Avoidable hospitalizations and access to primary care: comparisons among Italians, resident immigrants and undocumented immigrants in administrative hospital discharge records

Airoldi, Chiara; Banks, H. Stanley; Devillanova, Carlo

doi:10.1016/j.eclinm.2022.101345

Cited by 7 publications

(13 citation statements)

References 29 publications

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“…However, we believe that our research enriches the literature on undocumented migrants by enlarging the scope of research beyond hospital admissions, which have been the main focus of previous studies [ 25 , 29 ]. The consideration of multiple types of healthcare services enables the drawing of a more complete picture of the phenomenon.…”

Section: Discussionmentioning

confidence: 84%

“…Several factors undermine their access to healthcare services, in fact, such as language barriers, fear of being reported to the police, poor language skills, lack of networks with native citizens, lack of knowledge about the healthcare system and lack of knowledge about informal networks of healthcare professionals [ 21 , 22 , 23 , 24 ]. An additional obstacle encountered by undocumented migrants in Italy is that they cannot access General Practitioners (GPs), whom the SSN contracts to provide primary care, preventive care and gatekeeping referrals to specialised care for all legal residents [ 25 ]. This limitation raises doubts about the care pathways that chronic undocumented migrants requiring essential care should follow.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Healthcare Services for Undocumented Migrants: Organisation and Costs from the Italian NHS Perspective

Listorti¹,

Torbica²,

Cella

et al. 2022

IJERPH

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Based on the principle of health equity, the Italian National Health Service is known worldwide for being a universalistic system that guarantees healthcare services for all its population, among which there are undocumented migrants. A commitment for their health needs is further motivated by their lower utilisation rates of healthcare services, which becomes even more crucial when considering chronic conditions such as diabetes that require adherence and continuity of care. However, the need for more official data has resulted in little research documenting these healthcare usage patterns. For this reason, our objective has been to deepen, from the Italian NHS perspective, the quantity, costs, type, preventability and organisation of healthcare services directed to undocumented migrants. We used official healthcare data from the Lombardy Region, which enable the identification of people receiving the STP code (undocumented migrants) and of people with foreign citizenship (documented migrants). After quantifying the average annual amount and expenditure for healthcare services grouped by Italian citizens, documented migrants and undocumented migrants for all clinical conditions (quantity and costs), we performed three primary investigations where we enlightened differences between the three mentioned groups focusing on the diagnosis of diabetes: (i) mapping the types of healthcare services used and their characteristics (type); (ii) quantifying the impact of preventable hospital admissions (preventability); (iii) examining the healthcare patterns linking pharmaceutical prescriptions with hospital accesses (organisation). Our results reveal significant differences among the three groups, such as more urgent hospital admissions, more preventable complications, and a higher recurrence in terms of access and costs to hospital services rather than pharmaceutical prescriptions for undocumented migrants. These findings can represent the leverage to raise awareness toward the emerging challenges of the migrant health burden.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Healthcare Services for Undocumented Migrants: Organisation and Costs from the Italian NHS Perspective

Listorti¹,

Torbica²,

Cella

et al. 2022

IJERPH

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“…Accordingly, several studies indicate that ethnic minorities overuse the emergency room. 32,33,34 Despite the existence of alternative health structures, information campaigns to inform undocumented persons of processes and rights are limited. At present, there is little state support to empower health workers to deliver health messaging, or to provide tailored training on language support and contact with social workers.…”

Section: Health and Healthcare Of Undocumented Migrants In Italymentioning

confidence: 99%

Considerazioni chiave: equità e partecipazione nella promozione della vaccinazione per il covid-19 tra le persone razzializzate e senza documenti

Vallerani¹,

Storer²,

Torre³

2022

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Questo documento espone alcune considerazioni a proposito della promozione dei vaccini per il SARS-CoV-2 e delle strategie per garantirne un’equa distribuzione tra gli immigrati senza documenti residenti in Italia e, in particolare, a Roma. Quanto emerge dal caso italiano può essere in parte applicabile ad altri contesti in cui la somministrazione del vaccino è stata legata al dispositivo del “passaporto vaccinale”, ovvero il certificato COVID digitale dell'UE, in Italia Green Pass. Nell’organizzazione della campagna vaccinale alcune categorie sociali sono state identificate come “difficili da raggiungere” (hard to reach) e per cui è necessario immaginare interventi specifici.1 In questo testo si sceglie di parlare di persone razzializzate e illegalizzate poiché senza documenti per riferirsi a persone immigrate che non hanno cittadinanza, permesso di soggiorno e status di rifugiato. Questo documento esplora il contesto quotidiano delle vite delle persone illegalizzate e come l’esperienza della pandemia di COVID-19 abbia esacerbato le difficoltà che queste persone incontrano, 23 mettendo in luce il collegamento tra le vulnerabilità, consolidate ed emergenti, con la percezione dei vaccini. Si suggerisce come l’orientamento e la percezione dei vaccini si inseriscano all’interno dei contesti di vita delle persone, in cui molto spesso la priorità è data al sostentamento economico. In molti casi, l’accettazione della vaccinazione è motivata dalla necessità di continuare ad avere un lavoro retribuito piuttosto che a una preoccupazione connessa alla salute o a una fiducia nei confronti delle istituzioni sanitarie. Il seguente documento si pone l’obiettivo di esaminare come i vaccini possano essere distribuiti in modo equo e capace di aumentare la fiducia e i processi di inclusione nella società post-pandemica. Il testo si basa principalmente sulla ricerca etnografica e le testimonianze raccolte attraverso interviste e osservazioni con persone razzializzate e illegalizzate nella città di Roma, insieme a rappresentanti della società civile e operatori socio-sanitari tra dicembre 2021 e gennaio 2022. Questo documento è stato sviluppato per SSHAP da Sara Vallerani (Università di Roma Tre), Elizabeth Storer (LSE) e Costanza Torre (LSE). È stato revisionato da Santiago Ripoll (IDS, Università del Sussex), con ulteriori revisioni da parte di Paolo Ruspini (Università Roma Tre) ed Eloisa Franchi (Université Paris Saclay, Università di Pavia). La ricerca è stata finanziata dalla British Academy COVID-19 Recovery: G7 Fund (COVG7210058). La ricerca si è svolta presso il Firoz Lalji Institute for Africa, London School of Economics. La sintesi è di responsabilità di SSHAP.

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“…Several studies involving patients with chronic diseases have reported that receiving high-quality primary care services through a USC effectively reduces PPH by securing continuity of care. However, some studies have reported that a USC does not affect preventable admissions in healthcare settings where the primary healthcare system is not well established (11)(12)(13)25). A few studies on the relationship between USC and PPH in the case of people with disabilities and chronic diseases have consistently reported that the incidence of PPH is higher in people with disabilities and chronic conditions than that in people without disabilities owing to poor access to medical services, despite the availability of a USC (11,(26)(27)(28).…”

Section: Introductionmentioning

confidence: 99%

“…High PPH indicates low accessibility to and low quality of outpatient services (11). Factors in uencing PPH include individual demographic characteristics such as sex, age, race, and insurance status; socioeconomic characteristics such as income and education level and disability and health status; accessibility to and e ciency of primary care; continuity of medical service through a usual source of care (USC); and patient-centred communication (PCC) (9,(12)(13)(14). The incidence of PPH is relatively higher in patients with complex conditions (1,(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Effect of Patient-Centred Communication and Usual Source of Care on Potentially Preventable Hospitalization among Patients with Chronic Diseases and Disabilities

Choi

Yoon

Jung

2023

Preprint

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Background: This study examined the effect of the degree of patient-centred communication (PCC) and having a usual source of care (USC) on potentially preventable hospitalization (PPH) among chronic disease patients with disability. In particular, we empirically analysed whether PCC and USC could reduce the possibility of PPH among patients with disabilities compared to that among those without disabilities. Methods: This study used data from the Korean Health Panel Survey 2017-2018 (7,271 patients without disabilities and 774 patients with disabilities). The dependent variable was extracted from the 2018 KHPS data, while all other variables included in the analysis were extracted from the 2017 KHPS data and subjected to multivariate logistic regression analysis; subgroup analysis was performed according to the severity of disability. Results: The incidence of PPH was higher in the group with disabilities (4.5%) than in the group without disabilities (2.2%). Significantly more patients with disabilities than those without disabilities had a USC (67.7% vs. 56.9%), and more patients with severe disabilities than those with mild disabilities had a USC (75.9% vs. 63.5%). Multivariate logistic regression analysis showed that the risk of PPH increased when PCC was insufficient in patients with disabilities (OR = 2.92, 95%CI [1.41–6.04]), those with mild disabilities (OR = 2.51, 95%CI [1.02–6.20]), and those in the severe disability group who did not have a USC (OR = 5.06, 95%CI [1.03–24.80]). The effects of USCs and PCC on PPH were not observed in patients without disabilities. Conclusion: Sufficient PCC and having a USC helped reduce the incidence of PPH among patients with disabilities and chronic conditions. It is necessary to find practical ways to enhance PCC and expand the use of USCs among patients with disabilities so that they can receive appropriate primary healthcare services in a timely manner.

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Avoidable hospitalizations and access to primary care: comparisons among Italians, resident immigrants and undocumented immigrants in administrative hospital discharge records

Cited by 7 publications

References 29 publications

Healthcare Services for Undocumented Migrants: Organisation and Costs from the Italian NHS Perspective

Healthcare Services for Undocumented Migrants: Organisation and Costs from the Italian NHS Perspective

Considerazioni chiave: equità e partecipazione nella promozione della vaccinazione per il covid-19 tra le persone razzializzate e senza documenti

Effect of Patient-Centred Communication and Usual Source of Care on Potentially Preventable Hospitalization among Patients with Chronic Diseases and Disabilities

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