The lower quality of preventive care among forced migrants in a country with universal healthcare coverage

Abstract Objective To assess the association between socio-demographic factors and the quality of preventive care and chronic care of cardiovascular (CV) risk factors in a country with universal health care coverage. Methods Our retrospective cohort assessed a random sample of 966 patients aged 50–8...

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Bibliographic Details
Published in:	Preventive medicine 2014-02, Vol.59, p.19-24
Main Authors:	Martin, Yonas, Collet, Tinh-Hai, Bodenmann, Patrick, Blum, Manuel R, Zimmerli, Lukas, Gaspoz, Jean-Michel, Battegay, Edouard, Cornuz, Jacques, Rodondi, Nicolas
Format:	Article
Language:	eng
Subjects:	Aged Aged, 80 and over Biological and medical sciences Chronic Disease - ethnology Chronic Disease - prevention & control Coverage Female Forced migrants General aspects Health care Human Rights - standards Humans Internal Medicine Male Medical sciences Middle Aged Migrants Miscellaneous Multivariate Analysis Prevention and actions Preventive care Preventive health care Preventive Health Services - economics Preventive Health Services - standards Primary Health Care - statistics & numerical data Public health. Hygiene Public health. Hygiene-occupational medicine Quality Indicators, Health Care Quality insurance (general aspects) Quality of care Quality of Health Care - standards Retrospective Studies Socio-demographic characteristics Sociodemographic aspects Socioeconomic Factors Switzerland Transients and Migrants - legislation & jurisprudence Transients and Migrants - statistics & numerical data Universal Coverage - economics Universal Coverage - standards Vulnerable populations
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Summary:	Abstract Objective To assess the association between socio-demographic factors and the quality of preventive care and chronic care of cardiovascular (CV) risk factors in a country with universal health care coverage. Methods Our retrospective cohort assessed a random sample of 966 patients aged 50–80 years followed over 2 years (2005–2006) in 4 Swiss university primary care settings (Basel/Geneva/Lausanne/Zürich). We used RAND's Quality Assessment Tools indicators and examined recommended preventive care among different socio-demographic subgroups. Results Overall patients received 69.6% of recommended preventive care. Preventive care indicators were more likely to be met among men (72.8% vs. 65.4%; p < 0.001), younger patients (from 71.0% at 50–59 years to 66.7% at 70–80 years, p for trend = 0.03) and Swiss patients (71.1% vs. 62.7% in forced migrants; p = 0.001). This latter difference remained in multivariate analysis adjusted for gender, age, civil status and occupation (OR 0.68; 95% CI 0.54–0.86). Forced migrants had lower scores for physical examination and breast and colon cancer screening (all p ≤ 0.02). No major differences were seen for chronic care of CV risk factors. Conclusion Despite universal healthcare coverage, forced migrants receive less preventive care than Swiss patients in university primary care settings. Greater attention should be paid to forced migrants for preventive care.
ISSN:	0091-7435 1096-0260