Background
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Do migrants more often contact an acute care service than native borns?
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How does this relate to the number of contacts with their GP?
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How can possible differences in acute care use by migrants be explained?
Methods
Design and population
Setting per country
Data collection and questionnaire
Outcome measures
Analyses
Results
Population
Factors | Categories | Native born (Nmax = 2,733)a | Non-western migrants (Nmax = 175)b | Western migrants (Nmax = 547)c |
---|---|---|---|---|
Age | Mean (SD) | 46.0 (10.2) | 39.2 (9.1) | 44.4 (9.9) |
Median (IQR) | 51.0 (36–55) | 36 (32–50) | 40 (35–53.5) | |
Sex | Male | 47.5 | 49.1 | 40.8 |
Female | 52.5 | 50.9 | 59.2 | |
Education level | Low | 12.5 | 13.1 | 8.1 |
Middle | 52.6 | 40.6 | 52.0 | |
High | 34.9 | 46.3 | 39.9 | |
Medical education | None | 89.6 | 93.1 | 91.4 |
Some/nurse/doctor | 10.4 | 6.9 | 8.6 | |
Employment | Unemployed | 19.1 | 29.2 | 22.3 |
Employed | 80.9 | 70.8 | 77.7 | |
Living status | Living alone | 16.8 | 11.4 | 19.0 |
Living with another adult | 83.2 | 88.6 | 81.0 | |
Social support | Lacking social support | 24.0 | 36.2 | 29.7 |
Receiving social support | 75.9 | 63.2 | 70.3 | |
Health literacy – navigating the system | Low/middle ability | 28.4 | 28.0 | 35.1 |
High ability | 71.6 | 72.0 | 64.9 | |
Health literacy – sufficient information | Low ability | 9.5 | 8.8 | 15.5 |
High ability | 90.5 | 91.2 | 84.5 | |
Self-efficacy | Low | 50.6 | 56.6 | 40.1 |
High | 49.4 | 43.4 | 59.9 | |
Anxiety | No anxiety | 88.8 | 80.8 | 85.7 |
Anxiety | 11.2 | 19.2 | 14.3 | |
Attitude towards use OOH-PC | Low barrier | 36.8 | 52.4 | 52.5 |
High barrier | 63.2 | 47.6 | 47.5 | |
Degree of severity before contacting OOH-PC | Mean (SD) | 8.1 (1.5) | 7.8 (1.6) | 8.2 (1.7) |
Median (IQR) | 8 (7–9) | 8 (7–9) | 8 (7–10) | |
Travel time | < 15 min | 45.7 | 51.4 | 56.1 |
≥ 15 min | 54.3 | 48.6 | 43.9 | |
Problems in contacting GP due to own work or private appointments | No/few problems | 84.0 | 75.6 | 84.1 |
Some/many problems | 16.0 | 24.4 | 15.9 | |
Problems in contacting GP due to accessibility own GP | No/few problems | 78.4 | 71.4 | 84.7 |
Some/many problems | 21.6 | 28.6 | 15.3 | |
Problems in contacting GP due to availability own GP | No/few problems | 84.8 | 80.7 | 86.4 |
Some/many problems | 15.2 | 19.3 | 13.6 | |
Self-assessed health | Poor | 13.7 | 13.7 | 13.5 |
Good | 86.3 | 86.3 | 86.5 |
Self-reported acute care use
Model A | Model Ba | |
---|---|---|
IRR (95% CI) | IRR (95% CI) | |
Migrant background (ref = native born) | ||
Western migrant | 1.18 (0.96–1.43) | 1.15 (0.94–1.40) |
Non-western migrant | 2.02 (1.54–2.61)* | 1.78 (1.35–2.30)* |
GP care use
Model Ca | Model Da | |
---|---|---|
IRR (95% CI) | IRR (95% CI) | |
Migrant background (ref = native born) | ||
Western migrant | 1.08 (0.91–1.28) | 1.46 (0.97–2.13) |
Non-western migrant | 1.54 (1.21–1.93) | 1.73 (0.94–3.04) |
Number of GP contacts | 1.50 (1.44–1.57) | 1.53 (1.46–1.60) |
Interaction | ||
Western migrant* number of GP contacts | 0.92 (0.83–1.02) | |
Non-western migrant* number of GP contacts | 0.97 (0.83–1.13) |
Mediation analyses
Potential mediators | Direct effect | Mediation effect | Total effect | % Mediated |
---|---|---|---|---|
IRR (95% CI) | IRR (95% CI) | IRR (95% CI) | % (95% CI) | |
Employment | 1.69 (1.20–2.51)* | 1.04 (1.00–1.09)* | 1.75 (1.24–2.64)* | 6.9 (0.6–19.0)* |
Social support | 1.71 (1.21–2.66)* | 1.01 (1.00–1.04) | 1.74 (1.22–2.66)* | 2.2 (-1.0–10) |
Health literacy: sufficient information | 1.66 (1.20–2.48)* | 1.04 (1.00–1.11) | 1.72 (1.23–2.61)* | 6.8 (-0.3–20.0) |
Anxiety | 1.65 (1.21–2.46)* | 1.05 (1.01–1.11)* | 1.73 (1.24–2.61)* | 8.4 (1.6–23,0)* |
Attitude towards use OOH-PC | 1.59 (1.13–2.34)* | 1.07 (1.03–1.14)* | 1.70 (1.20–2.53)* | 13.4 (4.5–35.0)* |
Degree of severity before contacting OOH-PC | 1.61 (1.16–2.46)* | 1.02 (0.98–1.08) | 1.65 (1.18–2.56)* | 4.6 (-6.3–18.0) |
Travel time | 1.72 (1.23–2.69)* | 0.99 (0.96–1.00) | 1.69 (1.21–2.61)* | -2.6 (-11.6–0.0) |
Problems in contacting GP due to own work or private appointments | 1.67 (1.18–2.56)* | 1.03 (1.00–1.07)* | 1.72 (1.20–2.69)* | 5.8 (0.1–18.0)* |
Problems with accessibility own GP | 1.68 (1.22–2.56)* | 1.02 (1.00–1.06)* | 1.72 (1.24–2.59)* | 4.2 (0.1–13.0)* |