Emergency Department Discharge Outcome and Psychiatric Consultation in North African Patients

Abstract

Studies in Europe have found that immigrants, compared to the local population, are more likely to seek out medical care in Emergency Departments (EDs). In addition, studies show that immigrants utilize medical services provided by EDs for less acute issues. Despite these observed differences, little is known about the characteristics of ED use by North African (NA) immigrants. The main objective of this study was to examine whether there were differences in ED discharge outcomes and psychiatric referrals between NA immigrants and Swiss nationals. A retrospective analysis was conducted using patient records from NA and Swiss adults who were admitted to the ED of the University Hospital in Bern (Switzerland) from 2013–2016. Measures included demographic information as well as data on types of admission. Outcome variables included discharge type and psychiatric referral. A total of 77,619 patients generated 116,859 consultations to the ED, of which 1.1 per cent (n = 1338) were consultations by NA patients. Compared to Swiss national patients, NA patients were younger, with a median age of 38.0 (IQR 28–51 years vs. 52.0 (IQR 32–52) for Swiss and predominantly male (74.4% vs. 55.6% in the Swiss). NA patient admission type was more likely to be “walk-in” or legal admission (7.5% vs 0.8 in Swiss,). Logistic regressions indicated that NA patients had 1.2 times higher odds (95% CI 1.07–1.40, p < 0.003) of receiving ambulatory care. An effect modification by age group and sex was observed for the primary outcome “seen by a psychiatrist”, especially for men in the 16–25 years age group, whereby male NA patients had 3.45 times higher odds (95% CI: 2.22–5.38) of having being seen by a psychiatrist. In conclusion differences were observed between NA and Swiss national patients in ED consultations referrals and outcomes, in which NA had more ambulatory discharges and NA males, especially young, were more likely to have been seen by psychiatrist. Future studies would benefit from identifying those factors underlying these differences in ED utilization.

Health of Refugees and Migrants—Where Do We Stand and What Directions Should We Take?

“…This issue also documents how migrants and refugees access health services and some of their health care outcomes [26,27,28,29,30,31,32,33,34,35]. Studies in this special issue emphasize the need for well-structured policies and guidelines in the EU to ensure the proper integration of AS and refugees within health systems.…”

“…In comparison with the local population, migrants (mainly from North Africa) use ER more often and for less urgent complaints and are more often discharged as outpatients; young males more often consulted psychiatrists [27].…”

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

“…Patients seeking care for non-acute medical issues appear to make up a large percentage of ED visits, ranging up to 62%, with a mean of 37% [15]. Triage data from a study of North African patients who had recently migrated to Switzerland showed that they were less likely to need highly urgent care [16]. In a recent interview-based study of low-acuity ED patients in Germany, two factors were identified [17]: firstly, patients felt it would be more convenient to present in the ED, as this did not require an appointment and was not restricted to office hours.…”