Adequate Utilization of Emergency Services in Germany: Is There a Differential by Migration Background?

Abstract

Background: The role of emergency services (ES) is to provide round-the-clock acute care. In recent years, inadequate use of ES has been internationally thematised because of overcrowding and the associated cost. Evidence shows that migrant populations tend to use more ES than non-migrant but it remains to show if there is a differential in inadequacy.Method: Quantitative data from consecutive patients visiting three ES in Berlin (hospital-based outpatient clinics for internal medicine or gynecology) from July 2017 to July 2018 were obtained. Utilization was defined as adequate if the patient was admitted to hospital and/or if all of the three following criteria were fulfilled: reported to have been sent by medical staff; reported strong pain; and reported a high urgency (both ≥7, scale from 0 to 10). Differences between migrants (1st generation), their offspring (2nd generation), and non-migrants were evaluated using logistic regression.Results: Of the 2,327 patients included, 901 had a migration background. Adjusting for gender, age, gynecological hospital-based outpatient clinic, and the number of chronic diseases, 1st generation migrant patients (n = 633) had significantly lower odds than non-migrants to have an adequate utilization of services [OR 0.78, 95% confidence interval (0.62, 0.99), p-value 0.046]. For 2nd generation patients (n = 268), no statistically significant difference was found [OR 0.80, 95% confidence interval (0.56, 1.15), p-value 0.231]. Only adjusting for gynecological hospital-based outpatient clinic did weaken the association between migration status on adequacy but interactions between type of hospital-based outpatient clinic and migration were not significant.Discussion: First generation migrants show lower odds of adequate ES use compared to non-migrants. Only visiting a gynecological hospital-based outpatient clinic as opposed to internal medicine could partly explain the lower odds of adequate use among immigrants. This indicates a need for structural changes in the healthcare system: The threshold of access to general practices needs to be lowered, considering the needs of diverse subgroups of migrant patients.

Public Knowledge About Emergency Care—Results of a Population Survey From Germany

“…Limited health literacy was also demonstrated for people with migration background (3) and there is evidence for higher use of emergency services among migrants compared to non-migrants across Europe (25). A recent German study found that migrants show lower odds of adequate emergency department use compared to non-migrants (26). Our results indicate that a lack of knowledge especially of the medical on call service among people with a migration background may in part explain these differences.…”

Intended healthcare utilisation in cases of severe COVID-19 and inflammatory gastrointestinal disease: results of a population survey with vignettes

“…Against the background of the current organisation of urgent and emergency care services in Germany, the present study introduces the individual predisposing factors sex, age, education, migration background and having children into the analyses of utilisation. Predisposing factors as lower education and a migration background are often associated with more frequent or inadequate prehospital and hospital emergency care utilisation in Germany and further European countries,7 23–26 although some current findings for Germany did not confirm these inequalities 27–29. Moreover, higher age predicts increased ED use while sex does not seem to play a significant role 7 24 27 28.…”

“…Additionally, the daytime plays an important role for symptoms like that. Overall, measurement of adequate utilisation is very diverse and remains difficult 7 23 47 63. Thus, interpretations should be done carefully.…”

Einfluss der (un)angemessenen Inanspruchnahme klinischer Notfallambulanzen und der verbalen Kommunikation auf die Zufriedenheit von Ärzten mit der Arzt-Patient-Interaktion unter besonderer Berücksichtigung des Migrationshintergrundes

“…As part of a non-interventional cross-sectional study [ 8 ], factors influencing patients’ utilization of hospital emergency departments (EDs) were assessed and analyzed with a focus on how satisfied physicians were with the doctor–patient interactions (DPIs). We collected data from three sources: 1) standardized questionnaire-based interviews with patients, 2) short questionnaires for attending physicians concerning the DPI, 3) evaluation of the patient’s medical report from the ED.…”

“…We used four parameters to determine appropriate ED utilization. ED utilization was defined as appropriate if the patient had been admitted as an inpatient (criterion A), or/and if all three of the following criteria were met: 1) patient indicates a treatment urgency of at least 7 out of 10 as well as 2) a pain intensity of at least 7 out of 10, and 3) the decision to seek emergency medical care was made by a physician (criterion B) [ 8 ]. The patients were asked to assess their perceived urgency and intensity of pain using an 11-point Likert scale (from 0 = “no urgent need for treatment” to 10 = “very urgent; imminent danger to life”/from 0 = “no pain at all” to 10 = “unbearable pain”).…”