How can we bridge the cardiac needs of a large underserved immigrant population

Abstract

Purpose Immigrant and resettled refugee populations in the US face several barriers to seeking health care, especially access to subspecialty pediatric care. These barriers can lead to delays in diagnosis and treatment, with negative effects on the physical and psychosocial health of these children. We observed that immigrant / resettled refugee families referred for pediatric cardiac evaluation from a community federally qualified healthcare clinic demonstrated a high “no show” rate at tertiary referral centers. We hypothesized that introduction of an outreach pediatric cardiology clinic where by the cardiology team goes to the primary care clinic would help to increase compliance and mitigate the barriers to health care in this population. Currently, there is no study that evaluates the pediatric cardiac care of immigrant families in the US. Methods A monthly outreach pediatric cardiology clinic was established at a federally qualified healthcare clinic serving an immigrant and resettled refugee population. The team was comprised of a pediatric cardiologist, cardiology fellow and a cardiac sonographer. Patients deemed to require further evaluation were then referred to a tertiary specialty hospital with social services and transportation support facilitated by the primary clinic. Following IRB approval, medical records for patients seen between 2/2014 to 12/2017 were retrospectively reviewed at both institutions. Descriptive analysis was performed. Results A total of 366 patients (222 Males, 61%), median age 6.3 (range 0.02 - 18.2) years were evaluated. Indications for referral included murmur (257, 70%), non-exertional symptoms (31, 9%), exertional symptoms (24, 7%), arrhythmia/bradycardia (12, 3%) and others (42, 11%). Echocardiograms were performed on 136 patients (51 were abnormal, 38%) and 70 patients were referred on for further management at the tertiary center. These referrals were for cardiac reasons in 63 patients and for non-cardiac reasons in 7 patients. Eleven patients did not follow up. Cardiac surgery was performed in 9 patients, transcatheter interventions in 4 patients, medical therapy was initiated in 4 patients and 2 patients are being scheduled for surgery/interventions. Patients have been followed for a median of 0.7 years (range 0 - 3.3). Conclusion An outreach pediatric cardiac clinic can help mitigate the healthcare barriers in an underserved immigrant and resettled refugee population in the US. This clinic served as a means to develop referral channels for long term care for these children with heart diseases. This platform can also be utilized for other subspecialty pediatric care in these populations.