Joaquim Soares

Good practice in health care for migrants: views and experiences of care professionals in 16 European countries

BackgroundHealth services across Europe provide health care for migrant patients every day. However, little systematic research has explored the views and experiences of health care professionals in different European countries. The aim of this study was to assess the difficulties professionals experience in their service when providing such care and what they consider constitutes good practice to overcome these problems or limit their negative impact on the quality of care.MethodsStructured interviews with open questions and case vignettes were conducted with health care professionals working in areas with high proportion of migrant populations in 16 countries. In each country, professionals in nine primary care practices, three accident and emergency hospital departments, and three community mental health services (total sample = 240) were interviewed about their views and experiences in providing care for migrant patients, i.e. from first generation immigrant populations. Answers were analysed using thematic content analysis.ResultsEight types of problems and seven components of good practice were identified representing all statements in the interviews. The eight problems were: language barriers, difficulties in arranging care for migrants without health care coverage, social deprivation and traumatic experiences, lack of familiarity with the health care system, cultural differences, different understandings of illness and treatment, negative attitudes among staff and patients, and lack of access to medical history. The components of good practice to overcome these problems or limit their impact were: organisational flexibility with sufficient time and resources, good interpreting services, working with families and social services, cultural awareness of staff, educational programmes and information material for migrants, positive and stable relationships with staff, and clear guidelines on the care entitlements of different migrant groups. Problems and good care components were similar across the three types of services.ConclusionsHealth care professionals in different services experience similar difficulties when providing care to migrants. They also have relatively consistent views on what constitutes good practice. The degree to which these components already are part of routine practice varies. Implementing good practice requires sufficient resources and organisational flexibility, positive attitudes, training for staff and the provision of information.

Social Support, Socio-Economic Status, Health and Abuse among Older People in Seven European Countries

Background Social support has a strong impact on individuals, not least on older individuals with health problems. A lack of support network and poor family or social relations may be crucial in later life, and represent risk factors for elder abuse. This study focused on the associations between social support, demographics/socio-economics, health variables and elder mistreatment. Methods The cross-sectional data was collected by means of interviews or interviews/self-response during January-July 2009, among a sample of 4,467 not demented individuals aged 60–84 years living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, and Sweden). Results Multivariate analyses showed that women and persons living in large households and with a spouse/partner or other persons were more likely to experience high levels of social support. Moreover, frequent use of health care services and low scores on depression or discomfort due to physical complaints were indicators of high social support. Low levels of social support were related to older age and abuse, particularly psychological abuse. Conclusions High levels of social support may represent a protective factor in reducing both the vulnerability of older people and risk of elder mistreatment. On the basis of these results, policy makers, clinicians and researchers could act by developing intervention programmes that facilitate friendships and social activities in old age.

Health care for irregular migrants: pragmatism across Europe. A qualitative study

BackgroundHealth services in Europe face the challenge of delivering care to a heterogeneous group of irregular migrants (IM). There is little empirical evidence on how health professionals cope with this challenge. This study explores the experiences of health professionals providing care to IM in three types of health care service across 16 European countries.ResultsSemi-structured interviews were conducted with health professionals in 144 primary care services, 48 mental health services, and 48 Accident & Emergency departments (total n = 240). Although legal health care entitlement for IM varies across countries, health professionals reported facing similar issues when caring for IM. These issues include access problems, limited communication, and associated legal complications. Differences in the experiences with IM across the three types of services were also explored. Respondents from Accident & Emergency departments reported less of a difference between the care for IM patients and patients in a regular situation than did respondents from primary care and mental health services. Primary care services and mental health services were more concerned with language barriers than Accident & Emergency departments. Notifying the authorities was an uncommon practice, even in countries where health professionals are required to do this.ConclusionsThe needs of IM patients and the values of the staff appear to be as important as the national legal framework, with staff in different European countries adopting a similar pragmatic approach to delivering health care to IM. While legislation might help to improve health care for IM, more appropriate organisation and local flexibility are equally important, especially for improving access and care pathways.

Differences in reporting somatic complaints in elderly by education level

AimTo evaluate the association between somatic complaints and education level among elders in selected European countries.MethodsCross-sectional study among randomly selected community dwelling persons aged 60–84 years from seven cities in Europe: Ancona (Italy), Athens (Greece), Granada (Spain), Kaunas (Lithuania), Stuttgart (Germany), Porto (Portugal) and Stockholm (Sweden). Somatic complaints were measured with the 24-item version of the Giessen Complaint List (GBB-24). A regression analysis was done to investigate the association between education and somatic complaints. Results. The mean GBB-24 scale was 16.3±14.9. The most common complaints were pain in joints and limbs (29.6%), back-pain (24.1%), heaviness or tiredness in the legs (19.1%) and general tiredness (15.7%). Respondents with less than primary education reported higher levels of somatic symptoms compared to those with university degree. A regression analysis showed that higher education (OR=0.69) and being male (OR=0.48) were associated with a decreased risk for high levels of somatic complaints, and the opposite for older age (OR=1.03) and being single/divorced/window (OR=1.28).ConclusionsThe results indicate that less educated elders are more likely to expressed somatic complaints.

Somatic complaints and refrain from buying prescribed medications. Results from a cross-sectional study on people 60 years and older living in Kaunas (Lithuania)

BackgroundThe use of medicines by elderly people is a growing area of concern in social pharmacy. A significant proportion of older people do not follow the recommendations from physicians and refrain from buying prescribed medications. The aim of this study is to evaluate associations between self-rated health, somatic complaints and refraining from buying prescribed medications by elderly people.FindingsData was collected in a cross-sectional study in 2009. We received 624 completed questionnaires (response rate – 48.9%) from persons aged 60–84 years living in Kaunas (Lithuania). Somatic complaints were measured with the 24 item version of the Giessen Complaint List (GBB-24). Logistic regression (Enter model) was used for evaluation of the associations between refraining from buying medications and somatic complaints. These associations were measured using odds ratio (OR) and calculating the 95% confidence interval (CI).The mean scores in total for the GBB scale and sub-scales (exhaustion, gastrointestinal and cardiovascular) were lowest among respondents who did not refrain from buying prescribed medications (means for GBB-24 scale: 21.04 vs. 24.82; p=0.001). Logistic regression suggests that somatic complaints were associated with a increased risk of refraining from buying prescribed medications (OR=1.35, 95% CI=1.15-1.60).ConclusionsSomatic complaints were significantly associated with the decision to refrain from buying prescribed medications.

Factors associated with quality of services for marginalized groups with mental health problems in 14 European countries

BackgroundDifferent service characteristics are known to influence mental health care delivery. Much less is known about the impact of contextual factors, such as the socioeconomic circumstances, on the provision of care to socially marginalized groups.The objectives of this work were to assess the organisational characteristics of services providing mental health care for marginalized groups in 14 European capital cities and to explore the associations between organisational quality, service features and country-level characteristics.Methods617 services were assessed in two highly deprived areas in 14 European capital cities. A Quality Index of Service Organisation (QISO) was developed and applied across all sites. Service characteristics and country level socioeconomic indicators were tested and related with the Index using linear regressions and random intercept linear models.ResultsThe mean (standard deviation) of the QISO score (minimum = 0; maximum = 15) varied from 8.63 (2.23) in Ireland to 12.40 (2.07) in Hungary. The number of different programmes provided was the only service characteristic significantly correlated with the QISO (p < 0.05). The national Gross Domestic Product (GDP) was inversely associated with the QISO. Nearly 15% of the variance of the QISO was attributed to country-level variables, with GDP explaining 12% of this variance.ConclusionsSocioeconomic contextual factors, in particular the national GDP are likely to influence the organisational quality of services providing mental health care for marginalized groups. Such factors should be considered in international comparative studies. Their significance for different types of services should be explored in further research.

Quality of Life among Persons Aged 60-84 Years in Europe: The Role of Psychological Abuse and Socio-Demographic, Social and Health Factors

Background: Elder abuse and its effects are a serious public health issue. However, little is known about the relation between psychological abuse, other factors (e.g. social support) and quality of life (QoL) by domain. This study addressed differences in QoL by domain between psychologically abused and non-abused. While considering other factors such as social support. Methods: The respondents were 4,467 (2,559 women) randomly selected persons aged 60-84 years living in 7 European cities. The mean response across countries was 45.2%. The cross-sectional data were analyzed with bivariate/multivariate methods. Results: Abused respondents contrasted to non-abused scored lower in QoL (autonomy, 67.42 ± 21.26 vs. 72.39 ± 19.58; intimacy, 55.31 ± 31.15 vs. 67.21 ± 28.55; past/present/future activities, 62.79 ± 19.62 vs. 68.05 ± 18.09; social participation, 65.03 ± 19.84 vs. 68.21 ± 19.77). Regressions showed that abuse was negatively associated with autonomy, intimacy and past/present/future activities, and positively with the social participation. All QoL dimensions were negatively associated with country and depressive/anxiety symptoms, and positively with social support. Further, variables such as age, sex and somatic symptoms were negatively associated with some of the QoL dimensions and others such as family structure, education, health care use and drinking positively. The regression model “explained” 32.8% of the variation in autonomy, 45.6% in intimacy, 44.8% in past/present/future activities and 41.5% in social participation. Conclusions: Abuse was linked to lower QoL in most domains, but other factors such as depressive symptoms also carried a negative impact. Social support and to some extent family structure had a “protective” effect on QoL. Abuse, health indicators (e.g. depressive symptoms) and social support should be considered in addressing the QoL of older persons. However, QoL was influenced by many factors, which could not be firmly disentangled due to the crosssectional approach, calling for longitudinal research to address causality.

Use of medications amongst older persons in Kaunas, Lithuania

AimTo evaluate the associations between socio-economical factors and the use of medications in the elderly.MethodsThe data was collected in a cross-sectional study in 2009. We received 624 completed questionnaires (response rate — 48.9%) from elderly people aged 60–84 years living in Kaunas (Lithuania). For an evaluation of the impact of explanatory variables on the analyzed events (binary dependent variable), an Enter model of logistic regression was used.ResultsOur findings suggest that 50.8% (n=317) of respondents used at least one drug daily. 18.3% (n=114) of respondents indicated that they use medications regularly, but not on a day-by-day basis. One quarter (25.6%; n=160) used medication only on an “at need” basis. Only 5.3% (n=33) of older persons did not use any medications at all. Logistic regression showed that being male (OR=0.67; 95%CI:0.45–0.98) was associated with using medications “regularly + daily.” For the use of “daily” medications, older age (OR=1.33; 95%CI:1.15–1.53) was associated with using medications daily. An opposite association was observed for respondents having no paid work (OR=0.48; 95%CI:0.26–0.82).ConclusionsOur study suggests that more than half of older persons in Lithuania use medications every day. Use was associated with socioeconomic factors (gender, age, and employment status).

Violence and Abuse and older men's mental health in seven urban centers in Europe

Background Violence, abuse and neglect of older persons (VAO) is an increasing public health problem. Despite growing evidence of the increasing size of the problem, data on prevalence of past 12 month VAO (PVAO) are still scarce in Europe, and conceptual and methodological differences limit the extent to which comparisons can be made between national studies. We aimed to 1) estimate the scope …