Health Care Utilisation of Recently Arrived Asylum Seekers and Refugees in the South-West of Germany

Background: Limited evidence on utilisation of health care by recently arrived asylum seekers and refugees in high-income countries is available.Methods: In a monocentric cohort study design, we followed inhabitants of a reception centre in Germany between 11.10.2015 and 30.05.2018. We assessed frequency of visits and revisits to a newly established integrated care facility (ICF), the effects of the ICF on visits to the local emergency department (LED) in the regional tertiary hospital using survival analysis and time series regression.Findings: 14,419 total medical visits were recorded from 1,883 persons seeking health care in the ICF. The absolute number of visits per day remained similar over the study period (19·9/day), yet the relative number of visits changed from 2·2 to 15 per 100 inhabitants from phase 2 to 3, respectively. Most visits were due to respiratory infections (612/3080, 20%), and trauma and musculoskeletal conditions (441/3080, 14%). The rate of revisits to ICF was 2·9 per person per month (95%CI 2·9-3), more for those older, female, from North Africa and those with a translator present. The ratio of visits to the LED changed from 0·3/100 inhabitants per day to 0·14/100 inhabitants after implementation of the ICF and back to 0·3/100 inhabitants during the routine running.Interpretation: Though seasonal variation and referral practices must be considered, a high rate of revisits to the ICF were recorded. Visits to the LED returned to the pre-ICF levels during the routine running of the ICF after a decrease during the establishment of the ICF.Funding: Although no specific funding was received for undertaking this study, the authors of this study are supported by various funding grants and scholarships. AB is supported by a scholarship from the Studienstiftung des deutschen Volkes to undertake her doctoral dissertation. BL has received funding from the European Union Horizon 2020 research and innovation program under grant agreement No 101003480, the Initiative and Networking Fund of the Helmholtz Association, and NaFOUniMedCovid19 (FKZ: 01KX2021) supported by the German Federal Ministry of Education and Research (BMBF).Declaration of Interest: None to declare.Ethical Approval: Ethical approval was given by the ethical committee of the Freiburg University for this study (N 271/17- 273/17).