Use of emergency primary care among pregnant undocumented migrants over ten years: an observational study from Oslo, Norway.

OBJECTIVE: To compare consultations with pregnant undocumented migrants at emergency primary health care to consultations with pregnant residents of Norway. DESIGN: A cross-sectional study of consultations at several time points. SETTING: The study was conducted at the Oslo Accident and Emergency Outpatient Clinic (OAEOC), the main emergency primary care service in Oslo, Norway. SUBJECTS: Consultations with pregnant patients without a Norwegian identity number seeking care at the Department of Emergency General Practice at the OAEOC were identified through a manual search of registration lists from 2009 to 2019. The consultations were categorized by women's residency status as 'probably documented migrant', 'uncertain migrant status', or 'probably undocumented migrant'. We also extracted aggregated data for women with a Norwegian identity number (i.e. residents) presenting in consultations with pregnancy-related (ICPC-2 chapter W) conditions. MAIN OUTCOME MEASURES: Manchester Triage System urgency level at presentation, and hospitalization. RESULTS: Among 829 consultations with female patients categorized as probably undocumented migrants, we found 27.1% (225/829) with pregnant women. About half of the pregnant women (54.6% (123/225)) presented with a pregnancy-related condition. Pregnant women that were probably undocumented migrants had an increased risk of being triaged with a high level of urgency at presentation (relative risk (RR) 1.86, 95% CI 1.14-3.04) and being hospitalized (RR 1.68, 95% CI 1.21-2.34), compared to pregnant residents. CONCLUSION: Pregnant undocumented migrants were more severely sick when presenting to emergency primary care services than pregnant residents. Increased access to primary care and emergency primary care services for pregnant undocumented migrants is urgently needed.

Restricted access to primary care may increase the use of primary care facilities intended for emergency care.A considerable proportion of the consultations with undocumented migrant women at the emergency primary care services are related to pregnancy.Consultations with pregnant undocumented migrants more often contained severe pregnancy-related conditions compared to consultations with pregnant residents of Norway.Interventions to increase access to primary care for pregnant undocumented migrants are urgently needed.

Reasons for attending a general emergency outpatient clinic versus a regular general practitioner - a survey among immigrant and native walk-in patients in Oslo, Norway.

OBJECTIVE: To explore reasons for attending a general emergency outpatient clinic versus a regular general practitioner (RGP). DESIGN: Cross-sectional study using a multilingual anonymous questionnaire. SETTING: Native and immigrant walk-in patients attending a general emergency outpatient clinic in Oslo (Monday-Friday, 08:00-23:00) during 2 weeks in September 2009. SUBJECTS: We included 1022 walk-in patients: 565 native Norwegians (55%) and 457 immigrants (45%). MAIN OUTCOME MEASURES: Patients' reasons for attending an emergency outpatient clinic versus their RGP. RESULTS: Among patients reporting an RGP affiliation, 49% tried to contact their RGP before this emergency encounter: 44% of native Norwegian and 58% of immigrant respondents. Immigrants from Africa [odds ratio (OR) = 2.55 (95% confidence interval [CI]: 1.46-4.46)] and Asia [OR = 2.32 (95% CI: 1.42-3.78)] were more likely to contact their RGP before attending the general emergency outpatient clinic compared with native Norwegians. The most frequent reason for attending the emergency clinic was difficulty making an immediate appointment with their RGP. A frequent reason for not contacting an RGP was lack of access: 21% of the native Norwegians versus 4% of the immigrants claimed their RGP was in another district/municipality, and 31% of the immigrants reported a lack of affiliation with the RGP scheme. CONCLUSIONS AND IMPLICATIONS: Access to primary care provided by an RGP affects patients' use of emergency health care services. To facilitate continuity of health care, policymakers should emphasize initiatives to improve access to primary health care services. KEY POINTS Access to immediate primary health care provided by a regular general practitioner (RGP) can reduce patients' use of emergency health care services. The main reason for attending a general emergency outpatient clinic was difficulty obtaining an immediate appointment with an RGP. A frequent reason for native Norwegians attending a general emergency outpatient clinic during the daytime is having an RGP outside Oslo. Lack of affiliation with the RGP scheme is a frequent reason for attending a general emergency outpatient clinic among immigrants.

Is it a matter of urgency? A survey of assessments by walk-in patients and doctors of the urgency level of their encounters at a general emergency outpatient clinic in Oslo, Norway.

BACKGROUND: Emergency room (ER) use is increasing in several countries. Variability in the proportion of non-urgent ER visits was found to range from 5 to 90 % (median 32 %). Non-urgent emergency visits are considered an inappropriate and inefficient use of the health-care system because they may lead to higher expenses, crowding, treatment delays, and loss of continuity of health care provided by a general practitioner. Urgency levels of doctor-walk-in patient encounters were assessed based on their region of origin in a diverse Norwegian population. METHODS: An anonymous, multilingual questionnaire was distributed to all walk-in patients at a general emergency outpatient clinic in Oslo during two weeks in September 2009. We analysed demographic data, patient-doctor assessments of the level of urgency, and the results of the consultation. We used descriptive statistics to obtain frequencies with 95 % confidence interval (CI) for assessed levels of urgency and outcomes. Concordance between the patients' and doctors' assessments was analysed using a Kendall tau-b test. We used binary logistic regression modelling to quantify associations of explanatory variables and outcomes according to urgency level assessments. RESULTS: The analysis included 1821 walk-in patients. Twenty-four per cent of the patients considered their emergency consultation to be non-urgent, while the doctors considered 64 % of encounters to be non-urgent. The concordance between the assessments by the patient and by their doctor was positive but low, with a Kendall tau-b coefficient of 0.202 (p < 0.001). Adjusted logistic regression analysis showed that patients from Eastern Europe (odds ratio (OR) = 3.04; 95 % CI 1.60-5.78), Asia and Turkey (OR = 4.08; 95 % CI 2.43-6.84), and Africa (OR = 8.47; 95 % CI 3.87-18.5) reported significantly higher urgency levels compared with Norwegians. The doctors reported no significant difference in assessment of urgency based on the patient's region of origin, except for Africans (OR = 0.64; 95 % CI 0.43-0.96). CONCLUSION: This study reveals discrepancies between assessments by walk-in patients and doctors of the urgency level of their encounters at a general emergency clinic. The patients' self-assessed perception of the urgency level was related to their region of origin.

Use of emergency care services by immigrants­a survey of walk-in patients who attended the Oslo Accident and Emergency Outpatient Clinic.

BACKGROUND: The Oslo Accident and Emergency Outpatient Clinic (OAEOC) experienced a 5-6% annual increase in patient visits between 2005 and 2011, which was significantly higher than the 2-3% annual increase among registered Oslo residents. This study explored immigrant walk-in patients' use of both the general emergency and trauma clinics of the OAEOC and their concomitant use of regular general practitioners (RGPs) in Oslo. METHODS: A cross-sectional survey of walk-in patients attending the OAEOC during 2 weeks in September 2009. We analysed demographic data, patients' self-reported affiliation with the RGP scheme, self-reported number of OAEOC and RGP consultations during the preceding 12 months. The first approach used Poisson regression models to study visit frequency. The second approach compared the proportions of first- and second-generation immigrants and those from the four most frequently represented countries (Sweden, Pakistan, Somalia and Poland) among the patient population, with their respective proportions within the general Oslo population. RESULTS: The analysis included 3864 patients: 1821 attended the Department of Emergency General Practice ("general emergency clinic"); 2043 attended the Section for Orthopaedic Emergency ("trauma clinic"). Both first- and second-generation immigrants reported a significantly higher OAEOC visit frequency compared with Norwegians. Norwegians, representing 73% of the city population accounted for 65% of OAEOC visits. In contrast, first- and second-generation immigrants made up 27% of the city population but accounted for 35% of OAEOC visits. This proportional increase in use was primarily observed in the general emergency clinic (42% of visits). Their proportional use of the trauma clinic (29%) was similar to their proportion in the city. Among first-generation immigrants only 71% were affiliated with the RGP system, in contrast to 96% of Norwegians. Similar finding were obtained when immigrants were grouped by nationality. Compared to Norwegians, immigrants from Sweden, Pakistan and Somalia reported using the OAEOC significantly more often. Immigrants from Sweden, Poland and Somalia were over-represented at both clinics. The least frequent RGP affiliation was among immigrants from Sweden (32%) and Poland (65%). CONCLUSIONS: In Norway, immigrant subgroups use emergency health care services in different ways. Understanding these patterns of health-seeking behaviour may be important when designing emergency health services.