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 …
Highlights
Our experiences show that quality circle (QC), which have proved a suitable instrument for quality improvement in German primary care over years, are helpful to foster quality improvements in special settings such as RCs for asylum seekers
Structural barriers such as legal restrictions, financial limitations, or a lack of national clinical guidelines for the specific setting of RCs limit the full potential of QCs to improve care
We argue that measures to assure high quality standards should be enforced in healthcare services for asylum seekers just as in regular care
Summary
After a negotiation and planning period of 8 months, medical services were initiated in February 2016. The cooperation of different professions in the clinic was seen as advantage but due to a high turnover of staff assuring continuity of care was challenging In this context, the need for improved documentation of medical data was raised. Legal aspects were mentioned as aggravating factors: The German Asylum Seekers Benefits Act limits the provision of care to acute and painful conditions, maternity care services, preventive medical checkups, vaccinations, and so called ’indispensable services’.7. This vague definition created uncertainties among providers about the scope of care provided in the clinic: acute and emergency care or continuous primary and specialised care. The strong commitment of all staff who perceived their tasks as being meaningful was considered a facilitating factor
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