Care pathway of asylum seekers in the health care access points following inclusion in the PREMENTADA project: an observational study

Abstract

Objectives: The health service access point (PASS) allows people in precarious situations to benefit from medical and social care. A mobile PASS service was set up in 2020 in Marseille for people seeking asylum (DA). The objective of our study was to describe the care pathways within the PASS for DA.

Study design: We led a retrospective observational study of care pathways of the 418 DA included in the PREMENTADA study (ClinicalTrials number: NCT05423782) in the 3 months following their inclusion.

Methods: We conducted a quantitative study, which ran from March 1, 2021, to August 31, 2021, to collect data from mobile and hospital PASS consultations, referrals following PASS consultations or hospitalizations, emergency room visits, hospitalizations, prescription, and dispensing of treatment following PASS consultations or on discharge from hospital, between D0 and M3.

Results: A total of 163 (39.0%) patients were lost to follow-up after an initial assessment of their health status. Overall, 74.4% of the patients were followed only by the mobile PASS for a mental health problem, and 57.4% were followed for a somatic problem until they obtained their rights. The mobile PASS referred 43.5% of patients to the hospital PASS for access to various technical facilities: medical imaging, pharmacy (63% of them benefited from the dispensing of health products), biological tests, and so on. The morbidities of the DAs were severe enough to require technical support that the mobile PASS could not provide, but recourse to the emergency department was fairly low (1.6%), testifying to the efficiency of the primary care provided by the mobile PASS.

Conclusions: Our study provides the first data concerning the DA's healthcare pathway in France. Considering the health status of this population and the fact that early management of health problems allows for rationalization of costs, we can ask the question of the future of these patients in the absence of adapted care systems. The PASS and the hospitals to which they are attached will have to adapt their care offer to take into account the DA's specific problems.

Keywords: Health care access; Hospital to community; Precarious status; Primary healthcare; Seeking asylum.