title: Impact on and use of health services by international migrants: questionnaire survey of inner city London A&E attenders.
abstract: BACKGROUND
  Changing immigration trends pose new challenges for the UK's open access health service and there is considerable speculation that migrants from resource-poor countries place a disproportionate burden on services. Data are needed to inform provision of services to migrant groups and to ensure their access to appropriate health care. We compared sociodemographic characteristics and impact of migrant groups and UK-born patients presenting to a hospital A&E/Walk-In Centre and prior use of community-based General Practitioner (GP) services.
  
  
  METHODS
  We administered an anonymous questionnaire survey of all presenting patients at an A&E/Walk-In Centre at an inner-city London hospital during a 1 month period. Questions related to nationality, immigration status, time in the UK, registration and use of GP services. We compared differences between groups using two-way tables by Chi-Square and Fisher's exact test. We used logistic regression modelling to quantify associations of explanatory variables and outcomes.
  
  
  RESULTS
  1611 of 3262 patients completed the survey (response rate 49.4%). 720 (44.7%) were overseas born, representing 87 nationalities, of whom 532 (73.9%) were new migrants to the UK (< or =10 years). Overseas born were over-represented in comparison to local estimates (44.7% vs 33.6%; p < 0.001; proportional difference 0.111 [95% CI 0.087-0.136]). Dominant immigration status' were: work permit (24.4%), EU citizens (21.5%), with only 21 (1.3%) political asylum seekers/refugees. 178 (11%) reported nationalities from refugee-generating countries (RGCs), eg, Somalia, who were less likely to speak English. Compared with RGCs, and after adjusting for age and sex, the Australians, New Zealanders, and South Africans (ANS group; OR 0.28 [95% CI 0.11 to 0.71]; p = 0.008) and the Other Migrant (OM) group comprising mainly Europeans (0.13 [0.06 to 0.30]; p = 0.000) were less likely to have GP registration and to have made prior contact with GPs, yet this did not affect mode of access to hospital services across groups nor delay access to care.
  
  
  CONCLUSIONS
  Recently arrived migrants are a diverse and substantial group, of whom migrants from refugee-generating countries and asylum seekers comprise only a minority group. Service reorganisation to ensure improved access to community-based GPs and delivery of more appropriate care may lessen their impact on acute services.
authors.affiliation: International Health Unit, Department of Infectious Diseases and Immunity, Faculty of Medicine, Imperial College, Hammersmith Hospital Campus, London, W12 ONN, UK. s.hargreaves@imperial.ac.uk <s.hargreaves@imperial.ac.uk>
authors.forename: Sally
authors.initials: S
authors.lastname: Hargreaves
authors.forename: Jon S
authors.initials: JS
authors.lastname: Friedland
authors.forename: Philip
authors.initials: P
authors.lastname: Gothard
authors.forename: Sonia
authors.initials: S
authors.lastname: Saxena
authors.forename: Hugh
authors.initials: H
authors.lastname: Millington
authors.forename: Joseph
authors.initials: J
authors.lastname: Eliahoo
authors.forename: Peter
authors.initials: P
authors.lastname: Le Feuvre
authors.forename: Alison
authors.initials: A
authors.lastname: Holmes
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D004641:Emigration and Immigration / Q000706:statistics & numerical data* / Q000639:trends; D005194:Family Practice; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006773:Hospitals, Municipal / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000706:statistics & numerical data; D011320:Primary Health Care; D012036:Refugees / Q000706:statistics & numerical data; D012923:Social Class; D011795:Surveys and Questionnaires; D014171:Transients and Migrants / Q000706:statistics & numerical data; D014504:Urban Health / Q000706:statistics & numerical data*