CG123 Common mental health disorders - National Institute for ...

Access to healthcareAll studies were narratively reviewed because the heterogeneity of interventionsand outcomes reported across studies meant it was not possible to perform statisticalmeta-analyses. ANDERSON2003 was limited to countries with established marketeconomies, as defined by the World Bank 9 . BEACH2006, FISHER2007 andMEGHANI2009 included only US-based papers in the review. FLORES2005 andVANCITTERS2004 did not limit studies by country. It should be noted that moststudies evaluating new services and interventions were primarily focused on treatmentoutcomes (for example, symptoms, remission rates and so on), with outcomesevaluating access being of secondary importance.4.4.4 Clinical evidenceIndividual-/practitioner-level interventions for black and minority ethnic groupsANDERSON2003 reported that individuals who had language-concordance with theirhealthcare practitioner were less likely to be discharged without a follow-up appointmentthan individuals who needed and used an interpreter (OR 1.92, 95% CI, 1.11 to 3.33,k 1). Furthermore, the same study found that people who needed but were notprovided with an interpreter were more likely to be discharged without a follow-upappointment than those who had used language-concordant practitioners (OR 1.79,95% CI, 1.00 to 3.23, k 1). However, there was no difference between groups in uptakeof treatment. The review by FLORES2005 supports this conclusion because it found thatindividuals with limited English proficiency who did not have use of an interpreter weretwo times more likely to be discharged without an appointment than people who spokethe same language as the practitioner. However, no significant difference in knowledgeof appointments and appointment attendance was observed between the three groups.MEGHANI2009 found a positive association between individual-practitioner‘race-concordance’ and healthcare utilisation, with fewer missed appointments forpeople in ‘race-concordant’ relationships with their healthcare practitioner. However,this was based on just two of the 27 studies included in the review and other studiesfound no significant effect of this on failure to use needed care or delay in usingneeded care. Furthermore, the review found a negative association between ‘raceconcordance’and the use of preventative and basic healthcare services, as well asretention in outpatient substance misuse treatment. Additionally, no significant effectof ‘race-concordance’ was observed for individual/practitioner communication, serviceuser satisfaction and service user perception of respect, although a positive trendwas observed for service user satisfaction (three out of five studies based on the samedata source). Furthermore, across studies in this review, individuals’ preference for apractitioner of their own race revealed mixed findings, with the majority of includedstudies finding no individual preference. It must be noted that some studies included9 Established market economies as defined by the World Bank are Andorra, Australia, Austria, Belgium,Bermuda, Canada, Channel Islands, Denmark, Faeroe Islands, Finland, France, Germany, Gibraltar,Greece, Greenland, Holy See, Iceland, Ireland, the Isle of Man, Italy, Japan, Liechtenstein, Luxembourg,Monaco, the Netherlands, New Zealand, Norway, Portugal, San Marino, Spain, St Pierre and Miquelon,Sweden, Switzerland, the UK and the US.82