Differences in the prevalence of hospitalizations and utilization of emergency outpatient services for ambulatory care sensitive conditions between asylum-seeking children and children of the general population: a cross-sectional medical records study (2015)

Abstract

BackgroundHospitalizations for ambulatory care sensitive (ACS) conditions are established indicators for the availability and quality of ambulatory care. We aimed to assess the differences between asylum-seeking children and children of the general population in a German city with respect to (i) the prevalence of ACS hospitalizations, and (ii) the utilization of emergency outpatient services for ACS conditions.MethodsUsing anonymous account data, all children admitted to the University Hospital Heidelberg in 2015 were included in our study. A unique cost unit distinguished asylum seekers residing in a nearby reception center (exposed) from the children of the general population. We adapted international lists of ACS conditions and calculated the prevalence of ACS hospitalizations and the utilization of emergency outpatient services for ACS conditions, attributable fractions among the exposed (Afe) and the population attributable fraction among total admissions (PAF) for each outcome. Differences in the prevalence of each outcome between exposed and controls were analyzed in logistic regression models adjusted for sex, age group and quarterly admission.ResultsOf the 32,015 admissions in 2015, 19.9% (6287) were from inpatient and 80.1% (25,638) from outpatient care. In inpatient care, 9.8% (622) of all admissions were hospitalizations for ACS conditions. The Afe of ACS hospitalizations was 46.57%, the PAF was 1.12%. Emergency service use for ACS conditions could be identified in 8.3% (3088) of all admissions (Afe: 79.57%, PAF: 5.08%). The odds ratio (OR) of asylum-seeking children being hospitalized for ACS conditions in comparison to the control group was 1.81 [95% confidence interval, CI: 1.02; 3.2]. The OR of the asylumseeking population compared to the general population for the utilization of emergency service use for ACS conditions was 4.93 [95% CI: 4.11; 5.91].ConclusionsAsylum-seeking children had significantly higher odds of ACS hospitalization and of utilization of emergency outpatient services for ACS conditions. Using the concept of ACS conditions allowed measuring the strength of primary care provided to this local asylum-seeking population. This approach could help to compare the strength of primary care provision in different locations, and allow an objective.

Health care provided to recent asylum-seeking and non-asylum-seeking pediatric patients at a Swiss tertiary hospital

“…Interestingly, in our study the asylum-seeking children had a lower proportion of emergency department visits compared to nonasylum-seeking children. This nding contrasts to a recently published study, showing that asylumseeking children were 5 times more likely to use emergency services [16]. One explanation for the lower proportion in our setting may be that the nurse-led health care system present at Swiss asylum-seeking reception centers which may help to prevent visits to the emergency department, as diseases are detected early.…”

Health care provided to asylum-seeking and non-asylum-seeking paediatric patients at a Swiss tertiary hospital

“…Current health care delivery models to asylum-seekers vary substantially between regions and countries. As mentioned in a German study, presentations with ambulatory care sensitive conditions at tertiary health care facilities could be used as an indicator to compare primary care delivery models for asylum-seekers in different regions (16).…”

“…However, a direct comparison between the groups was not done (15). Only one recent study from Germany included health care delivery data from both asylumseeking and non-asylum seeking children (16). The study showed that asylum-seeking children were more frequently admitted for diseases with the potential for outpatient care, when detected early In summary, there is a knowledge gap on recent health data of asylum-seeking children in comparison with non-asylum-seeking children.…”

Effects of introducing a walk-in clinic on ambulatory care sensitive hospitalisations among asylum seekers in Germany: a single-centre pre–post intervention study using medical records

“…Mostly these have been developed on the basis of expert consensus procedures or by analysis of discharge records. ACS conditions for children were operationalised following an approach which we applied in a previous study 28. The approach synthesised seven international studies,21–27 which had identified and validated paediatric ACS conditions.…”