Utilization of somatic specialist services among psychiatric immigrant patients: the Norwegian patient registry study

Dawit Shawel Abebe,Jon Ivar Elstad,Lars Lien

doi:10.1186/s12913-018-3672-y

Dawit Shawel Abebe, Jon Ivar Elstad + Show 1 more

Open Access

https://doi.org/10.1186/s12913-018-3672-y

Copy DOI

Abstract

BackgroundAmongst psychiatric patients, the leading causes of reduced quality of life and premature death are chronic viral infections and cardiovascular diseases. In spite of this, there are extremely high levels of disparity in somatic healthcare amongst such populations. Little research has explored patterns of healthcare utilisation and, therefore, this study aims to examine the use of somatic specialist healthcare for infectious diseases and diseases of circulatory system among psychiatric patients from different immigrant groups and ethnic Norwegians.MethodsRegister data from the Norwegian Patient Registry and Statistics Norway were used. The sample (ages 0–90+) consisted of 276,890 native-born Norwegians and 52,473 immigrants from five world regions – Western countries, East Europe, Africa, Asia, and Latin America, all of whom had contacts with specialist mental healthcare during the period 2008–2011. Statistical analyses were applied using logistic regression models.ResultsRates of outpatient consultation for circulatory system diseases were significantly lower amongst patients from Africa, Asia and Latin America compared with ethnic Norwegian psychiatric patients. Only patients from Eastern Europeans had a higher rate. With regard to hospital admission, all psychiatric patients had a lower rate than ethnic Norwegians with the exception of those from Africa where the finding was non-significant. In terms of infectious diseases, patients from African countries had significantly higher outpatient and admission rates than ethnic Norwegians. Outpatient consultation rates were lower amongst those from Western and Latin America and hospital admission rates were lower amongst those from Eastern Europe and Asia.ConclusionsThe findings suggest that the majority of immigrant psychiatric patients have lower hospitalization rates for circulatory system diseases than Norwegian psychiatric patients. This may suggest that poor access for immigrants is a contributing factor, though the findings were less pronounced for infectious diseases.

Highlights

Amongst psychiatric patients, the leading causes of reduced quality of life and premature death are chronic viral infections and cardiovascular diseases
Utilization of specialist somatic healthcare services across world regions of origin Table 2 presents utilization rates among Norwegians and immigrants from the five world regions of origin, i.e., the proportions who made contact at least once during 2008–2011. It indicates that Norwegians and Eastern European psychiatric patients had a higher proportion of outpatient visits for circulatory system diseases, while immigrants with African origins had a higher proportion of hospital admission for circulatory system diseases
We suggest that underutilization is likely among non-Western immigrants, in the sense that comorbidities between mental disorders and circulatory system diseases that would normally trigger specialist healthcare for Norwegians, do not lead to specialist healthcare for many non-Western immigrants

Summary

Introduction

The leading causes of reduced quality of life and premature death are chronic viral infections and cardiovascular diseases. Abebe et al BMC Health Services Research (2018) 18:852 among refugees with post-traumatic stress syndrome and depression [14, 15] Despite such a high burden of somatic comorbidities, rates of undiagnosed and untreated somatic illness are greater in mental disorder patients than in the general population [16]. Mental disorder patients are subject to unacceptably high levels of disparity in healthcare access and utilization, which contribute to poor somatic health outcomes [16]. Such disparities could be much worse among immigrant patients where underutilization of healthcare services is highly prevalent compared with non-immigrant patients [17, 18]. This study aims to examine the use of specialist somatic healthcare services among psychiatric patients with and without immigrant backgrounds

Objectives

Methods

Results

Discussion

Conclusion