Assessing adherence to accepted national guidelines for immigrant and refugee screening and vaccines in an urban primary care practice: A retrospective chart review

BACKGROUND: 36.7 million people in the US are foreign-born. Primary care providers are challenged by the need to provide appropriate screening, immunization and follow up to this population. OBJECTIVE: To assess provider adherence to accepted national guidelines for immigrant and refugee health screenings and vaccines in the primary care clinic at Boston Medical Center. METHODS: Retrospective chart review of foreign-born patients seen at the Primary Care Clinic at Boston Medical Center. A random sample of 100 charts was assessed for patient demographics, receipt of vaccines and screenings, immigration history and status. Results were analyzed using SPSS. RESULTS: Migration history was recorded in 35% of charts. Only 43% of patients had TB screening, 36% screened for HIV and varicella, and 33% received TD boosters. No significant differences were observed by type of clinician, number of visits, or patient age. Screening for TB was strongly associated with Hepatitis B screening, but paradoxically did not predict HIV screening. CONCLUSION: Foreign-born patients are not getting screenings and immunizations that conform to CDC recommendations. Suggestions for direct interventions include: adding prompts and dropdown menus to the EMR; initiation of protocol and standing orders for screening foreign-born patients as part of the nursing intake; and creation of a checklist for the direct care provider. In addition, initiation of regular educational programs with current information on local immigrant populations, their cultures, concerns and history, and collaborating with other immigrant focused programs will foster greater motivation to meet the needs of this community.