Effects of introducing a walk-in clinic on ambulatory care sensitive hospitalisations among asylum seekers in Germany: a single-centre pre–post intervention study using medical records

Abstract

ObjectiveMeasuring the effect of introducing a walk-in clinic on ambulatory care sensitive (ACS) hospitalisations among asylum seekers in a large state reception- and registration centre.Design and settingPre–post intervention study using anonymous account data from a university hospital functioning as referral facility for a state reception- and registration centre in the third largest German federal state.ParticipantsWe included all asylum seekers residing in the reception centre and admitted to the referral hospital between 2015 to 2017.InterventionsEstablishment of an interdisciplinary walk-in clinic in the reception centre (02/2016).Main outcome measuresInternational lists for ACS conditions for both adults and children were adapted and used to calculate the prevalence of ACS conditions among the population (primary outcome measure). The impact of the intervention on the outcome was analysed using a segmented Poisson regression to calculate incidence-rate ratios with respective 95% CIs, adjusted for age, sex and admission.ResultsThe prevalence of ACS hospitalisations changed over time, as did the effect of age, sex and quarter of admission. Introducing the walk-in clinic reduced the prevalence of ACS hospitalisations among asylum seekers compared with the period before establishment of the clinic (incidence-rate ratios (IRR)=0.80 (0.65 to 1.00), p=0.054), but the effect was attenuated after adjustment for time trends. The average difference in prevalence of ACS hospitalisations compared with the period before establishment of the clinic, corrected for pre-existing time trends, age and sex of asylum seekers was IRR=1.03 ((0.69 to 1.55), p=0.876).ConclusionsA walk-in clinic in reception centres may be effective to reduce ACS hospitalisations, but our study could not prove evidence for a measurable effect after full adjustment for time trends. Further research, ideally with parallel control groups, is required to establish evidence for the effectiveness of walk-in clinics in reception centres on reducing ACS hospitalisations.

Barriers and facilitators of maternal healthcare utilisation in the perinatal period among women with social disadvantage: A theory-guided systematic review

“…Despite such programmes, there appears to be a lack of new investment, which may be attributable to the difficulty in demonstrating a programme's effect. For instance, the walk-in clinic programme for asylum-seekers in Germany ( Lichtl and Bozorgmehr, 2019 ) could not show any effect in reducing unnecessary hospitalisations after confounds were controlled. In Switzerland, the fragmented nature of follow-up care ( Kurth et al, 2016 ), which is financed and overseen by different regional governments, makes it difficult to assess its impact.…”

“…One patient-outreach programme established in Switzerland in 2015 offers relief to families with social disadvantage ( Kurth et al, 2016 ;Staehelin et al, 2013 ). Another programme in Germany operates walk-in clinics for asylum seekers, designed to reduce unnecessary hospitalisations ( Lichtl and Bozorgmehr, 2019 ). Despite such programmes, there appears to be a lack of new investment, which may be attributable to the difficulty in demonstrating a programme's effect.…”

Health care utilisation of asylum seekers and refugees in the South-West of Germany

“…Similar approaches are taken in Nuremberg and in Bremen [ 44 ]. A Heidelberg study examined the impact of a walk-in clinic in a reception centre on ambulatory care sensitive hospitalisations between 2015 and 2017, finding that such clinics may be effective in reducing hospitalisations [ 45 ].…”