{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:10:20Z","timestamp":1789607420670,"version":"build-2803163510"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T00:00:00Z","timestamp":1713398400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Unions Horizon 2020 research and innovation program","award":["101003480"],"award-info":[{"award-number":["101003480"]}]},{"DOI":"10.13039\/501100009318","name":"Helmholtz Association","doi-asserted-by":"publisher","award":["Initiative and Networking Fund"],"award-info":[{"award-number":["Initiative and Networking Fund"]}],"id":[{"id":"10.13039\/501100009318","id-type":"DOI","asserted-by":"publisher"}]},{"name":"German Federal Ministry of Education and Research","award":["NaFOUniMedCovid19 (FKZ: 01KX2021)"],"award-info":[{"award-number":["NaFOUniMedCovid19 (FKZ: 01KX2021)"]}]},{"DOI":"10.13039\/501100004350","name":"Studienstiftung des Deutschen Volkes","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004350","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nLimited evidence on utilisation of health care by recently arrived asylum seekers and refugees in high-income countries is available. This study aims to describe the implementation of an integrated care facility (ICF) in an initial reception centre and measure the utilisation of care and the influence of operational parameters.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nIn a retrospective cohort study design, using medical records, 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), and 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. We also explore the influence of operational parameters on the different implementation phases; phase 1: provisional clinic with 1\u20132 hours of physician presence daily, phase 2: implementation of ICF with 2\u20134 hours of care by a team of doctors and nurses daily, phase 3: routine running of ICF with daily operational hours of 10am\u20132pm with care provided by an interdisciplinary team of doctors and nurses.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\n14,419 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\u00b79\/day), yet the relative number of visits changed from 2\u00b72 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\u00b79 per person per month (95%CI 2\u00b79\u20133), more for those older, female, from North Africa and those with a translator present. The ratio of visits to the LED changed from 0\u00b73\/100 inhabitants per day to 0\u00b714\/100 inhabitants after implementation of the ICF and back to 0\u00b73\/100 inhabitants during the routine running.<\/jats:p>\n<\/jats:sec>\n\nConclusions<\/jats:title>\nThough seasonal variation and referral practices must be considered, a high rate of revisits to the ICF were recorded. While visits to the LED decreased after the implementation of the ICF, visits returned to the pre-ICF levels during the routine running of the ICF. The results show that AS&R require reliable access to health care, yet the needs of specific groups of migrants may be different, especially those with language barriers, minority groups or those from certain regions. As such, care should be migrant sensitive and adapt to the changing needs of the population. Though more research is required to better understand the differing needs of migrants, this study may help to inform guidelines surrounding migrant sensitive standards of care in Germany.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0299886","type":"journal-article","created":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T17:54:35Z","timestamp":1713462875000},"page":"e0299886","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Health care utilisation of asylum seekers and refugees in the South-West of Germany"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6970-3095","authenticated-orcid":true,"given":"Annabelle J.","family":"Bockey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelia","family":"Braun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Camp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ale\u0161","family":"Janda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winfried V.","family":"Kern","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Maria","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarina","family":"Stete","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siegbert R.","family":"Rieg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berit","family":"Lange","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,4,18]]},"reference":[{"issue":"5","key":"pone.0299886.ref001","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.polgeo.2011.04.011","article-title":"Domopolitics, governmentality and the regulation of asylum accommodation.","volume":"30","author":"J. Darling","year":"2011","journal-title":"Political Geography"},{"issue":"3","key":"pone.0299886.ref002","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/s12134-013-0296-2","article-title":"The Importance of Resources and Security in the Socio-Economic Integration of Refugees. A Study on the Impact of Length of Stay in Asylum Accommodation and Residence Status on Socio-Economic Integration for the Four Largest Refugee Groups in the Netherlands","volume":"15","author":"L Bakker","year":"2014","journal-title":"Journal of International Migration and Integration"},{"key":"pone.0299886.ref003","volume-title":"Ausgabe 02|2018 der Kurzanalysen des Forschungszentrums Migration, Integration und Asyl.","author":". Die Wohnsituation Gefl\u00fcchteter","year":"2018"},{"key":"pone.0299886.ref004","doi-asserted-by":"crossref","first-page":"1605786","DOI":"10.3389\/ijph.2023.1605786","article-title":"Type of Refugee Accommodation and Health of Residents: A Cross-Sectional, Population-Based Cluster Analysis in South-West Germany.","volume":"68","author":"A Mohsenpour","year":"2023","journal-title":"Int J Public Health."},{"key":"pone.0299886.ref005","unstructured":"Asylbewerberleistungsgesetz (AsylbLG) (Asylum Seekers\u2019 Benefits Act), (2022)."},{"issue":"1","key":"pone.0299886.ref006","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s12939-021-01607-y","article-title":"Inequalities in access to healthcare by local policy model among newly arrived refugees: evidence from population-based studies in two German states.","volume":"21","author":"J Wenner","year":"2022","journal-title":"Int J Equity Health"},{"issue":"4","key":"pone.0299886.ref007","first-page":"462","article-title":"[How do asylum seekers experience access to medical care?].","volume":"60","author":"A Spura","year":"2017","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"pone.0299886.ref008","author":"Robert Koch Institut","year":"2016","journal-title":"Dem Robert Koch-Institut \u00fcbermittelte meldepflichtige Infektionskrankheiten bei Asylsuchenden in Deutschland"},{"key":"pone.0299886.ref009","first-page":"41","year":"2015","journal-title":"Robert Koch Institut. Konzept zur Umsetzung fr\u00fchzeitiger Impfungen bei Asylsuchenden nach Ankunft in Deutschland Epidemiologisches Bulletin"},{"key":"pone.0299886.ref010","unstructured":"Robert Koch Institut Thorax-R\u00f6ntgenuntersuchungen bei Asylsuchenden1 gem\u00e4\u00df \u00a7 36 Absatz 4 IfSG Stellungahme des Robert Koch-Instituts Berlin2015 [Available from: https:\/\/www.rki.de\/DE\/Content\/InfAZ\/T\/Tuberkulose\/Tuberkulose_Roentgen-Untersuchungen_Asylsuchende.html."},{"issue":"1","key":"pone.0299886.ref011","first-page":"e8","article-title":"[Spectrum of diseases occurring in refugees and asylum seekers: data from three different medical institutions in the Munich area from 2014 and 2015].","volume":"141","author":"M Alberer","year":"2016","journal-title":"Dtsch Med Wochenschr"},{"issue":"9","key":"pone.0299886.ref012","doi-asserted-by":"crossref","first-page":"e1003337","DOI":"10.1371\/journal.pmed.1003337","article-title":"The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis.","volume":"17","author":"R Blackmore","year":"2020","journal-title":"PLoS Med"},{"key":"pone.0299886.ref013","volume-title":"The Roles, Functions, and Motivations of Volunteers in Helping to Ameliorate Reception Conditions for Asylum Seekers and Refugees-A case study of voluntary engagement at temporary asylum accommodation centres in Germany","author":"A. 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The Lancet"},{"issue":"10006","key":"pone.0299886.ref017","doi-asserted-by":"crossref","first-page":"1861","DOI":"10.1016\/S0140-6736(15)60854-6","article-title":"Health and climate change: policy responses to protect public health","volume":"386","author":"N Watts","year":"2015","journal-title":"The Lancet"},{"issue":"2","key":"pone.0299886.ref018","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.06.020704","article-title":"Health system resilience: Lebanon and the Syrian refugee crisis","volume":"6","author":"W Ammar","year":"2016","journal-title":"Journal of global health"},{"issue":"11","key":"pone.0299886.ref019","first-page":"772","article-title":"[Health care of refugees\u2014A short review with focus on infectious diseases].","volume":"141","author":"B Lange","year":"2016","journal-title":"Deutsche medizinische Wochenschrift (1946)."},{"issue":"4","key":"pone.0299886.ref020","first-page":"130","article-title":"Gesundheitsversorgung von Gefl\u00fcchteten: Zu gesicherten Daten kommen.","volume":"113","author":"O Razum","year":"2016","journal-title":"Dtsch Arztebl International."},{"issue":"1","key":"pone.0299886.ref021","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1186\/s12913-020-05579-7","article-title":"Patient satisfaction & use of health care: a cross-sectional study of asylum seekers in the Freiburg initial reception centre.","volume":"20","author":"AJ Bockey","year":"2020","journal-title":"BMC Health Serv Res"},{"issue":"9596","key":"pone.0299886.ref022","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"370","author":"E von Elm","year":"2007","journal-title":"Lancet"},{"issue":"1","key":"pone.0299886.ref023","first-page":"51","article-title":"Medizinethische Herausforderungen der Gesundheitsversorgung in der Erstaufnahme f\u00fcr Gefl\u00fcchtete am Beispiel des Aufbaus eines integrierten Versorgungsmodells in der Erstaufnahme in Freiburg.","volume":"64","author":"B Lange","year":"2018","journal-title":"Zeitschrift f\u00fcr medizinische Ethik."},{"key":"pone.0299886.ref024","volume-title":"Stata: Release 17. 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WHOROftW","year":"2016"},{"issue":"1","key":"pone.0299886.ref034","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1186\/s12889-020-08749-8","article-title":"Migrants\u2019 and refugees\u2019 health status and healthcare in Europe: a scoping literature review.","volume":"20","author":"A Lebano","year":"2020","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0299886.ref035","doi-asserted-by":"crossref","first-page":"47","DOI":"10.17294\/2330-0698.1709","article-title":"Enhancing Immunization Rates in Two Urban Academic Primary Care Clinics: A Before and After Assessment.","volume":"7","author":"Z Yacoob","year":"2020","journal-title":"J Patient Cent Res Rev."},{"issue":"21","key":"pone.0299886.ref036","first-page":"647","article-title":"Evaluation of a Program to Improve Linkage to and Retention in Care Among Refugees with Hepatitis B Virus Infection\u2014Three U.S. Cities, 2006\u20132018.","volume":"69","author":"J Young","year":"2020","journal-title":"MMWR: Morbidity & Mortality Weekly Report."},{"issue":"10164","key":"pone.0299886.ref037","doi-asserted-by":"crossref","first-page":"2606","DOI":"10.1016\/S0140-6736(18)32114-7","article-title":"The UCL-Lancet Commission on Migration and Health: the health of a world on the move","volume":"392","author":"I Abubakar","year":"2018","journal-title":"Lancet"},{"key":"pone.0299886.ref038","doi-asserted-by":"crossref","first-page":"23445","DOI":"10.3402\/gha.v7.23445","article-title":"The global health concept of the German government: strengths, weaknesses, and opportunities.","volume":"7","author":"K Bozorgmehr","year":"2014","journal-title":"Glob Health Action"},{"key":"pone.0299886.ref039","author":"\u00c4. Schleswig-Holstein","year":"2016","journal-title":"\u00c4rztliche Versorgung von Fl\u00fcchtlingen in Schleswig-Holstein"},{"key":"pone.0299886.ref040","author":"Verbraucherschutz SfSu","year":"2015","journal-title":"Gemei nsame Verwaltungsvorschrift des S\u00e4chsischen Staatsministeriums f\u00fcr soziales und Verbraucherschutz und des S\u00e4chsischen Staatsministeriums des lnnern zur gesundheitlichen Betreuung von Asylbewerbern und unbegleiteten minderi\u00e4hrigen Ausl\u00e4ndern durch die Gesundheits\u00e4mter im Freistaat Sachsen."},{"key":"pone.0299886.ref041","author":"D. Aidshilfe","year":"2014","journal-title":"Deutsche AIDS-Hilfe: HIV-Zwangstests in Bayern jetzt abschaffen"},{"key":"pone.0299886.ref042","article-title":"D, Fuchs O, von Mutius E. Caring for the Wave of Refugees in Munich","author":"M Nicolai T","year":"2015","journal-title":"N Engl J Med"},{"issue":"38","key":"pone.0299886.ref043","first-page":"1498","article-title":"\u00c4rzte in der Fl\u00fcchtlings-Erstaufnahme: Fr\u00fche Versorgung erm\u00f6glichen.","volume":"112","author":"P Brandenburg","year":"2015","journal-title":"Dtsch Arztebl International"},{"issue":"38","key":"pone.0299886.ref044","first-page":"1496","article-title":"Fl\u00fcchtlinge: Viele \u00c4rztinnen und \u00c4rzte helfen.","volume":"112","author":"H. Korzilius","year":"2015","journal-title":"Dtsch Arztebl International."},{"issue":"12","key":"pone.0299886.ref045","doi-asserted-by":"crossref","first-page":"e027945","DOI":"10.1136\/bmjopen-2018-027945","article-title":"Effects of introducing a walk-in clinic on ambulatory care sensitive hospitalisations among asylum seekers in Germany: a single-centre pre-post intervention study using medical records","volume":"9","author":"C Lichtl","year":"2019","journal-title":"BMJ Open"},{"issue":"5","key":"pone.0299886.ref046","doi-asserted-by":"crossref","first-page":"e0197881","DOI":"10.1371\/journal.pone.0197881","article-title":"Asylum-seekers in Germany differ from regularly insured in their morbidity, utilizations and costs of care.","volume":"13","author":"S Bauhoff","year":"2018","journal-title":"PLoS One."},{"issue":"10","key":"pone.0299886.ref047","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.3390\/ijerph15102163","article-title":"Healthcare Utilization in a Large Cohort of Asylum Seekers Entering Western Europe in 2015","volume":"15","author":"M Wetzke","year":"2018","journal-title":"International Journal of Environmental Research and Public Health"},{"issue":"1","key":"pone.0299886.ref048","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1186\/s12913-018-3174-y","article-title":"Health care provision for refugees in Germany\u2014one-year evaluation of an outpatient clinic in an urban emergency accommodation.","volume":"18","author":"HS Borgschulte","year":"2018","journal-title":"BMC Health Serv Res"},{"issue":"3","key":"pone.0299886.ref049","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1111\/1467-6494.00020","article-title":"Time series analysis in historiometry: a comment on Simonton.","volume":"66","author":"WF Velicer","year":"1998","journal-title":"J Pers."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0299886","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T17:54:59Z","timestamp":1713462899000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0299886"}},"subtitle":[],"editor":[{"given":"Cesar","family":"Infante Xibille","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,4,18]]},"references-count":49,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0299886","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,18]]}}}