SPECIALIST REFERRAL RATES AND PATIENT NATIONALITY IN SPAIN

1. Antonio Sarría Santamera Mª del Rocío Carmona Alférez Mª Auxiliadora Martín Martínez Pilar Gallego Berciano Enrique Regidor Poyatos SPECIALIST REFERRAL RATES AND PATIENT NATIONALITY IN SPAIN Agency for Health Technology Assessment INSTITUTO DE SALUD CARLOS III

2. Sandín Vázquez M Conde Espejo P de Bustos Guadaño M Asunsolo del Barco A Riesgo Fuertes R Garrido Elustondo S Cabello Ballesteros ML Escortell Mayor ME Sanz Cuesta T Primary Health Care Utilization Research Group Calvo Parra I Villaitodo Villén P Bartolomé Casado MS Jiménez Carramiñana J Casado López M Parralejo Buendía M Basanta López M Bonache Blay M Martínez-Toledano Olaya P Rico Blázquez M

3. INTRODUCTION • The phenomenon of immigration is relatively new in Spain: the number of immigrants is low but increasing in the last few years. • 12% of the population of Spain is of foreign nationality (INE, 2009). • 44.8% of all registered immigrants in Spain reside in in three provinces (Madrid, Barcelona and Alicante).

4. INTRODUCTION • Previous research indicates that the immigrant population is young and healthy, and there are no differences (age-adjusted). • Although their health status could be similar to that of local populations, they could have different behaviors in accessing the health care system. • Also, health care professionals could have different behavior when treating immigrants.

5. OBJECTIVE • To compare referralsto specialists from PC in the Region of Madrid between immigrant and native populations.

6. Health areas: 1, 3, 7, 8, 9 y 10 METHODOLOGY • Design, location and sources of information • Design: transversal, observational and ecological. • Location: 6 health areas in the Community of Madrid. • Sources of information: - Electronic medical records of Primary Care (OMI-AP). - Institute of Statistics of the Community of Madrid.

7. PATIENTS OVER 24 YEARS WITH AT LEAST ONE VISIT TO THE CENTRE OF HEALTH IN 2006 IN 6 HEALTH AREAS (1,325,327) DUPLICATE PATIENTS (7,307) PATIENTS WITHOUT NATIONALITY (264,754) PATIENTS INCLUDED IN STUDY (1,053,266) METHODOLOGY • Flowchart of patient selection

8. METHODOLOGY

9. METHODOLOGY • Nationalityvariable was used to reflect whether a patient was an immigrant or not. • 8 categories of nationality: • Native • Western Countries • Eastern Europe • North Africa • Sub-Saharan Africa • Central America and Caribbean • South America • Middle East, South Asia and East

10. “SOCIO-ECONOMIC DATA” Patient Per capita Gross Disposable Income in 2000 of the Basic Health Zone METHODOLOGY

11. MODEL 1: BINOMIAL REGRESSION • DEPENDENT VARIABLE: Referral (yes/no) • INDEPENDENTS VARIABLES: • Immigrant (yes/no) • Age • Sex • Total disease • Per capita income Socio-demographic Morbidity Socio-economic METHODOLOGY

12. MODEL 2: BINOMIAL REGRESSION • DEPENDENT VARIABLE: Referral (yes/no) • INDEPENDENTS VARIABLES: • Nationality (8 categories) • Age • Sex • Total disease • Per capita income Socio-demographic Morbidity Socio-economic METHODOLOGY

13. RESULTS

14. RESULTS

15. RESULTS

16. RESULTS

17. RESULTS

18. CONCLUSIONS • Immigrants are younger and healthier than the native population. • Overall, women have a higher probability of being referred to specialists. • After controlling for socio-demographic and economic characteristics, and morbidity, immigrants show a higher likelihood of referrals to specialist.

19. CONCLUSIONS • Compared to Spanish natives, specialist referrals are higher in women from those from Eastern Europe, Central and South America, and in men for those from South America. • Further studies will allow to gain a better understanding of the relationship between national origin and referrals.

20. THANK YOU