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      Frecuentación de las consultas de medicina general y especializada por población inmigrante y autóctona: una revisión sistemática Translated title: Use of health services for immigrants and native population: a systematic review

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          Abstract

          Fundamentos: España pasó a ser en 2006 el país europeo con mayor saldo migratorio. Un aspecto poco estudiado es el acceso y utilización de los servicios sanitarios de esta población. El objetivo de este estudio fue describir la evidencia científica sobre si existen diferencias en la utilización de los servicios de medicina general y especializada entre la población inmigrante con respecto a la autóctona. Métodos: Revisión sistemática. Se llevó a cabo una búsqueda de la literatura científica nacional e internacional de estudios que comparaban la utilización de los servicios de medicina general y especializada entre inmigrantes y autóctonos desde 1994 hasta 2013. Se utilizó para ello la base de datos MEDLINE además de una búsqueda manual, sin límite de lengua ni tipo de estudio. Se evaluó la calidad metodológica de los 29 trabajos finalmente incluidos. Se recopilaron características de los sujetos, del contexto, metodológicas y extrínsecas para comparar los estudios incluidos. Resultados: Se seleccionaron 29 estudios relativos a consulta de medicina general (9 realizados en España) y 15 sobre consulta a especialistas (7 de España) los cuales utilizan principalmente las encuestas de salud como fuente de información. Analizaron tanto la frecuentación como el contacto con el médico general y/o especialista según la nacionalidad o el país de nacimiento (entre otros), ajustando en su mayoría por variables de necesidad y/o socioeconómica. Conclusiones: En líneas generales, en España la población inmigrante hace el mismo uso de los servicios de medicina general que la autóctona y un menor o igual uso de los servicios de medicina especializada. Los resultados de los estudios realizados en otros países van en la misma línea.

          Translated abstract

          Background: Spain was among the top immigration destinations globally between 1990 and 2005, becoming in 2006 in the European country with the highest net migration. As a result of the migration process and the living conditions in the host countries, immigrants' health may be affected. Limited research has investigated access and use of health services for this population. The aim of this study was to describe the scientific evidence on the use of general and specialist medical services for the immigrant population compared to the native. Methods: Systematic review. It has carried out a search of the national and international scientific literature of comparative studies on the use of general and specialist medical services among immigrant and native since 1994-2013. It was used the MEDLINE database as well as a manual search, no language limit or type of study. The methodological quality of the 29 studies included was evaluated. Subject, context, methodological and extrinsic characteristics were collected for comparison of the included studies. Results: We selected 29 studies on the general practitioners' (9 from Spain) and 15 of specialist physician (7 from Spain), they mainly used health surveys as a source of information. Analyze both the attendance and contact with the general practitioner / specialist by nationality or country of birth (among others), mostly by adjusting variables of need and / or socioeconomic. Conclusion: Overall, the immigrant population in Spain have a similar use of general medical services than the native population, and less or similar use of the specialist physician services. These results are in line with studies in other countries.

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          Most cited references162

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          Access to care, health status, and health disparities in the United States and Canada: results of a cross-national population-based survey.

          We compared health status, access to care, and utilization of medical services in the United States and Canada and compared disparities according to race, income, and immigrant status. We analyzed population-based data on 3505 Canadian and 5183 US adults from the Joint Canada/US Survey of Health. Controlling for gender, age, income, race, and immigrant status, we used logistic regression to analyze country as a predictor of access to care, quality of care, and satisfaction with care and as a predictor of disparities in these measures. In multivariate analyses, US respondents (compared with Canadians) were less likely to have a regular doctor, more likely to have unmet health needs, and more likely to forgo needed medicines. Disparities on the basis of race, income, and immigrant status were present in both countries but were more extreme in the United States. United States residents are less able to access care than are Canadians. Universal coverage appears to reduce most disparities in access to care.
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            Reported health, lifestyles, and use of health care of first generation immigrants in The Netherlands: do socioeconomic factors explain their adverse position?

            Differences in health, lifestyles, and use of health care between groups of varying ethnic origin can have important implications for preventive and curative health care. This paper studies whether socioeconomic factors explain ethnic differences in these outcomes. Data on health status, lifestyles, and use of health care were obtained from interviews with 3296 people aged 16-64 years (response: 60.6%), among whom were 848 first generation immigrants. Ethnic differences in these outcomes were examined with and without adjustment for socioeconomic factors, using logistic regression. General population of Amsterdam, the Netherlands. Health status (self rated health, General Health Questionnaire, functional limitations), lifestyles (smoking, alcohol), and use of health care (general practice, pharmaceuticals, hospitalisations). Immigrants from Turkey, Morocco and (former) Dutch colonies report a poorer health and a higher use of health care, especially primary health care among the elderly. An adverse socioeconomic position partially explains the poor health of these immigrants. In turn, their poor health explains most of their higher use of health care. Cultural factors and poor living conditions seem to contribute to the poor health of immigrants, besides an adverse socioeconomic position. The pressure on various health services will increase in future because of the relatively high increase in immigrants' needs at older ages and their presently low mean age.
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              Health care utilization, family context, and adaptation among immigrants to the United States.

              We use the 1990 National Health Interview Survey supplement on Family Resources to examine the health care utilization patterns of immigrant and native-born adults in the United States. We modify a standard health care utilization framework by including duration of residence in the United States and measures of immigrant adaptation and family health context to model both the probability and number of physician contacts in the previous year. We find that duration of residence has a strong effect. Recently-arrived immigrants are much less likely to have had a contact in the previous year and had fewer contacts than either native-born or longer-term immigrant adults. Once the measures of adaptation--age at immigration and language of survey interview--are included, immigrants who have been in the United States for 10 years or more are not statistically different from the native-born. Family characteristics, including measures of exposure to the formal health care system, slightly reduce the size of the effects but do not alter the basic relationship between duration of residence and health care utilization. These results suggest that, net of socioeconomic characteristics, access to health insurance, and differences in morbidity, recent immigrants are much less likely than both the native-born and those immigrants of longer duration, to receive timely health care.
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                Author and article information

                Journal
                resp
                Revista Española de Salud Pública
                Rev. Esp. Salud Publica
                Ministerio de Sanidad, Consumo y Bienestar social (Madrid, Madrid, Spain )
                1135-5727
                2173-9110
                February 2014
                : 88
                : 1
                : 135-155
                Affiliations
                [03] Madrid orgnameRed de Investigación en Servicios de Salud y Enfermedades Crónicas (REDISSEC)
                [05] Madrid orgnameConsorcio de Investigación Biomédica En Red de Epidemiología y Salud Pública (CIBERESP)
                [01] orgnameMinisterio de Economía y Competitividad orgdiv1Instituto de Salud Carlos III orgdiv2Agencia de Evaluación de Tecnologías Sanitarias
                [04] Madrid orgnameUniversidad Complutense de Madrid orgdiv1Departamento de Medicina Preventiva, Salud Pública e Historia de la Ciencia
                [02] Alcalá de Henares orgnameUniversidad de Alcalá orgdiv1Departamento de Medicina Preventiva y Salud Pública
                Article
                S1135-57272014000100009 S1135-5727(14)08800100009
                10.4321/S1135-57272014000100009
                24728396
                1f1648d6-051e-4f9a-a1b3-a900b8660627

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

                History
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 41, Pages: 21
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                SciELO Public Health

                Categories
                Revisiones Sistemáticas

                Revisión sistemática,Health Services Accessibility,Emigrants and Immigrants,Systematic review,Accesibilidad a los Servicios de Salud,Emigrantes e inmigrantes

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