The lower quality of preventive care among forced migrants in a country with universal healthcare coverage

Martin, Yonas; Collet, Tinh‐Hai; Bodenmann, Patrick; Blum, Manuel R.; Zimmerli, Lukas; Gaspoz, Jean‐Michel; Battegay, Edouard; Cornuz, Jacques; Rodondi, Nicolas

doi:10.1016/j.ypmed.2013.11.006

Cited by 11 publications

(9 citation statements)

References 22 publications

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“…Patients are free to choose their primary care physician (PCP). However, high quality of care might not be fully explained by health insurance status only; we have recently found that both forced migrants and undocumented migrants in Switzerland had lower quality of preventive care, albeit forced migrants have health care coverage and undocumented migrants do not [35].…”

Section: Discussionmentioning

confidence: 90%

Multimorbidity and Quality of Preventive Care in Swiss University Primary Care Cohorts

et al. 2014

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BackgroundCaring for patients with multimorbidity is common for generalists, although such patients are often excluded from clinical trials, and thus such trials lack of generalizability. Data on the association between multimorbidity and preventive care are limited. We aimed to assess whether comorbidity number, severity and type were associated with preventive care among patients receiving care in Swiss University primary care settings.MethodsWe examined a retrospective cohort composed of a random sample of 1,002 patients aged 50–80 years attending four Swiss university primary care settings. Multimorbidity was defined according to the literature and the Charlson index. We assessed the quality of preventive care and cardiovascular preventive care with RAND’s Quality Assessment Tool indicators. Aggregate scores of quality of provided care were calculated by taking into account the number of eligible patients for each indicator.ResultsParticipants (mean age 63.5 years, 44% women) had a mean of 2.6 (SD 1.9) comorbidities and 67.5% had 2 or more comorbidities. The mean Charlson index was 1.8 (SD 1.9). Overall, participants received 69% of recommended preventive care and 84% of cardiovascular preventive care. Quality of care was not associated with higher numbers of comorbidities, both for preventive care and for cardiovascular preventive care. Results were similar in analyses using the Charlson index and after adjusting for age, gender, occupation, center and number of visits. Some patients may receive less preventive care including those with dementia (47%) and those with schizophrenia (35%).ConclusionsIn Swiss university primary care settings, two thirds of patients had 2 or more comorbidities. The receipt of preventive and cardiovascular preventive care was not affected by comorbidity count or severity, although patients with certain comorbidities may receive lower levels of preventive care.

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Section: Discussionmentioning

confidence: 90%

Multimorbidity and Quality of Preventive Care in Swiss University Primary Care Cohorts

et al. 2014

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“…Other cantons either delegate this task to nongovernmental organizations (NGO) or offer no service at all, apart from access to the emergency department of public hospitals. Consequently, undocumented migrants receive less preventive healthcare than other groups of the population and management strategies for those with chronic disease are lacking in regions without dedicated primary care programs [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Health of undocumented migrants in primary care in Switzerland

2018

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BackgroundUndocumented migrants endure adverse living conditions while facing barriers to access healthcare. Evidence is lacking regarding their healthcare needs, notably in regards to chronic diseases. Our goal was to investigate health conditions in undocumented migrants attended in primary care setting.MethodsThis study was conducted at the primary care outpatient clinic, Geneva University Hospitals, Switzerland. We retrospectively recorded and coded all medical conditions of a random sample of 731 undocumented migrants using the International Classification of Primary Care, 2nd version (ICPC-2). We dichotomized conditions as chronic or non-chronic and considered multimorbidity in the presence of three or more chronic conditions.ResultsParticipants originated from 72 countries and were mainly female (65.5%) with a mean age of 42.4 (standard deviation [SD]: 11.4) years. They presented a mean of 2.9 (SD: 2.1; range: 1–17) health conditions. In multivariable analysis, the number of conditions was associated with female gender (p = 0.011) and older age (p <0.001), but not with origin (p = 0.373). The body systems most frequently affected were endocrine, metabolic and nutritional (n = 386; 18.4%), musculoskeletal (n = 308, 14.7%) and digestive (n = 266, 12.8%). Hypertension (17.9%; 95% CI: 15.2%, 29.9%), obesity or overweight (16%; 95% CI: 13.4%, 18.9%) and gastric problems (14.1%; 95% CI: 11.6%, 16.8%) were most prevalent. Overall, 71.8% (95% CI: 68.5%, 75%) participants had at least one chronic condition while 20% (95% CI: 17.2%, 23.1%) had three or more. In multivariable analysis, age (p <0.001) was the only predictor of presenting at least one or three or more chronic conditions.ConclusionsUndocumented migrants present multiple health problems in primary care settings and bear an important burden of chronic diseases. The extent of multimorbidity highlights the need to provide and facilitate the access to comprehensive and long-term primary healthcare services.

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“…Type 2 diabetes prevalence is rather low in Switzerland compared to neighboring countries [ 13 ]. Even when accessing to care and with insurance coverage, vulnerable immigrants are less likely to receive preventive measures for cardiovascular risk factors, including diabetes [ 14 ]. Moreover, insured diabetics from lower socio-economic status in Switzerland receive lower quality of care and have poorer outcomes, adding to similar inequalities found in patients with other chronic health conditions [ 13 , 15 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

Quality of diabetes care and health insurance coverage: a retrospective study in an outpatient academic public hospital in Switzerland

Jackson

Becerra

Carpentier

2016

BMC Health Serv Res

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BackgroundSocioeconomic disadvantage is associated with an increased risk of adverse diabetes outcomes. In Switzerland, a country with theoretical universal healthcare coverage, people without health insurance face barriers in accessing to and in receiving standard quality care. The Geneva University Hospitals (HUG) have implemented policies aiming at reducing these gaps. We compared quality of diabetes care and ambulatory healthcare services utilization among insured and uninsured diabetic patients.MethodsThis retrospective study linked health and administrative data of type 2 diabetic outpatients with at least one HbA1c test performed in 2012–2013 at HUG. Quality of care evaluation relied on processes (annual serum HbA1c, cholesterol and microalbuminuria tesing) and outcomes (HbA1c) assessment. Healthcare utilization was assessed by the number of ambulatory clinical and laboratory visits. Results were stratified by disease course (newly diagnosed versus prevalent diabetes).ResultsOf the 198 patients included, 80 (40.4 %) were uninsured. Both groups underwent annual testing of HbA1c, cholesterol, kidney function and microalbuminuria at comparably high rates and numbers of ambulatory visits did not significantly differ. After adjustments for age and sex, there were no significant differences in serum HbA1c between groups both in those with prevalent or with newly diagnosed diabetes. Initial medical intervention entailed comparable glycaemic improvement after 6 months in incident diabetes among insured and uninsured patients.ConclusionsThis study did not find any difference in quality of diabetes care between insured and uninsured patients in a public hospital enforcing health-equity policies for access to and for delivery of standard diabetes care. It highlights the frontline role of public hospitals in contributing to care delivery equity even in countries with theoretical universal healthcare coverage.

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The lower quality of preventive care among forced migrants in a country with universal healthcare coverage

Cited by 11 publications

References 22 publications

Multimorbidity and Quality of Preventive Care in Swiss University Primary Care Cohorts

Multimorbidity and Quality of Preventive Care in Swiss University Primary Care Cohorts

Health of undocumented migrants in primary care in Switzerland

Quality of diabetes care and health insurance coverage: a retrospective study in an outpatient academic public hospital in Switzerland

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