Characteristics and Utilization of Primary Care Services in a Torture Rehabilitation Center

DOI: 10.1007/s10903-006-8524-xJournal of Immigrant and Minority Health, Vol. 8, No. 2, April 2006 ( C 2006)Characteristics and Utilization of Primary Care

Services in a Torture Rehabilitation CenterAlejandro Moreno,1,2,3 Linda Piwowarczyk,1,5 Wayne W. LaMorte,4,6Michael A. Grodin1,3,5We conducted a retrospective chart review to look into the utilization of healthcare services

of refugees. Between December 1998 and June 2001, 146 refugees received care at the Boston

Center for Refugee Health and Human Rights. The mean age was 39 1 years; 57% were

males, and 84% were survivors of torture. A significant number of patients were diagnosed

with major depression (70%), post-traumatic stress disorder (58%), past hepatitis A infection

(77%), and tuberculosis classes 2 and 3 (42%). Patients had on average 2.3 0.1 initial health

assessments visits and 3.6 0.3 primary care follow-up visits during a mean follow-up period

of 12.8 0.8 months. Subjects with two or fewer initial health assessment visits were less

likely to be undergoing psychological counseling (OR: 0.22; 95%CI:0.080.58), less likely to

be seeking asylum (OR: 0.16; 95%CI: 0.060.43), and more likely to be self-referred (OR:9.6; 95%CI:2.439.6). Four or fewer primary care follow-up visits were more likely in subjects

who had no health insurance (OR: 7.2; 95%CI:2.025.5) and less likely in those referred for

psychological counseling (OR: 0.017; 95%CI:0.050.54). Patients had a higher prevalence of

mental health conditions than that reported in other studies and often declined diagnostic

and therapeutic interventions.KEY WORDS: refugees; depression; post-traumatic stress disorder; primary care; utilization of health

services.INTRODUCTIONRefugees are individuals who owing to a wellfounded fear of being persecuted for reasons of race,1Boston Center for Refugee Health and Human Rights, Boston

Medical Center, Boston, Massachusetts.2Austin Medical Education Programs at Brackenridge Hospital,

Austin, Texas.3Health Law Department, Boston University School of Public

Health, Boston, Massachusetts.4Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.5Department of Psychiatry, Boston University School of

Medicine, Boston, Massachusetts.6Department of Surgery, Boston University School of Medicine,

Boston, Massachusetts.7Correspondence should be directed to Alejandro Moreno, MD,

MPH, FACP, JD Candidate 2006, Austin Medical Education

Programs, Brackenridge Hospital, 601 East 15th Street, Annex

Building, Austin, TX 78701; e-mail: [email protected], nationality, membership of a particular social group or political opinion... request special

protection from the host nation (1). Over the past

25 years, their numbers have rapidly increased worldwide from...