Preventable admissions and emergency-department-visits in pediatric asylum-seeking and non-asylum-seeking patients

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Abstract

Background

Migrant health has become an essential part of public health. According to the World Health Organization, many health systems in Europe have not yet adapted adequately to the needs of asylum-seekers, which might result in untimely and inefficient health care for asylum-seeking patients. The aim of this study was to assess the number of preventable hospital admissions and emergency department visits in asylum-seeking and non-asylum-seeking pediatric patients.

Methods

This is a retrospective, hospital-based study. The study was done at the University Children’s Hospital Basel in Switzerland. Patients admitted or presenting to the emergency department were included and split into the groups of asylum-seeking and non-asylum-seeking patients.

All admissions and emergency-department visits were extracted from the administrative electronic health records from 1st Jan 2016-31st Dec 2017. The main outcome was the proportion of admissions due to ambulatory-care-sensitive conditions (which refer to conditions for which admission can be prevented by early interventions in primary care) in asylum-seeking and non-asylum-seeking patients. Ambulatory-care-sensitive conditions were defined by a validated list of ICD-10 codes.

The secondary objective was to assess the number of preventable emergency-department visits by asylum-seeking patients defined as proportion of visits with a non-urgent triage score.

Results

A total of 75′199 hospital visits were included, of which 63′405 were emergency department visits and 11′794 were admissions. Ambulatory-care-sensitive conditions accounted for 12.1% (18/149) of asylum-seeking and 10.9% (1270/11645) of non-asylum seeking patients’ admissions. Among the emergency department visits by asylum-seeking patients, non-urgent conditions accounted for 82.2% (244/297).

Conclusions

Admissions due to ambulatory-care-sensitive conditions are comparable in asylum-seeking and non-asylum-seeking children, suggesting few delayed presentations to ambulatory care facilities. Strategies to prevent non-urgent visits at pediatric emergency department facilities are needed.

Related collections

Most cited references 32

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Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research

Luke Robertshaw, Surindar Dhesi, Laura L Jones (2017)

Objectives To thematically synthesise primary qualitative studies that explore challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries. Design Systematic review and qualitative thematic synthesis. Methods Searches of MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science. Search terms were combined for qualitative research, primary healthcare professionals, refugees and asylum seekers, and were supplemented by searches of reference lists and citations. Study selection was conducted by two researchers using prespecified selection criteria. Data extraction and quality assessment using the Critical Appraisal Skills Programme tool was conducted by the first author. A thematic synthesis was undertaken to develop descriptive themes and analytical constructs. Results Twenty-six articles reporting on 21 studies and involving 357 participants were included. Eleven descriptive themes were interpreted, embedded within three analytical constructs: healthcare encounter (trusting relationship, communication, cultural understanding, health and social conditions, time); healthcare system (training and guidance, professional support, connecting with other services, organisation, resources and capacity); asylum and resettlement. Challenges and facilitators were described within these themes. Conclusions A range of challenges and facilitators have been identified for health professionals providing primary healthcare for refugees and asylum seekers that are experienced in the dimensions of the healthcare encounter, the healthcare system and wider asylum and resettlement situation. Comprehensive understanding of these challenges and facilitators is important to shape policy, improve the quality of services and provide more equitable health services for this vulnerable group.

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A narrative synthesis of the impact of primary health care delivery models for refugees in resettlement countries on access, quality and coordination

Chandni Joshi, Grant Russell, I-Hao Cheng … (2013)

Introduction Refugees have many complex health care needs which should be addressed by the primary health care services, both on their arrival in resettlement countries and in their transition to long-term care. The aim of this narrative synthesis is to identify the components of primary health care service delivery models for such populations which have been effective in improving access, quality and coordination of care. Methods A systematic review of the literature, including published systematic reviews, was undertaken. Studies between 1990 and 2011 were identified by searching Medline, CINAHL, EMBASE, Cochrane Library, Scopus, Australian Public Affairs Information Service – Health, Health and Society Database, Multicultural Australian and Immigration Studies and Google Scholar. A limited snowballing search of the reference lists of all included studies was also undertaken. A stakeholder advisory committee and international advisers provided papers from grey literature. Only English language studies of evaluated primary health care models of care for refugees in developed countries of resettlement were included. Results Twenty-five studies met the inclusion criteria for this review of which 15 were Australian and 10 overseas models. These could be categorised into six themes: service context, clinical model, workforce capacity, cost to clients, health and non-health services. Access was improved by multidisciplinary staff, use of interpreters and bilingual staff, no-cost or low-cost services, outreach services, free transport to and from appointments, longer clinic opening hours, patient advocacy, and use of gender-concordant providers. These services were affordable, appropriate and acceptable to the target groups. Coordination between the different health care services and services responding to the social needs of clients was improved through case management by specialist workers. Quality of care was improved by training in cultural sensitivity and appropriate use of interpreters. Conclusion The elements of models most frequently associated with improved access, coordination and quality of care were case management, use of specialist refugee health workers, interpreters and bilingual staff. These findings have implications for workforce planning and training.

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A profile of nonurgent emergency department use in an urban pediatric hospital.

Katrina Kubicek, Deborah Liu, Christy Beaudin … (2012)

This study was designed to develop a descriptive profile of parents and caregivers who bring their children to the emergency department (ED) for nonurgent issues and to explore the reasons for presenting to an urban hospital pediatric ED for nonurgent conditions. Such work is necessary to develop effective interventions. A total of 106 parents/caregivers whose child was triaged with a nonemergent/urgent condition completed a 15- to 20-minute computerized survey (English and Spanish) in an urban pediatric ED. Most respondents described themselves as Latino (76%) and foreign born (62%). About one half (49%) reported having an annual income of less than $20,000, and 43% of respondents did not have health insurance for themselves. Almost all (95%) of the index children had a primary care physician and health insurance. Despite being triaged as nonurgent, more than one half (63%) described their child's condition as "very" or "extremely" urgent. About one half of the respondents reported not receiving basic information on childhood illnesses from their child's physician. Reasons for nonurgent visits seemed to revolve around issues of convenience and perception of quality of care. Interventions should focus on health literacy and ensure that parents are provided relevant and accurate education on pediatric illnesses and common safety concerns; by increasing parental education on pediatric health, parents may be better able to assess acuity of their child's health issues.

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Author and article information

Contributors

Julia Brandenberger: Julia.brandenberger@ukbb.ch

Journal

Journal ID (nlm-ta): Int J Equity Health

Journal ID (iso-abbrev): Int J Equity Health

Title: International Journal for Equity in Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1475-9276

Publication date (Electronic): 1 May 2020

Publication date PMC-release: 1 May 2020

Publication date Collection: 2020

Volume: 19

Electronic Location Identifier: 58

Affiliations

[1 ]GRID grid.6612.3, ISNI 0000 0004 1937 0642, University of Basel Children’s Hospital, Migrant Health Service, ; Basel, Switzerland

[2 ]GRID grid.412353.2, Pediatric Emergency Department, , University Children’s Hospital, ; Bern, Switzerland

[3 ]GRID grid.5253.1, ISNI 0000 0001 0328 4908, Department of General Practice and Health Services Research, , University Hospital Heidelberg, ; Heidelberg, Germany

[4 ]GRID grid.7491.b, ISNI 0000 0001 0944 9128, Department of Population Medicine and Health Services Research School of Public Health, , Bielefeld University, ; Bielefeld, Germany

[5 ]GRID grid.11505.30, ISNI 0000 0001 2153 5088, Unit of NTDs, Department of Clinical Sciences, Institute of Tropical Medicine, ; Antwerp, Belgium

[6 ]GRID grid.7914.b, ISNI 0000 0004 1936 7443, Centre for International Health, , University of Bergen, ; Bergen, Norway

[7 ]GRID grid.6612.3, ISNI 0000 0004 1937 0642, University of Basel Children’s Hospital, Pediatric Infectious Disease and Vaccinology, ; Basel, Switzerland

[8 ]GRID grid.1008.9, ISNI 0000 0001 2179 088X, Department of Pediatrics, Royal Children’s Hospital Melbourne, , University of Melbourne, ; Melbourne, Australia

Article

Publisher ID: 1172

DOI: 10.1186/s12939-020-01172-w

PMC ID: 7193367

PubMed ID: 32357879

SO-VID: 6f526c0a-3554-4bac-8f18-a165d0cb7481

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 4 December 2019

Date accepted : 13 April 2020

Funding

Funded by: Fondation Botnar (CH)

Award ID: not available

Award Recipient : Julia Brandenberger

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: migrant health,refugee health,immigrant children,use of health care,ambulatory-care-sensitive conditions,emergency department,health care delivery,equitable access to health care

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: migrant health, refugee health, immigrant children, use of health care, ambulatory-care-sensitive conditions, emergency department, health care delivery, equitable access to health care