Cargando…

Medical care of asylum seekers: a descriptive study of the appropriateness of nurse practitioners' care compared to traditional physician-based care in a gatekeeping system

BACKGROUND: Medical care for asylum seekers is a complex and critical issue worldwide. It is influenced by social, political, and economic pressures, as well as premigration conditions, the process of migration, and postmigration conditions in the host country. Increasing needs and healthcare costs...

Descripción completa

Detalles Bibliográficos
Autores principales: Bodenmann, Patrick, Althaus, Fabrice, Burnand, Bernard, Vaucher, Paul, Pécoud, Alain, Genton, Blaise
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2194697/
https://www.ncbi.nlm.nih.gov/pubmed/17974001
http://dx.doi.org/10.1186/1471-2458-7-310
_version_ 1782147676305883136
author Bodenmann, Patrick
Althaus, Fabrice
Burnand, Bernard
Vaucher, Paul
Pécoud, Alain
Genton, Blaise
author_facet Bodenmann, Patrick
Althaus, Fabrice
Burnand, Bernard
Vaucher, Paul
Pécoud, Alain
Genton, Blaise
author_sort Bodenmann, Patrick
collection PubMed
description BACKGROUND: Medical care for asylum seekers is a complex and critical issue worldwide. It is influenced by social, political, and economic pressures, as well as premigration conditions, the process of migration, and postmigration conditions in the host country. Increasing needs and healthcare costs have led public health authorities to put nurse practitioners in charge of the management of a gatekeeping system for asylum seekers. The quality of this system has never been evaluated. We assessed the competencies of nurses and physicians in identifying the medical needs of asylum seekers and providing them with appropriate treatment that reflects good clinical practice. METHODS: This cross-sectional descriptive study evaluated the appropriateness of care provided to asylum seekers by trained nurse practitioners in nursing healthcare centers and by physicians in private practices, an academic medical outpatient clinic, and the emergency unit of the university hospital in Lausanne, Switzerland. From 1687 asylum seeking patients who had consulted each setting between June and December 2003, 450 were randomly selected to participate. A panel of experts reviewed their medical records and assessed the appropriateness of medical care received according to three parameters: 1) use of appropriate procedures to identify medical needs (medical history, clinical examination, complementary investigations, and referral), 2) provision of access to treatment meeting medical needs, and 3) absence of unnecessary medical procedures. RESULTS: In the nurse practitioner group, the procedures used to identify medical needs were less often appropriate (79% of reports vs. 92.4% of reports; p < 0.001). Nevertheless, access to treatment was judged satisfactory and was similar (p = 0.264) between nurse practitioners and physicians (99% and 97.6% of patients, respectively, received adequate care). Excessive care was observed in only 2 physician reports (0.8%) and 3 nurse reports (1.5%) (p = 0.481). CONCLUSION: Although the nursing gatekeeping system provides appropriate treatment to asylum seekers, it might be improved with further training in recording medical history and performing targeted clinical examination.
format Text
id pubmed-2194697
institution National Center for Biotechnology Information
language English
publishDate 2007
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-21946972008-01-12 Medical care of asylum seekers: a descriptive study of the appropriateness of nurse practitioners' care compared to traditional physician-based care in a gatekeeping system Bodenmann, Patrick Althaus, Fabrice Burnand, Bernard Vaucher, Paul Pécoud, Alain Genton, Blaise BMC Public Health Research Article BACKGROUND: Medical care for asylum seekers is a complex and critical issue worldwide. It is influenced by social, political, and economic pressures, as well as premigration conditions, the process of migration, and postmigration conditions in the host country. Increasing needs and healthcare costs have led public health authorities to put nurse practitioners in charge of the management of a gatekeeping system for asylum seekers. The quality of this system has never been evaluated. We assessed the competencies of nurses and physicians in identifying the medical needs of asylum seekers and providing them with appropriate treatment that reflects good clinical practice. METHODS: This cross-sectional descriptive study evaluated the appropriateness of care provided to asylum seekers by trained nurse practitioners in nursing healthcare centers and by physicians in private practices, an academic medical outpatient clinic, and the emergency unit of the university hospital in Lausanne, Switzerland. From 1687 asylum seeking patients who had consulted each setting between June and December 2003, 450 were randomly selected to participate. A panel of experts reviewed their medical records and assessed the appropriateness of medical care received according to three parameters: 1) use of appropriate procedures to identify medical needs (medical history, clinical examination, complementary investigations, and referral), 2) provision of access to treatment meeting medical needs, and 3) absence of unnecessary medical procedures. RESULTS: In the nurse practitioner group, the procedures used to identify medical needs were less often appropriate (79% of reports vs. 92.4% of reports; p < 0.001). Nevertheless, access to treatment was judged satisfactory and was similar (p = 0.264) between nurse practitioners and physicians (99% and 97.6% of patients, respectively, received adequate care). Excessive care was observed in only 2 physician reports (0.8%) and 3 nurse reports (1.5%) (p = 0.481). CONCLUSION: Although the nursing gatekeeping system provides appropriate treatment to asylum seekers, it might be improved with further training in recording medical history and performing targeted clinical examination. BioMed Central 2007-10-31 /pmc/articles/PMC2194697/ /pubmed/17974001 http://dx.doi.org/10.1186/1471-2458-7-310 Text en Copyright © 2007 Bodenmann et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Bodenmann, Patrick
Althaus, Fabrice
Burnand, Bernard
Vaucher, Paul
Pécoud, Alain
Genton, Blaise
Medical care of asylum seekers: a descriptive study of the appropriateness of nurse practitioners' care compared to traditional physician-based care in a gatekeeping system
title Medical care of asylum seekers: a descriptive study of the appropriateness of nurse practitioners' care compared to traditional physician-based care in a gatekeeping system
title_full Medical care of asylum seekers: a descriptive study of the appropriateness of nurse practitioners' care compared to traditional physician-based care in a gatekeeping system
title_fullStr Medical care of asylum seekers: a descriptive study of the appropriateness of nurse practitioners' care compared to traditional physician-based care in a gatekeeping system
title_full_unstemmed Medical care of asylum seekers: a descriptive study of the appropriateness of nurse practitioners' care compared to traditional physician-based care in a gatekeeping system
title_short Medical care of asylum seekers: a descriptive study of the appropriateness of nurse practitioners' care compared to traditional physician-based care in a gatekeeping system
title_sort medical care of asylum seekers: a descriptive study of the appropriateness of nurse practitioners' care compared to traditional physician-based care in a gatekeeping system
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2194697/
https://www.ncbi.nlm.nih.gov/pubmed/17974001
http://dx.doi.org/10.1186/1471-2458-7-310
work_keys_str_mv AT bodenmannpatrick medicalcareofasylumseekersadescriptivestudyoftheappropriatenessofnursepractitionerscarecomparedtotraditionalphysicianbasedcareinagatekeepingsystem
AT althausfabrice medicalcareofasylumseekersadescriptivestudyoftheappropriatenessofnursepractitionerscarecomparedtotraditionalphysicianbasedcareinagatekeepingsystem
AT burnandbernard medicalcareofasylumseekersadescriptivestudyoftheappropriatenessofnursepractitionerscarecomparedtotraditionalphysicianbasedcareinagatekeepingsystem
AT vaucherpaul medicalcareofasylumseekersadescriptivestudyoftheappropriatenessofnursepractitionerscarecomparedtotraditionalphysicianbasedcareinagatekeepingsystem
AT pecoudalain medicalcareofasylumseekersadescriptivestudyoftheappropriatenessofnursepractitionerscarecomparedtotraditionalphysicianbasedcareinagatekeepingsystem
AT gentonblaise medicalcareofasylumseekersadescriptivestudyoftheappropriatenessofnursepractitionerscarecomparedtotraditionalphysicianbasedcareinagatekeepingsystem