RESUMO
INTRODUCTION: Studies have shown mixed findings regarding the impact of immigration policy changes on immigrants' utilization of primary care. METHODS: We used a difference-in-differences analysis to compare changes in missed primary care appointments over time across two groups: patients who received care in Spanish, Portuguese, or Haitian Creole, and non-Hispanic, white patients who received care in English. RESULTS: After adjustment for age, sex, race, insurance, hospital system, and presence of chronic conditions, immigration policy changes were associated with an absolute increase in the missed appointment prevalence of 0.74 percentage points (95% confidence interval: 0.34, 1.15) among Spanish, Portuguese and Haitian-Creole speakers. We estimated that missed appointments due to immigration policy changes resulted in lost revenue of over $185,000. CONCLUSIONS: We conclude that immigration policy changes were associated with a significant increase in missed appointments among patients who receive medical care in languages other than English.
Assuntos
Emigração e Imigração , Provedores de Redes de Segurança , Agendamento de Consultas , Haiti , Humanos , Massachusetts , Políticas , Estados UnidosRESUMO
OBJECTIVE: To compare diabetes care and outcomes among Haitians, African Americans, and non-Hispanic whites. RESEARCH DESIGN AND METHODS: We analyzed data from 715 Haitian, 1,472 African American, and 466 non-Hispanic white adults with diabetes using χ² testing and multiple logistic regression. RESULTS: Haitians had a higher mean A1C than African Americans (8.2 ± 1.9 vs. 7.7 ± 2.0%) and non-Hispanic whites (7.5 ± 1.7%) (both P < 0.0001). There was no difference in completion of process measures. Haitians were more likely than non-Hispanic whites to have elevated LDL cholesterol or blood pressure. Macrovascular complications were fewer among Haitians than African Americans (adjusted odds ratio 0.35 [95% CI 0.23-0.55]), as were microvascular complications (0.56 [0.41-0.76]). Haitians also had fewer macrovascular (0.32 [0.20-0.50]) and microvascular (0.55 [0.39-0.79]) complications than non-Hispanic whites. CONCLUSIONS: Haitians have worse glycemic control than African Americans or non-Hispanic whites. Future research and interventions to improve diabetes care should target Haitians as a distinct racial/ethnic group.