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Effects of introducing a walk-in clinic on ambulatory care sensitive hospitalisations among asylum seekers in Germany: a single-centre pre–post intervention study using medical records
  1. Celina Lichtl1,2,
  2. Kayvan Bozorgmehr1,3
  1. 1 Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
  2. 2 Institute of General Practice and Family Medicine, Ludwig Maximilians University Munich, Munich, Germany
  3. 3 Department of Population Medicine and Health Services Research, School of Publilc Health, Bielefeld University, Bielefeld, Germany
  1. Correspondence to Prof Dr Kayvan Bozorgmehr; kayvan.bozorgmehr{at}


Objective Measuring the effect of introducing a walk-in clinic on ambulatory care sensitive (ACS) hospitalisations among asylum seekers in a large state reception- and registration centre.

Design and setting Pre–post intervention study using anonymous account data from a university hospital functioning as referral facility for a state reception- and registration centre in the third largest German federal state.

Participants We included all asylum seekers residing in the reception centre and admitted to the referral hospital between 2015 to 2017.

Interventions Establishment of an interdisciplinary walk-in clinic in the reception centre (02/2016).

Main outcome measures International lists for ACS conditions for both adults and children were adapted and used to calculate the prevalence of ACS conditions among the population (primary outcome measure). The impact of the intervention on the outcome was analysed using a segmented Poisson regression to calculate incidence-rate ratios with respective 95% CIs, adjusted for age, sex and admission.

Results The prevalence of ACS hospitalisations changed over time, as did the effect of age, sex and quarter of admission. Introducing the walk-in clinic reduced the prevalence of ACS hospitalisations among asylum seekers compared with the period before establishment of the clinic (incidence-rate ratios (IRR)=0.80 (0.65 to 1.00), p=0.054), but the effect was attenuated after adjustment for time trends. The average difference in prevalence of ACS hospitalisations compared with the period before establishment of the clinic, corrected for pre-existing time trends, age and sex of asylum seekers was IRR=1.03 ((0.69 to 1.55), p=0.876).

Conclusions A walk-in clinic in reception centres may be effective to reduce ACS hospitalisations, but our study could not prove evidence for a measurable effect after full adjustment for time trends. Further research, ideally with parallel control groups, is required to establish evidence for the effectiveness of walk-in clinics in reception centres on reducing ACS hospitalisations.

  • ambulatory care sensitive hospitalisations
  • ambulatory care sensitive conditions
  • quality in health care
  • health services research
  • asylum seekers

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  • Contributors Conceived the study: KB. Data analysis: CL, KB. Writing of first draft: KB, CL. Writing of subsequent drafts: KB, CL. All authors have approved and contributed to the final written manuscript.

  • Funding This study was part of the BMBF-funded project RESPOND ('Improving Regional Health System Responses to the challenge of forced migration through tailored interventions for asylum-seekers and refugees'). The last author received financial support by the Federal Ministry of Research and Education (BMBF) in the scope of the research programme 'Strukturaufbau in der Versorgungsforschung' (grant number: FKZ 01GY1611). We acknowledge financial support by Deutsche Forschungsgemeinschaft and Ruprecht-Karls-Universität Heidelberg within the funding programme Open Access Publishing.

  • Competing interests KB was actively involved in designing and setting-up the walk-in clinic. KB functions (among others) as coordinator for primary care related aspects of the walk-in clinic for the University Hospital Heidelberg, CL was involved in the process of the establishment of the walk-in clinic as a member of the Students4PHV-Project Heidelberg.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the ethical committee of the Medical Faculty of the University of Heidelberg prior to onset of the study (Ethical approval number S-061/2016).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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