Hargreaves Sally, Friedland Jon S, Gothard Philip, Saxena Sonia, Millington Hugh, Eliahoo Joseph, Le Feuvre Peter, Holmes Alison
International Health Unit, Department of Infectious Diseases and Immunity, Faculty of Medicine, Imperial College, Hammersmith Hospital Campus, London, W12 ONN, UK.
BMC Health Serv Res. 2006 Nov 29;6:153. doi: 10.1186/1472-6963-6-153.
Changing immigration trends pose new challenges for the UK's open access health service and there is considerable speculation that migrants from resource-poor countries place a disproportionate burden on services. Data are needed to inform provision of services to migrant groups and to ensure their access to appropriate health care. We compared sociodemographic characteristics and impact of migrant groups and UK-born patients presenting to a hospital A&E/Walk-In Centre and prior use of community-based General Practitioner (GP) services.
We administered an anonymous questionnaire survey of all presenting patients at an A&E/Walk-In Centre at an inner-city London hospital during a 1 month period. Questions related to nationality, immigration status, time in the UK, registration and use of GP services. We compared differences between groups using two-way tables by Chi-Square and Fisher's exact test. We used logistic regression modelling to quantify associations of explanatory variables and outcomes.
1611 of 3262 patients completed the survey (response rate 49.4%). 720 (44.7%) were overseas born, representing 87 nationalities, of whom 532 (73.9%) were new migrants to the UK (< or =10 years). Overseas born were over-represented in comparison to local estimates (44.7% vs 33.6%; p < 0.001; proportional difference 0.111 [95% CI 0.087-0.136]). Dominant immigration status' were: work permit (24.4%), EU citizens (21.5%), with only 21 (1.3%) political asylum seekers/refugees. 178 (11%) reported nationalities from refugee-generating countries (RGCs), eg, Somalia, who were less likely to speak English. Compared with RGCs, and after adjusting for age and sex, the Australians, New Zealanders, and South Africans (ANS group; OR 0.28 [95% CI 0.11 to 0.71]; p = 0.008) and the Other Migrant (OM) group comprising mainly Europeans (0.13 [0.06 to 0.30]; p = 0.000) were less likely to have GP registration and to have made prior contact with GPs, yet this did not affect mode of access to hospital services across groups nor delay access to care.
Recently arrived migrants are a diverse and substantial group, of whom migrants from refugee-generating countries and asylum seekers comprise only a minority group. Service reorganisation to ensure improved access to community-based GPs and delivery of more appropriate care may lessen their impact on acute services.
不断变化的移民趋势给英国的开放式医疗服务带来了新挑战，人们普遍猜测，来自资源匮乏国家的移民给医疗服务带来了不成比例的负担。需要数据来为向移民群体提供服务提供依据，并确保他们能够获得适当的医疗保健。我们比较了前往医院急诊室/随诊中心就诊的移民群体和英国出生患者的社会人口学特征及影响，以及他们此前使用社区全科医生（GP）服务的情况。
我们对伦敦市中心一家医院急诊室/随诊中心在1个月内就诊的所有患者进行了匿名问卷调查。问题涉及国籍、移民身份、在英国的时间、GP服务的注册和使用情况。我们使用卡方检验和费舍尔精确检验的双向表格比较了不同群体之间的差异。我们使用逻辑回归模型来量化解释变量与结果之间的关联。
3262名患者中有1611名完成了调查（回复率49.4%）。720名（44.7%）为海外出生，代表87个国籍，其中532名（73.9%）是英国的新移民（≤10年）。与当地估计相比，海外出生者的比例过高（44.7%对33.6%；p<0.001；比例差异0.111[95%CI 0.087 - 0.136]）。主要的移民身份有：工作许可（24.4%）、欧盟公民（21.5%），只有21名（1.3%）政治庇护寻求者/难民。178名（11%）报告的国籍来自产生难民的国家（RGCs），例如索马里，他们不太可能说英语。与RGCs相比，在调整年龄和性别后，澳大利亚人、新西兰人和南非人（ANS组；比值比0.28[95%CI 0.11至0.71]；p = 0.008）以及主要由欧洲人组成的其他移民（OM）组（0.13[0.06至0.30]；p = 0.000）注册GP的可能性较小，且此前与GP联系的可能性也较小，但这并未影响各群体获得医院服务的方式，也未延迟获得护理的时间。
新到的移民是一个多样化且数量可观的群体，其中来自产生难民的国家的移民和寻求庇护者仅占少数群体。进行服务重组以确保更好地获得社区全科医生服务并提供更适当的护理，可能会减轻他们对急症服务的影响。
