Comparing provision and appropriateness of health care between immigrants and non-immigrants in Germany using the example of neuraxial anaesthesia during labour: cross-sectional study

Razum O, Reiss K, Breckenkamp J, Kaufner L, Brenne S, Bozorgmehr K, Borde T, David M (2017)
BMJ Open 7(8): e015913.

Download
OA 370.30 KB
Zeitschriftenaufsatz | Veröffentlicht | Englisch
Autor
; ; ; ; ; ; ;
Abstract / Bemerkung
Objective Research on health services for immigrants has mostly been concerned with access barriers but rarely with appropriateness and responsiveness of care. We assessed whether appropriateness and responsiveness of care depend on migration status, using provision of neuraxial anaesthesia (NA) during labour as indicator. In relation to their migration status, we analysed whether (1) women undergoing elective or secondary/urgent secondary caesarean sections (ESCS) appropriately receive NA (instead of general anaesthesia), (2) women delivering vaginally appropriately receive NA and (3) women objecting to NA, for example, for religious reasons, may deliver vaginally without receiving NA (provider responsiveness). Design Cross-sectional study. Setting Three obstetric hospitals in Berlin, Germany. Methods Questionnaire survey covering 6391 women with migration history (first and second generations) and non-immigrant women giving birth; data linkage with routine obstetric data. We assessed the effects of migrant status, German language proficiency, religion and education on the provision of NA (primary outcome) after adjusting for other maternal and obstetric parameters. Results The chance of receiving NA for elective/ESCS was independent of migrant status after controlling for confounding variables (adjusted OR (aOR) 0.93, 95% CI 0.65 to 1.33). In vaginal deliveries, first (but not second) generation women (aOR 0.79, 95% CI 0.65 to 0.95), women with low German language skills (aOR 0.77, 95% CI 0.58 to 0.99) and women with low educational attainment (aOR 0.62, 95% CI 0.47 to 0.82) had lower chances of receiving NA; there was no evidence of overprovision among women with strong affinity to Islam (aOR 0.77, 95% CI 0.63 to 0.94). Conclusions We found evidence for underprovision of care among first-generation immigrants, among women with low German language proficiency and particularly among all women with low educational attainment, irrespective of migration status. There was no evidence for overprovision of care to immigrant women, either inappropriately (general anaesthesia for ESCS) or because of low provider responsiveness (no opt-out for NA in vaginal delivery).
Erscheinungsjahr
Zeitschriftentitel
BMJ Open
Band
7
Zeitschriftennummer
8
Artikelnummer
e015913
ISSN
Finanzierungs-Informationen
Article Processing Charge funded by the Deutsche Forschungsgemeinschaft and the Open Access Publication Fund of Bielefeld University.
PUB-ID

Zitieren

Razum O, Reiss K, Breckenkamp J, et al. Comparing provision and appropriateness of health care between immigrants and non-immigrants in Germany using the example of neuraxial anaesthesia during labour: cross-sectional study. BMJ Open. 2017;7(8): e015913.
Razum, O., Reiss, K., Breckenkamp, J., Kaufner, L., Brenne, S., Bozorgmehr, K., Borde, T., et al. (2017). Comparing provision and appropriateness of health care between immigrants and non-immigrants in Germany using the example of neuraxial anaesthesia during labour: cross-sectional study. BMJ Open, 7(8), e015913. doi:10.1136/bmjopen-2017-015913
Razum, O., Reiss, K., Breckenkamp, J., Kaufner, L., Brenne, S., Bozorgmehr, K., Borde, T., and David, M. (2017). Comparing provision and appropriateness of health care between immigrants and non-immigrants in Germany using the example of neuraxial anaesthesia during labour: cross-sectional study. BMJ Open 7:e015913.
Razum, O., et al., 2017. Comparing provision and appropriateness of health care between immigrants and non-immigrants in Germany using the example of neuraxial anaesthesia during labour: cross-sectional study. BMJ Open, 7(8): e015913.
O. Razum, et al., “Comparing provision and appropriateness of health care between immigrants and non-immigrants in Germany using the example of neuraxial anaesthesia during labour: cross-sectional study”, BMJ Open, vol. 7, 2017, : e015913.
Razum, O., Reiss, K., Breckenkamp, J., Kaufner, L., Brenne, S., Bozorgmehr, K., Borde, T., David, M.: Comparing provision and appropriateness of health care between immigrants and non-immigrants in Germany using the example of neuraxial anaesthesia during labour: cross-sectional study. BMJ Open. 7, : e015913 (2017).
Razum, Oliver, Reiss, Katharina, Breckenkamp, Jürgen, Kaufner, Lutz, Brenne, Silke, Bozorgmehr, Kayvan, Borde, Theda, and David, Matthias. “Comparing provision and appropriateness of health care between immigrants and non-immigrants in Germany using the example of neuraxial anaesthesia during labour: cross-sectional study”. BMJ Open 7.8 (2017): e015913.
Alle Dateien verfügbar unter der/den folgenden Lizenz(en):
Copyright Statement:
This Item is protected by copyright and/or related rights. [...]
Volltext(e)
Access Level
OA Open Access
Zuletzt Hochgeladen
2018-01-15T09:26:02Z

35 References

Daten bereitgestellt von Europe PubMed Central.


Smedley BD, Stith AY, Nelson AR., 2003
The health gap: the challenge of an unequal world.
Marmot M., Lancet 386(10011), 2015
PMID: 26364261
Maternal characteristics and satisfaction associated with intrapartum epidural analgesia use in Canadian women.
Koteles J, de Vrijer B, Penava D, Xie B., Int J Obstet Anesth 21(4), 2012
PMID: 22918025
The use of epidural analgesia for intrapartum pain relief in publicly funded healthcare.
Raisanen S, Kokki M, Kokki H, Gissler M, Kramer MR, Heinonen S., Acta Anaesthesiol Scand 58(3), 2014
PMID: 24433265
Overestimation and underestimation of labor pain.
Sheiner E, Sheiner EK, Hershkovitz R, Mazor M, Katz M, Shoham-Vardi I., Eur. J. Obstet. Gynecol. Reprod. Biol. 91(1), 2000
PMID: 10817876
Pain and women's satisfaction with the experience of childbirth: a systematic review.
Hodnett ED., Am. J. Obstet. Gynecol. 186(5 Suppl Nature), 2002
PMID: 12011880
Do social norms play a role in explaining involvement in medical decision-making?
Brabers AE, van Dijk L, Groenewegen PP, de Jong JD., Eur J Public Health 26(6), 2016
PMID: 27161909

Export

Markieren/ Markierung löschen
Markierte Publikationen

Open Data PUB

Web of Science

Dieser Datensatz im Web of Science®

Quellen

PMID: 28827247
PubMed | Europe PMC

Suchen in

Google Scholar