Wahedi Katharina, Biddle Louise, Jahn Rosa, Ziegler Sandra, Kratochwill Steffen, Pruskil Susanne, Noest Stefan, Bozorgmehr Kayvan
Sektion Health Equity Studies & Migration, Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
Gesundheitsamt Altona, Hansestadt Hamburg, Hamburg, Deutschland.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2020 Dec;63(12):1460-1469. doi: 10.1007/s00103-020-03243-3. Epub 2020 Nov 12.
During the time of increased in-migration of asylum seekers to Germany in 2015 and 2016, different models of healthcare provision were established in reception centres, often on an ad hoc basis and influenced by local actors. The goal of this study was to map different care models and identify challenges in the implementation of effective and needs-based health service structures.Data was generated through 13 semi-structured interviews and in an interactive workshop with group discussions. An analysis was conducted using a qualitative content analysis method. Participants were stakeholders from clinics in reception centres, including medical and healthcare personnel, administrators, representatives of public health offices and researchers.Different models of ambulatory care have formed as a response to the particular medical needs of asylum seekers and the complex context in which care takes place, often exceeding the simple offer of primary care. The facilities fundamentally differ with regard to objectives and organisational aspects, e.g. the responsible carrier, structure of human resources and the extent of health services provided. Shared challenges include planning needs-based care, the lack of shared guidelines and a lack of opportunities for exchange between the different actors working in the clinics. Action is required to transform ad hoc initiatives into resilient health care practices, particularly regarding structured and continued opportunities for exchange, as well as the development and implementation of nation-wide guidelines. Jointly developed areas for action and proposed solutions presented here can serve as a basis for further work in this area.
在2015年和2016年寻求庇护者大量涌入德国期间，在接待中心建立了不同的医疗服务模式，这些模式通常是临时建立的，并受到当地行为体的影响。本研究的目的是梳理不同的护理模式，并确定实施有效且基于需求的卫生服务结构时面临的挑战。通过13次半结构化访谈以及一次有小组讨论的互动研讨会收集了数据。采用定性内容分析法进行了分析。参与者是接待中心诊所的利益相关者，包括医疗和医护人员、管理人员、公共卫生办公室代表和研究人员。针对寻求庇护者的特殊医疗需求以及护理所处的复杂环境，形成了不同的门诊护理模式，这些模式往往超出了初级护理的简单范畴。这些设施在目标和组织方面存在根本差异，例如责任承担方、人力资源结构以及所提供卫生服务的范围。共同面临的挑战包括规划基于需求的护理、缺乏共享指南以及诊所内不同行为体之间缺乏交流机会。需要采取行动将临时举措转变为有韧性的医疗保健实践，特别是在结构化和持续的交流机会以及制定和实施全国性指南方面。此处提出的共同制定的行动领域和建议解决方案可作为该领域进一步工作的基础。
