Conditions for the success and the feasibility of health mediation for healthcare use by underserved populations: a scoping review

Richard, Elodie; Vandentorren, Stéphanie; Cambon, Linda

doi:10.1136/bmjopen-2022-062051

Cited by 16 publications

(32 citation statements)

References 42 publications

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“…Initially, HM focused on persons living with AIDS and mental health diseases, and then expanded to patients with other chronic conditions, but was not designed for FUEDs [ 16 , 23 ]. In our trial, 13.4% reported not having a GP, a slightly higher proportion than in the general population, and 24.3% had not seen a GP in the last three months, despite a higher prevalence of chronic diseases and a poorer quality of life than the general population.…”

Section: Discussionmentioning

confidence: 99%

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Health mediation does not reduce the readmission rate of frequent users of emergency departments living in precarious conditions: what lessons can be learned from this randomised controlled trial?

Rotily,

Persico,

Lamouroux

et al. 2024

BMC Emerg Med

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Background Severe overcrowding of emergency departments (EDs) affects the quality of healthcare. One factor of overcrowding is precariousness, but it has rarely been considered a key factor in designing interventions to improve ED care. Health mediation (HM) aims to facilitate access to rights, prevention, and care for the most vulnerable persons and to raise awareness among healthcare providers about obstacles in accessing healthcare. The primary aim was to determine whether HM intervention for frequent users of EDs (FUED) living in precarious conditions could reduce the readmission rate at 90 days. Methods Between February 2019 and May 2022, we enrolled and interviewed 726 FUED in four EDs of southeastern France in this randomised controlled trial. The HM intervention started in the ED and lasted 90 days. In addition to the primary endpoint (first readmission at 90 days), secondary endpoints (readmission at 30 and 180 days, number of hospitalisations at 30, 90, 180 days, admissions for the same reasons as the first admission) were also studied. The outcomes were measured in the ED information systems. Statistical methods included an intention-to-treat analysis and a per-protocol analysis. Comparisons were adjusted for gender, age, ED, and health mediator. Results 46% of patients reported attending the ED because they felt their life was in danger, and 42% had been referred to the ED by the emergency medical dispatch centre or their GP; 40% of patients were considered to be in a serious condition by ED physicians. The proportion of patients who were readmitted at 90 days was high but did not differ between the control and the HM intervention groups (31.7% vs. 36.3%, p = 0.23). There was no significant difference in any of the secondary outcome measures between the control and HM intervention groups. Per-protocol analysis also showed no significant difference for the primary and secondary endpoints. Conclusions This randomised controlled trial did not show that our health mediation intervention was effective in reducing the use of emergency services by FUED living in precarious conditions. Some limitations are discussed: the duration of the intervention (90 days), the long-term effects (> 6 months), the involvement of the ED staff. Trial registration Registered on clinicaltrials.gov as NCT03660215 on 4th September 2018.

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Section: Discussionmentioning

confidence: 99%

“…In their scoping review, Richard et al identified the conditions for the success and the feasibility of HM, in particular the status and training of HMrs [ 23 ]. They also noted that most papers took the effectiveness of HM for granted and only presented an analysis of the conditions.…”

Section: Discussionmentioning

confidence: 99%

Health mediation does not reduce the readmission rate of frequent users of emergency departments living in precarious conditions: what lessons can be learned from this randomised controlled trial?

Rotily,

Persico,

Lamouroux

et al. 2024

BMC Emerg Med

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“…Long lacking a legal framework and professional benchmark, HM has been officially recognized in France by the law of modernization of the healthcare system in 2016, and defined in 2017 by the French National Authority for Health [ 33 ], as a set of actions to improve access to rights, prevention, and care, in order to promote health and thus move towards greater equity. Although HM has been widely promoted by the French Ministry of Health and many actors in the healthcare system, and its implementation has been evaluated in the context of health promotion and access to health in vulnerable people, tangible data on its effectiveness on access to health, quality and efficiency of health care in these populations are not available [ 30 , 38 – 40 ]. Although it seems entirely appropriate in the context of deprived frequent ED users, HM has never yet been tested or even evaluated in this context.…”

Section: Introductionmentioning

confidence: 99%

“…HM could respond to patients’ needs as they express it, respect their need for control over the situation, promote their ability to make their decisions, strengthen their sense of self-efficiency and their motivation to healthcare use. HM could also strengthen the ability to make decisions favourable to health in a logic of empowerment, and reinforce people’s perception of the healthcare benefits [ 40 ]. A HM intervention targeting deprived frequent ED users, starting in ED and consisting of education actions and navigation in care system could reduce readmissions to ED.…”

Section: Introductionmentioning

confidence: 99%

Health mediation: an intervention mode for improving emergency department care and support for patients living in precarious conditions

Salem

Rotily

Apostolidis

et al. 2023

BMC Health Serv Res

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Background Severe overcrowding of emergency departments (EDs) impacts the quality of healthcare. One factor of this overcrowding is precariousness, but it has rarely been considered a key factor in designing interventions to improve ED care. Health mediation (HM) aims to facilitate access to rights, prevention, and care for the most vulnerable persons and to raise awareness among healthcare providers about obstacles in accessing healthcare. We here present the results of an ancillary qualitative study to explore the prospects regarding a health mediation intervention implemented in EDs for deprived persons who are frequent ED users, from professionals’ and patients’ perspectives. Methods Design, data collection, and data analysis were done according to a psychosocial approach, based on thematic content analysis and semi-structured interviews of 16 frequent ED users and deprived patients exposed to HM and of 14 professionals in 4 EDs of South-eastern France. Results All patients reported multifactorial distress. Most of them expressed experiencing isolation and powerlessness, and lacking personal resources to cope with healthcare. They mentioned the use of ED as a way of quickly meeting a professional to respond to their suffering, and recognized the trustworthy alliance with health mediators (HMrs) as a means to put them back in a healthcare pathway. The presence of HMrs in EDs was appreciated by ED professionals because HMrs responded to requests they were not able to access and were perceived as an efficient support for caring for deprived persons in emergency contexts. Conclusions Our results are in favour of health mediation in EDs as a promising solution, requested by patients and ED professionals, to cope with frequent ED users and deprived patients. Our results could also be used to adapt other strategies for the most vulnerable populations to reduce the frequency of ED readmissions. At the interface of the patients’ health experience and the medico-social sector, HM could complete the immediate responses to medical needs given in EDs and contribute in alleviating the social inequalities of health.

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“…A committee of experts from outside the study reviewed the questionnaire. Questions and variables were standardized on previous PARCOURS studies, on precariousness scales and on the conceptual framework for describing CHW activities previously validated in the literature ( 12 , 23 , 24 ).…”

Section: Methodsmentioning

confidence: 99%

Enhancing sexual health and empowerment among migrant women sex workers: a community health worker-led intervention in Marseille, France

Mosnier,

Hoyer,

Artigas

et al. 2024

Front. Public Health

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IntroductionGiven the high infection rate of sexually transmitted infections (STI) among migrant women sex workers (WSWs), it is necessary to understand how to improve prevention, information and care for this vulnerable population. Community health workers (CHWs), by linking community to health services, are positioned to improve health outcomes in migrant communities. This article aims to describe a pilot innovative intervention performed by CHWs to improve sexual health in migrant WSWs.MethodsThis one-year intervention study used a respondent-driven sampling (RDS) to recruit a representative cohort of migrant WSWs in Marseille, France. Four CHWs were recruited from different communities and participated in all stages of the research. They performed individual and group interventions of prevention, support in care and empowerment. Data on participant characteristics, type of intervention and adherence to the intervention were reported via questionnaires given to participants. Simultaneously, semi-structured interviews and informal interviews of migrant WSW, CHWs and care providers were carried out.ResultsA total of 132 migrant WSWs were included in the cohort. Very few of them knew about PrEP (12%) or already used HIV post-exposure treatment (9%). Migrant WSWs were often victims of rape or racism, 15 and 21%, respectively. In two-thirds of cases the level of health literacy was low. Participants suffered from a combination of vulnerability factors: difficulties with access to social rights, food or housing. Only 13% reported having benefited from medical follow-up or assistance by an NGO in the 3 months prior to the program. By 3 months, more than one third of the participants had been tested for HIV (35%) and 63% knew about PrEP. A total retention rate of 70% was reported in the cohort after 6 months.ConclusionCHWs enabled to improve care access for migrant WSWs by improving the collaboration between care and social actors at a local level. Through these “bring-back-to” interventions for this hard-to-reach population, CHWs enabled an optimization of the care pathway. Our results also highlight the importance of a population-based approach for individual and group support of empowerment interventions in order to strengthen their capacity for action.

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Conditions for the success and the feasibility of health mediation for healthcare use by underserved populations: a scoping review

Cited by 16 publications

References 42 publications

Health mediation does not reduce the readmission rate of frequent users of emergency departments living in precarious conditions: what lessons can be learned from this randomised controlled trial?

Health mediation does not reduce the readmission rate of frequent users of emergency departments living in precarious conditions: what lessons can be learned from this randomised controlled trial?

Health mediation: an intervention mode for improving emergency department care and support for patients living in precarious conditions

Enhancing sexual health and empowerment among migrant women sex workers: a community health worker-led intervention in Marseille, France

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