gms | German Medical Science

18. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

09. - 11.10.2019, Berlin

Impact factors on the emergency room utilization by refugees

Meeting Abstract

Suche in Medline nach

  • Karoline Köster - bbw Hochschule, fib Forschungsinstitut, Berlin, Germany
  • Thomas Zahn - bbw Hochschule, fib Forschung, Berlin, Germany

18. Deutscher Kongress für Versorgungsforschung (DKVF). Berlin, 09.-11.10.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. Doc19dkvf501

doi: 10.3205/19dkvf501, urn:nbn:de:0183-19dkvf5011

Veröffentlicht: 2. Oktober 2019

© 2019 Köster et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Background: There are numerous special demands, burdens and risks associated with being a refugee in Germany. In the migratory process, which often takes several generations, people are required to make drastic and subtle adaptations in the long term. Germany is providing health care for people with a migration background for more than 30 years. The number of immigrants has increased sharply since 2015, forming a special group of potential patients.

The aim of this innovation fonds funded study is to contribute significantly to a relevant and up-to-date data base, which allows to develop effective intercultural concepts to integrate refugees into the German health care. Based on the findings of the study it is intended to implement those concepts to educate refugees and professionals in order to conduct health services appropriately.

Research question: The primary research question of this study is where and how to take action to prevent inappropriate use of emergency care by migrants.

The study part B conducted by bbw University examines the specific group of refugees in order to determine the impact migration-specific elements on the one hand and knowledge, experiences and attitudes regarding health care on the other hand on emergency room utilization.

The primary outcome parameter of this study is the use of emergency room services within 12 Month. Investigated impact factors include migration background, health literacy, language skills, information habits and knowledge on German healthcare system.

Hypothesis: The use of emergency rooms by patients with a refugee background is often inappropriate. This is mainly caused by communication difficulties and lack of health literacy.

Methods: 559 participants have been interviewed in integration and language courses of bbw Bildungswerk and cooperating organizations supporting the integration of refugees between 07/2017 and 06/2018. The interviews were conducted in the mother tongue of the study participant. 48 % of study population were male, the average age was 28,5. The participants were mainly originating from Syria (88%), Iran (15%), Iraq (9%) and Afghanistan with 74% indicating flight as their main reason for coming to Germany. The vast majority (90%) has entered Germany 2015 or later.

In structured interviews data have been collected regarding the following topics: basic information about life situation, language competencies, state of acculturation, knowledge of the German healthcare system, procedure in case of illness, information habits and channels, and use of various health care services especially emergency rooms.

Results: Problems in communication and interaction with outpatient physicians are significantly associated with higher use of emergency units by refugees. i.e. participants with communication problems reported more than doubled use of emergency rooms.

Lack of basic knowledge of German health care also significantly influences the overuse of emergency units. i.e. study participants, who couldn‘t tell a correct helpline number used emergency units nearly twice as often as participants with knowledge of at least one German helpline number.

50% of the participants lack any knowledge about preventive care and 25% don’t know anything about medication, health aids and appliances.

In addition, the habits of gathering information about health correlate with the use of emergency units. A positive habit or attitude about gathering health information is linked to fewer use of emergency units. In comparison, Interviewees who don’t inform / don’t want to inform themselves have on average 46% more visits to emergency rooms than informed/information seeking respondents.

Discussion: Scant knowledge in German health care structures and communication problems (not reduced to language barriers) between refugees and medical staff are the main reasons of higher use of emergency units. Therefore, approaches to improve health care provision for refugees must be designed in those regards. Employers, doctors and public authorities can each inform up to 20% more refugees about responsibilities in case of illness and thus significantly extend their impact on appropriate use of care. Also improving the intercultural communication between primary care physicians and refugees is likely to have a positive impact on the number of refugees using emergency units.

Practical implications: To assist in the process of providing appropriate care to refugees intercultural trained guides could be established during the setup of new integrated (inpatient / outpatient) emergency centers. Those guides would be capable of helping especially multi users of emergency rooms, to understand and organize their individual health situation. They should serve as mediators between different cultural preconditions and health relevant habits – not simply as translators to overcome language barriers.