Lichtl Celina, Bozorgmehr Kayvan
Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany.
Institute of General Practice and Family Medicine, Ludwig Maximilians University Munich, Munich, Germany.
BMJ Open. 2019 Dec 4;9(12):e027945. doi: 10.1136/bmjopen-2018-027945.
Measuring the effect of introducing a walk-in clinic on ambulatory care sensitive (ACS) hospitalisations among asylum seekers in a large state reception- and registration centre.
Pre-post intervention study using anonymous account data from a university hospital functioning as referral facility for a state reception- and registration centre in the third largest German federal state.
We included all asylum seekers residing in the reception centre and admitted to the referral hospital between 2015 to 2017.
Establishment of an interdisciplinary walk-in clinic in the reception centre (02/2016).
International lists for ACS conditions for both adults and children were adapted and used to calculate the prevalence of ACS conditions among the population (primary outcome measure). The impact of the intervention on the outcome was analysed using a segmented Poisson regression to calculate incidence-rate ratios with respective 95% CIs, adjusted for age, sex and admission.
The prevalence of ACS hospitalisations changed over time, as did the effect of age, sex and quarter of admission. Introducing the walk-in clinic reduced the prevalence of ACS hospitalisations among asylum seekers compared with the period before establishment of the clinic (incidence-rate ratios (IRR)=0.80 (0.65 to 1.00), p=0.054), but the effect was attenuated after adjustment for time trends. The average difference in prevalence of ACS hospitalisations compared with the period before establishment of the clinic, corrected for pre-existing time trends, age and sex of asylum seekers was IRR=1.03 ((0.69 to 1.55), p=0.876).
A walk-in clinic in reception centres may be effective to reduce ACS hospitalisations, but our study could not prove evidence for a measurable effect after full adjustment for time trends. Further research, ideally with parallel control groups, is required to establish evidence for the effectiveness of walk-in clinics in reception centres on reducing ACS hospitalisations.
评估在一个大型州接收和登记中心引入随诊诊所对寻求庇护者中门诊医疗敏感型（ACS）住院率的影响。
采用前后干预研究，使用来自一所大学医院的匿名账户数据，该医院是德国第三大联邦州一个州接收和登记中心的转诊机构。
纳入了2015年至2017年期间居住在接收中心并被转诊至该医院的所有寻求庇护者。
2016年2月在接收中心设立了一个跨学科随诊诊所。
采用适用于成人和儿童的ACS疾病国际清单来计算该人群中ACS疾病的患病率（主要结局指标）。使用分段泊松回归分析干预对结局的影响，计算发病率比及相应的95%置信区间，并对年龄、性别和入院情况进行调整。
ACS住院率随时间变化，年龄、性别和入院季度的影响也如此。与诊所设立前相比，引入随诊诊所降低了寻求庇护者中ACS住院率（发病率比（IRR）=0.80（0.65至1.00），p=0.054），但在对时间趋势进行调整后，该效果减弱。在对寻求庇护者的既往时间趋势、年龄和性别进行校正后，与诊所设立前相比，ACS住院率的平均差异为IRR=1.03（（0.69至1.55），p=0.876）。
接收中心的随诊诊所可能有助于降低ACS住院率，但我们的研究未能在对时间趋势进行充分调整后证明其有可测量的效果。需要进一步开展研究，理想情况下设置平行对照组，以证实接收中心的随诊诊所在降低ACS住院率方面的有效性。
