Asylum seeker and refugee patients represent a vulnerable group in many regards. Ensuring the provision of adequate medical care for refugee patients in Germany poses challenges for both healthcare system structures and medical professionals. There were anecdotal reports of overly frequent re-admissions of patients in primary care settings. This may indicate inappropriate provision of care. This dissertation aims to examined how often recently arrived refugees visit general practice consultation hours and how demographic factors, quality of communication, prescription of medication and the presence of certain diseases may impact re-admission rates. Methods: Socio-demographic data (age, gender, country of origin, refugee category) as well as the practitioners' opinions about the understanding with patients of a refugee cohort that was accommodated in the border transit camp in Friedland between August 2017 and August 2018 were collected. Furthermore, a retrospective extraction of diagnoses and prescriptions from patient records was performed. Descriptive and bivariate statistics were used to describe the distribution of sociodemografic factors and their impact on frequent referrals. Subsequently, a subgroup analysis of patients with the most frequent treatment contacts was conducted. Finally, a linear regression analysis was performed considering several aspects that might influence the number of admissions. Results: A total of 2,111 patients from 5,133 residents were evaluated in this study. During the study period, a total of 3,811 general medical consultations, 136 emergency hospital treatments and 712 specialist consultations were registered. The gender ratio in the cohort was balanced, patients were on average 26 years old. The main countries of origin were Syria, Iraq, Georgia and Afghanistan. These 5,133 residents had an average of 12.3 annual doctor contacts, 0.44 annual emergency hospital treatments and 2.30 specialist treatments. Most visits to doctors were among the age group of 20 to 29-year-olds (Ø 2.7). Numerous factors were found to influence repeated visits: Most physician contacts had patients with diagnoses from the ICD chapter O (pregnancy, birth and puerperium) with on the average 5.7 visits (n = 25 patients) followed by D50-D90 (diseases of the blood and blood-forming organs) with 5.5 average visits (n = 24 patients), C00-D48 (neoplasms) with 5.2 visits (n = 20 patients) and F (psychological and behavioral disturbances) with an average of 5.1 visits (n = 108 patients). It was noticeable that asylum-seeking patients received significantly more often medical treatment than resettled refugees (Ø 2.8 vs. Ø 1.3) and female patients had slightly more contacts with doctors than male (Ø 2.3 vs. Ø 2.1). Patients treated for non-specific symptoms, presumably of somatoform origin (10.9% of all patients, n = 231), were also associated with an increase in physician contacts (Ø 3.9 vs. Ø 2.0). Also high re-admission rates were seen in patients prescribed antidepressants (Ø 5.4, n = 80), anxiolytics (Ø 5.7, n = 54), antipsychotics (Ø 6.6, n = 38) or opioids (Ø 8.9, n = 14). But also the 720 patients who received analgesics had more visits at physicians (Ø 3.0 visits). It was also noticeable that patients who migrated from the former Soviet Union and Europe had disproportionately more contacts with doctors. In the subgroup of patients with six or more physician contacts, most of them came from Georgia (n = 28), Iraq (n = 19), Moldova (n = 16) and Afghanistan (n = 15), although the largest patient group in the overall cohort was from Syria, which was strongly underrepresented in this subgroup. No significant effects on the quality of communication as assessed by the physicians could be found on the accumulation of presentations, but the presence of a lay interpreter was associated with a significant increase in the frequency of contacts with physician (Ø 3.4 contacts).
Other studies on admission facilities for refugees in Germany and Europe had significant lower physician contact rates. This may be due to the fact that professional language interpretation services are not regularly available in the Friedland facility. Even though this study found that patients with interpreter support had more doctor contacts than patients without interpreter support, reliable communication with the aim of establishing an empathetic doctor-patient relationship could be crucial, especially in light of the frequent doctor contacts in pre- and postnatal care, as well as of patients with psychiatric diagnoses and particularly patients with rather somatoform complaints. Furthermore, social medicine programs (as already partly implemented by the social services) and alternative patient management instruments (e.g. for dental care) could possibly lead to a more effective and demand-oriented care provision.The new EU Directive 2013/33, on which the EU Commission has initiated infringement procedures against Germany, could in the mid-term have a lasting postive impact on the much-criticized national legal framework which restricts provision of medical care to refugees and asylum seeker today.||de