Appropriateness of er utilization and emergency admissions of Romanians before and after their entry into European Union. The case of five large hospitals in Rome, Italy

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.