Referrals to secondary care in an outpatient primary care walk-in clinic for refugees in Germany: results from a secondary data analysis based on electronic medical records

• Published in: BMJ open Vol. 10; no. 10; p. e035625
• Main Authors: Schäfer, Ingmar, Oltrogge, Jan Hendrik, Pruskil, Susanne, Mews, Claudia, Schlichting, Dana, Jahnke, Martin, Wagner, Hans-Otto, Lühmann, Dagmar, Scherer, Martin
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 22.10.2020; BMJ Publishing Group
• Series: Original research
• Subjects: Adult; Africa, Northern; Chronic illnesses; Codes; Data Analysis; Datasets; Electronic Health Records; Emergency medical care; Female; Germany; Health care access; Health insurance; Humans; Infectious diseases; Male; Medical records; Medical referrals; Medical treatment; Middle East; Outpatients; Patients; Pregnancy; Primary care; Primary Health Care; Public Health; Referral and Consultation; Refugees; Registration; Retrospective Studies; Secondary Care; Young Adult; Africa, Northern; Middle East; Germany; primary care; public health; health services administration & management
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2019-035625

ObjectivesThe aims of our study were to describe the disease spectrum of refugees, to analyse to what extent their healthcare needs could be met in an outpatient primary care walk-in clinic and which cases required additional services from secondary care (ie, outpatient specialists or hospitals).DesignRetrospective longitudinal observational study.SettingThe study was based on routine data from a walk-in clinic in the largest central first reception centre in Hamburg, Germany between 4 November 2015 and 21 July 2016.Participants1467 asylum seekers with 4006 episodes of care (ie, distinctive health problems) resulting in 5545 consultations. The patients were 60% men and had a mean age of 23.2 years. About 90% of the patients were from Central Asia or from the Middle East and North Africa.Primary and secondary outcome measuresThe endpoint of our analyses was referral to secondary care. Time to event was defined as days under treatment until the first referral. Predictor variables were the patients’ diagnoses grouped in 46 categories. The data set was analysed by Cox regression allowing for multiple failure times per patient. This analysis was adjusted for age, sex and country of origin.ResultsReferrals to secondary care occurred in 15.5% of the episodes. The diagnosis groups with the highest referral rates were ‘eye’ (HR 4.9; 95% CI 3.12 to 7.8; p≤0.001), ‘teeth/gum symptom/complaint or disease’ (3.51; 2.52 to 4.9; p≤0.001) and ‘urological system/female or male genital’ (2.50; 1.66 to 3.77; p≤0.001). Age, sex and country of origin had no significant effect on time until referral.ConclusionsIn most cases, the walk-in clinic physicians could provide first-line medical care for the health problems of patients not integrated in the German healthcare system. Additional resources were needed particularly not only for visual impairment and dental problems but also for psychological disorders, antenatal care and certain infections and injuries.