Self-rated treatment outcomes in medical rehabilitation among German and non-German nationals residing in Germany: an exploratory cross-sectional study

Satisfaction With Primary Care Among the Foreign-Born and the General Population in Finland: A Survey-Based study

Foreign-born people have been found to be less satisfied with health care than native populations across countries. However, studies on differences in satisfaction with treatment between different foreign-born groups are lacking. This study explores differences in satisfaction with primary health care between the foreign-born population from different regions of origins and the general population of Finland. The study uses survey data on foreign-born population (n = 2708) and general population (n = 6671) living in Finland who report using health services. Satisfaction with experienced respect for privacy during treatment, benefit of treatment and smoothness of treatment are predicted by region of origin using logistic regression. Almost all foreign-born groups were less likely to consider treatment appointments beneficial as compared to the general population. Some foreign-born groups (people from Southeast Asia and South and Central Asia) were more satisfied with smoothness of care compared to general population. People from East Asia were less likely than the general population to consider that their privacy had been respected during the examinations and treatment. While we made the positive finding of high overall satisfaction with treatment, we also found important differences between groups. In particular, appointments were found less useful among the foreign-born population. Perceived unusefulness of treatment might lead to underuse of health care, which might result in accumulation of untreated health problems. The results point toward potential development points in the health care system. Addressing these issues might help decrease health disparities between population groups.

Preferences for cardiovascular and pulmonary rehabilitation care: A discrete choice experiment among patients in Lebanon

OBJECTIVE

Patient preferences are important in designing optimal rehabilitation care. The aim of this study is to assess preferences for rehabilitation care among two groups of respondents.

DESIGN

An online discrete choice experiment survey was carried out.

SETTING

We use data for Lebanon, a country where rehabilitation care is still underdeveloped.

PARTICIPANTS

Patients who have undergone or are currently undergoing rehabilitation treatment (users) and those who have not (yet) used rehabilitation care (non-users).

INTERVENTION

Patients were asked to repeatedly choose between two hypothetical rehabilitation care packages with seven different attributes: attitude of the staff, travel time to clinic, out-of-pocket costs, medical equipment, rehabilitation plan, additional lifestyle education session, and support during rehabilitation care.

MAIN MEASURES

Preference heterogeneity among patients with different characteristics was investigated using random effect binary logistic regression (software package Stata 15).

RESULTS

In total, 126 respondents completed the survey. The most preferred attribute was an informal and friendly attitude of the staff followed by modern medical equipment, additional lifestyle education session via eHealth, and support during the rehabilitation program via phone call or SMS. Respondents were less in favor of going to the rehabilitation clinic and paying additional out-of-pocket costs for the rehabilitation treatment. This rank order was similar between users and non-users.

CONCLUSION

Preferences of patients regarding the type of program chosen (eHealth or at clinical-based) need to be included in future rehabilitation programs. Improving patient experience with rehabilitation programs by giving the best care based on a patient-centered approach is essential.

Coordination and Perceived Support for Return to Work: A Cross-Sectional Study among Patients in Swedish Healthcare

Background: Receiving support from a return-to-work (RTW) coordinator (RTWC) may be beneficial for people on long-term sick leave. The aim of this study was to investigate whether the number of contacts with an RTWC and their involvement in designing rehabilitation plans for the patients were associated with perceiving support for RTW, emotional response to the RTWC, and healthcare utilization. Methods: In this cross-sectional study, 274 patients who had recently been in contact with an RTWC in Swedish primary or psychiatric care answered questions regarding their interaction with an RTWC, perceived support for RTW, and emotional response to the RTWC. Results: Having more contact with an RTWC was associated with perceiving more support in the RTW process (adjusted OR 4.14, 95% CI 1.49–11.47). RTWC involvement in designing a rehabilitation plan for the patient was associated with perceiving more support in the RTW process from an RTWC and having a more positive emotional response to the RTWC. Conclusions: From the patient’s perspective, this study indicates that the involvement of an RTWC and receiving a rehabilitation plan that an RTWC has helped to design might be perceived as important in the RTW process.

Clinical outcomes and cardiac rehabilitation in underrepresented groups after percutaneous coronary intervention: an observational study

AIMS

Underrepresentation of migrants, women, and older adults in cardiovascular disease (CVD) trials may contribute to disparate care and survival. Among patients who underwent percutaneous coronary intervention (PCI), we aimed to investigate the associations of (i) underrepresented groups with major adverse cardiac events (MACE), CVD mortality, and non-CVD mortality, (ii) underrepresented groups with cardiac rehabilitation (CR) uptake, and (iii) CR uptake with outcomes.

METHODS AND RESULTS

We included 15 211 consecutive patients from the CARDIOBASE Bern PCI registry (2009-18). In multi-state models comparing transition probabilities of events, sex was not associated with increased risk of any event. For each year increase in age, the increased risk of non-CVD and CVD mortality was 8% [95% confidence interval (CI) 6-9%]. Being migrant was associated with a lower risk of non-CVD mortality [hazard ratio (HR) (95% CI) 0.49 (0.27-0.90)] but not with CVD mortality. In logistic regression analysis, CR uptake was lower among women [odds ratio (95% CI) = 0.72 (0.57-0.86)] and older adults [0.32 (0.27-0.38)], but not among migrants. In cox regression, CR was independently associated with lower all-cause [HR (95% CI) = 0.12 (0.03-0.37)] and CVD mortality [0.1 (0.02-0.7)], but not with MACE [1.08 (0.8-1.4)].

CONCLUSION

Among underrepresented groups undergoing PCI, age, but not migration status nor sex, contributed to disparities in mortality. Migrant status did not result in lower attendance of CR. Considering the protective associations of CR on CVD mortality independent of age, sex, and migration status, the lower uptake in women and older adults is noteworthy.

[Utilization of Medical Rehabilitation and Access Barriers for Persons with a Migrant Background - Results of the lidA Cohort Study]

INTRODUCTION

Rehabilitation services are considerably less used by persons with a migration background of working age in Germany than by persons without migration background. One reason could be access barriers. They can arise both from the structures of the health/rehabilitation system as well as from influences of the personal environment, e. g. financial burdens incurred through the use of rehabilitation or cultural expectations. In addition to the migration status, other factors such as country of origin, reasons for immigration, length of stay as well as the religious affiliation and social status could influence the utilization of medical rehabilitation. It was examined to what extent differences in utilisation are due to the migration background and to migration-independent personal barriers to access.

METHODS

The lidA-study is a nationwide, representative prospective cohort study among employees with insurable employment born in 1959 and 1965 with a focus on work, age, health and employment. Data from the first (2011) and the second wave (2014) were combined for the analyses. In addition to bivariate analyses to describe the sample according to migration status, logistic regression analyses were carried out to estimate the odds ratios for the influence of migration background or nationality and other factors on the use of a medical rehabilitation measure.

RESULTS

The chance of receiving medical rehabilitation is increased for migrants of the 1^st generation (odds ratio (OR) 1.56, 95% confidence interval (CI): 1.09-2.25). If predominantly or exclusively no German is spoken at home, this could be associated with a comparatively much lower chance of utilisation (OR: 0.56, 95% CI: 0.28-1.15). Because only nationality is often available in routine data to determine the status of migration, another model only considers migrants and 2^nd generation nationals and examines the influence of nationality on utilisation. A foreign nationality was not associated with a higher utilisation (OR: 1.07, 95% CI: 0.55-2.08).

DISCUSSION

Results of previous studies on the use of medical rehabilitation for people with a migration background are inconsistent. This could be due to different examined population groups, different indications for rehabilitation, a temporal change in utilisation and the various study designs as well as data sources. We found a higher use of medical rehabilitation services by persons with a migrant background (1^st generation) compared to non-migrant persons. One reason could be our more precise definition of the migration background compared to analyses of routine data. If predominantly or exclusively another language than German is spoken at home, the utilisation tends to be lower. The finding coincides with a lack of German language skills described as an access barrier in the literature.

Utilisation of medical rehabilitation services by persons of working age with a migrant background, in comparison to non-migrants: a scoping review

In Germany, an ageing population is affected by societal and political changes due to demographic transition, e.g. by a prolonged working life for older employees. Demographic change also influences persons of higher working age with a migrant background. In 2018, 25% of all employees in Germany had a migrant background. Those affected by poor health at a higher working age can benefit from medical rehabilitation services, which aim to prevent early retirement and disabilities. So far, the utilisation of medical rehabilitation has been lower among persons of foreign nationality (often the only available proxy for migrant background), compared to that of Germans. The aim of this scoping review is to assess the utilisation of medical rehabilitation services by those with migrant background (PMB) and those without (non-PMB) and to identify the differences between these groups. We included 25 studies in our analysis, which were mainly secondary analyses of routine data and also a small number of primary studies. The results were inconsistent: studies published before 2018 showed a lower use of rehabilitation services for persons of foreign nationality compared to Germans. However, no differences were found between PMB and non-PMB in studies published in 2018 or later. PMB, as well as foreign nationals, showed poorer health before medical rehabilitation utilisation and had a higher chance of occupational disease and a lower education level. We identified a lower work-related performance, as well as barriers (e.g. information deficits) in the utilisation of rehabilitation services for groups of PMB. Our review is limited in that we cannot generalise our results to all PMB living in Germany. This is because of the heterogeneity, the limited number of studies and lack of representativeness in some studies. In many cases, studies only analyse the nationality, but they lack information about the second generation PMB. Future studies should survey the utilisation of medical rehabilitation services by migrant background rather than by nationality and focus on changes in the provision of rehabilitation measures following diversity-centred strategies.

[Utilization of medical rehabilitation prior to disability retirement : Comparison of German and non-German nationals with a special focus on ethnic German resettlers]

BACKGROUND

So far little is known about the utilization of medical rehabilitation among non-German nationals and ethnic German resettlers.

OBJECTIVE

The aim of this study was to examine the utilization of medical rehabilitation in non-German nationals and ethnic German resettlers prior to disability retirement.

MATERIAL AND METHODS

Routine data from the German statutory pension insurance scheme were used. Information on 17,369 individuals who retired due to disability in 2015 was available. Ethnic German resettlers were defined by means of information stemming from a prior occupation in the country of origin. The outcome of interest was the utilization of medical rehabilitation in the past 5 years prior to the disability pension. Multilevel logistic regression was used to control the influence of demographic and socioeconomic factors.

RESULTS

Compared to Germans without resettler status, non-German nationals had a lower chance of utilizing medical rehabilitation. The adjusted odds ratios (OR) were 0.79 (95% confidence interval, CI: 0.67-0.92) for Turkish nationals and 0.56 (95% CI: 0.45-0.71) for nationals from EU countries. Ethnic German resettlers had a higher chance of utilizing medical rehabilitation (adjusted OR = 1.40, 95% CI: 1.20-1.64).

CONCLUSION

Non-German nationals utilized medical rehabilitation prior to disability retirement less frequently than German nationals. This is presumably because of the barriers non-Germans experience in utilization, resulting from poor information and problems emerging in the transition from general practitioner to rehabilitative care. Ethnic German resettlers do not seem to be disadvantaged in terms of access to rehabilitation.

[Migrant-sensitive health care strategies in orthopedic rehabilitation : A postal survey in North Rhine-Westphalia and Schleswig-Holstein]

BACKGROUND

Migrants utilize rehabilitative care less frequently than the majority population in Germany. They also have less favorable treatment outcomes. Little is known about migrant-sensitive measures implemented by rehabilitation hospitals in order to provide a more patient-centered health care for this population group.

OBJECTIVES

The aim of the present study was to examine which measures of migrant-sensitive health care are used by rehabilitation hospitals in North Rhine-Westphalia and Schleswig-Holstein and to identify potential barriers that may affect the implementation of such measures.

MATERIALS AND METHODS

We surveyed the administrative and medical management of all 122 orthopedic rehabilitation hospitals in North Rhine-Westphalia and Schleswig-Holstein by means of a postal questionnaire. The questionnaire comprised, amongst others, questions on the implementation of migrant-sensitive measures in accommodation and health care provision. After one postal reminder, a total of 55 hospitals responded to the survey.

RESULTS

Of the hospitals surveyed, 83.6% consider migrant-sensitive health care to be important or partially important. Only a few migrant-sensitive measures are employed by hospitals. Thirty percent of all hospitals do not use measures of migrant-sensitive health care at all. Perceived barriers preventing an implementation of these measures are limited financial resources (71.0%) as well as structural (32.7%) and organizational (38.2%) problems.

CONCLUSIONS

Rehabilitation hospitals are willing to implement measures of migrant-sensitive health care. Structural and organizational support is necessary in order to overcome existing implementation barriers. In addition, measures need to be cost-effective.

Disparities in health care outcomes between immigrants and the majority population in Germany: A trend analysis, 2006-2014

Background

Immigrants often encounter barriers in the health system that may affect their health care outcomes. In order to better cater to the needs of immigrants, many health care institutions have increased their efforts in recent years to provide services which are more sensitive to the needs of an increasingly diverse population. Little is known about whether these efforts are successful. This study examines difference in outcomes of tertiary prevention between immigrants and the autochthonous population in Germany over the period of 2006–2014.

Methods

The analysis is based on a 10% random sample of routine data on completed tertiary preventive treatments in Germany during 2006–2014. Four different indicators of treatment effectiveness were compared between patients with a nationality from Germany, Portugal/Spain/Italy/Greece, Turkey and Former Yugoslavia using logistic regression adjusted for demographic/socioeconomic factors. Interaction terms for year were modeled to examine group differences over time.

Results

Depending on the outcome, Turkish and Former Yugoslavian nationals had an 23%-69% higher chance of a poor treatment effectiveness than Germans (OR = 1.23 [95%-CI = 1.15,1.32] and OR = 1.69 [95%-CI = 1.55,1.83], respectively). Fewer differences were observed between nationals from Portugal/Spain/Italy/Greece and Germans. Disparities did not significantly differ between the years in which services were utilized.

Conclusion

Measures implemented by health care institutions did not reduce existing health care disparities between immigrants and the majority population in Germany. One potential reason is that existing approaches are unsystematic and often not properly evaluated. More targeted strategies and a thorough evaluation is needed in order to improve health care for immigrants sustainably.

Satisfaction with rehabilitative health care services among German and non-German nationals residing in Germany: a cross-sectional study

OBJECTIVES

Rehabilitation following medical conditions is largely offered as in-patient service in Germany. Foreign-national residents use rehabilitative services less often than Germans and attain less favourable treatment outcomes. These differences are independent of demographic, socioeconomic and health characteristics. Satisfaction with different aspects of rehabilitative care presumably affects the effectiveness of rehabilitative services. We compared the degree of satisfaction with different domains of the rehabilitative care process between Germans and non-German nationals residing in Germany.

METHODS

We used data from a cross-sectional rehabilitation patient survey annually conducted by the German Statutory Pension Insurance Scheme. The sample comprises 274 513 individuals undergoing medical rehabilitation in 642 hospitals during the years 2007-2011. Participants rated their satisfaction with different domains of rehabilitation on multi-item scales. We dichotomised each scale to low/moderate and high satisfaction. For each domain, a multilevel adjusted logistic regression analysis was conducted to examine differences in the levels of satisfaction between German and non-German nationals. Average marginal effects (AMEs) and 99.5% CI were computed as effect estimates. AMEs represent differences in the probability for the occurrence of the outcome.

RESULTS

Turkish nationals had a higher probability for being less satisfied with most aspects of their rehabilitation, with AMEs ranging between 0.05 (99.5% CI 0.00 to 0.09) for 'satisfaction with psychological care' and 0.11 (99.5% CI 0.08 to 0.14) for 'satisfaction with treatments during rehabilitation'. Patients from former Yugoslavia and from Portugal/Spain/Italy/Greece were as satisfied as Germans with most aspects of their rehabilitation.

CONCLUSIONS

Turkish nationals are less satisfied with their rehabilitative care than other population groups. This may be attributable to the diversity of the population in terms of its expectations towards rehabilitation. Rehabilitative care institutions need to provide services that are sensitive to the needs of all clients. Diversity management can contribute to this process.

A qualitative study of immigrant women on long-term sick leave and their experience of dignity

PURPOSE

The purpose of this study was to explore if and how immigrant women suffering from chronic pain experience and maintain their dignity, during rehabilitation.

METHODS

The study was designed as a field study, with participant observation and in-depth interviews. Participant observations were carried out during a rehabilitation course for 14 immigrant women on an outpatient clinic at a rehabilitation hospital in southern Norway. In-depth interviews were performed after the rehabilitation period. Hermeneutic analysis was applied to interpret the data.

RESULTS

Findings show that the immigrant women experienced dignity by being seen, respected and believed by family-members, healthcare personnel and other patients at the outpatient clinic. Moreover, they maintained their dignity through a sense of their own value, integrity, religious faith and hope for the future.

CONCLUSIONS

The immigrant women maintained and protected their dignity by finding strength, pride, and self-worth in their religion and through their family-members' affection. Taking responsibility for themselves and others and experiencing fellowship and equality with other women, they enhanced their dignity during their rehabilitation process. The caring attitudes and behavior of some healthcare personnel promoted patient dignity. They also gained hope and dignity by experiencing goodness, cultural competence, and sensitivity from healthcare personnel. Implications for rehabilitation This study shows that the family role is more important for the immigrant women than the role as an employee, although financial independence and being able to help relatives financially also were central. Fellowship and equality with other patients, together with a rehabilitation program, which is facilitated for different language levels, were understood as important factors for an effective recovery. Enough time to get to know the patients and cultural competence seems to be central components for the health care personnel to give efficient help to immigrants in rehabilitation. Immigrants from low/middle-income countries appear to apply their religiousness as a resource in their lives to a greater extent than native Norwegians do, and should be taken into consideration when planning and implementing rehabilitation programs for immigrants.