“‘探索难民姑息治疗需求的混合方法研究’”

"'": mixed-methods study exploring palliative care needs amongst refugees'.

作者信息

Gupta Priya, Gill Ashlinder, Panza Michael, Wahoush Olive, Saeed Humaira, Chagani Jehan Ara, Owoo Christiana, Klinger Christopher

机构信息

Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada.

Division of Palliative Care, Department of Family Medicine, McMaster University, 5th Floor David Braley Health Sciences Centre, 100 Main Street West, Hamilton, ON, L8P 1H6, Canada.

出版信息

Palliat Care Soc Pract. 2025 Feb 6;19:26323524251317539. doi: 10.1177/26323524251317539. eCollection 2025.

DOI:10.1177/26323524251317539

PMID:39926420

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11803610/

Abstract

BACKGROUND

The increasing life expectancy and resultant chronic medical comorbidities have resulted in more people requiring palliative care. Unfortunately, palliative care is restricted to marginalized populations, including refugees. In Canada, refugees are only eligible for federal health insurance, which provides basic medical and social coverage until they can obtain provincial health insurance.

OBJECTIVES

This study explored limitations in providing palliative care to refugees who had either federal or provincial health insurance in two care settings in Ontario, Canada.

DESIGN

An explanatory sequential mixed-methods approach guided the review of local administrative data and interview data to understand palliative care delivery for refugees.

METHODS

Local administrative data from a community health centre and an acute care hospital providing a palliative care approach were collected to review healthcare utilization for refugees with palliative care needs. Interviews from two focus groups with fourteen healthcare providers shared their care experiences in coordinating palliative care for refugees with either federal or provincial health insurance.

RESULTS

Refugee patients with palliative care needs appeared to be accessing acute care services frequently to meet their needs over a 5-year period. Due to a lack of citizenship or permanent residency status, many refugees have access to only federal health insurance. Compared to those with routine provincial coverage, federally insured patients were admitted more frequently. Furthermore, healthcare provider experiences revealed that refugees with only federal insurance coverage had significant barriers to accessing community palliative care support, leading to increased reliance on acute care for quality palliative care.

CONCLUSION

This study highlights significant gaps in palliative care access for refugees, especially those with federal health insurance. Equitable access is essential in ensuring that patient-centred, quality palliative care is available to all.

摘要

背景

预期寿命的增加以及随之而来的慢性疾病合并症导致越来越多的人需要姑息治疗。不幸的是，姑息治疗仅限于包括难民在内的边缘化人群。在加拿大，难民仅符合联邦医疗保险资格，该保险提供基本医疗和社会覆盖，直至他们能够获得省级医疗保险。

目的

本研究探讨了在加拿大安大略省的两种护理环境中，为难民提供姑息治疗时存在的局限性，这些难民拥有联邦或省级医疗保险。

设计

采用解释性序列混合方法，指导对当地行政数据和访谈数据的审查，以了解为难民提供的姑息治疗情况。

方法

收集了来自社区卫生中心和提供姑息治疗方法的急症护理医院的当地行政数据，以审查有姑息治疗需求的难民的医疗保健利用情况。来自两个焦点小组的14名医疗服务提供者的访谈分享了他们在为拥有联邦或省级医疗保险的难民协调姑息治疗方面的护理经验。

结果

有姑息治疗需求的难民患者在5年期间似乎经常使用急症护理服务来满足他们的需求。由于缺乏公民身份或永久居民身份，许多难民只能获得联邦医疗保险。与拥有常规省级保险的患者相比，拥有联邦保险的患者入院频率更高。此外，医疗服务提供者的经验表明，仅拥有联邦保险的难民在获得社区姑息治疗支持方面存在重大障碍，导致对优质姑息治疗的急症护理依赖增加。