Use of emergency primary care among pregnant undocumented migrants over ten years: an observational study from Oslo, Norway

To compare consultations with pregnant undocumented migrants at emergency primary health care to consultations with pregnant residents of Norway.
A cross-sectional study of consultations at several time points.
The study was conducted at the Oslo Accident and Emergency Outpatient Clinic (OAEOC), the main emergency primary care service in Oslo, Norway.
Consultations with pregnant patients without a Norwegian identity number seeking care at the Department of Emergency General Practice at the OAEOC were identified through a manual search of registration lists from 2009 to 2019. The consultations were categorized by women’s residency status as ‘probably documented migrant’, ‘uncertain migrant status’, or ‘probably undocumented migrant’. We also extracted aggregated data for women with a Norwegian identity number (i.e. residents) presenting in consultations with pregnancy-related (ICPC-2 chapter W) conditions.
Manchester Triage System urgency level at presentation, and hospitalization.
Among 829 consultations with female patients categorized as probably undocumented migrants, we found 27.1% (225/829) with pregnant women. About half of the pregnant women (54.6% (123/225)) presented with a pregnancy-related condition. Pregnant women that were probably undocumented migrants had an increased risk of being triaged with a high level of urgency at presentation (relative risk (RR) 1.86, 95% CI 1.14–3.04) and being hospitalized (RR 1.68, 95% CI 1.21–2.34), compared to pregnant residents.
Pregnant undocumented migrants were more severely sick when presenting to emergency primary care services than pregnant residents. Increased access to primary care and emergency primary care services for pregnant undocumented migrants is urgently needed.
Restricted access to primary care may increase the use of primary care facilities intended for emergency care.
A considerable proportion of the consultations with undocumented migrant women at the emergency primary care services are related to pregnancy.
Consultations with pregnant undocumented migrants more often contained severe pregnancy-related conditions compared to consultations with pregnant residents of Norway.
Interventions to increase access to primary care for pregnant undocumented migrants are urgently needed.

本研究旨在对比挪威急诊基层医疗中，无合法居留身份孕妇与挪威常住孕妇的就诊情况。
本研究为多时间点横断面就诊研究。
本研究于挪威奥斯陆市核心急诊基层医疗服务机构——奥斯陆急诊门诊诊所（OAEOC）开展。
本研究通过手动检索2009年至2019年的登记清单，筛选出在OAEOC急诊全科门诊就诊的无挪威身份号码孕妇的就诊记录。研究人员依据女性居留身份将就诊者分为「疑似合法居留移民」「移民身份不确定」以及「疑似无合法居留身份移民（undocumented migrant）」三类。同时，本研究还提取了持有挪威身份号码（即常住居民）孕妇因妊娠相关疾病（ICPC-2第W章）就诊的汇总数据。
记录就诊时的曼彻斯特分诊系统（Manchester Triage System）分级与住院情况。
在被归类为疑似无合法居留身份移民的829例女性就诊记录中，孕妇占比27.1%（225/829）。其中约半数孕妇（54.6%，123/225）因妊娠相关疾病就诊。与常住孕妇相比，疑似无合法居留身份的孕妇在就诊时被分诊为高优先级的相对风险（relative risk, RR）为1.86，95%置信区间（CI）为1.14~3.04；住院相对风险为1.68，95%置信区间为1.21~2.34。
无合法居留身份的孕妇前往急诊基层医疗就诊时，病情较常住孕妇更为严重。
亟需提升无合法居留身份孕妇对基层医疗及急诊基层医疗服务的可及性。
基层医疗服务可及性不足，可能会导致急诊基层医疗设施的使用量增加。
急诊基层医疗中，无合法居留身份女性的就诊记录有相当比例与妊娠相关。
与挪威常住孕妇的就诊记录相比，无合法居留身份孕妇的就诊记录中，严重妊娠相关疾病的占比更高。
亟需出台相关干预措施，提升无合法居留身份孕妇对基层医疗服务的可及性。