265999 Assessing adherence to accepted national guidelines for immigrant and refugee screening and vaccines in an urban primary care practice: A retrospective chart review

Monday, October 29, 2012 : 11:15 AM - 11:30 AM

Barbara Waldorf, BSN, MPH , International Health Department, Boston University School of Public Health, Boston, MA
Christopher Gill, MS, MD , International Health Department, Boston University School of Public Health, Boston, MA
Sondra Crosby, MD , Department of Medicine, Boston University School of Medicine, Boston, MA
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.

Learning Areas:
Clinical medicine applied in public health
Public health or related nursing

Learning Objectives:
1. Identify three reasons why it is important to take migration history as part of the screening of foreign-born populations. 2. Describe 3 potential methods to increase accurate screening and provision of recommended screening and immunizations to foreign-born populations.

Keywords: Refugees, Screening

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an RN with experience in primary care and community outreach. I am currently enrolled in an MPH program at BUSPH and have completed this research as part of my studies.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.