Factors affecting emergency department use among pediatric immigrants and refugees: A qualitative narrative review

Purpose: To identify factors affecting emergency department (ED) use by immigrant and refugee children under the age of 18 years in North America and Europe, where similar primary, secondary, and tertiary healthcare structures exist. Methods: A narrative review methodology was used to complete a search of three databases including CINAHL, MEDLINE, and SCOPUS. Inclusion criteria and exclusion criteria were applied following screening and full-text review, resulting in the 8 articles that were selected for this review. Results: Six central themes were identified for presentation to ED’s including: (1) financial accessibility; (2) health insurance; (3) presence of a primary care provider; (4) language barriers; (5) transportation; and (6) health literacy, with health literacy further being divided into a lack of knowledge and parental perception and understanding of illness. Implications and Conclusion: Factors that influence ED use by pediatric immigrant and refugee patients are multi-factorial and interconnected. Recommendations are made to encourage informed changes based on population healthcare needs, with the overall goal to reduce non-essential ED use and improve patient health outcomes. While this review identifies and evaluates the limited research available in this area, further studies need to be completed before generalizations can be made for all pediatric immigrant and refugee populations.