Emergency department utilization rates and modalities among immigrant population. A 5-year survey in a large Italian urban emergency department

Abstract

The rates and modalities of healthcare services utilization for migrant population may differ from natives, since the health needs of the former are influenced by some factors such as health status, self-perceived needs, healthseeking behavior, language barriers and cultural differences. Only scarce and often conflicting data have been published so far on migrants' utilization of healthcare services in Europe, and even less data are available on emergency departments (EDs). The aim of this cross-sectional study was to compare utilization rates and modalities of presentation to the large urban ED of the University Hospital of Parma, Italy (averaging 85,000 visits per year), by Italian native and foreign-born populations during 2008-2012. Throughout the study period 424,466 ED visits were recorded, 64,435 (15.4%) of which by foreign-born patients. A significant difference between utilization rates was observed for all the triage-codes, with higher rates for foreign-born low-acuity codes (green plus white codes: 87.5 vs 73.9, P<0.0001) and lower rates for high-acuity codes (yellow plus red codes: 12.5 vs 26.1%, P<0.0001). The utilization rate was 253.9 visits per 1000 inhabitants for the Italian-native group and 309.7 per 1000 for the foreign-born group (odds ratio 1.23; 95% CI: 1.01-1.48; P=0.034). Different modalities of presentation were also observed, with a high rate of selfreferrals (82.3 vs 71.4%, P<0.001). The results of this study suggest that a better knowledge of available Italian healthcare services among immigrants is advisable and should be encouraged.

Targeting frequent users of emergency departments: Prominent risk factors and policy implications

“…Regarding nationality, being an extra-European Union foreigner seems to increase disproportionally the use of emergency services (IRR = 1.187, p-value < 0.001) and the probability of being a frequent and highly frequent user of the services. This relationship has been confirmed in several previous studies, and has also been applied to the Italian context [30]. Interestingly the inclusion of a variable controlling for domestic violence episodes seems to be relevant in explaining AED heavy use, even though, to the best of our knowledge, such a variable has not been included traditionally (probably due to the lack of suitable data on the topic).…”

“…In the Italian context, previous studies (e.g. [30]) found foreign-born individuals to have a higher utilization rate (309.7 visits per 1000 inhabitants compared to 253.9 for native Italians) and foreign individuals seem to attend AED more often for low-acuity triage codes. In addition, interesting associations have been found between ethnicity and specific diagnosis; for example, Cervellin et al [31] found that women from Sub-Saharan Africa, especially Nigeria, record particularly high AED access rates for unexpected pregnancy, suggesting the need for information campaigns addressed toward certain vulnerable minority groups.…”

The number of emergency department visits for psychiatric emergencies is strongly associated with mean temperature and humidity variations. Results of a nine year survey

“…As earlier observed in a five year survey, 57 the immigrants account for 15.4% of the total Parma's ED visits, despite representing 13.5% of the whole population. This percentage seems to be stable, so that fluctuation in the number of visits within the same year is unlikely to be attributable to variation in the number of inhabitants.…”

Emergency physician's perception of cultural and linguistic barriers in immigrant care: results of a multiple-choice questionnaire in a large Italian urban emergency department

“…[10] Approximately 83% of the patients were occasional attenders, with less than 3 visits during the previous year. The prevalence of ethnicity was in substantial agreement with the number of representatives of each ethnic groups of our city, with the notable exception of patients born in western Africa (17.8% of overall questionnaires versus the prevalence of residents lower than 5%).…”

“…Consequently, the emergency departments (EDs) are the first, if not the only, reference healthcare settings, especially for irregular immigrants; although scarce and often controversial data are available on utilization of the EDs by immigrants, some reports seem to confi rm higher rates of access. [3][4][5][6][7][8][9][10] In 2011, the Regional Health and Social Care Agency published a dossier on the health status immigrants in the Emilia Romagna Region, that is the region where our Hospital is located, confirming that despite hospitalization is overall lower among immigrants than among the native population (after excluding obstetric causes), immigrants, especially irregular immigrants, tend to undergo urgent hospitalization more frequently. [11] A successful management of patient needs is largely dependent on bridging the gap in the mutual expectations between patients and physicians, with communicative aspects being one of the most crucial issues.…”