PRIMARY CARE AND ROMA POPULATION / PATIENTS
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1 PRIMARY CARE AND ROMA POPULATION / PATIENTS EFPC Barcelona, September 2, 2014 Pim de Graaf, Danica Rotar Pavlic et al
2 Workshop plan What did we talk about, Presentation and interview Mihaela Covaci, Brx, Belgium Presentation Ghent, Belgium Presentation Erika Zeliko, Slovenia Presentation ECDC, Irina Dinca Discussion
3 Putting our own house in order: examples of health-system action on socially determined health inequalities World Health Organization 2010
4 Primary Care for Roma population and patients, barriers for effective delivery Different cultural norms and concepts of health and disease (Health) illiteracy Lack of trust, weak empathy (mutual) Practical: distance to services, unavailability of services
5 1. Health mediator Primary Care for Roma population and patients, overcoming the barriers 2. Support to GP s, nurses, social workers and other primary care staff to engage with Roma community and strengthen trust and relations 3. Local research on concepts of health and disease
6 1) Health mediator Success with community based health mediator in several countries: Spain, UK, Romania, Bulgaria Training curriculum, job description, effectiveness: evidence available. Political will needed to secure funding
7 2) Support to GP s, nurses, social workers and other primary care staff to engage with Roma community and strengthen trust and relations Training and CME? Messages from the top? Who provides stewardship? MoH, Health Insurance, Quality Institutes, professional organisations?
8 3) Local research on concepts of health and disease Example from Slovenia
9 How are Roma people taking self-care after first signs of illness? Qualitative study in Slovenia
10 Conclusions Roma generally do not use a thermometer, but instead define health or illness according to their general wellbeing. However, more than half were aware of the benefits of antipyretics. Some of the Roma interviewees first attempt to treat fever with the help of traditional folk medicine (teas, compresses). They usually see the doctor if their health problems last more than 3 days.
11 Mihaela Covaci Intercultural mediator in healthcare
12 Purpose of our service To provide equal access to healthcare To improve the quality of healthcare
13 Bridge-function: the 5 tasks Interpretating Providing information to health professionals Providing information to the patients Being involved in case discussions Advocacy
14 Education A three-year training program (social promotion) Social skills Anthropology Healthcare Methodology Intercultural communication
15 Services that the Foyer provides Call-service from 9am until 12.30pm - On call-system: 02/ Support for other care providers - Child and mother-care - GP s practice - Hospitals
16 Arabic Albanian Berbers Chinese Turkish Romanian Roma language Russian Serbian The available languages at Foyer
17 Health Care & Roma A descriptive study Prof. dr. Sara Willems Barbara Cottenie Janique Lobbestael Lise Hanssens
18 auteur + titel
19 State of the art: Roma population in Ghent An estimate of 5000 Roma live in Ghent (mostly coming from Bulgaria and Slovakia). Many are undocumented migrants, unemployed, live in poverty and/or in precarious circumstances poor health difficult access to health care services
20 Research Question What are the experiences of the Roma population in Ghent with regard to (access) to health care? How do these experiences shape their perception of the health care system? Objectives To gain insight in the barriers that are experienced by the Roma population. To explore how Roma experience their health. To identify factors which contribute to a mutual relation of trust and respect between patient and health care provider.
21 Method In depth-interviews with Roma - invited by the health mediator from the city of Ghent (Barbara) - maximal variance (viz.: age, sex, years in Belgium and country of origin) - possibility of a translator In depth-interviews with health/welfare professionals working with Roma - physicians, health care workers, volunteers, Importance of the complementarity of the Integration department of the City of Ghent and Ghent University
22 Topics Roma interviews Health need trigger for searching health care health beliefs Health care use health providers trust barriers facilitating factors discrimination transversal question: comparison with situation in land of origin
23 Preliminary results (Roma interviews) Health need trigger for searching health care Usually small things: cold, toothache, back pain. For urgent cases like bleedings, respiratory problems emergency departments are used. health beliefs -In general the same methods of prevention and self-treatment are used (hygiene, eating healthy, ) -Alcohol as a method of killing bacteria -Other interpretation of age
24 Preliminary results (Roma interviews) Health care use health providers All respondents use a WCG as primary care facility. Trust Mostly the result of good communication, empathy and absence of discrimination
25 Preliminary results (Roma interviews) Barriers Financial, psychological, administrative, physical, language facilitating factors Previous positive experiences, the ability to use transport and the feeling of being taken seriously Discrimination Predominating in land of origin but mostly absent in Ghent
26 Further steps Interviews with Roma: 9 completed 3 planned Interviews with professionals: 12 completed 2 planned Dissemination: 02/12/2014: symposium for health care workers in Ghent Policy brief A publication in an international scientific journal
27 CONTACT Prof. dr. Sara Willems 1 Sara.Willems@UGent.be Barbara Cottenie 2 Barbara.Cottenie@gent.be Lise Hanssens 1 Lise.Hanssens@ugent.be 1 Department of Family Medicine and Primary Health Care Ghent University Hospital, 6K3 De Pintelaan 185 B9000 GHENT 2 Consulent Gezondheid Integratiedienst - Departement Bevolking en Welzijn - Stad Gent Visiting adress: Woodrow Wilsonplein 1, 9000 Gent Corresopondence: Stadhuis, Botermarkt 1, 9000 Gent
28 Asist.Mag.Erika Zelko Barcelona,
29
30 Table 1: Demographic characteristics of the sample Age between 18 and 74 years with a mean value of 38.7±12.1 years Number of Roma in a sample (N=574) % of Roma in a sample p value Gender: 0.56 men women Marital status: 0.95 Married or cohabitating Single divorced widowed
31
32 Table 1: Demographic characteristics of the sample Educational status: 0.68 Incomplete elementary school Elementary school vocational middle College, University Employment: 0.68 Employed student Housewife retired Unemployed
33
34 Table 2: Self-reported diagnosed chronic diseases in the last 12 months Diseases Sample of Prekmurje Roma p Cluster CVD n=574 % a. High blood pressure b. High Cholesterol c. Heart failure d. Heart attack or chest pain (angina pectoris) Cluster musculoskeletal disease e. Low back pain and musculoskeletal system f. Rheumatism Cluster mental disorders g. Depression h. Anxiety Cluster others i. High blood Sugar (diabetes mellitus) j. COPD, Asthma or Emphysema k. Gastritis, Ventricular ulcer l. Cancer
35
36 HRQoL Mental health problem group NO YES TOTAL MOBILITY Without problems 272 (69.57%) 92 (50.27%) 364 (63.41%) Moderate problems 116 (29.67%) 88 (48.09%) 204 (35.54%) Severe problems 3 (0.77%) 3 (1.64%) 6 (1.05%) N 391 (100%) 183 (100%) 574 (100%) Chi-square=20.12; df=2; p<0.001 Cramer s V=0.19 CARE OF SELF Without problems 362 (92.58%) 146 (79.78%) 508 (88.50%) Moderate problems 28 (7.16%) 31 (16.94%) 59 (10.28 %) Severe problems 1 (0.26%)) 6 (3.28%) 7 (1.22%) N 391 (100%) 183 (100%) 574 (100%) Chi-square=23.25; df=2; p<0.001 Cramer s V=0.20 PRESENCE OF PAIN Without problems 169 (43.22%) 40 (21.86%) 209 (36.41%) Moderate problems 207 (52.94%) 109 (59.56%) 316 (55.05%) Severe problems 15 (3.84%) 34 (18.58%) 49 (8.54%) N 391 (100%) 183 (100%) 574 (100%) Chi-square=48.36; df=2; p<0.001 Cramer s V=0.29 DIFFICULTY IN USUAL DAILY ACTIVITIES Without problems 287 (73.40%) 98 (53.55%) 385 (67.07%) Moderate problems 96 (24.55%) 68 (37.16%) 164 (28.57%) Severe problems 8 (2.05%) 17 (9.29%) 25 (4.36%) N 391 (100%) 183 (100%) 574 (100%) Chi-square=29.27; df=2; p<0.001 Cramer s V=0.23 PRESENCE OF ANXIETY OR DEPRESSION Without problems 275 (70.33%) 20 (10.93%) 295 (51.39%) Moderate problems 108 (27.62%) 123 (67.21%) 231 (40.24%) Severe problems 8 (2.05%) 40 (21.86%)) 48 (8.36%) N 391 (100%) 183 (100%) 574 (100%) Chi-square=192.66; df=2; p<0.001 Cramer s V=0.58
37
38 From science to practice - ECDC guide in use Dr. Irina Dinca, Senior Expert, Public Health and Communication Unit (PHC), ECDC 2 September 2014
39 Structure of the presentation Science=LR + meeting experts Develop guidance Use the guide 39
40 Literature review healthcare workers role in keeping MMR vaccination uptake high - Parents consider healthcare workers to be the most important source of information when deciding whether their children should be immunized with MMR vaccine - Parents are more likely to trust information given by health professional more than the one given by the government - Main problem: lack of knowledge among health professionals 40
41 Meetings with expert groups and stakeholders 41
42 Meetings with expert groups and stakeholders TOP INTERVENTIONS Invest in education for physicians and nurses to communicate more efficiently and emphatically; Make remembering easier, e.g. efficient alert systems to remind people about vaccination; Include measles under broader concerns about children s health and support the role of mothers as key opinion leaders on health issues in their families; Address stigma and discrimination; Cooperate with field workers; 42
43 Develop the communication guide REFRAMING Reframe the focus of discussions on the benefits of getting protected and protecting prevent diseases/ POSITIVE rather than on side effects of vaccination/ NEGATIVE Make vaccine communication more of a two-way information exchange; strengthen HCP capacity to become more client-centered Give voice to the beneficiaries messages are based on research done with the beneficiary groups 43
44 Cultural adaptation in pilot MS in: Bulgaria, Czech Republic, Hungary, Romania content and format adaptation of the guide and flip book + methodology of adaptation 44
45 Instead of conclusion Primary healthcare professionals are KEY in ensuring better access to preventative services for un- and under-served population groups Science and practice can work very well together Involving beneficiaries is KEY How can such an evidence-based approach become the best practice? 45
46 Extra slides Thank you!
47 Meetings with expert groups and stakeholders TOP INTERVENTIONS Invest in education for physicians and nurses to communicate more efficiently and emphatically; Make remembering easier, e.g. efficient alert systems to remind people about vaccination; Include measles under broader concerns about children s health and support the role of mothers as key opinion leaders on health issues in their families; Address stigma and discrimination; Cooperate with field workers; 47
48 Website: Tel:
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