Have Romanians changed the use of Italian healthcare services after their entry into EU?

Background: The appropriate use of the National Health Systems (NHS) can be difficult for foreigners, leading to misuse of emergency rooms (ERs) and to underuse of primary care services. This study investigated the risk of avoidable hospitalization using Prevention Quality Indicators (PQIs) for several chronic and acute conditions that can be prevented with appropriate ambulatory care among Romanians, the most representative foreign population in Rome, highlighting differences before and after their entry into the EU in 2007. Methods: Data on ER accesses between 1999 and 2014 were collected from five large hospitals in Rome. Poisson regression models were built to estimate incidence rate ratios (IRR) of Romanian population before and after 2007, for emergency hospitalization for each of 14 PQI and for composite PQIs (overall, acute, chronic and diabetes). Results: Globally, 31.8% of Romanians (53,089) accessed ER before 2007, while 68.2% (113,982) afterwards. Poisson regression showed that among Romanians the risk of hospitalization for the overall composite PQI (PQI 90), acute composite PQI (PQI 91), chronic composite PQI (PQI 92) showed no significant variations after 2007. Concerning diabetes composite PQI (PQI 93), Poisson regression showed that the risk of hospitalization decreased significantly after 2007 (IRR: 0.40, 95% CI: 0.20-0.82). In particular, “Uncontrolled diabetes admission rate” (PQ14) and “Lower extremity amputations among patients with diabetes admission rate” (PQI 16) largely decreased after 2007 (IRR: 0.29, 95% CI: 0.09-0.95; IRR: 0.40, 95% CI: 0.20-0.82). Conclusions: The utilization of the ERs by Romanians in Italy was not globally modified after their entry into the EU. However, the significant decrease of avoidable hospitalizations for chronic conditions such diabetes and its complications suggests a change in the use of primary healthcare services by this population.