Detecting and describing heterogeneity in health care cost trajectories among asylum seekers.

BACKGROUND: The mechanism underlying the health care cost trajectories among asylum seekers is not well understood. In the canton of Vaud in Switzerland, a nurse-led health care and medical Network for Migrant Health ("Réseau santé et migration" RESAMI) has established a health care model focusing on the first year after arrival of asylum seekers, called the "community health phase". This model aims to provide tailored care and facilitate integration into the Swiss health care system. The aim of this study is to explore different health care cost trajectories among asylum seekers during this phase and identify the associated factors. METHODS: We detected different patterns of health care cost trajectories using time-series clustering of longitudinal data of asylum seekers in the canton of Vaud in Switzerland. These data included all adult asylum seekers and recipients of emergency aid who entered the canton between 2012 and 2015 and were followed until 2018. The different clusters of health care cost trajectories were then described using a multinomial logistic regression model. RESULTS: We identified a concave, an upward trending, and a downward trending cluster of health care cost trajectories with different characteristics being associated with each cluster. The likelihood of being in the concave cluster is positively associated with coming from the Eastern Mediterranean region or Africa rather than Europe and with a higher share of consultations with an interpreter. The likelihood of being in the upward trending cluster, which accrued the highest costs, is positively associated with 20-24-year-olds rather than older individuals, coming from Europe than any other region and having a mental disorder. In contrast to the other two clusters, the likelihood of being in the downward trending cluster is positively associated with having contacted the RESAMI network within the first month after arrival, which might indicate the potential of early intervention. It is also positively associated with older age and living in a group lodge. CONCLUSIONS: Asylum seekers are heterogeneous in terms of health care cost trajectories. Exploring these differences can help point to possible ways to improve the care and supporting services provided to asylum seekers. Our findings could indicate that early and patient-centered interventions might be well-suited to this aim.

Medical Facilities for Refugees in Europe: Creating a Consultation for Resettled Syrian Families.

The wave of migration that has hit Europe in recent years has led to several changes in the organization of asylum systems and medical care provided to migrants. Previous studies indicate that asylum seekers and refugees face multiple barriers in accessing health care. For that reason, adapted structures are needed. In this context, a family consultation service was implemented in our medical center in Lausanne, Switzerland. It aimed at addressing the unique health care needs of recently resettled families from Syria, which has been the leading source country for refugees since 2014. This intervention, developed through collaboration between the University Center for Primary Care and Public Health (Unisanté) and the Children's Hospital of Lausanne (HEL) involved a multidisciplinary team comprising a pediatrician, a general practitioner and a pediatric nurse. Bringing together a multidisciplinary team optimized care coordination, facilitated communication between care providers and enabled a more global vision of the family system with the aim of enhancing quality of care.

[Left behind populations, COVID-19 and risks of health inequities†: a guide of the local social-health network (Vaud, Switzerland)]. / Populations précarisées, COVID-19 et risques d'iniquités en santé†: guide du réseau socio-sanitaire vaudois.

Since the emergence of the COVID-19 pandemic, the Confederation has referred to «â€…vulnerable populations ¼ over the age of 65 and/or with co-morbidities as potentially at risk. This group should not overshadow other highly vulnerable populations such as forced migrants, people deprived of their liberty, and the homeless. In the context of the current pandemic, there is a risk of increasing inequities in care among these populations. In this practical article, we list the marginalized and disadvantaged left behind populations in the canton of Vaud and the issues of inequities in care in the context of the pandemic; we also present the implementation of procedures sometimes original, always inter-professional and interdisciplinary, specifying who the partners are and what the resources are for front-line caregivers.

Depuis l'apparition de la pandémie du COVID-19, la Confédération évoque comme potentiellement à risque les «â€…populations vulnérables ¼ de plus de 65 ans et/ou présentant des comorbidités. Ce groupe ne doit pas «â€…éclipser ¼ d'autres populations en situation de grande vulnérabilité telles que les personnes issues de la migration forcée, celles privées de liberté, ainsi que les sans domicile fixe. Dans cet article qui se veut pratique, nous énumérons différentes populations marginalisées du canton de Vaud et les enjeux d'iniquités dans les soins dans le cadre de la pandémie ; nous présentons également l'implémentation de procédures, parfois originales, toujours interprofessionnelles et interdisciplinaires, en précisant qui sont les partenaires et quelles sont les ressources pour les soignants de première ligne.