Description
Background
In Belgium universal health coverage depends on registration in the national registry wherefor an address and a residence permit are mandatory. Therefore, undocumented migrants and the homeless often have no effective access to health services. Médecins du Monde Belgium (MdM-BE) is figthing for access to health care for all. Amongst others, by organizing medical consultations in different projects across Belgium with volunteer physicians, nurses, and midwives. The Humanitarian Hub is catering mostly for transmigrants, the care antennas public is more diverse. In CASO/COZO (Centre d’accueil, Soins et Orientation) patients in special need are seen on a more regular basis. This study seeks to evaluate aspects of safety and appropriateness of care delivered during medical consultations and the potential impact of the inauguration of a health department within the NGO in November 2019.
Methods
This study uses a quantitative retrospective analysis of data from electronic health records and protocols obtained from MdM-BE. Patient encounters with diagnosis of acute otitis media and cystitis were used to assess appropriateness of treatment, those with scabies,tuberculosis, and haemoptysis to assess safety of care. An algorithm for correct treatment was defined and variables such as age, gender, region of provenance, housing, and project were extracted. Statistical process control (p-charts and run charts) was used to describe patterns over time and logistic regression with the binary outcome of correct treatment was performed to assess influence of different predictors.
Results
908 of 37,229 consultations in projects between 01/2019 and 12/2021 matched the inclusion criteria and after data-cleaning (elimination of duplicates) 897 consultations were left for analysis. 158 diagnoses of cystitis were made in 58 men and 100 women with a median age of 32 years (IQR=24-42). 83 patients received treatment according to guidelines whereas 50 did not and for 25 patients information was missing. In logistic regression with age, gender, project and region as predictors, the odds ratio (OR) for receiving correct treatment for women compared to men was 4.4 (95%CI: 1.8-11.1, p=.002), ORs for receiving correct treatment in Hub and care antennas compared to CASO/COZO were 0.19 (95%CI: 0.03-0.75, p=.025) and 0.05 (95%CI: 0-0.25, p=.014) respectively. McFadden’s R-squared was 0.259 and the c-statistic 0.795.
542 diagnoses of scabies were made during the project period in 42 women and 500 men with a median age of 24 years (IQR=20-30). An initial analysis revealed an overall median of only 44% (IQR=33.5-60) correct referral, however after manually adding missing data retrieved through individual chart views this increased to an overall median of 94% (IQR=80.75-100). A p-chart with proportion of missing data clearly indicated a change in stability end 2019. After parting the chart, the median percentage of missing data was 63% (IQR=44-75) until 11/2019 and 21% thereafter (IQR=9.5-36.5).
Conclusion
Care delivered by volunteers in projects of MdM-BE is comparable to Belgian national standards and positive changes over time could be depicted. Yet big differences between projects exist. Additional protocols and better encoding of medical consultations are necessary ways forward to facilitate evaluation and guarantee adequate quality in all projects.
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