Health care provision for refugees in Germany – one-year evaluation of an outpatient clinic in an urban emergency accommodation

Abstract

BackgroundIn 2015, Germany recorded the highest rates of refugees since the early 1990s. Access to medical care is a legally regulated fundamental element of aid for refugees. In practice, there are several hurdles such as language barriers and legal regulations. In response to the massively increased need, special outpatient services for refugees were started in several German cities. In Cologne, an outpatient clinic (OPD) was established in the largest emergency accommodation centre for refugees supported by the Cologne municipality and operated by the German Red Cross and physicians from the Association of Statutory Health Insurance Physicians. This study reports experiences of the first year of the OPD regarding structure, processes and utilization.MethodsEmploying mixed methods, between May and December 2015 cross sectional pseudonymized data from patients’ contacts were collected, coded in the International Classification of Primary Care (ICPC) and evaluated. Infrastructure, equipment, process organisation and function of the OPD were assessed during five participatory observations and triangulated with results of a self-administered questionnaire for staff and four qualitative interviews with key informants.ResultsDuring the observation period a total of 2205 persons (67% male) stayed in the emergency accommodation and 984 patient contacts (51% male) were registered, mainly by young persons from Western Balkan countries and Syria. Medical treatment was sought primarily for acute respiratory-, loco-motor-system- and skin symptoms followed by chronic physical diseases. Headache, back and neck pain and acute respiratory infection were the most frequent diagnoses. Questionnaires and interviews among staff revealed language barriers and psycho-trauma as the most frequently reported challenges. Equipment and staffing was adequate, but patient documentation was not systematic, leading to loss of information.ConclusionTo facilitate refugees’ appropriate access to health care, the OPD was seen as functional for this refugee accommodation centre. Need was recognised for standardized, data protective documentation and a health passport for clients for medical information. Psychological support for refugees needs expansion taking legal circumstances and coverage of costs into consideration. To improve patient communication employees working with refugees should be offered an introduction to culturally sensitive understanding of health and illness.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3174-y) contains supplementary material, which is available to authorized users.

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

“…The highest amount of provided medical care was related to infections, which is in line with most cross-sectional observations [ 14 , 23 ]. Non-communicable diseases (ICPC-2 category ‘other diagnoses’) comprised one-fifth of provided medical care.…”

“…Regarding the applicability of our data we note that virtually all published studies on health care at refugee camps provided consultation-based data that use given diagnoses of a consultation as a proxy of disease prevalence [ 8 , 23 ]. The expenditure of time and workforce may be underestimated through such a consultation-based analysis.…”

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

“…An outpatient clinic at an emergency accommodation in Cologne, for example, reported a higher rate of headache, back/neck problems and abdominal pain than found in our study. 23 The difference between our study and many other studies might be explained by the fact that the consultations at our walk-in clinic were guided by the patients’ self-reported reasons for consultation and that there was no general screening for psychological disorders. Studies including general screenings reported that almost half of the recently arrived refugees in Germany screened positive for post-traumatic stress disorder, depression or somatisation.…”

Eritrean Refugees’ Utilization of Antenatal Services in Israel

“…In the operation of these concepts, studies have mostly focused on single dichotomous variables referring to the use or non-use of a single service (e.g., Correa-Velez and Ryan, 2012;Michaan et al, 2014;Choi et al, 2015). A few studies have focused on the comparison of user rates, analysing frequency rates with regard to different facilities (Kiss et al, 2013) or different services (Borgschulte et al, 2018).…”

“…Meta‐reviews have concluded that such utilization is “limited” and “late” (Carolan, : 411), “low” (Correa‐Velez and Ryan, : 14) and “less” and “later” than user rates of host country citizens (e.g., Munro et al., : 283). Numerous case studies also point to refugees’ problematic or low utilization of health services (e.g., Asgary and Segar, ; Correa‐Velez and Ryan, ; Michaan et al., ; Choi et al., ; Langlois et al., ; Gottlieb et al., ), although a few studies argue that there is “no evidence of under‐use” (Kiss et al., : 57), that access for refugees is “relatively good” (El Arab and Sagbakken, ), and that refugees’ demands for health services are “largely met” (Borgschulte et al., : 6). The findings of both positive and negative health service utilization in host countries begs the question of how such use is conceptualized and operationalized, as well as how it is contextualized, that is, what country‐specific legislation relates to refugees and their entitlement to health services in the host country.…”