CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Universià del Piemonte Orientale, Novara, 28100, Italy.
Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, 13100, Italy.
BMC Public Health. 2024 Apr 5;24(1):963. doi: 10.1186/s12889-024-18472-3.
Migrants face several barriers when accessing care and tend to rely on emergency services to a greater extent than primary care. Comparing emergency department (ED) utilization by migrants and non-migrants can unveil inequalities affecting the migrant population and pave the way for public health strategies aimed at improving health outcomes. This systematic review aims to investigate differences in ED utilization between migrant and non-migrant populations to ultimately advance research on migrants' access to care and inform health policies addressing health inequalities.
A systematic literature search was conducted in March 2023 on the Pubmed, Scopus, and Web of Science databases. The included studies were limited to those relying on data collected from 2012 and written in English or Italian. Data extracted included information on the migrant population and the ED visit, the differences in ED utilization between migrants and non-migrants, and the challenges faced by migrants prior to, during, and after the ED visit. The findings of this systematic review are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.
After full-text review, 23 articles met the inclusion criteria. All but one adopted a quantitative methodology. Some studies reported a higher frequency of ED visits among migrants, while others a higher frequency among non-migrants. Migrants tend to leave the hospital against medical advice more frequently than the native population and present at the ED without consulting a general practitioner (GP). They are also less likely to access the ED via ambulance. Admissions for ambulatory care-sensitive conditions, namely health conditions for which adequate, timely, and effective outpatient care can prevent hospitalization, were higher for migrants, while still being significant for the non-migrant population.
The comparison between migrants' and non-migrants' utilization of the ED did not suggest a clear pattern. There is no consensus on whether migrants access EDs more or less than non-migrants and on whether migrants are hospitalized at a higher or lower extent. However, migrants tend to access EDs for less urgent conditions, lack a referral from a GP and access the ED as walk-ins more frequently. Migrants are also discharged against medical advice more often compared to non-migrants. Findings of this systematic review suggest that migrants' access to care is hindered by language barriers, poor insurance coverage, lack of entitlement to a GP, and lack of knowledge of the local healthcare system.
移民在获得医疗服务方面面临着多种障碍，并且往往比初级保健更依赖急诊服务。比较移民和非移民对急诊部门（ED）的利用情况，可以揭示影响移民人群的不平等问题，并为旨在改善健康结果的公共卫生策略铺平道路。本系统综述旨在研究移民和非移民人群对 ED 的利用情况之间的差异，最终推进对移民获得医疗服务的研究，并为解决医疗不平等问题的卫生政策提供信息。
2023 年 3 月，我们在 Pubmed、Scopus 和 Web of Science 数据库中进行了系统文献检索。纳入的研究仅限于依赖于 2012 年及以后收集的数据并以英文或意大利文撰写的研究。提取的数据包括有关移民人群和 ED 就诊的信息、移民和非移民之间 ED 就诊利用情况的差异，以及移民在 ED 就诊前、就诊期间和就诊后所面临的挑战。本系统综述的结果根据《系统评价和荟萃分析的首选报告项目》（PRISMA）2020 指南进行报告。
经过全文审查，有 23 篇文章符合纳入标准。除一篇外，所有文章均采用定量方法。一些研究报告称移民就诊频率较高，而另一些研究则报告称非移民就诊频率较高。与本地人群相比，移民更倾向于在未经医嘱的情况下离开医院，而且他们直接到急诊就诊而不先看家庭医生（GP）。他们也不太可能通过救护车进入急诊。对于门诊护理敏感条件（即通过充分、及时和有效的门诊护理可以预防住院的健康状况）的住院治疗，移民比例较高，而非移民比例也仍然较高。
移民和非移民对 ED 的利用情况进行比较后，并没有呈现出明确的模式。关于移民是否比非移民更频繁地使用 ED，以及移民的住院程度是否更高或更低，没有达成共识。然而，移民倾向于因不太紧急的情况就诊，缺乏 GP 的转诊，并且更频繁地作为门诊病人直接就诊。与非移民相比，移民更经常被建议出院。本系统综述的研究结果表明，语言障碍、保险覆盖不足、缺乏家庭医生就诊资格以及对当地医疗保健系统缺乏了解等因素阻碍了移民获得医疗服务。
