Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, POB 653, 8410501, Beer Sheva, Israel.
Department of Emergency Medicine, Tel Aviv Medical Center, Tel Aviv, Israel.
Int J Equity Health. 2020 Apr 29;19(1):56. doi: 10.1186/s12939-020-1152-6.
Irregular migrants (IMM) are excluded from the National health insurance in most developed countries and may use the emergency department (ED) as a source for medical care. This study aims to compare the use of ED by IM with that of Israeli citizens (IC) in a large urban hospital in Tel Aviv, including socio-demographic characteristics, hospitalization proportion and medical conditions on admission.
This cross-sectional study included all IM and IC patients older than 18 years who attended the ED between 2007 and 2011, and compared their socio-demographic characteristics, the administrative details of the visit and clinical variables upon admission. Hospitalization proportion was calculated by dividing the number of patients who were admitted to the hospital ward by the number of all patients who attended the ED.
IM who attended the ED were younger compared to IC (mean 39 ± 17 versus 52 ± 22 years, respectively), mostly males (1.4 Male/Female ratio) and mainly originated from developing countries. IM were more commonly self-referred, more likely to attend the ED during evening hours and weekends, complained of occupational injuries and frequented the surgical rather the medical ward of the ED compared with IC. IM stayed at the ED for longer periods than IC, yet the proportion of their hospitalization was lower than that of IC (19.4% versus 23.5%, respectively).
IM stayed in the ED for longer periods and were less likely to be admitted to the hospital wards, suggesting presentation of non-severe medical conditions or possible barriers in ensuring care continuity in the community following discharge. Minimizing the barriers of IM to primary care in the community can reduce unnecessary referrals to the ED. Additionally, hospitals managements should respond to the high-volume of IM by shifting staff to busy hours and improving the communication with IM.
在大多数发达国家，非正规移民（IMM）被排除在国家医疗保险之外，他们可能会使用急诊部（ED）作为医疗保健的来源。本研究旨在比较在特拉维夫的一家大型城市医院中，IM 与以色列公民（IC）在使用 ED 方面的差异，包括社会人口统计学特征、住院比例和入院时的医疗状况。
本横断面研究包括 2007 年至 2011 年间在 ED 就诊的所有年龄大于 18 岁的 IMM 和 IC 患者，并比较了他们的社会人口统计学特征、就诊的行政细节和入院时的临床变量。住院比例通过将住院患者人数除以所有就诊 ED 的患者人数计算得出。
就诊 ED 的 IMM 比 IC 更年轻（平均 39±17 岁与 52±22 岁），大多数为男性（男女比例为 1.4），主要来自发展中国家。IM 更常自行就诊，更可能在晚上和周末就诊 ED，与 IC 相比，他们更常抱怨职业伤害，并常去 ED 的外科病房而非内科病房就诊。IM 在 ED 停留的时间比 IC 长，但住院比例低于 IC（分别为 19.4%和 23.5%）。
IM 在 ED 停留的时间更长，且不太可能被收治入院，这表明他们的病情可能不严重，或者在出院后在社区中确保医疗连续性方面可能存在障碍。减少 IM 对社区初级保健的障碍可以减少不必要的 ED 转诊。此外，医院管理层应通过在繁忙时段调配工作人员并改善与 IM 的沟通来应对 IM 就诊人数的增加。
