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Daniel KE, Blackstone SR, Tan JS, Merkel RL, Hauck FR, Allen CW. Integrated model of primary and mental healthcare for the refugee population served by an academic medical centre. Fam Med Community Health 2023; 11:fmch-2022-002038. [PMID: 37012045 PMCID: PMC10083854 DOI: 10.1136/fmch-2022-002038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/26/2023] [Indexed: 04/05/2023] Open
Abstract
Refugees are at increased risk for developing mental health concerns due to high rates of trauma exposure and postmigration stressors. Moreover, barriers to accessing mental health services result in ongoing suffering within this population. Integrated care-which combines primary healthcare and mental healthcare into one cohesive, collaborative setting-may improve refugees' access to comprehensive physical and mental health services to ultimately better support this uniquely vulnerable population. Although integrated care models can increase access to care by colocating multidisciplinary services, establishing an effective integrated care model brings unique logistic (eg, managing office space, delineating roles between multiple providers, establishing open communication practices between specialty roles) and financial (eg, coordinating across department-specific billing procedures) challenges. We therefore describe the model of integrated primary and mental healthcare used in the International Family Medicine Clinic at the University of Virginia, which includes family medicine providers, behavioural health specialists and psychiatrists. Further, based on our 20-year history of providing these integrated services to refugees within an academic medical centre, we offer potential solutions for addressing common challenges (eg, granting specialty providers necessary privileges to access visit notes entered by other specialty providers, creating a culture where communication between providers is the norm, establishing a standard that all providers ought to be CC'ed on most visit notes). We hope that our model and the lessons we have learned along the way can help other institutions that are interested in developing similar integrated care systems to support refugees' mental and physical health.
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Affiliation(s)
- Katharine E Daniel
- Department of Psychology, University of Virginia, Charlottesville, Virginia, USA
- Department of Family Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sarah R Blackstone
- Department of Family Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Joseph S Tan
- Department of Family Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Richard L Merkel
- Department of Psychiatry, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Fern R Hauck
- Department of Family Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Claudia W Allen
- Department of Family Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
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Elmore CE, Mitchell EM, Debnam K, Keim-Malpass J, Laughon K, Tanabe KO, Hauck FR. Predictors of cervical cancer screening for refugee women attending an international family medicine clinic in the United States. Cancer Causes Control 2022; 33:1295-1304. [PMID: 35978212 PMCID: PMC11316516 DOI: 10.1007/s10552-022-01612-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 07/07/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Cervical cancer screening (CCS) rates are lower for foreign-born women in the United States (U.S.) compared with the overall population. This study aimed to determine the CCS rate and predictors among refugees who were identified as female attending a family medicine clinic. METHODS A retrospective chart review included refugee individuals aged 21+, seen in the previous 3 years (3/23/2015-3/20/2018), without hysterectomy (n = 525). Lab results determined CCS rate. Chi-square and logistic regression models explored predictors of CCS. RESULTS Overall, 60.0% were up-to-date (UTD) on CCS. Individuals aged 30-49, married, and with [Formula: see text] 1 child had higher odds of being UTD. Ten or more years living in the U.S. was a significant bivariate predictor of CCS, and approached significance in the multivariate model. CONCLUSION This study begins to fill gaps in knowledge about cervical cancer control among individuals who resettled in the U.S. as refugees and, given that CCS rates are suboptimal, informs clinical practice improvements and directions for future research.
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Affiliation(s)
- Catherine E Elmore
- College of Nursing, University of Utah, 10 S. 2000 E., Salt Lake City, UT, 84112, USA.
- School of Nursing, University of Virginia, Charlottesville, VA, USA.
| | - Emma McKim Mitchell
- Department of Family, Community & Mental Health Systems, School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Katrina Debnam
- School of Nursing & School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | - Jessica Keim-Malpass
- Department of Acute and Specialty Care, School of Nursing, and Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Kathryn Laughon
- Department of Family, Community & Mental Health Systems, School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Kawai O Tanabe
- Division of Student Affairs, Department of Student Health & Wellness, University of Virginia, Charlottesville, VA, USA
- Department of Family Medicine, University of Virginia, Charlottesville, VA, USA
| | - Fern R Hauck
- Department of Family Medicine and Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA
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Blackstone SR, Hauck FR. Telemedicine Use in Refugee Primary Care: Implications for Care Beyond the COVID-19 Pandemic. J Immigr Minor Health 2022; 24:1480-1488. [PMID: 35378695 PMCID: PMC8979148 DOI: 10.1007/s10903-022-01360-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/03/2022]
Abstract
The expansion of telemedicine during the COVID-19 pandemic offers an opportunity to reach vulnerable refugee communities with limited access to healthcare; however, there are limited data on characteristics of refugee patients that are associated with telemedicine use. We examined primary care encounters between March 2020 and February 2021. We compared telemedicine encounters among refugee and non-refugee patients and examined patient characteristics associated with telemedicine use in refugee patients. Overall, refugees used telemedicine less (aOR = 0.59, p < .001). Among refugee patients, telemedicine encounters were more likely if the patient had hypertension or diabetes, had an activated patient portal, carried private insurance and spoke English as their primary language. Telemedicine may be a useful modality of care management for refugee patients who require many follow-up visits; however, language barriers remain a concern. This is important to consider as telemedicine efforts continue and are expanded.
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Affiliation(s)
- Sarah R Blackstone
- Department of Family Medicine, University of Virginia, PO Box 800729, Charlottesville, VA, 22900-0729, USA.
| | - Fern R Hauck
- Department of Family Medicine, University of Virginia, PO Box 800729, Charlottesville, VA, 22900-0729, USA
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Elmore CE, Keim-Malpass J, Mitchell EM. Health Inequity in Cervical Cancer Control Among Refugee Women in the United States by Country of Origin. Health Equity 2021; 5:119-123. [PMID: 33778314 PMCID: PMC7990565 DOI: 10.1089/heq.2020.0108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose: To describe cervical cancer control practices from common countries of origin for women who resettle in the United States as refugees to highlight this persistent health inequity. Methods: Describe presence/type of national cervical cancer screening program, screening coverage percentage, and human papillomavirus (HPV) vaccination program presence and coverage. Results: Nine of 15 included countries screen opportunistically. Most do not use high-performing tests, and estimates of screening coverage were limited. Only one country offers HPV vaccination. Conclusion: Countries of origin for refugee women may lack effective national cervical cancer control programs. To meet the World Health Organization (WHO)'s call to eliminate cervical cancer by 2030, focus on culturally tailored education, and continued research are paramount.
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Affiliation(s)
| | - Jessica Keim-Malpass
- Department of Acute and Specialty Care, School of Nursing, University of Virginia, Charlottesville, Virginia, USA
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Emma McKim Mitchell
- Department of Family, Community and Mental Health Systems, School of Nursing, University of Virginia, Charlottesville, Virginia, USA
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Elmore CE, Compton R, Uhlmann E. Models of Health Care: Interprofessional Approaches to Serving Immigrant Populations. Prim Care 2020; 48:163-177. [PMID: 33516420 DOI: 10.1016/j.pop.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Developing an integrated model of health care for refugees, asylees, immigrants, and special immigrant visa holders requires a multifaceted approach due to their unique and complex health care needs. This article provides an in-depth understanding of the components necessary to develop a model of care addressing the needs of immigrants and to share opportunities and challenges associated with these models. This includes highlighting population- and individual-level factors important to caring for immigrant populations, providing guidance on creating a model of care that addresses these factors, and describing established clinics that exemplify various models of care.
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Affiliation(s)
- Catherine E Elmore
- School of Nursing, University of Virginia, PO Box 800729, Charlottesville, VA 22908, USA.
| | - Rebekah Compton
- Department of Family Medicine, University of Virginia, PO Box 800729, Charlottesville, VA 22908, USA
| | - Erica Uhlmann
- International Rescue Committee, 609 East Market Street, Suite 104, Charlottesville, VA 22902, USA
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Brown CM, Swaminathan L, Saif NT, Hauck FR. Health Care for Refugee and Immigrant Adolescents. Prim Care 2020; 47:291-306. [DOI: 10.1016/j.pop.2020.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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