Evidence map›Paper›PMID 33093028›Full record

Observational studyBMJ open2020

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.

Ingmar Schäfer, Jan Hendrik Oltrogge, Susanne Pruskil, Claudia Mews, Dana Schlichting, Martin Jahnke, Hans-Otto Wagner, Dagmar Lühmann, Martin Scherer

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Ingmar SchäferDepartment of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany in.schaefer@uke.de.ORCID 0000-0002-1038-7478
Jan Hendrik OltroggeDepartment of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Susanne PruskilDepartment of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Claudia MewsDepartment of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Dana SchlichtingDepartment of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Martin JahnkeDepartment of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Hans-Otto WagnerDepartment of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Dagmar LühmannDepartment of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Martin SchererDepartment of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

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 MEASURES: The 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.

Indexed as

RefugeesAdultAfrica, NorthernData AnalysisElectronic Health RecordsFemaleGermanyHumansMaleMiddle EastOutpatientsPregnancyPrimary Health CareReferral and ConsultationRetrospective StudiesSecondary Health Carehealth services administration & managementprimary carepublic health

Identifiers

PMID33093028
PMCPMC7583080

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.