Quality circles to identify barriers, facilitating factors, and solutions for high-quality primary care for asylum seekers.

Abstract

In 2015 Germany received more than 476 600 asylum applications.1 Incoming asylum seekers are accommodated in reception centres (RCs) for up to 6 months before they are dispersed to other federal states or districts. Due to the high immigration since the end of 2014, many federal states established new RCs to expand their capacities in hosting asylum seekers. Baden Wurttemberg, for example, one of the largest federal states receiving about 13% of incoming asylum seekers, expanded its capacity from one RC up until 2014 to five RCs thereafter. Since there are no nationwide standards in place, healthcare provision in RCs is highly heterogeneously organised and fragmented.2 In Heidelberg, former barracks of the US army were reorganised as an RC in August 2015 and hosted about 6500 asylum seekers. The concentration of asylum seekers in the RC, linked with insufficient provision of primary health care, led to an unmanageable number of consultations in emergency departments of nearby hospitals. Asylum seekers have specific healthcare needs due to exposure to pre-, peri-, and postmigration health risks. These include traumatic events,3 endemic infectious diseases in the countries of origin or transit,4 and chronic conditions which may have been exacerbated during the migration process. They are also at higher risk of developing psychological distress5 and acquiring infectious diseases in the host country due to mass accommodation.6 To address both the shortcomings in primary care provision and the special needs, a walk-in clinic jointly led by the university hospital, the public health services, and the local physicians’ association was established in the RC with funds from the state government and the university hospital. The clinic provides general medicine as well as gynecological, paediatric, and psychiatric and psychosomatic health care. The aim of this article is to report challenges and solutions of …