Department of General Practice, Faculty of Medicine, Aix-Marseille Univ, 27 Bd Jean Moulin, 13385, Marseille, France.
Aix-Marseille Univ, UR3279 CERESS, Marseille, France.
BMC Public Health. 2024 Jun 10;24(1):1552. doi: 10.1186/s12889-024-19048-x.
Migrants have complex health needs but face multiple barriers to accessing health care. In France, permanent healthcare access offices (PASSs), as specific primary health care facilities (SPHCs), provide care to people without health insurance coverage. Once these patients obtain health insurance, they are referred to common ambulatory general practice. The aim of this study was to explore migrants' experiences and strategies for seeking common primary care after having been treated by an SPHC.
We conducted a qualitative study based on grounded theory between January and April 2022. We held semi-structured interviews with migrants who had consulted a PASS. Two researchers performed an inductive analysis.
We interviewed 12 migrants aged 22 to 65 to confirm data saturation. The interviewees relied on "referents": professional referents (to be properly treated for specific health problems), guides (to find their way through the healthcare system), or practical referents (to address practical issues such as translation, travel needs, or medical matters). Those who considered the PASS to be a referent expressed disappointment and incomprehension at the time of discharge. Referral procedures and the first encounter with common ambulatory general practice were decisive in whether the interviewees accessed and stayed in a coordinated primary care pathway. The perceived quality of care depended on a feeling of being considered and listened to. For interviewees who received first-time services from an ambulatory general practice, the way in which they were referred to and their first experience with an ambulatory GP could influence their adherence to care.
The conditions of transition from SPHCs to common ambulatory general practice can impact migrants' adherence to a coordinated primary care pathway. Referral can improve these patients' care pathways and ease the transition from a PASS to ambulatory care. Healthcare professionals at SPHCs should pay special attention to vulnerable migrants without previous experience in ambulatory general practice and who depend on referents in their care pathways. For these patients, adapted referral protocols with further individual support and empowerment should be considered.
移民有着复杂的健康需求，但在获得医疗保健方面面临着多种障碍。在法国，永久性医疗保健接入办公室（PASS）作为特定的初级保健机构（SPHC），为没有医疗保险的人提供医疗服务。一旦这些患者获得医疗保险，他们就会被转介到常见的门诊一般实践。本研究的目的是探讨移民在接受 SPHC 治疗后寻求常见初级保健的经验和策略。
我们在 2022 年 1 月至 4 月期间进行了一项基于扎根理论的定性研究。我们对曾咨询过 PASS 的移民进行了半结构化访谈。两名研究人员进行了归纳分析。
我们采访了 12 名年龄在 22 至 65 岁的移民，以确认数据达到饱和。受访者依赖于“参考人”：专业参考人（为特定健康问题得到妥善治疗）、引导者（在医疗保健系统中找到自己的方式）或实用参考人（解决翻译、旅行需求或医疗问题等实际问题）。那些将 PASS 视为参考人的人在出院时表示失望和困惑。转诊程序和与普通门诊一般实践的首次接触是决定受访者是否接受并保持协调的初级保健途径的关键。护理质量的感知取决于被认为和倾听的感觉。对于从普通门诊一般实践获得首次服务的受访者，他们被转介的方式和他们与普通门诊医生的首次接触可能会影响他们对护理的坚持。
从 SPHC 过渡到普通门诊一般实践的条件可能会影响移民对协调的初级保健途径的坚持。转诊可以改善这些患者的护理途径，并缓解从 PASS 到门诊护理的过渡。SPHC 的医疗保健专业人员应特别关注没有门诊一般实践经验且依赖护理途径中的参考人的脆弱移民。对于这些患者，应考虑采用适应性转诊协议，并提供进一步的个人支持和赋权。
