Description
Introduction - Objectives
Migrants face several barriers when accessing care, some rooted in the structural, political, and social determinants of health (i.e. limited health literacy, administrative problems, financial constraints), as well as language barriers. Owing to this, they often rely on emergency services to a greater extent than primary care: comparing emergency department (ED) utilization by migrants and non-migrants can therefore unveil inequalities affecting migrant populations, paving the way for public health strategies aimed at improving health outcomes. This is ultimately what this systematic review aimed to investigate, with the goal of advancing research on migrants’ access to care.
Methodology
A literature search was conducted in March 2023 on PubMed, Scopus, and Web of Science databases. The included studies were limited to those relying on data collected starting from 2012 and written in English or Italian. Data extracted included information on the migrant population and the ED visit, the differences in ED utilization between migrants and non-migrants, and the challenges faced by migrants prior to, during, and after the ED visit. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Results - Discussions
After full-text review, 24 articles met the inclusion criteria. All but one adopted a quantitative methodology. The included studies were conducted in 12 host countries: United States, Switzerland, Germany, Italy, Spain, Australia, Canada, China, France, Lebanon, Singapore, Türkiye. Some studies reported a higher frequency of ED visits among migrants, while others a higher frequency among non-migrants. Migrants tend to leave the hospital against medical advice more frequently than the native population and present more often at the ED without consulting a general practitioner (GP ). They are also less likely to access the ED via ambulance. Admissions for Ambulatory Care Sensitive Conditions were found to be higher for migrants, while still being significantly high for the non-migrant population. In our presentation possible interpretations of these findings will be showcased, i.e. interpreting cases of lower utilization in light of the “healthy immigrant effect” and examining the possible reasons behind the higher proportion of walk-in patients in the migrant groups, one example being that economically disadvantaged migrants may be unable to sustain the charges for ambulance services that some countries impose. To the best of our knowledge, this is the first systematic review exploring migrants’ access to the ED without applying geographical restrictions, thus allowing a more comprehensive understanding of the phenomenon.
Conclusions
The comparison between migrants’ and non-migrants’ utilization of EDs, while not suggesting a clear pattern in aspects such as access and severity, shows that migrants’ access to care is hindered by systemic inequalities such as language barriers, poor insurance coverage, and limited working hours of GPs. Research exploring differences in ED utilization by migrants and non-migrants adopting a qualitative methodology is needed.
Acknowledgments
This manuscript is the result of a study conducted in the International PhD in Global Health, Humanitarian Aid, and Disaster Medicine organized by Università del Piemonte Orientale (UPO). This study was supported by Fondazione Cariplo (grant number 2022-1447).
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