraguayans [71.4%] vs Bolivians [42.9%]), P=.02). The use of health services was 85.4% (males [75%] vs women [95.2%], P=02) and 51% went to an emergency department. Consultation with a dentist was reported in 43.9% (Paraguayans [56.2%] vs Bolivians [26.5%], P=.007); 65.9% considered the Spanish public health system as being excellent, very good or good. CONCLUSION The lifestyle, the use of private resources and the assessment of health status are different in both groups studied. The assessment of the Spanish public health system was good in both. Strategies are needed to improve lifestyle, counselling for smoking cessation, alcohol use and control of dyslipidaemia.
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Affiliation(s)
- I G Gallegos-Juárez
- Medicina Familiar y Comunitaria, Departamento de Salud 20, Centro de Salud del Raval, Elche, España
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Esteban-Vasallo MD, Domínguez-Berjón MF, Aerny-Perreten N, Astray-Mochales J, Martín-Martínez F, Gènova-Maleras R. Pandemic influenza A (H1N1) 2009 in Madrid, Spain: incidence and characteristics in immigrant and native population. Eur J Public Health 2011; 22:792-6. [PMID: 22158997 DOI: 10.1093/eurpub/ckr171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Some immigrants and refugees might be more vulnerable than other groups to pandemic influenza because of pre-existing health and social disparities, migration history and living conditions. The objective of this study was to compare, between the immigrant and autochtonous population, the incidence and characteristics of influenza cases consulting in primary care (PC) and severe influenza cases. METHODS Descriptive cross-sectional study of influenza episodes registered in PC and severe influenza cases reported between 1 May 2009 and 22 May 2010, by gender and origin. Age-adjusted rates were calculated and the association between origin and chronic pathology, pregnancy, delay in admission to hospital and admission to intensive care units (ICU) was analyzed by logistic regression and generalized linear models. RESULTS The influenza rate in PC, adjusted by age, was lower for immigrant population (2396.3, 95% confidence interval (95% CI) 2362.5-2430.0 vs. 2795.9, 95% CI 2780.4-2811.5 per 100, 000). The difference between severe influenza rates by origin was not statistically significant. Chronic conditions were less common in immigrant population. In severe influenza cases, pregnancy was more common in immigrant women, and the probability of admission to ICU was higher in men from Central and Eastern Europe (prevalence ratio (PR) 8.44, 95% CI 2.81-25.40) and North African women (PR 3.30, 95% CI 1.09-10.05). CONCLUSION Differences in influenza rates were detected by origin. This information could be useful for new pandemic wave management purposes, in addition to targetting future investigations. Pandemic influenza preparedness and response plans should incorporate specific actions to improve immigrants' access to health services and to decrease cultural barriers.
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Affiliation(s)
- María D Esteban-Vasallo
- Health Reports and Studies Department, Madrid Regional Health Affairs Authority, Madrid, Spain
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Hempler NF, Larsen FB, Nielsen SS, Diderichsen F, Andreasen AH, Jørgensen T. A registry-based follow-up study, comparing the incidence of cardiovascular disease in native Danes and immigrants born in Turkey, Pakistan and the former Yugoslavia: do social inequalities play a role? BMC Public Health 2011; 11:662. [PMID: 21861890 PMCID: PMC3189134 DOI: 10.1186/1471-2458-11-662] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 08/23/2011] [Indexed: 11/25/2022] Open
Abstract
Background This study compared the incidence of cardiovascular disease (CVD) and acute myocardial infarction (AMI) between native Danes and immigrants born in Turkey, Pakistan and the former Yugoslavia. Furthermore, we examined whether different indicators of socioeconomic status (SES), such as employment, income and housing conditions influenced potential differences. Methods In this registry-based follow-up study individuals were identified in a large database that included individuals from two major regions in Denmark, corresponding to about 60% of the Danish population. Incident cases of CVD and AMI included fatal and non-fatal events and were taken from registries. Using Cox regression models, we estimated incidence rates at 5-year follow-up. Results Immigrant men and women from Turkey and Pakistan had an increased incidence of CVD, compared with native Danish men. In the case of AMI, a similar pattern was observed; however, differences were more pronounced. Pakistanis and Turks with a shorter duration of residence had a lower incidence, compared with those of a longer residence. Generally, no notable differences were observed between former Yugoslavians and native Danes. In men, differences in CVD and AMI were reduced after adjustment for SES, in particular, among Turks regarding CVD. In women, effects were particularly reduced among Yugoslavians in the case of CVD and in Turks in the case of CVD and AMI after adjustment for SES. Conclusions In conclusion, country of birth-related differences in the incidence of CVD and AMI were observed. At least some of the differences that we uncovered were results of a socioeconomic effect. Duration of residence also played a certain role. Future studies should collect and test different indicators of SES in studies of CVD among immigrants.
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Affiliation(s)
- Nana F Hempler
- Research Centre for Prevention and Health, the Capital Region, Glostrup University Hospital, Denmark.
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Rodríguez-Rieiro C, Hernández-Barrera V, Carrasco-Garrido P, de Andres AL, Jiménez-García R. Vaccination against 2008/2009 and 2009/2010 seasonal influenza in Spain: Coverage among high risk subjects, HCWs, immigrants and time trends from the 2005/2006 campaign. Vaccine 2011; 29:6029-34. [DOI: 10.1016/j.vaccine.2011.06.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 05/24/2011] [Accepted: 06/09/2011] [Indexed: 02/04/2023]
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Ben Cheikh W, Abad JM, Arribas F, Andrés E, Rabanaque MJ. Utilización de los hospitales públicos por la población extranjera en Aragón (2004-2007). GACETA SANITARIA 2011; 25:314-21. [DOI: 10.1016/j.gaceta.2011.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 01/26/2011] [Accepted: 02/01/2011] [Indexed: 10/18/2022]
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Volodina A, Bertsche T, Kostev K, Winkler V, Haefeli WE, Becher H. Drug utilization patterns and reported health status in ethnic German migrants (Aussiedler) in Germany: a cross-sectional study. BMC Public Health 2011; 11:509. [PMID: 21711531 PMCID: PMC3141468 DOI: 10.1186/1471-2458-11-509] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Accepted: 06/28/2011] [Indexed: 12/16/2022] Open
Abstract
Background Inadequate utilization of healthcare services by migrant populations is an important public health concern. Inadequate drug consumption and poor compliance to the therapeutic regimen are common manifestations of low health-care seeking behavior present in migrants even in the countries with well-established healthcare systems. There are few studies on the use of medicines among the different groups of migrants in Germany. The objective of this study is to investigate drug consumption patterns of ethnic German migrants (Aussiedler) and their current health status. Methods A cross-sectional study nested into a cohort of 18,621 individuals aged 20-70 years who migrated to Germany from the former Soviet Union between 1990 and 2005 was conducted. Data on consumption of drugs, drug handling, major health risk factors, and one-year disease prevalence were obtained for 114 individuals through a self-administered questionnaire and phone interviews. Results were compared to the data on the German population derived from the Disease Analyzer database and Robert Koch Institute (RKI) annual reports. Direct age standardization, test of differences, Chi-square test, and descriptive statistics were applied as appropriate. For drug classification the Anatomical Therapeutic Chemical (ATC) system was used. Results Of the respondents, 97% reported to have at least one disease within a 12-month period. The one-year prevalence of asthma (6.9%), hypertension (26.7%), chronic bronchitis (8.6%), and diabetes (4.9%) in migrants was similar to the general German population. 51% regularly took either over-the-counter (OTC) medication or prescription medicines. Six ATC groups were analyzed. The highest drug consumption was reported for the ATC cardiovascular (22%), nervous (9%), and muskulo-skeletal system (8%). 30% used OTC medicines obtained in the country of origin. Difficulties with drug handling were rare. Alcohol consumption did not differ from the German population (p = 0.19 males and 0.27 females), however smoking prevalence was lower (p < 0.01) in both sexes. Conclusion Ethnic German migrants seem to differ only slightly from Germans in health status, drug utilization, and disease risk factors, and if so, not in an extreme way. Country of origin remains a source of medicines for a substantial part of migrants. The study is limited by a small sample size and low response rate.
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Affiliation(s)
- Anna Volodina
- Institute of Public Health, University of Heidelberg, Germany.
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Salinero-Fort MÁ, del Otero-Sanz L, Martín-Madrazo C, de Burgos-Lunar C, Chico-Moraleja RM, Rodés-Soldevila B, Jiménez-García R, Gómez-Campelo P. The relationship between social support and self-reported health status in immigrants: an adjusted analysis in the Madrid Cross Sectional Study. BMC FAMILY PRACTICE 2011; 12:46. [PMID: 21651759 PMCID: PMC3129304 DOI: 10.1186/1471-2296-12-46] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 06/08/2011] [Indexed: 11/17/2022]
Abstract
Background Social support is an important factor in the adaptation process of immigrants, helping for their integration in a new environment. The lack of social support may influence on well-being and health status. The aim of this study is to describe the social support of immigrant and native population and study the possible association between immigration and lack social support after adjusting for sociodemographic factors, income, stress and self-reported health status. Methods Cross-sectional population based study of immigrants and national patients without mental disorders of 15 urban primary health centers in the north-eastern area of Madrid. Participants provided information on social support, stress level, perceived health status and socio-economic characteristics. Descriptive and multiple logistic regression were conducted. Results The proportion of the global perception of social support among immigrants and natives was 79.2% and 94.2%, respectively. The lack of global social support adjusted prevalence ratio (PR) of immigrant was 2.72 (95% Confidence Interval = 1.81-4.09), showing a significant association with being male (PR = 2.26), having monthly income below 500 euros (PR = 3.81) and suffering stress (PR = 1.94). For the dimensions of lack of social support the higher association was being an immigrant and suffering stress. Conclusions We conclude that with regardless of the level of monthly income, stress level, self-reported health status, and gender, immigrant status is directly associated with lack social support. The variable most strongly associated with lack social support has been monthly income below 500 euros.
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Affiliation(s)
- Miguel Á Salinero-Fort
- Fundación de Investigación Biomédica, Hospital Carlos III, and Departamento de Medicina Preventiva, Universidad Rey Juan Carlos, (Avda. de Atenas, s/n.), Alcorcón, C/Sinesio Delgado, 10, Madrid (28029), Spain.
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Calderón-Larrañaga A, Gimeno-Feliu LA, Macipe-Costa R, Poblador-Plou B, Bordonaba-Bosque D, Prados-Torres A. Primary care utilisation patterns among an urban immigrant population in the Spanish National Health System. BMC Public Health 2011; 11:432. [PMID: 21645335 PMCID: PMC3128023 DOI: 10.1186/1471-2458-11-432] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 06/06/2011] [Indexed: 11/23/2022] Open
Abstract
Background There is evidence suggesting that the use of health services is lower among immigrants after adjusting for age and sex. This study takes a step forward to compare primary care (PC) utilisation patterns between immigrants and the native population with regard to their morbidity burden. Methods This retrospective, observational study looked at 69,067 individuals representing the entire population assigned to three urban PC centres in the city of Zaragoza (Aragon, Spain). Poisson models were applied to determine the number of annual PC consultations per individual based on immigration status. All models were first adjusted for age and sex and then for age, sex and case mix (ACG System®). Results The age and sex adjusted mean number of total annual consultations was lower among the immigrant population (children: IRR = 0.79, p < 0.05; adults: IRR = 0.73, p < 0.05). After adjusting for morbidity burden, this difference decreased among children (IRR = 0.94, p < 0.05) and disappeared among adults (IRR = 1.00). Further analysis considering the PC health service and type of visit revealed higher usage of routine diagnostic tests among immigrant children (IRR = 1.77, p < 0.05) and a higher usage of emergency services among the immigrant adult population (IRR = 1.2, p < 0.05) after adjusting for age, sex and case mix. Conclusions Although immigrants make lower use of PC services than the native population after adjusting the consultation rate for age and sex, these differences decrease significantly when considering their morbidity burden. These results reinforce the 'healthy migration effect' and discount the existence of differences in PC utilisation patterns between the immigrant and native populations in Spain.
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Affiliation(s)
- Amaia Calderón-Larrañaga
- Instituto Aragonés de Ciencias de la Salud, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
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Dorn T, Ceelen M, Tang MJ, Browne JL, de Keijzer KJC, Buster MCA, Das K. Health care seeking among detained undocumented migrants: a cross-sectional study. BMC Public Health 2011; 11:190. [PMID: 21443761 PMCID: PMC3078097 DOI: 10.1186/1471-2458-11-190] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 03/28/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As in many European countries, access to care is decreased for undocumented migrants in the Netherlands due to legislation. Studies on the health of undocumented migrants in Europe are scarce and focus on care-seeking migrants. Not much is known on those who do not seek care. METHODS This cross-sectional study includes both respondents who did and did not seek care, namely undocumented migrants who have been incarcerated in a detention centre while awaiting expulsion to their country of origin. A consecutive sample of all new arrivals was studied. Data were collected through structured interviews and reviews of medical records. RESULTS Among the 224 male migrants who arrived at the detention centre between May and July 2008, 173 persons were interviewed. 122 respondents met inclusion criteria. Only half of the undocumented migrants in this study knew how to get access to medical care in the Netherlands if in need. Forty-six percent of respondents reported to have sought medical help during their stay in the Netherlands while having no health insurance (n = 57). Care was sought most frequently for injuries and dental problems. About 25% of these care seekers reported to have been denied care by a health care provider. Asian migrants were significantly less likely to seek care when compared to other ethnic groups, independent from age, chronic health problems and length of stay in the Netherlands. CONCLUSION The study underlines the need for a better education of undocumented patients and providers concerning the opportunities for health care in the Netherlands. Moreover, there is a need to further clarify the reasons for the denial of care to undocumented patients, as well as the barriers to health care as perceived by undocumented migrants.
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Affiliation(s)
- Tina Dorn
- Public Health Service, Department of Epidemiology, Documentation and Health Promotion, P.O. Box 2200, 1000 CE Amsterdam, The Netherlands.
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Good practice in health care for migrants: views and experiences of care professionals in 16 European countries. BMC Public Health 2011; 11:187. [PMID: 21439059 PMCID: PMC3071322 DOI: 10.1186/1471-2458-11-187] [Citation(s) in RCA: 171] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 03/25/2011] [Indexed: 11/27/2022] Open
Abstract
Background Health services across Europe provide health care for migrant patients every day. However, little systematic research has explored the views and experiences of health care professionals in different European countries. The aim of this study was to assess the difficulties professionals experience in their service when providing such care and what they consider constitutes good practice to overcome these problems or limit their negative impact on the quality of care. Methods Structured interviews with open questions and case vignettes were conducted with health care professionals working in areas with high proportion of migrant populations in 16 countries. In each country, professionals in nine primary care practices, three accident and emergency hospital departments, and three community mental health services (total sample = 240) were interviewed about their views and experiences in providing care for migrant patients, i.e. from first generation immigrant populations. Answers were analysed using thematic content analysis. Results Eight types of problems and seven components of good practice were identified representing all statements in the interviews. The eight problems were: language barriers, difficulties in arranging care for migrants without health care coverage, social deprivation and traumatic experiences, lack of familiarity with the health care system, cultural differences, different understandings of illness and treatment, negative attitudes among staff and patients, and lack of access to medical history. The components of good practice to overcome these problems or limit their impact were: organisational flexibility with sufficient time and resources, good interpreting services, working with families and social services, cultural awareness of staff, educational programmes and information material for migrants, positive and stable relationships with staff, and clear guidelines on the care entitlements of different migrant groups. Problems and good care components were similar across the three types of services. Conclusions Health care professionals in different services experience similar difficulties when providing care to migrants. They also have relatively consistent views on what constitutes good practice. The degree to which these components already are part of routine practice varies. Implementing good practice requires sufficient resources and organisational flexibility, positive attitudes, training for staff and the provision of information.
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Motivos de consulta dermatológicos en la población inmigrante y española del área de salud del Hospital Son Llàtzer (Mallorca). ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2009.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Aerny Perreten N, Ramasco Gutiérrez M, Cruz Maceín JL, Rodríguez Rieiro C, Garabato González S, Rodríguez Laso Á. La salud y sus determinantes en la población inmigrante de la Comunidad de Madrid. GACETA SANITARIA 2010; 24:136-44. [DOI: 10.1016/j.gaceta.2009.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 09/25/2009] [Accepted: 10/07/2009] [Indexed: 11/29/2022]
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Taberner R, Nadal C, Llambrich A, Vila A, Torné I. Dermatology Service Utilization and Reasons for Consultation by Spanish and Immigrant Patients in the Region Served by Hospital Son Llàtzer, Palma de Majorca, Spain. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70642-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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