Health professionals’ lack of familiarity with the medical conditions that may affect migrants before they reach our shores can be an obstacle to the detection of certain diseases and conditions in these populations. To improve access to more targeted and quality care in primary health care settings, researchers from the Barcelona Institute for Global Health (ISGlobal)—a centre supported by the ”la Caixa” Banking Foundation—and the University Institute for Primary Care Research Jordi Gol (IDIAPJGol), in collaboration with professionals from the Clínic Foundation (FCRB), have developed a computerised tool to help health professionals make decisions about screening immigrants in Catalonia. The tool, which was developed with the support of a PERIS research grant, is currently being piloted in four primary health care centres in Catalonia to determine whether it improves patient care by making doctors more aware of the need to take global health issues into account in the care of these patients.
The tool alerts the family doctor by way of a note in the patient’s computerised medical record when a series of variables—country of origin, age and sex—indicate that particular tests and/or procedures should be carried out. The aim of the system is to provide the most personalised care possible for each patient.
“We are concerned that some migrants are not receiving appropriate care and screening when they come to primary care facilities,” commented Ethel Sequeira, the project’s principal investigator. “The purpose of this tool is to provide health professionals with the best possible information in a timely manner, to maximise the impact of care for the migrants and for the host society.”
The alerts warn doctors of possible infectious diseases—including hepatitis B and C, active tuberculosis, HIV infection, Chagas disease, schistosomiasis and strongyloidiasis—as well as the risk of mental health problems and female genital mutilation. These conditions were selected because they satisfy three criteria: 1) cost-effective diagnostic methods are available; 2) the diseases are chronic; and 3) given the potential severity of the conditions, treatment not only benefits the patients but also the public health system.
To develop the tool, the authors searched the literature for recommendations on diseases that affect migrant populations and compiled their findings on screening for these conditions in consultation with a variety of health professionals from hospitals and other facilities in Catalonia. The resulting consensus document was then distributed to health personnel at the eight primary care centres taking part in the pilot programme. This information was complemented by training sessions on imported diseases, mental health and female genital mutilation at all eight centres.
The aim of the pilot programme is to compare the results of the intervention in the eight centres, which were chosen because they serve catchment areas with similar demographic profiles and health care access and have medical teams with similar characteristics. At four of the centres, health personnel received only the screening recommendations document and specific training on health care for migrants; at the other four centres, the recommendations and training were complemented by the implementation of the computerised alert system. At the end of the pilot programme, the authors will compare the results obtained in the centres equipped with the computerised alert system with those obtained in the four centres where the intervention was limited to training and the distribution of the recommendations document.