Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, PO Box 10 01 31, 33501, Bielefeld, Germany.
Department of Health Care Management, Technische Universität Berlin, Strasse des 17. Juni 135, 10623, Berlin, Germany.
Int J Equity Health. 2023 May 23;22(1):99. doi: 10.1186/s12939-023-01914-6.
Despite a high burden of chronic and mental illness, asylum-seekers show low utilization of ambulatory specialist healthcare. Forgoing timely healthcare when facing access barriers may direct them toward emergency care. This paper examines interrelations of physical and mental health and utilization of ambulatory and emergency care, and explicitly addresses associations between the different types of care.
A structural equation model was applied to a sample of n = 136 asylum-seekers living in accommodation centers in Berlin, Germany. Utilization patterns of emergency care (outcome) and physical and mental ambulatory care (endogenous predictors) were estimated, while controlling for age, gender, chronic conditions, bodily pain, depression, anxiety, length of stay in Germany (exogenous predictors) and self-rated health (endogenous predictor).
Associations were observed between ambulatory care utilization and poor self-rated health (0.207, CI: 0.05; 0.364), chronic illness (0.096, CI: 0.017; 0.175) and bodily pain (0.019, CI: 0.002; 0.036); between mental healthcare utilization and anxiety (0.202, CI: 0.051; 0.352); and between emergency care utilization and poor self-rated health (0.621, CI: 0.059; 1.183), chronic illness (0.287, CI: 0.012; 0.563), mental healthcare utilization (0.842, CI: 0.148; 1.535) and anxiety (0.790, CI: 0.141; 1.438) (values in parentheses show estimated regression coefficients and 95% confidence intervals). We found no associations between the utilization of ambulatory and emergency care.
Our study generates mixed results concerning associations between healthcare needs and ambulatory and emergency care utilization among asylum-seekers. We found no evidence that low utilization of ambulatory care contributes to emergency care utilization; neither did we find evidence that ambulatory treatment obviates the need to seek emergency care. Our results indicate that higher physical healthcare needs and anxiety are associated with more utilization of both ambulatory and emergency care; whereas healthcare needs related to depression tend to remain unmet. Both the undirected and under-utilization of health services may reflect navigation and accessibility issues. To facilitate more needs-based and effective healthcare utilization and thus contribute to health equity, support services such as interpretation and care navigation as well as outreach are warranted.
尽管慢性疾病和精神疾病负担沉重，但寻求庇护者对门诊专科医疗保健的利用程度较低。当面临获得医疗服务的障碍时，他们可能会放弃及时的医疗保健，转而寻求急诊护理。本文研究了身心健康之间的相互关系，以及门诊和急诊护理的利用情况，并明确探讨了不同类型护理之间的关联。
本研究采用结构方程模型，对居住在德国柏林住宿中心的 136 名寻求庇护者进行了样本分析。在控制年龄、性别、慢性疾病、身体疼痛、抑郁、焦虑、在德停留时间（外生预测因子）和自我报告健康状况（内生预测因子）的情况下，估计了急诊护理（结局）和身体及精神门诊护理（内源性预测因子）的利用模式。
门诊护理利用与自我报告健康状况较差（0.207，CI：0.05；0.364）、慢性疾病（0.096，CI：0.017；0.175）和身体疼痛（0.019，CI：0.002；0.036）之间存在关联；精神保健服务利用与焦虑（0.202，CI：0.051；0.352）之间存在关联；急诊护理利用与自我报告健康状况较差（0.621，CI：0.059；1.183）、慢性疾病（0.287，CI：0.012；0.563）、精神保健服务利用（0.842，CI：0.148；1.535）和焦虑（0.790，CI：0.141；1.438）之间存在关联（括号内的值表示估计的回归系数和 95%置信区间）。我们未发现门诊护理和急诊护理利用之间存在关联。
我们的研究结果在寻求庇护者的医疗需求与门诊和急诊护理利用之间的关联方面产生了混合结果。我们没有发现门诊护理利用率低会导致急诊护理利用率增加的证据；我们也没有发现门诊治疗可以避免急诊护理需求的证据。我们的结果表明，较高的身体保健需求和焦虑与门诊和急诊护理的利用都呈正相关；而与抑郁相关的保健需求往往得不到满足。卫生服务的无导向和低利用可能反映了导航和可及性问题。为了促进更基于需求的、有效的医疗保健利用，并促进健康公平，需要提供诸如翻译和护理导航以及外展等支持服务。
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