Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, Zurich, 8091, Switzerland.
Research Unit for General Practice, Bartholins Alle 2, Aarhus, 8000, Denmark.
BMC Fam Pract. 2021 Jun 21;22(1):119. doi: 10.1186/s12875-021-01460-6.
High demands create pressure on acute care services, such as emergency medical services (EMS), emergency departments (ED) and out-of-hours primary care (OOH-PC) services. A variety of patient- and organisational factors have been discussed as reasons why especially non-western migrants more frequently contact an ED or OOH-PC service than native born. We aim to investigate whether persons with a non-western and western migrant background more often contact an acute care service than native born and how this relates to the number of contacts with their general practitioners (GPs). In addition, we aim to explore how possible differences in acute care use by migrants can be explained.
We performed secondary analysis of data collected for the EurOOHnet survey on OOH help-seeking behaviour in Denmark, the Netherlands and Switzerland. Differences in self-reported acute care use (sum of number of contacts with OOH-PC, the ED and 1-1-2/1-4-4) between non-western and western migrants and native born were tested with a quasi Poisson regression analysis. Mediation analyses were performed to examine the impact of factors related to help-seeking on the relation between self-reported acute care use and migrant background.
Non-western migrants had more acute care contacts than native born (adjusted IRR 1.74, 95% CI 1.33-2.25), whereas no differences were found between western migrants and native born. Migrants who regularly contacted OOH-PC or the ED also regularly contacted their GP. Mediation analyses showed that the factors employment, anxiety, attitude towards use of OOH-PC and problems in accessing the own GP could partly explain the higher acute care use of non-western migrants.
The higher use of acute care services by non-western migrants compared with native born could partly be explained by feeling fewer barriers to contact these services, feeling more anxiety, more unemployment and problems making an appointment with the GP. Increasing awareness and improving GP access could help migrants in navigating the healthcare system.
高需求给急症医疗服务带来了压力，如急诊医疗服务（EMS）、急诊部门（ED）和非工作时间初级保健（OOH-PC）服务。已经讨论了各种患者和组织因素，这些因素被认为是导致非西方移民比本地出生者更频繁地接触 ED 或 OOH-PC 服务的原因。我们旨在调查非西方和西方移民背景的人是否比本地出生者更频繁地接触急症医疗服务，以及这与他们与全科医生（GP）的接触次数有何关系。此外，我们旨在探讨移民对急症护理使用的差异如何解释。
我们对在丹麦、荷兰和瑞士进行的 EurOOHnet 调查中收集的 OOH 寻求帮助行为数据进行了二次分析。使用准泊松回归分析检验了非西方和西方移民与本地出生者之间自我报告的急症护理使用（OOH-PC、ED 和 1-1-2/1-4-4 的接触次数之和）的差异。进行中介分析以检查与寻求帮助相关的因素对自我报告的急症护理使用与移民背景之间关系的影响。
非西方移民的急症护理接触次数多于本地出生者（调整后的 IRR 为 1.74，95%CI 为 1.33-2.25），而西方移民与本地出生者之间没有差异。经常接触 OOH-PC 或 ED 的移民也经常接触他们的 GP。中介分析表明，就业、焦虑、对 OOH-PC 使用的态度以及与 GP 联系的问题等因素可以部分解释非西方移民更高的急症护理使用率。
与本地出生者相比，非西方移民对急症医疗服务的使用更高，这在一定程度上可以解释为他们接触这些服务的障碍感较低、焦虑感较高、失业人数较多以及与 GP 预约的问题较多。提高认识和改善 GP 就诊机会可以帮助移民更好地利用医疗保健系统。
