Changes in health and primary health care use of Moroccan and Turkish migrants between 2001 and 2005: a longitudinal study

Background: Social environment and health status are related, and changes affecting social relations may also affect the general health state of a group. During the past few years, several events have affected the relationships between Muslim immigrants and the non-immigrant population in many countries. This study investigates whether the health status of the Moroccan and Turkish immigrants in the Netherlands has changed in four years, whether changes in health status have had any influence on primary health care use, and which socio-demographic factors might explain this relationship. Methods: A cohort of 108 Turkish and 102 Moroccan respondents were interviewed in 2001 and in 2005. The questionnaire included the SF-36 and the GP contact frequency (in the past two months). Interviews were conducted in the language preferred by the respondents. Data were analysed using multivariate linear regression. Results: The mental health of the Moroccan group improved between 2001 and 2005. Physical health remained unchanged for both groups. The number of GP contacts decreased with half a contact/2 months among the Turkish group. Significant predictors of physical health change were: age, educational level. For mental health change, these were: ethnicity, age, civil status, work situation in 2001, change in work situation. For change in GP contacts: ethnicity, age and change in mental and physical health. Conclusion: Changes in health status concerned the mental health component. Changes in health status were paired with changes in health care utilization. Among the Turkish group, an unexpected decrease in GP contacts was noticed, whilst showing a generally unchanged health status. Further research taking perceived quality of care into account might help shedding some light on this outcome.

Determinants of health care utilization by immigrants in Portugal

<p>Abstract</p> <p>Background</p> <p>The increasing diversity of population in European Countries poses new challenges to national health systems. There is a lack of data on accessibility and use of health care services by migrants, appropriateness of the care provided, client satisfaction and problems experienced when confronting the health care system. This limits knowledge about the multiple determinants of the utilization of health services. The aim of this study was to describe the access of migrants to health care and its determinants in Portugal.</p> <p>Methods</p> <p>The study sample included 1513 immigrants (53% men), interviewed at the National Immigrant Support Centre, in Lisbon. Data were collected using questionnaires. The magnitude of associations between use of National Health Service and socio-demographic variables was estimated by means of odds ratios (OR) at 95% confidence intervals, calculated using logistic regression.</p> <p>Results</p> <p>Among participants, 3.6% stated not knowing where to go if facing a health problem. Approximately 20% of the respondents reported that they had never used the National Health Service, men more than women. Among National Health Service users, 35.6% attended Health Centres, 12% used Hospital services, and 54.4% used both. Among the participants that ever used the health services, 22.4% reported to be unsatisfied or very unsatisfied. After adjusting for all variables, utilization of health services, among immigrant men, remained significantly associated with length of stay, legal status, and country of origin. Among immigrant women, the use of health services was significantly associated with length of stay and country of origin.</p> <p>Conclusion</p> <p>There is a clear need to better understand how to ensure access to health care services and to deliver appropriate care to immigrants, and that special consideration must be given to recent and undocumented migrants. To increase health services use, and the uptake of prevention programs, barriers must be identified and approaches to remove them developed, through coherent and comprehensive strategies.</p

Good practice in health care for migrants: views and experiences of care professionals in 16 European countries

<p>Abstract</p> <p>Background</p> <p>Health services across Europe provide health care for migrant patients every day. However, little systematic research has explored the views and experiences of health care professionals in different European countries. The aim of this study was to assess the difficulties professionals experience in their service when providing such care and what they consider constitutes good practice to overcome these problems or limit their negative impact on the quality of care.</p> <p>Methods</p> <p>Structured interviews with open questions and case vignettes were conducted with health care professionals working in areas with high proportion of migrant populations in 16 countries. In each country, professionals in nine primary care practices, three accident and emergency hospital departments, and three community mental health services (total sample = 240) were interviewed about their views and experiences in providing care for migrant patients, i.e. from first generation immigrant populations. Answers were analysed using thematic content analysis.</p> <p>Results</p> <p>Eight types of problems and seven components of good practice were identified representing all statements in the interviews. The eight problems were: language barriers, difficulties in arranging care for migrants without health care coverage, social deprivation and traumatic experiences, lack of familiarity with the health care system, cultural differences, different understandings of illness and treatment, negative attitudes among staff and patients, and lack of access to medical history. The components of good practice to overcome these problems or limit their impact were: organisational flexibility with sufficient time and resources, good interpreting services, working with families and social services, cultural awareness of staff, educational programmes and information material for migrants, positive and stable relationships with staff, and clear guidelines on the care entitlements of different migrant groups. Problems and good care components were similar across the three types of services.</p> <p>Conclusions</p> <p>Health care professionals in different services experience similar difficulties when providing care to migrants. They also have relatively consistent views on what constitutes good practice. The degree to which these components already are part of routine practice varies. Implementing good practice requires sufficient resources and organisational flexibility, positive attitudes, training for staff and the provision of information.</p

Explaining health and healthcare utilisation of ethnic minorities in the Netherlands: a longitudinal perspective.

Werk, discriminatie, en belemmeringen en moeilijkheden in het dagelijkse leven, beïnvloeden de gezondheid en het zorggebruik van migranten en vluchtelingen, zo blijkt uit onderzoek bij het NIVEL en AMC waarop Majda Lamkaddem 30 mei promoveert aan de Universiteit van Amsterdam. De etnische diversiteit in de Westerse wereld neemt steeds meer toe. Migranten en vluchtelingen maken gebruik van dezelfde gezondheidszorgvoorzieningen als autochtone Nederlanders. Hoe staat het met hun lichamelijke en geestelijke gezondheid en hoe vaak gaan ze naar de dokter? Majda Lamkaddem keek naar het zorggebruik en de lichamelijke en mentale gezondheid van groepen migranten en vluchtelingen in Nederland. In het bijzonder: Marokkaanse, Turkse, Surinaamse en Antilliaanse Nederlanders en vluchtelingen uit Iran, Somalië en Afghanistan. Werk Lamkaddem onderzocht de rol van verschillende sociale en omgevingsfactoren op verschillende momenten in de tijd. De arbeidssituatie, discriminatie, en belemmeringen en moeilijkheden in het dagelijkse leven blijken van grote invloed te zijn op de gezondheid en het zorggebruik van deze groepen. “Vooral de werksituatie blijkt heel belangrijk. De gezondheid van etnische minderheidsgroepen is ook het product van economische en culturele factoren en van factoren uit de fysieke en sociale omgeving. Discriminatie blijkt een barrière om zorg te gebruiken. Werk blijkt de mentale en algemene gezondheid te verbeteren.” Verblijfsvergunning Opmerkelijk in het onderzoek blijkt de invloed van een verblijfsvergunning op de gezondheid. Als vluchtelingen een verblijfsvergunning krijgen, worden ze gezonder. De verklaring is vooral praktisch volgens de promovenda: “Gezondheid wordt ook bepaald door de omstandigheden waarin je leeft. Mensen worden niet gezonder van een verblijfsvergunning, maar doordat hun leefomstandigheden hierdoor verbeteren. Ze kunnen aan het werk, een huis huren, ze kunnen eindelijk meedoen in de samenleving. En daardoor voelen ze zich gezonder.” PTSS Ongeveer 15% van de vluchtelingen heeft symptomen van een Post Traumatische Stress Stoornis (PTSS). Ruim twee keer zoveel als gemiddeld in Nederland. Dit percentage blijft in een periode van 7 jaar onveranderd. Dat is op verschillende manieren te verklaren, stelt Majda Lamkaddem. “Bij de eerste meting had slechts 21% van de mensen met PTSS contact met de GGZ. Deze vluchtelingen met PTSS bleken significant meer kans te hebben op verbetering. Contact met de GGZ in Nederland had dus een positief effect. De meerderheid bleef echter onbehandeld en daarnaast werden bij een deel van de vluchtelingen de symptomen van PTSS pas na langere tijd zichtbaar.