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
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
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DOI：
10.1186/1471-2458-7-310
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发表时间：
2007-10-31
影响因子：
4.5
通讯作者：
Genton, Blaise
中科院分区：
文献类型：
--
作者：
Bodenmann, Patrick;Althaus, Fabrice;Genton, Blaise
背景：寻求庇护者的医疗保健是一个复杂而关键的问题。它受到社会、政治和经济压力的影响，也受到东道国的移民前条件、移民过程和移民后条件的影响。日益增长的需求和医疗保健费用导致公共卫生当局让执业护士负责管理寻求庇护者的守门系统。该系统的质量从未得到评估。我们评估了护士和医生在确定寻求庇护者的医疗需求并为他们提供反映良好临床实践的适当治疗方面的能力。方法：这项横断面描述性研究评估了护理保健中心训练有素的执业护士和私人诊所的医生向寻求庇护者提供护理的适当性，以及瑞士洛桑大学医院的急诊室。从2003年6月至12月期间咨询过每个设置的1687名寻求庇护的患者中，随机选择了450名患者参加。一个专家小组审查了他们的医疗记录，并根据三个参数评估了所接受的医疗护理的适当性：1）使用适当的程序来确定医疗需求（病史、临床检查、补充检查和转诊）; 2）提供满足医疗需求的治疗; 3）没有不必要的医疗程序。在执业护士组中，用于确定医疗需求的程序通常不太合适（79%的报告对92.4%的报告; p < 0.001）。然而，获得治疗的机会被认为是令人满意的，并且在执业护士和医生之间相似（p = 0.264）（分别有99%和97.6%的患者接受了充分的护理）。过度照顾，观察到只有2个医生的报告（0.8%）和3个护士的报告（1.5%）（p = 0.481）。结论：虽然护理守门系统提供适当的治疗，寻求庇护者，它可能会得到改善，进一步培训，记录病史，并进行有针对性的临床检查。
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.