Ricerc@Sapienza

Background:
The appropriate use of National Health Systems can be
difficult for foreigners, leading to misuse of emergency rooms
(ERs) and to underuse of primary care services. This study
investigated the appropriateness of access to ERs and emergency admissions (EAs) for ambulatory care sensitive conditions (ACSCs) of Romanians, the largest foreign population
in Rome, focusing on before and after their entry into the
European Union in 2007.
Methods:
Data on ER access between 1999 and 2014 were collected from
five large hospitals in Rome. Poisson regression models were
built to estimate the incidence rate ratios (IRR) of Romanians
compared to Italians and to compare the Romanian population before and after 2007, for inappropriateness, measured as
white codes resulting in discharge home, and EAs for ACSCs.
Results:
Globally, 31.8% of Romanians (53,089) accessed ERs before
2007, while 68.2% (113,982) afterwards. Poisson regression
showed that Romanians had a higher risk of inappropriateness
than Italians both before and after 2007 (IRR: 1.30, 95% CI:
1.27-1.33; IRR: 1.38, 95% CI: 1.35-1.40, respectively), while the
risk of EAs for ACSCs as a whole became lower after 2007
(IRR: 0.89, 95% CI: 0.83-0.95). In particular, the risk of EAs
decreased significantly after 2007 for vaccine-preventable
diseases and for angina. Moreover, within the Romanian
population, the risk of inappropriateness and of EAs for
vaccine-preventable diseases decreased after 2007 (IRR: 0.80;
95% CI: 0.76-0.84; IRR: 0.29; 95% CI: 0.09-0.97, respectively).
Conclusions:
Although the inappropriateness remained high, Romanians’
health status seemed to improve after 2007 for those conditions
in which the health policies could play an important role.
Main messages:
Romanians maintain a high rate of inappropriate access to
emergency rooms and of urgent hospitalisations after 2007.
The decrease of risk of emergency access for ACSCs in
Romanians after 2007 underline the importance of including
foreign populations in prevention programmes.