Immigrants’ access to health care: problems identified in a high-risk tuberculosis population

Abstract

Introduction: Immigrants may utilize health care services differently than other residents and may also have a greater risk for tuberculosis (TB). Objective: Identify barriers to healthcare access by immigrants, factors associated with these barriers, and discuss strategies that may reduce these barriers. Material and methods: Anonymous questionnaires were given to immigrants at National Immigrant Support Centres between 2015 and 2016. Barriers to healthcare were identified using logistic regression. Results: One-hundred and nineteen questionnaires were administered to immigrants, 9 of whom (8%) presented with TB while in Portugal. Twenty-one percent of immigrants reported barriers to healthcare access, and 69% had general practitioners (GPs). The presence of barriers to healthcare access was negatively associated with having a GP and with being married or in a de facto union. Conclusions: A considerable proportion of immigrants reported having difficulties accessing healthcare services in Portugal where legally these barriers are nonexistent. Certain factors were associated with these difficulties.

Similaridades e diferenças no tratamento de tuberculose multidroga resistente no Rio de Janeiro e Lisboa na perspectiva dos profissionais de saúde

“…Outro estudo observou que, em Portugal, casos TB-MDR eram mais propensos de terem nascido em outros países que os casos de TB não MDR (27,3% vs. 13,6%) (Oliveira et al, 2020). A dificuldade de entender como ter designado um médico de família e a incerteza sobre os direitos para acessar cuidados médicos são as principais dificuldades apontadas pelos imigrantes no acesso aos serviços de saúde (Linhas et al, 2019).…”

Tuberculosis amongst foreign-born and nationals: different delays, different risk factors

“…Exclusion due to inconsistencies represented a very small number of individuals and is therefore unlikely to affect our results. In addition, individuals were deemed as foreignborn based on the country of origin and we did not consider how long they had lived in Portugal, which could impact the results, as some studies suggest [28,36]. However, we performed an exploratory analysis with the time of stay in Portugal that showed foreign-born PTB cases had lived in Portugal for a median of 10 years.…”

“…The immigrant status is a well-known risk factor not only for TB disease but also for the diagnosis delay, with immigrants presenting significantly longer patient delays, which could be considered a proxy for access to healthcare services [3, 5, 7, 11-13, 18, 23-25]. Studies show that immigrants seek medical care at an advanced or intermediate TB stage [23,24,[26][27][28]. Delayed seeking of medical care amongst immigrants is often attributed to an interplay of several factors, such as living and working conditions, legal status, poor access to services, discrimination [24], poor knowledge regarding TB, availability of appropriate awareness materials, communication campaigns in different languages, literacy levels, and different sociocultural beliefs (i.e., preferring traditional healers) [24,29].…”