Hospital‑based case management for migrant patients: a systematic review

Background:
Although inequality in access
to health care for migrant patients is well
described, less is known about inequalities
originating within the health
-
c
are system
regarding choice of diagnostic procedure,
diagnostic delay, treatment options, secondary
prevention and follow
-
u
p offered to patients
with a refugee or immigrant background.
Provision of specialized services for migrant
patients, including case management with
multidisciplinary physical, cognitive and social
interventions, has been suggested as a way to
tackle inequalities in response to a growing
recognition of the complexity of both their
health needs and the skills needed to meet
these. However, categorical care is generally
considered to be stigmatizing and to decrease
care quality. The evidence base for both
arguments is unclear. The aim of this review
was therefore to investigate the effectiveness
of specialized hospital
-
b
ased case
management for ethnic minority patients.
Methods:
This review used a health
technology assessment model, including
a systematic search of literature in the
PubMed, Embase, the Cochrane Library,
Sociological Abstracts, the Cumulative Index
to Nursing and Allied Health Literature
databases and grey literature.
Results:
Of the 5328 studies found in the
literature search, only one matched the
criteria for inclusion. It described a specialized
tuberculosis
-
f
ocused hospital
-
b
ased treatment
programme supported by a cross
-
d
isciplinary
team that increased treatment completion
among ethnic minority patients. Despite
using broad search criteria and searching
a wide range of migrant health
-
r
elated
information networks and databases, no other
hospital
-
b
ased migrant health clinics were
identified. The single relevant study indicated
that benefits of a specialized hospital
-
b
ased
migrant management programme might
include reducing inequality and improving
clinical outcomes. No studies supporting the
argument that specialized hospital care is
stigmatizing or reduces quality of care were
identified.
Conclusion:
The review highlights
a fundamental lack of evidence against
specialized care for ethnic minorities. In view
of the current refugee situation in Europe,
there is an urgent need to identify the best
interventions for reducing inequalities in
hospital care for ethnic minority patients.