ABSTRACT
Background: Migrants in host countries are at risk for the development of mental health conditions. The two aims of the study were to describe routine diagnoses of mental disorders among migrant patients at primary healthcare level and the associated risk factors, and to test the utility of an innovative migrant mental health assessment by evaluating whether the health professionals followed the recommendations proposed by the clinical decision support system (CDSS) tool. Methods: A cross-sectional study was carried out in eight primary care centres (PCCs) in four non-randomly selected health regions of Catalonia, Spain from March to December 2018. Routine health data and mental health diagnoses based on the International Classification of Diseases (10th edition), including mental, behavioural and neuro developmental disorders (F01-F99), symptoms and signs involving emotional state (R45), and sleep disorders (G47), were extracted from the electronic health records. The proportion of mental health conditions was estimated and logistic regression models were used to assess any possible association with mental health disorders. The utility of the mental health assessment was assessed with the proportion of questionnaires performed by health professionals for migrants fulfilling the mental health screening criterion (country of origin with an active conflict in 2017) and the diagnoses given to the screened patients. Results: Of 14,130 migrants that visited any of the PCCs during the study period, 7,358 (52.1 %) were women with a median age of 38.0 years-old. There were 520/14,130 (3.7 %) migrant patients diagnosed with a mental disorder, being more frequent among women (342/7,358; 4.7 %, p-value < 0.001), migrants from Latin-America (177/3,483; 5.1 %, p < 0.001) and those who recently arrived in Spain (170/3,672; 4.6 %, p < 0.001). A lower proportion of mental disorders were reported in migrants coming from conflicted countries in 2017 (116/3,669, 3.2 %, p = 0.053).Out of the 547 mental health diagnoses reported in 520 patients, 69/14,130 (0.5 %) were mood disorders, 346/14,130 (2.5 %) anxiety disorders and 127/14,130 (0.9 %) sleeping disorders. Mood disorders were more common in migrants from Eastern Europe (25/2,971; 0.8 %, p < 0.001) and anxiety disorders in migrants from Latin-America (126/3,483; 3.6 %, p < 0.001), while both type of disorders were more often reported in women (p < 0.001).In the adjusted model, women (aOR: 1.5, [95 % CI 1.2-1.8, p < 0.001]), migrants with more than one visit to the health center during the study period (aOR: 4.4, [95 %CI 2.8-6.8, p < 0.001]) and who presented an infectious disease (aOR: 2.1, [95 %CI 1.5-3.1, p < 0.001]) had higher odds of having a mental disorder.Lastly, out of the 1,840 migrants coming from a conflicted country in 2017 who were attended in centres where the CDSS tool was implemented, 29 (1.6 %) had a mental health assessment performed and the tool correctly identified one individual. Conclusions: Mental health is a condition that may be overlooked in migrants at primary healthcare. Interventions at this level of care must be reinforced and adapted to the needs and circumstances of migrants to ensure equity in health services.
ABSTRACT
BACKGROUND: There are major shortfalls in the identification and screening of at-risk migrant groups. This study aims to evaluate the effectiveness of a new digital tool (IS-MiHealth) integrated into the electronic patient record system of primary care centres in detecting prevalent migrant infections. IS-MiHealth provides targeted recommendations to health professionals for screening multiple infections, including human immunodeficiency virus (HIV), hepatitis B and C, active tuberculosis (TB), Chagas disease, strongyloidiasis and schistosomiasis, based on patient characteristics (including variables of country of origin, age and sex). METHODS: A pragmatic pilot cluster-randomized-controlled trial was deployed from March to December 2018. Eight primary care centres in Catalonia, Spain, were randomly allocated 1:1 to use of the digital tool for screening, or to routine care. The primary outcome was the monthly diagnostic yield of all aggregated infections. Intervention and control sites were compared before and after implementation with respect to their monthly diagnostic yield using regression models. This study is registered on international standard randomised controlled trial number (ISRCTN) (ISRCTN14795012). RESULTS: A total of 15 780 migrants registered across the eight centres had at least one visit during the intervention period (March-December 2018), of which 14 598 (92.51%) fulfilled the criteria to be screened for at least one infection. There were 210 (2.57%) individuals from the intervention group with new diagnoses compared with 113 (1.49%) from the control group [odds ratio: 2.08, 95% confidence interval (CI) 1.63-2.64, P < 0.001]. The intervention centres raised their overall monthly diagnosis rate to 5.80 (95% CI 1.23-10.38, P = 0.013) extra diagnoses compared with the control centres. This monthly increase in diagnosis in intervention centres was also observed if we consider all cases together of HIV, hepatitis B and C, and active TB cases [2.72 (95% CI 0.43-5.00); P = 0.02] and was observed as well for the parasitic infections' group (Chagas disease, strongyloidiasis and schistosomiasis) 2.58 (95% CI 1.60-3.57; P < 0.001). CONCLUSIONS: The IS-MiHealth increased screening rate and diagnostic yield for key infections in migrants in a population-based primary care setting. Further testing and development of this new tool is warranted in larger trials and in other countries.
Subject(s)
Chagas Disease , HIV Infections , Hepatitis B , Strongyloidiasis , Transients and Migrants , Tuberculosis , Humans , HIV Infections/diagnosis , HIV Infections/epidemiology , Primary Health Care/methods , Chagas Disease/diagnosis , Chagas Disease/epidemiologyABSTRACT
OBJECTIVES: To evaluate the degree of control of blood pressure (BP) in the autochthonous and immigrant populations and to find the variables linked to good control. DESIGN: Cross-sectional, observational study. SETTING: Urban primary care team, Spain. PARTICIPANTS: All patients with hypertension seen between 1/1/2000 and 1/7/2005 and whose origin was known: 1.063 patients in all, 931 autochthonous and 132 immigrant ones. MAIN MEASUREMENTS: The main variable was hypertension control the last time BP was taken (BP
Subject(s)
Emigrants and Immigrants , Hypertension/therapy , Aged , Cross-Sectional Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , SpainABSTRACT
Objetivo. Evaluar el grado de control de la presión arterial (PA) en la población autóctona y la inmigrante y determinar las variables asociadas a un buen control. Diseño. Estudio observacional, transversal. Emplazamiento. Equipo urbano de atención primaria. Participantes. Todos los pacientes con hipertensión arterial (HTA), atendidos entre el 1 de enero de 2000 y el 1 de julio de 2005, de los que se conocía el origen: en total 1.063 pacientes, 931 autóctonos y 132 inmigrantes. Mediciones principales. La variable principal fue el control de la HTA según la última toma de PA (PA ≤ 140/90 y ≤ 130/80 en diabéticos). Además, se recogió: país de origen, edad, sexo, índice de masa corporal, factores de riesgo cardiovascular (diabetes, dislipemia, tabaquismo), exploraciones complementarias (analítica anual y electrocardiograma bienal) y fármacos prescritos. Se realizó una regresión logística para estimar el efecto del origen en el control de la PA. Resultados. Se consiguió un buen control en un 39,2% de los autóctonos y en un 25% de los inmigrantes (odds ratio [OR] = 1,6; intervalo de confianza [IC] del 95%, 1,2-2,1). No obstante, el análisis multivariable señala la edad (OR = 1,029; IC del 95%, 1,017-1,040) como único factor asociado al buen control de la PA. Conclusiones. El origen del paciente no influye en el control de la PA
Objectives. To evaluate the degree of control of blood pressure (BP) in the autochthonous and immigrant populations and to find the variables linked to good control. Design. Cross-sectional, observational study. Setting. Urban primary care team, Spain. Participants. All patients with hypertension seen between 1/1/2000 and 1/7/2005 and whose origin was known: 1.063 patients in all, 931 autochthonous and 132 immigrant ones. Main measurements. The main variable was hypertension control the last time BP was taken (BP ≤140/90 mm Hg and ≤130/80 mm Hg in diabetics). In addition, data on country of origin, age, gender, body mass index, cardiovascular risk factors (diabetes, lipaemia, tobacco dependency), further examinations (annual blood analysis and ECG every 2 years) and prescribed medication were recorded. Logistic regression was used to calculate the effect of origin on blood pressure monitoring. Results. Good BP control was achieved in 39.2% of autochthonous patients and 25% of immigrants (odds ratio [OR], 1.6; 95% confidence interval [CI], 95% CI, 1.2-2.1). Nevertheless, multivariate analysis indicated age (OR, 1.029; 95% CI, 1.017-1.040) as the sole factor determining good or bad BP control. Conclusions. The origin of the patient does not affect BP control
