Differences in the Use of Primary Care Services Between Spanish National and Immigrant Patients

Abstract

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.

A systematic review of the use of health services by immigrants and native populations

“…Those who had resided in the UK for <5 years had decreased odds Those who had migrated for education had increased odds of visiting an outpatient department compared to non-migrants decreased odds of seeing a GP for an emotional problem Gimeno-Feliu LA et al [ 27 ] 2016 Spain (Aragón) & Norway Norway 2008 & Spain 2010 Native born: Spain ( n = 1,102,391) Norway ( n = 4,351,084) Immigrants: Spain ( n = 35,851) Norway ( n = 60,733) Analyse all registered pharmacological treatments for immigrants from Poland, China, Morocco and Colombia compared to natives, aiming to identify patterns of drug use for each immigrant group compared to host countries Register-based study (1) Pharmaceutical Billing Database in Aragon (2) Norwegian Prescription Database-NorPD Drug prescription Country of birth (Poland, Chine, Colombia & Morocco) Age & gender – In the two countries studied, the proportion of immigrants that purchased drugs was significantly lower than that of the correspondingnative population Immigrants from Morocco showed the highest drug purchase rates in relation to natives, especially for antidepressants, pain killers and drugs for peptic ulcer. Immigrants from China and Poland showed lowest purchasing rates, while Colombians where more similar to host countries Gimeno-Feliu LA et al [ 39 ] 2013 Spain (Aragón) 2007 594,145 individuals Natives ( n = 527,881) Immigrants ( n = 66,264) All ages (1) To analyse the use of primary care services by immigrants compared to Spanish nationals, adjusted by age and sex (2) To analyse the differences in frequency of visits to primary care in relation to geographic origin Register-based study Electronic medical records register (OMI: Computerized Medical Office) (1) GP appointments (2) Paediatric appointments (3) Nurse appointments (4) Midwife appointments (5) Physiotherapy appointments (6) Dental appointments (7) Social worker appointments (8) PHC team appointments Nationality Age & gender – The immigrant population makes less use of PHC services. This is evident for all age groups and regardless of immigrants’ countries of origin Klaufus L et al [ 40 ] 2014 Netherlands 2008 14,131 individuals Native born ( n = 11,678) Immigrants ( n = 2453) >14 years To investigate ethnic differences as a factor in mental healthcare consumption in patients with medium & high risk of CMD (common mental disorders) and to identify determinants that may explain possible ethnic differences Survey-based study Health survey conducted by ...…”

“…Distribution of studies regarding publication year was as follows: 8 studies published in 2013 [ 17 , 22 – 24 , 27 , 28 , 41 , 42 ], 15 in 2014 [ 14 – 16 , 19 , 21 , 30 , 32 , 33 , 35 , 36 , 38 , 40 , 43 , 44 , 47 ], 10 in 2015 [ 13 , 18 , 25 , 26 , 29 , 31 , 34 , 45 , 46 , 48 ] and 3 in 2016 [ 20 , 37 , 39 ]. The majority of the publications analysed data from European countries (28; 78%), both North and Central (12) (Norway [ 13 – 15 , 19 , 20 ], Denmark [ 45 ], Sweden [ 35 ], the Netherlands [ 17 , 32 , 34 , 40 ] and Austria [ 41 ]) and South Europe (15) (France [ 22 , 36 ], Italy [ 18 , 24 , 29 , 37 , 43 ], Spain [ 23 , 27 , 28 , 31 , 38 , 39 , 46 ] and Portugal [ 33 ]) and 1 from the UK [ 26 ]. Seven papers (19%) explored this issue in North America (2 from USA [ 30 , 34 ] and 5 from Canada [ ...…”

Global healthcare use by immigrants in Spain according to morbidity burden, area of origin, and length of stay

“…Knowledge about immigrants’ use of health systems has been inconsistent. While most studies point to lower utilisation rates among immigrants [ 6 , 13 – 17 ], others have shown the reverse [ 18 ]. A review by Norredam and coworkers found higher utilisation rates in immigrants as compared with nationals [ 7 ], but noted a lack of appropriate epidemiological data and inconsistencies in the methods used to categorise immigrants across studies.…”

Resultados de dos encuestas dirigidas a inmigrantes y nativos del sureste español: salud, uso de servicios y necesidad de asistencia médica

“…6 Los inmigrantes utilizan los servicios de urgencias con más frecuencia que los nativos, 2,7 y aunque hay trabajos que reflejan un número mayor de hospitalizaciones entre los inmigrantes, 2,8 la mayoría de las investigaciones ponen de manifiesto el menor acceso de este colectivo a los servicios sanitarios. 4,9,10 Estas discrepancias reflejarían parcialmente la diversidad en cuanto al diseño, metodología o contexto geográfico y cultural de las investigaciones, pero también ilustran la simplificación que representa el estudio de los inmigrantes como un grupo uniforme. La población inmigrante en España es heterogénea con respecto a etnia, religión y cultura, pero también en edad, sexo, nivel educativo y motivación.…”