Treating Latent Tuberculosis Infection in Newly Arriving Refugees: An Advanced Practice Nurse Initiative at the University of Louisville Global Health Center

Background: A review of newly arriving refugees referred to the local health department for latent tuberculosis infection (LTBI) treatment during 2013-2015 revealed a treatment gap of 73%, supporting the need to identify new approaches to treat vulnerable populations and mirrored results in the literature. Objectives: 1) Describe an advanced practice registered nurse (APRN) led alternative approach to LTBI treatment in the refugee population; and 2) evaluate the impact of a 12-week regimen for LTBI on treatment acceptance, adherence and completion. Methods: During the initial health screening visit, treatment options were provided for those identified with LTBI consisting of either a 12-week regimen requiring weekly directly observed therapy (DOT) or the traditional 9-month treatment. Results: During March-December 2016, 50 refugees were referred and 24/50 were offered a 12-week regimen of Rifapentine and Isoniazid, administered with DOT. 23 of the 24 or 96% completed the entire treatment course. Conclusions: The new LTBI clinic process resulted in an increase in treatment acceptance and completion compared with the historic rate of 27%. Implications for Nursing: APRN initiatives such as this can result in positive benefits to patients and communities while serving to advance the nursing profession in all practice setting

Use of Emergency Department for Care Access by Refugees Resettling in Kentucky, 2015: Findings from the University of Louisville Global Health Center

Background: Kentucky is one of the largest rural resettlement areas for refugees in the US welcoming more than 3,000 refugees and other entrants during 2015. Refugees arrive with a number of chronic health conditions that require ongoing management in a healthcare system where they lack knowledge and ability to navigate. This may encourage them to seek care that is easy to access but episodic and fragmented. The objective of this study was to determine the frequency and reasons for accessing care via a local emergency department by resettling refugees during their first twelve months of resettlement. Methods: Using data from domestic health screening, crossmatching was done with the Emergency Department (ED) database of a local university medical center. Records were reviewed to determine If the ED was accessed for care, day and time care was accessed, chief complaint at the time of ED arrival, discharge diagnosis and final disposition. Results: Of 2616 refugees seen for health screening during 2011-2015, 77 (3%) sought care in the ED at least one time during the twelve months following their arrival, encompassing a total of 96 unique ED visits. Of the 96 ED visits, 83 (86%) were seen and discharged with the remaining 13 (14%) being admitted to ULH or referred for admission to another facility (e.g., mental health). Of the 83 discharged visits, 51 (61%) were determined to be preventable ED visits. Care was accessed more frequently on Monday (19%), Sunday (18%) and Thursday (17%). 57 of the 83 discharged visits (69%) occurred during hours that reflect those common for routine business in a clinic setting (8 AM - 4 PM). Of ED visits during those routine business hours, 34 (60%) were determined to be preventable ED visits. Discussion: This study represents the first published data regarding ED use by refugees resettling into a single community. These data provide insight into the use of an ED as a point of care access and the role that access plays in refugee healthcare, especially during the earliest phase of resettlement. Conclusions: These data may serve to inform development of a refugee-centered medical home with the objective to improve access to coordinated and comprehensive care