Episodes of care in a primary care walk-in clinic at a refugee camp in Germany – a retrospective data analysis

Abstract

Background From 2015 to 2016 Germany faced an influx of 1.16 million asylum seekers. In the state of Hamburg Primary Care walk-in clinics (PCWC) were commissioned at refugee camps because the high number of residents (57,000 individuals) could not be provided with access to regular healthcare services. Our study aims were (1) to describe the utilization of a PCWC by camp residents, (2) to compare episodes of continuous care with shorter care episodes and (3) to analyse which diagnoses predict episodes of continuous care in this setting. Methods A retrospective longitudinal observational study was conducted by reviewing all anonymized electronic medical records of a PCWC that operated from 4th November 2015 to 22nd July 2016 at a refugee camp in Hamburg. Episodes of care (EOC) were extracted based on the international classification of primary care-2nd edition (ICPC-2). Outcome parameters were episode duration, principal diagnoses, and medical procedures. Results We analysed 5547 consultations of 1467 patients and extracted 4006 EOC. Mean patient age was 22.7 ± 14.8 years, 37.3% were female. Most common diagnoses were infections (44.7%), non-communicable diseases (22.2%), non-definitive diagnoses describing symptoms (22.0%), and injuries (5.7%). Most patients (52.4%) had only single encounters, whereas 19.8% had at least one EOC with a duration of ≥ 28 days (defined as continuous care). Several procedures were more prevalent in EOC with continuous care: Blood tests (5.2 times higher), administrative procedures (4.3), imaging (3.1) and referrals to secondary care providers (3.0). Twenty prevalent ICPC-2-diagnosis groups were associated with continuous care. The strongest associations were endocrine/metabolic system and nutritional disorders (hazard ratio 5.538, p < 0.001), dermatitis/atopic eczema (4.279, p < 0.001) and psychological disorders (4.056, p < 0.001). Conclusion A wide spectrum of acute and chronic health conditions could be treated at a GP-led PCWC with few referrals or use of medical resources. But we also observed episodes of continuous care with more use of medical resources and referrals. Therefore, we conclude that principles of primary care like continuity of care, coordination of care and management of symptomatic complaints could complement future healthcare concepts for refugee camps.

Regional differences in the patient population of general practices in northern Germany: results of a mixed-methods study

“…It can be assumed that the refugees have only slowly integrated into the general practices. 22 Therefore, the patient types ‘patients with migration background and culturally different disease concepts’ and ‘patients with migration background and communication problems’ could be nowadays found more frequently in general practices. It could also affect other patient types like ‘patients with psychiatric problems’, which are frequently found in the refugee population.…”

Systematic review of electronic health records to manage chronic conditions among displaced populations

“…4 10 17-26 Nineteen studies assessed the impact of EHRs on health outcomes in populations after arriving in an asylum country. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] Quality assessment of included studies According to the critical appraisal tools described in the methods section, 20 articles were of medium-high quality, nine were of medium quality and three were low-quality. The qualitative studies demonstrated acceptable methodological quality but did not report on the influence of the researcher.…”

“…Nineteen studies assessed the impact of EHRs on chronic disease health outcomes for asylum seekers. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] The uses of EHRs in these studies ranged from screening measures to characterising the chronic diseases in a population to improving guidelines and reducing the health disparities in asylum populations compared with the general population. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] Several studies commented on the utility of EHRs as screening tools for asylum populations.…”

“…[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] The uses of EHRs in these studies ranged from screening measures to characterising the chronic diseases in a population to improving guidelines and reducing the health disparities in asylum populations compared with the general population. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] Several studies commented on the utility of EHRs as screening tools for asylum populations. Higgins et al showed that using a pharmacist to systematically review patients flagged by EHRs for possible chronic diseases led to better pharmaceutical recommendations to optimise medical management.…”

Acute respiratory infections in an adult refugee population: an observational study

“…High prevalence rates of scabies infestation 3 , reports of outbreaks of measles 4 , 5 and varicella 6 – 8 and protozoa infections 9 have been described in this population. Acute respiratory infections are among the most common reasons for seeking primary medical care among refugees, migrants, and nonmigrants in Germany 10 .…”