Potentially avoidable and ambulatory care sensitive hospitalisations among forced migrants: a protocol for a systematic review and meta-analysis

BMJ Open. 2016 Sep 22;6(9):e012216. doi: 10.1136/bmjopen-2016-012216.


Introduction: There is an increasing number of forced migrants globally, including refugees, asylum seekers, internally displaced persons and undocumented migrants. According to international law, forced migrants should enjoy access to health services free of discrimination equivalent to the host population, but they face barriers to healthcare worldwide. This may lead to a delay in care and result in preventable hospital treatment, referred to as potentially preventable hospitalisation (PPH) or ambulatory care sensitive hospitalisation (ACSH). There is as yet no overview of the prevalence of PPH in different countries and groups of forced migrants, and it is unknown whether the concept has been used among these migrant groups. We aim to systematically review the evidence (1) on the prevalence of PPH among forced migrants and (2) on differences in the prevalence of PPH between forced migrants and the general host population.

Methods and analysis: A systematic review will be conducted searching databases (PubMed/MEDLINE, Web of Science/Knowledge, Cochrane Library, CINAHL, Google Scholar) and the internet (Google).

Inclusion criteria: observational studies on forced migrants reporting PPH or ACSH with or without comparison groups published in the English or German language.

Exclusion criteria: studies on general migrant groups or hospitalisations without clear reference to avoidability.

Study selection: titles, abstracts and full texts will be screened in duplicate for eligibility. Data on the prevalence of PPH/ACSH among forced migrants, as well as any reported prevalence differences between host populations, will be systematically extracted. Quality appraisal will be performed using standardised checklists. The evidence will be synthesised in tabular form and by means of forest plots. A meta-analysis will be performed only among homogeneous studies (in terms of design and population).

Ethics and dissemination: Ethical clearance is not necessary (secondary research). The results will be disseminated via publication in open access journals, conferences and public media.

Prospero registration number: CRD42016037081.

Keywords: ambulatory care sensitive conditions; ambulatory care sensitive hospitalizations; forced migrants; potentially preventable hospitalizations.