Abstract
BackgroundSome studies, mainly coming from the U.S., indicate disparities in heart failure (HF) treatment according to migration/ethnicity. However, respective results are inconsistent and cannot be transferred to other health care systems. Thus, we will address the following research question: Are there differences in the diagnosis and management of HF between patients with and without a Turkish migration background in Germany?MethodsA factorial experimental design with video vignettes was applied. In the filmed simulated initial encounters, professional actors played patients, who consulted a primary care physician because of typical HF symptoms. While the dialog was identical in all videos, patients differed in terms of Turkish migration history (no/yes), sex (male/female), and age (55 years/75 years). After viewing the video, primary care physicians (N = 128) were asked standardized and open ended questions concerning their decisions on diagnosis and therapy.ResultsAnalyses revealed no statistically significant differences (p < 0.05), but a consistent tendency: Primary care doctors more often asked lifestyle and psychosocial questions, they more often diagnosed HF, they gave more advice to rest and how to behave in case of deterioration, they more often auscultated the lung, and more often referred to a specialist when the patient has a Turkish migration history compared to a non-migrant patient. Differences in the medical decisions between the two groups ranged between 1.6 and 15.8%. In 10 out of 12 comparisons, differences were below 10%.ConclusionsOur results indicate that are no significant inequalities in diagnosis and management of HF according to a Turkish migration background in Germany. Primary care physicians’ behaviour and medical decision making do not seem to be influenced by the migration background of the patients. Future studies are needed to verify this result and to address inequalities in HF therapy in an advanced disease stage.
Highlights
Some studies, mainly coming from the U.S, indicate disparities in heart failure (HF) treatment according to migration/ethnicity
About 81% of the physicians mention HF as possible diagnosis in case of a patient with a Turkish migration background, this rate is slightly lower in case of a German patient
While this is the first study analysing disparities in HF care according to ethnicity/migration in Germany, there are some studies coming from other countries, especially from the U.S
Summary
Mainly coming from the U.S, indicate disparities in heart failure (HF) treatment according to migration/ethnicity. While Bagchi et al [4] found racial and ethnic disparities in the receipt of pharmacological therapy, a study of Thomas et al [12] showed that the provision of guideline-based care was comparable for black, Hispanic, and white patients hospitalized with HF Most of these studies on disparities in HF care according to ethnicity/migration were conducted in the U.S. Less is known from Germany where the migration situation [14] as well as the health care system [15, 16] is different compared to the U.S. In Germany, about 25% of the population (about 21 million people) have a migration background, i.e. they immigrated themselves or are the offspring of immigrant parents [17]. They often face cultural and language barriers to health care [14]
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