title: The lower quality of preventive care among forced migrants in a country with universal healthcare coverage.
abstract: OBJECTIVE
  To assess the association between socio-demographic factors and the quality of preventive care and chronic care of cardiovascular (CV) risk factors in a country with universal health care coverage.
  
  
  METHODS
  Our retrospective cohort assessed a random sample of 966 patients aged 50-80years followed over 2years (2005-2006) in 4 Swiss university primary care settings (Basel/Geneva/Lausanne/Zürich). We used RAND's Quality Assessment Tools indicators and examined recommended preventive care among different socio-demographic subgroups.
  
  
  RESULTS
  Overall patients received 69.6% of recommended preventive care. Preventive care indicators were more likely to be met among men (72.8% vs. 65.4%; p<0.001), younger patients (from 71.0% at 50-59years to 66.7% at 70-80years, p for trend=0.03) and Swiss patients (71.1% vs. 62.7% in forced migrants; p=0.001). This latter difference remained in multivariate analysis adjusted for gender, age, civil status and occupation (OR 0.68; 95% CI 0.54-0.86). Forced migrants had lower scores for physical examination and breast and colon cancer screening (all p≤0.02). No major differences were seen for chronic care of CV risk factors.
  
  
  CONCLUSIONS
  Despite universal healthcare coverage, forced migrants receive less preventive care than Swiss patients in university primary care settings. Greater attention should be paid to forced migrants for preventive care.
authors.affiliation: Department for Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
authors.forename: Yonas
authors.initials: Y
authors.lastname: Martin
authors.affiliation: Department for Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland; Service of Endocrinology, Diabetes, and Metabolism, Lausanne University Hospital, Switzerland.
authors.forename: Tinh-Hai
authors.initials: TH
authors.lastname: Collet
authors.affiliation: Department for Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Bodenmann
authors.affiliation: Department of General Internal Medicine, Inselspital, University of Bern, Switzerland.
authors.forename: Manuel R
authors.initials: MR
authors.lastname: Blum
authors.affiliation: Division of Internal Medicine, University Hospital of Zürich, Zürich, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Zimmerli
authors.affiliation: Department of Community Medicine and Primary Care, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Gaspoz
authors.affiliation: Division of Internal Medicine, University Hospital of Zürich, Zürich, Switzerland.
authors.forename: Edouard
authors.initials: E
authors.lastname: Battegay
authors.affiliation: Department for Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
authors.forename: Jacques
authors.initials: J
authors.lastname: Cornuz
authors.affiliation: Department of General Internal Medicine, Inselspital, University of Bern, Switzerland. Electronic address: Nicolas.Rodondi@insel.ch.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Rodondi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000208:ethnology / Q000517:prevention & control*; D005260:Female; D006806:Human Rights / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011314:Preventive Health Services / Q000191:economics / Q000592:standards*; D011320:Primary Health Care / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013557:Switzerland; D014171:Transients and Migrants / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D019472:Universal Health Insurance / Q000191:economics / Q000592:standards*
keywords: Forced migrants; Preventive care; Quality of care; Socio-demographic characteristics; Vulnerable populations