Asylum Seekers and Swiss Nationals with Low-Acuity Complaints: Disparities in the Perceived level of Urgency, Health Literacy and Ability to Communicate—A Cross-Sectional Survey at a Tertiary Emergency Department

Abstract

Background: Emergency departments (EDs) are being increasingly used for low-acuity conditions and as primary care providers. Research indicates that patients with the status of asylum seeker (AS) may be seeking care in EDs at higher levels than nationals. The aim of this study was to identify disparities in the use of emergency care between AS and Swiss nationals (SN) with non-urgent complaints. Methods: Data were obtained from a survey in the period 01/12/2016–31/07/2017 of walk-in low-acuity patients attending the ED of the University Hospital Bern (Switzerland). AS and a gender, age-matched control group of SN of ≥16 years of age were included. Sociodemographic and survey data comprised information about health-seeking behavior in the home and reception country, knowledge of health care systems (HCSs), barriers to care and perceived acuity of the visit. Furthermore, attending physicians assessed the level of urgency of each case. Results: Among AS patients, 30.2% reported that they had no knowledge of the Swiss HCS. In total, 14.2% considered that their medical needs were non-urgent. On the other hand, 43.4% of the attending physicians in the ER considered that the medical needs were non-urgent. This contrast was less pronounced in SN patients. The majority of AS (63.2%) and SN (67.6%) patients sought care from the ED without first contacting a GP. In 53.8% of cases, an interpreter was needed during the ED consultation. Conclusions: Several factors associated with health-seeking behavior in the ED differed between AS and SN patients. Measures to increase health literacy, provision of easily accessible primary care services and intercultural-trained staff could improve quality of care and reduce the usage of EDs as primary care providers.

Health Care for Refugees in Europe: A Scoping Review

“…In literature, utilisation rates of 52-85% for GPs [30][31][32], 22.4-42.5% for specialist care [30,32,33], and from 1% to 15.5% for psychotherapeutic care were seen [18,19,30]. Differences can be partly explained by gender [30,33,34], length of stay [16,17], country of origin [24,33], age [34] and low health literacy [35,36]. Differences are probably also due to the living and housing situation, as well as legal status, and formal restrictions in access to care.…”

“…In addition, needs-based accommodation and social support can play a major key in access to health care [22,31]. [26] 2018 Germany Primary Care Quantitative Fang et al [12] 2015 UK Primary Care Qualitative Feldmann et al [47] 2007a Netherlands Primary Care Qualitative Feldmann et al [49] 2007b Netherlands Primary Care Qualitative Führer et al [19] 2020 Germany Psychiatric care Quantitative Gerritsen et al [34] 2006 Netherlands Primary Care Quantitative Hahn et al [10] 2020 Germany Inpatient and outpatient care Qualitative Jäger et al [27] 2019 Germany Primary care Quantitative Jensen et al [46] 2014 Denmark Inpatient psychiatric Care Qualitative Kang et al [13] 2019 UK Primary Care Qualitative Klingberg et al [35] 2020 Switzerland Emergency care Quantitative Kohlenberger et al [33] 2019 Austria Inpatient and outpatient care Quantitative Laban et al [16] 2007 Netherlands Primary care Quantitative Lamkaddem et al [38] 2014 Netherlands Psychiatric Care Quantitative Maier et al [23] 2010 Switzerland Cost analysis Quantitative Mangrio et al [43] 2018 Sweden Inpatient and outpatient care Mixed-Method Mårtensson et al [44] 2020 Sweden Health care information Qualitative Melamed et al [20] 2019 Switzerland Psychiatric care Qualitative Norredam et al [7] 2005 EU countries Comparative study Quantitative O'Donnell [39] 2007 UK Primary Care Qualitative O'Donnell [48] 2008 UK Primary Care Qualitative Razavi et al [45] 2011 Sweden Long term health care Qualitative Riza et al [37] 2020 EU Inpatient and outpatient care Quantitative Schein et al [42] 2019 Norway Inpatient and outpatient care Qualitative Schneider et al [11] 2015 Germany Inpatient and outpatient care Quantitative Spura et al [9] 2017 Germany Inpatient and outpatient care Qualitative Toar et al [21] 2009 Ireland Psychiatric care Quantitative Van Loenen et al [14] 2017 EU Primary Care Qualitative Wångdahl et al…”

Understanding Health Literacy among University Health Science Students of Different Nationalities

“…Being an immigrant has a socially determining role in terms of access to health care, health outcomes, health status, and health literacy [ 3 , 4 , 5 , 6 ]. Those who cannot speak the national language in a country often have a limited health literacy level [ 5 , 7 ]. The cultural background also has a deep impact on the level of HL [ 8 ].…”

Detecting and describing heterogeneity in health care cost trajectories among asylum seekers

“…We also observe higher emergency costs at the beginning in all clusters. This is not surprising, as many asylum seekers have limited knowledge of the local health care system upon their arrival, leading them to seek care in the emergency department [ 29 , 46 ]. The medication costs decrease in the downward trending cluster after the first six months and remain relatively steady throughout the observation period in the other two clusters.…”