The Patient-Centered Medical Home for Refugee Children in Rhode Island (original) (raw)
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Health screening of newly resettled refugees in a primary care setting
2013
Since October 2008, the Medicine/Pediatrics Primary Care Center (MPPCC) has been working with Rhode Island's refugee resettlement agency to coordinate medial care for newly resettled adults and adolescent refugees. The process includes obtaining extensive screening labs and providing immunizations. This review discusses the results of selected screening tests for latent TB, stool parasites, vitamin D, and vaccine-preventable diseases, such as hepatitis, performed as part of the initial intake exam during the first two years of operation of the MPPCC Refugee Clinic.
Health Care Utilization of Refugee Children After Resettlement
Journal of Immigrant and Minority Health, 2012
Refugee children can have significant health problems. Our objective was to describe health status and health care utilization of refugee children after resettlement. A retrospective chart review of refugee children was performed. Initial laboratory data was extracted. Primary care visits, emergency room visits, and subspecialty referrals in the first 15 months from arrival were recorded. The sample included 198 refugees, many with positive initial screening tests. After arrival, 21% had an emergency department visit, 40% had a primary care sick visit, and 71% had a primary care follow-up. Mean number of visits ranged from 0.3 for emergency department to 1.9 for follow-up. Fifty-seven percent were referred to at least one subspecialist. Refugee children had substantial disease burden at arrival. Most had primary care follow-up visits and subspecialty referral after resettlement. These visits were largely for problems identified on initial screening and for general pediatric illnesses.
Addressing Refugee Children's Health Needs: Have We Got It Right?
+61 In this project we collated information from three public clinics. Clinical information gathered was already collected for regular audit purposes, no new information was requested, no personal identifying information was sought. We did not apply for ethics approval.
28 Health Screening of Newly Resettled Refugees in a Primary Care Setting
2015
I was invited to introduce hot topics in pediatrics presenting in Rhode Island. Many exciting and innovative projects and services are currently underway in the Department of Pediatrics at Hasbro Children’s Hospital, a major teaching hospital for the Warren Alpert Medical School of Brown Uni-versity. Below is a sampling of local issues that are being addressed by its pediatric faculty. Articles at a glance: Health Care for Gender Variant or Gender Non-Conforming Children
2020
Background: The ongoing global refugee crises have raised concerns among medical communities worldwide. Methods: We compared data from refugee and Israeli children admitted to the pediatric department (PD) at Wolfson hospital in Israel, between 2013–2017. Results: 104,244 visits (0-18 years) to the pediatric emergency department (PED) were recorded. Admission rate to the PD for refugees was 695/2541 (27%) as compared to 11,858/101,703 (11.7%) for Israeli patients (P< 0.001). After matching for age groups (0-5 years), the hospital stay duration for the 0-2 years age was 3.22 (±4.80) days for the refugees and 2.78 (±3.17) for the local population (P<0.03). For 0-2 year old children, re-admission rates within 7 days, were 1.3% for refugees and 2.6% for Israelis, (p<0.05). Dermatological diseases (mainly impetigo and cellulitis) were more frequent in refugees (23.30% vs. 13.15%, p<0.01), however, acute gastroenteritis and respiratory diagnoses were more common in Israeli chi...
MedEdPORTAL, 2020
Introduction: With 70.8 million people displaced worldwide, there is an increasing need for medical professionals to provide medical care to refugees. Insufficient training on refugee health poses a barrier to effective care delivery. Methods: This workshop addressed common challenges in providing family-centered pediatric refugee care in community settings as well as barriers related to policy changes. Presentations covered prearrival experiences, medical screening, and trauma-based care. In small groups, participants discussed cases that featured medical, behavioral health, social, and cultural factors impacting the provision of family-centered pediatric care that was culturally respectful and included shared decision-making. After the breakout session, each small group informed the larger group of topics discussed. Facilitators identified themes and reinforced key learning points. At the workshop's conclusion, participants were guided to create their own personalized action plan. Results: This workshop was presented at two international conferences to more than 47 participants, including clinicians, nurse practitioners, pediatric residents, and medical students. Evaluations were completed by 34 individuals. Participants' overall comfort level with taking care of refugee patients increased from 3.3 to 4.0 (on a 5-point scale, p = .24) during the 3-hour version of the workshop and from 3.8 to 4.0 (p = .43) in the 1-hour version of the workshop. Mean overall ratings of the 3-and 1-hour workshop versions on conference-administered evaluations were 4.8 and 4.2, respectively, on a 5-point scale. Discussions: This workshop was well received and equipped participants with knowledge, tools, and strategies regarding pediatric refugee health in a community setting.
Journal of Paediatrics and Child Health, 2009
Aim: To determine the prevalence of common diseases in newly arrived refugee children, resettled in Sydney, by region of birth. To identify health needs of refugee children in Australia.Methods: We prospectively screened for common diseases in refugee children attending a specialist paediatric refugee clinic, the Children's Hospital, Westmead, between May 2005 and December 2006. Screening tests included full blood count, Mantoux, vitamin D level, hepatitis B serology, syphilis serology, Schistosomiasis serology and malarial antigens.Results: There were 239 patients, the majority (75%) from Africa, with 127 girls and 112 boys. Thirty-six percent were 0–7 years old, 45% were 8–12 years old and 19% were 13–17 years old. Of those tested, 16% had Schistosomiasis, 5% had malaria and 4% were hepatitis B carriers. Of 216 children who had Mantoux tests, 33% were ≥10 mm and 24% were ≥15 mm, including four children with active disease (2 lymphadenitis, 1 pulmonary and 1 gastric). Vitamin D deficiency was the most common diagnosis: 61% had serum 25(OH)D3 <50 nmol/L. Anaemia was present in 15%. Disease prevalence was higher in children from Africa than Asia or the Middle East, and most of the children were asymptomatic. Given that we have only seen about 10% of the refugee children resettled in New South Wales, our results may not be generalisable to all refugees.Conclusion: Our findings suggest that screening refugee children for common treatable conditions, even if they are asymptomatic, is paramount. In addition to infectious diseases screening, nutritional deficiencies should routinely be screened for.
Rhode Island medical journal (2013), 2017
Refugee populations in the US have a higher reported prevalence of latent tuberculosis infection (LTBI). The objective of this study was to assess adherence to LTBI treatment in refugee and non-refugee children living in Rhode Island. This was a retrospective review of LTBI patients seen in the Hasbro Pediatric Tuberculosis Clinic between August 2009 and September 2011. Of 120 patients with LTBI, 93% were foreign-born and 30% were refugees. Overall, 94 children (78.3%) completed therapy. Higher rates of treatment completion were seen among patients who were female, referred within the same hospital system, used an interpreter, and did not report side effects. Refugees attended more scheduled visits compared to non-refugees (p=0.019). Overall rates of completion of LTBI treatment were high in this population. Better adherence to clinic visits, likely due to the increased support and care coordination provided to the refugee children, improved treatment completion rates. [Full article...
Analysis of Refugee Children Hospitalized in a Tertiary Pediatric Hospital
Journal of Immigrant and Minority Health, 2020
Refugee children are defined as an at-risk population as they have a high risk of physical and mental health conditions. While data exist regarding the mental health of refugee children, there are limited data about their medical health issues and mortality. Therefore, this study aimed to analyze the demographic data, clinical results, treatment/management data, and mortality data of hospitalized refugee children. This is a descriptive study that analyzed the demographic data, clinical findings, treatment/management data, and mortality data of 728 refugee children aged between 1 month and 18 years who were hospitalized in a tertiary pediatric hospital between 2013 and 2018. During the 5 year duration of this study (2013-2018), there were 12,031 patients hospitalized in the department of general pediatrics. Of these patients, 728 (6%) were refugee children [median age 1.2 (IQR 4.4) years]. The most frequent ethnic origin was Syrian, followed by Iraqi and Afghan [465 (63.87%); 174 (23.9%), and 39 (5.3%), respectively]. The median duration of hospitalization was 6 (IQR 6) days. Those refugee patients who were hospitalized in the pediatric intensive care unit were significantly younger [median age 3.7 (IQR 9.4) years]. The mortality rate in the department of general pediatrics was 16.4% for refugee patients and 8.6% for non-refugee patients (p = 0.001). A logistic regression model revealed that factors associated with mortality included younger age (OR 1.6; CI 1.2-2.1) and being a refugee (OR 2.1; CI 1.3-3.2). Our study revealed detailed knowledge about demographic, clinical, and mortality data, with the largest known series about refugee children in the literature. The results show that mortality rates are significantly higher in refugee pediatric patients who are hospitalized in Turkey than in non-refugee patients.
Healthcare for Refugee and Immigrant Adolescents
Primary Care: Clinics in Office Practice, 2020
Adolescents are migrating to the United States in record numbers, and have unique health care needs and vulnerabilities. Refugees, a subset of immigrants, undergo predeparture medical screening before departure to the United States and postarrival screening, as mandated by the Centers for Disease Control and Prevention. Adequate medical follow-up and continuity of care after initial screening are essential to ensure identification and appropriate management of medical conditions, and to provide preventive health care and education. New migrants suffer from a multitude of acute and chronic medical conditions compounded by mental health and developmental conditions that may affect long term health. Cultural sensitivity and use of interpreters when indicated are essential to ensure that adolescents receive comprehensive medical and preventive treatment in an atmosphere in which the patients feel safe and welcomed.