Tuberculosis care for migrant patients in Portugal: a mixed methods study with primary healthcare providers.
Adult
Coinfection
/ epidemiology
Female
HIV Infections
/ therapy
Health Personnel
Health Services
/ statistics & numerical data
Health Services Accessibility
/ statistics & numerical data
Humans
Latent Tuberculosis
/ epidemiology
Male
Middle Aged
Portugal
/ epidemiology
Surveys and Questionnaires
Transients and Migrants
/ statistics & numerical data
Tuberculosis
/ epidemiology
HIV-TB
Healthcare providers
Migrants
Mixed methods research
Tuberculosis
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
18 Apr 2019
18 Apr 2019
Historique:
received:
16
11
2018
accepted:
28
03
2019
entrez:
20
4
2019
pubmed:
20
4
2019
medline:
8
6
2019
Statut:
epublish
Résumé
Tuberculosis (TB) is still a major global health problem. The increasing number of cases observed among foreign-born populations contrasts with the decreasing trends observed in later years in some high-income countries. Healthcare providers are key interveners in the control of TB and HIV-TB infections. In this study, we aimed to explore the perspectives of healthcare providers working in primary care in Portugal about the provision of TB care for migrant patients with TB or HIV-TB co-infection. We applied a mixed-methods approach using an online survey and semi-structured interviews with primary healthcare providers. A total of 120 Portuguese healthcare providers participated in the survey, and 17 were interviewed. Survey and interview data were analysed applying descriptive statistics and thematic analysis, respectively. Migrants' lack of knowledge on TB disease and its symptoms was the main reason for advanced-stage presentation of cases. Their high mobility and social isolation affect adherence to treatment. The providers also listed several barriers to migrants' access and use of TB care. The most frequently referred were limited socioeconomic resources, complex bureaucracy at the point of access and registration for healthcare services, especially for undocumented migrants, and obstacles for social protection. Providers also advocated more training initiatives on migrants' health, social and cultural contexts, on HIV and TB integrated care, and on TB scientific update for general practitioners and nurses working at primary healthcare centres. Future efforts should provide measures to overcome social, economic and administrative obstacles to care for TB-infected migrants, and promote regular training initiatives for national healthcare providers in order to raise awareness and facilitate better care to culturally diverse populations with TB.
Sections du résumé
BACKGROUND
BACKGROUND
Tuberculosis (TB) is still a major global health problem. The increasing number of cases observed among foreign-born populations contrasts with the decreasing trends observed in later years in some high-income countries. Healthcare providers are key interveners in the control of TB and HIV-TB infections. In this study, we aimed to explore the perspectives of healthcare providers working in primary care in Portugal about the provision of TB care for migrant patients with TB or HIV-TB co-infection.
METHODS
METHODS
We applied a mixed-methods approach using an online survey and semi-structured interviews with primary healthcare providers. A total of 120 Portuguese healthcare providers participated in the survey, and 17 were interviewed. Survey and interview data were analysed applying descriptive statistics and thematic analysis, respectively.
RESULTS
RESULTS
Migrants' lack of knowledge on TB disease and its symptoms was the main reason for advanced-stage presentation of cases. Their high mobility and social isolation affect adherence to treatment. The providers also listed several barriers to migrants' access and use of TB care. The most frequently referred were limited socioeconomic resources, complex bureaucracy at the point of access and registration for healthcare services, especially for undocumented migrants, and obstacles for social protection. Providers also advocated more training initiatives on migrants' health, social and cultural contexts, on HIV and TB integrated care, and on TB scientific update for general practitioners and nurses working at primary healthcare centres.
CONCLUSIONS
CONCLUSIONS
Future efforts should provide measures to overcome social, economic and administrative obstacles to care for TB-infected migrants, and promote regular training initiatives for national healthcare providers in order to raise awareness and facilitate better care to culturally diverse populations with TB.
Identifiants
pubmed: 30999913
doi: 10.1186/s12913-019-4050-0
pii: 10.1186/s12913-019-4050-0
pmc: PMC6472083
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
233Subventions
Organisme : Fundação para a Ciência e a Tecnologia (PT), through funds to the Global Health and Tropical Medicine Research Centre
ID : GHTM - UID/Multi/04413/2013
Organisme : Fundação para a Ciência e a Tecnologia
ID : PD/BD/105916/2014
Organisme : Fundação para a Ciência e a Tecnologia
ID : Investigador FCT programme
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