BackgroundUndocumented migrants face particular challenges in accessing healthcare services in many European countries. The aim of this study was to systematically review the academic literature on the utilization of healthcare services by undocumented migrants in Europe.MethodsThe databases Embase, Medline, Global Health and Cinahl Plus were searched systematically to identify quantitative, qualitative and mixed methods studies published in 2007–2017.ResultsA total of 908 articles were retrieved. Deletion of duplicates left 531. After screening titles, abstracts and full texts according to pre-defined inclusion and exclusion criteria, 29 articles were included in the review. Overall, quantitative studies showed an underutilization of different types of healthcare services by undocumented migrants. Qualitative studies reported that, even when care was received, it was often inadequate or insufficient, and that many undocumented migrants were unfamiliar with their entitlements and faced barriers in utilizing healthcare services.ConclusionsAlthough it is difficult to generalize findings from the included studies due to methodological differences, they provide further evidence that undocumented migrants in Europe face particular problems in utilizing healthcare services.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-2838-y) contains supplementary material, which is available to authorized users.

Despite major methodological differences between included studies, the results of this review indicate that the status of undocumented migrants exacerbates known health risks and hampers service use.

Background During the last few decades, preventing the development of cardiovascular disease has become a mainstay for reducing cardiovascular morbidity and mortality. It has been suggested that interventions should focus more on committed approaches of self-care, such as electronic health techniques. Objective This study aimed to provide evidence to understand the financial consequences of implementing the “Do Cardiac Health: Advanced New Generation Ecosystem” (Do CHANGE 2) intervention, which was evaluated in a multisite randomized controlled trial to change the health behavior of patients with cardiovascular disease. Methods The cost-effectiveness analysis of the Do CHANGE 2 intervention was performed with the Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing tool, based on a Markov model of five health states. The following two types of costs were considered for both study groups: (1) health care costs (ie, costs associated with the time spent by health care professionals on service provision, including consultations, and associated unplanned hospitalizations, etc) and (2) societal costs (ie, costs attributed to the time spent by patients and informal caregivers on care activities). Results The Do CHANGE 2 intervention was less costly in Spain (incremental cost was −€2514.90) and more costly in the Netherlands and Taiwan (incremental costs were €1373.59 and €1062.54, respectively). Compared with treatment as usual, the effectiveness of the Do CHANGE 2 program in terms of an increase in quality-adjusted life-year gains was slightly higher in the Netherlands and lower in Spain and Taiwan. Conclusions In general, we found that the incremental cost-effectiveness ratio strongly varied depending on the country where the intervention was applied. The Do CHANGE 2 intervention showed a positive cost-effectiveness ratio only when implemented in Spain, indicating that it saved financial costs in relation to the effect of the intervention. Trial Registration ClinicalTrials.gov NCT03178305; https://clinicaltrials.gov/ct2/show/NCT03178305

Objectives: The objectives of this study were to determine (1) the increase in antimicrobial resistance to frequently used antibiotics in the hospital setting over time and (2) the correlation between the amount of use of an antibiotic in a specific medical specialty and the observed resistance to that antibiotic in that specialty. Method: The total use of antibiotics and the use of ciprofloxacin (CIP), co-amoxicillin + clavulanic acid (AMCL) and firstand second-generation cephalosporins (CEF), respectively, in individual medical specialties were measured between 2001 and 2006 by means of prevalence surveys (two per year). The antimicrobial susceptibility patterns among E. coli isolated from hospitalized patients between 2003 and 2006 were obtained from the Laboratory Information System. Trends over time and correlation between use and resistance were calculated. Results: 6,639 patients were included in the prevalence surveys, of whom 3.0% (195) were treated with CIP, 9.7% (642) with AMCL, and 3.5% (232) with CEF. 4,790 E. coli isolates were obtained from hospitalized patients. Resistance to all antibiotics significantly increased over time, with the regression line showing that the strongest increase in resistance was for CIP (2.6% per year). There were large variations in antimicrobial use between various medical specialties. A significant correlation was found between the ward-specific prevalence of use and the percentage of resistance for CIP (R = 0.81, p < 0.001) and AMCL (R = 0.82, p = 0.003). Conclusion: At the level of individual medical specialties within one hospital, a higher prevalence of antimicrobial use among patients was associated with a significantly higher observed antimicrobial resistance. The use of CIP was associated with a stronger increase in resistance than the use of beta-lactams.

The objectives of the present study were to determine the effects of multiple targeted interventions on the level of use of quinolones and the observed rates of resistance to quinolones in Escherichia coli isolates from hospitalized patients. A bundle consisting of four interventions to improve the use of quinolones was implemented. The outcome was measured from the monthly levels of use of intravenous (i.v.) and oral quinolones and the susceptibility patterns for E. coli isolates from hospitalized patients. Statistical analyses were performed using segmented regression analysis and segmented Poisson regression models. Before the bundle was implemented, the annual use of quinolones was 2.7 defined daily doses (DDDs)/100 patient days. After the interventions, in 2007, this was reduced to 1.7 DDDs/100 patient days. The first intervention, a switch from i.v. to oral medication, was associated with a stepwise reduction in i.v. quinolone use of 71 prescribed daily doses (PDDs) per month (95% confidence interval [CI] ‫؍‬ 47 to 95 PDDs/month, P < 0.001). Intervention 2, introduction of a new antibiotic guideline and education program, was associated with a stepwise reduction in the overall use of quinolones (reduction, 107 PDDs/month [95% CI ‫؍‬ 58 to 156 PDDs/month). Before the interventions the quinolone resistance rate was increasing, on average, by 4.6% (95% CI ‫؍‬ 2.6 to 6.1%) per year. This increase leveled off, which was associated with intervention 2 and intervention 4, active monitoring of prescriptions and feedback. Trends in resistance to other antimicrobial agents did not change. This study showed that the hospital-wide use of quinolones can be significantly reduced by an active policy consisting of multiple interventions. There was also a stepwise reduction in the rate of quinolone resistance associated with the bundle of interventions.The use of antimicrobial agents and the rates of antimicrobial resistance vary significantly between countries (8,9,16,27). A substantial proportion of the antimicrobial use is considered inappropriate (30). Apart from the unnecessary costs and potential harm to the patient, inappropriate use can lead to increased selection for and transmission of resistant microorganisms. A recent survey in the Amphia Hospital, Breda, Netherlands, showed that approximately 40% of all antibiotic prescriptions were considered inappropriate (e.g., unnecessary, incorrect choice, or incorrect dosage). The only independent variable associated with inappropriate use was the use of quinolones (30). In many cases the use of quinolones was incorrect because there was no indication for antimicrobial therapy, alternative antimicrobials should have been used (on the basis of hospital, national, and international guidelines), or quinolones were used intravenously (i.v.) where oral forms would suffice. The use of quinolones promotes the spread of antibiotic resistance genes by activating an SOS response, as reported by Beaber et al. (1). This means that the use of quinolones could account for the rapid ma...