Detecting and describing heterogeneity in health care cost trajectories among asylum seekers.

BACKGROUND: The mechanism underlying the health care cost trajectories among asylum seekers is not well understood. In the canton of Vaud in Switzerland, a nurse-led health care and medical Network for Migrant Health ("Réseau santé et migration" RESAMI) has established a health care model focusing on the first year after arrival of asylum seekers, called the "community health phase". This model aims to provide tailored care and facilitate integration into the Swiss health care system. The aim of this study is to explore different health care cost trajectories among asylum seekers during this phase and identify the associated factors. METHODS: We detected different patterns of health care cost trajectories using time-series clustering of longitudinal data of asylum seekers in the canton of Vaud in Switzerland. These data included all adult asylum seekers and recipients of emergency aid who entered the canton between 2012 and 2015 and were followed until 2018. The different clusters of health care cost trajectories were then described using a multinomial logistic regression model. RESULTS: We identified a concave, an upward trending, and a downward trending cluster of health care cost trajectories with different characteristics being associated with each cluster. The likelihood of being in the concave cluster is positively associated with coming from the Eastern Mediterranean region or Africa rather than Europe and with a higher share of consultations with an interpreter. The likelihood of being in the upward trending cluster, which accrued the highest costs, is positively associated with 20-24-year-olds rather than older individuals, coming from Europe than any other region and having a mental disorder. In contrast to the other two clusters, the likelihood of being in the downward trending cluster is positively associated with having contacted the RESAMI network within the first month after arrival, which might indicate the potential of early intervention. It is also positively associated with older age and living in a group lodge. CONCLUSIONS: Asylum seekers are heterogeneous in terms of health care cost trajectories. Exploring these differences can help point to possible ways to improve the care and supporting services provided to asylum seekers. Our findings could indicate that early and patient-centered interventions might be well-suited to this aim.

[Asylum seekers : collaboration between nurses and medical students during the COVID-19 epidemic]. / Patients issus de l'asile : collaboration infirmiers-étudiants en médecine durant l'épidémie de Covid-19.

The exceptional health challenges generated by the COVID-19 pandemic have sparked a wave of mobilization among medical students. We were four students to provide support to the Migrant Care Units of the Vulnerability and Social Medicine Department of Unisanté. This two-month experience, very different from the academic framework we were used to during our studies, allowed us to discover a clinic grappling with social and cross-cultural issues, and taught us the mutual benefits of an interprofessional collaboration with experienced nurses. Through a few clinical vignettes, we would like to share the challenges of the care we have seen, as well as the significant lessons we have learned from them.

Les défis sanitaires exceptionnels générés par la pandémie de Covid-19 ont donné lieu à une vague de mobilisation parmi les étudiant·e·s en médecine. Nous avons été quatre étudiant·e·s à apporter notre soutien aux Unités de soins aux migrants du Département Vulnérabilités et médecine sociale d'Unisanté. Cette expérience de deux mois, bien différente du cadre académique dont nous avons eu l'habitude au cours de nos études, nous a permis de découvrir une clinique en prise avec des problématiques sociales et transculturelles, et nous a appris les bénéfices mutuels d'une collaboration interprofessionnelle avec des infirmier·ère·s expérimenté·e·s. Au travers de quelques vignettes cliniques, nous souhaitons ainsi partager les enjeux des prises en soins auxquelles nous avons assisté, ainsi que les enseignements marquants que nous en avons retirés.