Skip to main content

Advertisement

SpringerLink
Log in

Assessing Adherence to Accepted National Guidelines for Immigrant and Refugee Screening and Vaccines in an Urban Primary Care Practice: A Retrospective Chart Review

  • Original Paper
  • Published:
Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

In the United States, 38.5 million people are foreign-born, one in three arriving since 2000. Health issues include high rates of hepatitis B, humanimmunodeficiency virus infection, parasitic infections, and M. tuberculosis. We sought to determine rates of provider adherence to accepted national guidelines for immigrant and refugee health screening and vaccines done at the primary care clinics at Boston Medical Center. Randomized, retrospective chart review of foreign born patients in the primary care clinics. We found low screening and immunization rates that do not conform to CDC/ACIP guidelines. Only 43 % of immigrant patients had tuberculosis screening, 36 % were screened for HIV and hepatitis B, and 33 % received tetanus vaccinations. Organizational changes incorporating multi-disciplinary approaches such as creative use of nursing staff, protocols, standing orders, EMR reminders, and web based educational tools can contribute to better outcomes by identifying patients and improving utilization of guidelines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Cain LE, Logan R, Robins JM, Sterne JAC, Sabin C, Bansi L, et al. When to initiate combined antiretroviral therapy to reduce mortality and AIDS-defining illness in HIV-infected persons in developed countries: an observational study. Ann Intern Med. 2011;154(8):509–15.

    Article  PubMed  Google Scholar 

  2. Kitahata MM, Gange SJ, Abraham AG, Merriman B, Saag MS, Justice AC, et al. Effect of early versus deferred antiretroviral therapy for HIV on survival. N Engl J Med. 2009;360(18):1815–26.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. US Census Bureau. Selected characteristics of the Foreign-born population by period of entry into the United States—2010 American Community Survey 1 year estimates [Internet]. [cited 2012 Apr 27]. Available from: http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_1YR_S0502&prodType=table.

  4. Barnett ED. Infectious disease screening for refugees resettled in the United States. Clin Infect Dis. 2004;39(6):833–41.

    Article  PubMed  Google Scholar 

  5. Christiansen D, Barnett ED. Comparison of varicella history with presence of varicella antibody in refugees. Vaccine. 2004;22(31–32):4233–7.

    Article  PubMed  Google Scholar 

  6. Richards B. Tuberculosis surveillance among new immigrants in Montreal. The International Journal of Tuberculosis and Lung Disease. 2005; 9(8):pp 858–864(7).

  7. Skull SA, Ngeow JYY, Hogg G, Biggs B-A. Incomplete Immunity and missed vaccination opportunities in East African immigrants settling in Australia. J Immigrant Minority Health. 2007;10(3):263–8.

    Article  Google Scholar 

  8. Adams KM, Gardiner LD, Assefi N. Healthcare challenges from the developing world: post-immigration refugee medicine. BMJ. 2004;328(7455):1548–52.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Dicker S, Stauffer WM, Mamo B, Nelson C, O’Fallon A. Initial refugee health assessments. New recommendations for Minnesota. Minn Med. 2010;93(4):45–8.

    PubMed  Google Scholar 

  10. Martin D, Yankay J. Refugees and Asylees: 2011 [Internet]. 2012 [cited 2012 May 25]. Available from: http://www.dhs.gov/files/statistics/publications/refugees-asylees-2011.shtm.

  11. CDC—Medical Examination—immigrant and refugee health [Internet]. [cited 2012 Apr 27]. Available from: http://www.cdc.gov.ezproxy.bu.edu/immigrantrefugeehealth/exams/medical-examination.html.

  12. New Bostonians—Demographic report [Internet]. [cited 2012 Apr 27]. Available from: http://www.cityofboston.gov/newbostonians/publications.asp.

  13. Boston Medical Center | Boston Hospital, Academic Medical Center | Exceptional Care without Exception [Internet]. [cited 2011 Mar 24]. Available from: http://www.bmc.org/.

  14. Refugee and Immigrant Health—Massachusetts [Internet]. [cited 2010 Nov 9]. Available from: http://www.mass.gov/?pageID=eohhs2terminal&L=4&L0=Home&L1=Provider&L2=Guidelines+and+Resources&L3=Guidelines+for+Clinical+Treatment&sid=Eeohhs2&b=terminalcontent&f=dph_cdc_p_refugee_health&csid=Eeohhs2.

  15. Migration Information Source—Refugee Resettlement in Metropolitan America [Internet]. [cited 2013 Feb 7]. Available from: http://www.migrationinformation.org/feature/display.cfm?id=585.

  16. CDC—Refugee New Arrival Medical Screening Checklist—Domestic Guidelines—Immigrant and Refugee Health [Internet]. [cited 2012 Mar 26]. Available from: http://www.cdc.gov.ezproxy.bu.edu/immigrantrefugeehealth/guidelines/domestic/checklist.html.

  17. Initial Health Assessment/Refugee Health Assessment (RHA)—Health and Human Services—Mass.Gov [Internet]. [cited 2012 Apr 27]. Available from: http://www.mass.gov/eohhs/consumer/specific-populations/refugees-asylees/refugee-health/rha.html.

  18. CDC Data & Statistics | Feature: Reported Tuberculosis in the United States, 2010 [Internet]. [cited 2012 Apr 3]. Available from: http://www.cdc.gov.ezproxy.bu.edu/Features/dsTB2010Data/.

  19. Cain KP, Benoit SR, Winston CA, Mac Kenzie WR. Tuberculosis among foreign-born persons in the United States. JAMA. 2008;300(4):405–12.

    Article  CAS  PubMed  Google Scholar 

  20. CDC—Domestic Tuberculosis Guidelines—Immigrant and Refugee Health [Internet]. [cited 2012 Mar 31]. Available from: http://www.cdc.gov.ezproxy.bu.edu/immigrantrefugeehealth/guidelines/domestic/tuberculosis-guidelines.html.

  21. Museru OI, Vargas M, Kinyua M, Alexander KT, Franco-Paredes C, Oladele A. Hepatitis B virus infection among refugees resettled in the US: high prevalence and challenges in access to health care. J Immigrant Minority Health. 2010;12(6):823–7.

    Article  Google Scholar 

  22. Brodine SK, Thomas A, Huang R, Harbertson J, Mehta S, Leake J, et al. Community based parasitic screening and treatment of Sudanese refugees: application and assessment of centers for disease control guidelines. Am J Trop Med Hyg. 2009;80(3):425–30.

    PubMed  Google Scholar 

  23. Marcos L, Terashima A, Canales M, Gotuzzo E. Update on Strongyloidiasis in the Immunocompromised Host. Curr Infect Dis Rep. 2011;13(1):35–46.

    Article  PubMed  Google Scholar 

  24. Seybolt. Diagnostic evaluation of newly arrived asymptomatic refugees with Eosinophilia. Clin Infect Dis. 2006;42(3):363–7.

    Article  PubMed  Google Scholar 

  25. Stauffer WM, Kamat D, Walker PF. Screening of international immigrants, refugees, and adoptees. Prim Care: Clin Office Pract. 2002;29(4):879–905.

    Article  Google Scholar 

  26. Kroger AT, Atkinson WL, Marcuse EK, Pickering LK. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2006;55(RR-15):1–48.

    PubMed  Google Scholar 

  27. CDC—Domestic Immunizations Guidelines—Immigrant and Refugee Health [Internet]. [cited 2012 Mar 21]. Available from: http://www.cdc.gov.ezproxy.bu.edu/immigrantrefugeehealth/guidelines/domestic/immunizations-guidelines.html.

  28. Nelson KR, Bui H, Samet JH. Screening in special populations: a “case study” of recent vietnamese immigrants. Am J Med. 1997;102(5):435–40.

    Article  CAS  PubMed  Google Scholar 

  29. Stone EG, Morton SC, Hulscher ME, Maglone MA, Roth EA, Grimsjaw JM. Interventions that increase use of adult immunization and cancer screening services: a meta-analysis. Ann Intern Med. 2002;136(9):641–51.

    Article  PubMed  Google Scholar 

  30. Loo TS, Davis RB, Lipsitz LA, Irish J, Bates CK, Agarwal K, et al. Electronic medical record reminders and panel management to improve primary care of elderly patients. Arch Intern Med. 2011;171(17):1552–8.

    Article  PubMed  Google Scholar 

  31. The Community Guide—targeted vaccinations: Multiple interventions implemented in combination [Internet]. [cited 2012 Mar 25]. Available from: http://www.thecommunityguide.org/vaccines/targeted/multi_combination.html.

  32. Damiani G, Pinnarelli L, Colosimo SC, Almiento R, Sicuro L, Galasso R, et al. The effectiveness of computerized clinical guidelines in the process of care: a systematic review. BMC Health Serv Res. 2010;10:2.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Briss PA, Rodewald LE, Hinman AR, Shefer AM, Strikas RA, Bernier RR, et al. Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. Am J Prev Med. 2000;18(1, Supplement 1):97–140.

    Article  CAS  PubMed  Google Scholar 

  34. Refugee Health Provider Resources—Minnesota Dept. of Health [Internet]. [cited 2010 Nov 12]. Available from: http://www.health.state.mn.us/divs/idepc/refugee/hcp/index.html.

  35. Kennedy J, Seymour DJ, Hummel BJ. A comprehensive refugee health screening program. Public Health Rep. 1999;114(5):469–77.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Grigg-Saito D, Toof R, Silka L, Liang S, Sou L, Najarian L, et al. Long-term development of a “whole community” best practice model to address health disparities in the Cambodian refugee and immigrant community of Lowell, Massachusetts. Am J Public Health. 2010;100(11):2026–9.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Conflict of interest

The authors have no financial disclosures.

Author information

Authors and Affiliations

  1. Department of International Health, Boston University School of Public Health, 801 Massachusetts Ave, Crosstown 3, Boston, MA, 02118, USA

    Barbara Waldorf & Christopher Gill

  2. Department of Medicine, Boston University School of Medicine, Boston, MA, USA

    Sondra S. Crosby

  3. Department of Health Law, Bioethics and Human Rights, Boston University School of Public Health, Boston, MA, USA

    Sondra S. Crosby

Authors
  1. Barbara Waldorf
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher Gill
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sondra S. Crosby
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Barbara Waldorf.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Waldorf, B., Gill, C. & Crosby, S.S. Assessing Adherence to Accepted National Guidelines for Immigrant and Refugee Screening and Vaccines in an Urban Primary Care Practice: A Retrospective Chart Review. J Immigrant Minority Health 16, 839–845 (2014). https://doi.org/10.1007/s10903-013-9808-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10903-013-9808-6

Keywords

Search

Navigation