Lewiston Maine has the second highest number of refugees in the state of Maine, with 191 total intakes in 2015.  Refugee populations face unique health concerns, and providing care for refugees requires education and development of a specialized skill set.  This project provided a reference for clinic providers to assist with medical intake screening visits for refugees.https://scholarworks.uvm.edu/fmclerk/1244/thumbnail.jp

Hayes, Catherine

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University of VermontScholarWorks @ UVMFamily Medicine Clerkship Student Projects Larner College of Medicine2016Development of Guidelines for Refugee Screeningat CMMC Family Medicine Residency, Lewiston,MaineCatherine HayesUniversity of VermontFollow this and additional works at: https://scholarworks.uvm.edu/fmclerkPart of the Medical Education Commons, and the Primary Care CommonsThis Book is brought to you for free and open access by the Larner College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion inFamily Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contactdonna.omalley@uvm.edu.Recommended CitationHayes, Catherine, "Development of Guidelines for Refugee Screening at CMMC Family Medicine Residency, Lewiston, Maine"(2016). Family Medicine Clerkship Student Projects. 218.https://scholarworks.uvm.edu/fmclerk/218Development of Guidelines for Refugee Screening at CMMC Family Medicine Residency, Lewiston, MaineCatherine Hayes, UVM College of Medicine, MSIIIMentors: Dr. Bruce Kenney, Dr. John Lowery, Dr. Bethany Picker, Sally Weiss MSOctober - November 20162. Problem IdentificationInitial medical intake screening for refugees to be completed within 30-90 days of arrival in United States Increased risk of infectious and noninfectious diseases among refugee populationsSpecific conditions depend on country of origin [6]Lewiston has second highest number of refugees in state of Maine behind Portland, with 191 total intakes (primary and secondary refugees and asylum seekers) in 2015 [4]Typically about 300 total primary refugee screenings in Maine for patients over a 12 month periodAugust 2016: 160 new refugee patients needing screening, overwhelming systemDHHS reached out to medical clinics to help meet these needs3. Public Health CostSurvey of 232 New Americans living in Lewiston-Auburn found many living with a variety of health conditions [1]Chronic medical conditions: diabetes, high blood pressure (85 each)Mental health: stress (77), sadness/depression (62), trauma/violence (47)Other public health concerns: lead poisoning (52), hepatitis (21), tuberculosis (20)Lead poisoning: higher rates than state average in Lewiston-Auburn primarily due to older rental housing Estimated that each cohort of children born in Maine will earn $270 million less throughout lifetime due to on average 1 point lower IQ from effects of lead [2]Failing to detect other health conditions during initial refugee screening will likewise result in a public health burden4. Community PerspectiveJoan Churchill, Director B Street ClinicB Street Clinic (primary healthcare site for refugees in Lewiston-Auburn) was down a provider, wait times for appointmentsUsed to be periodic provider training offered through state of Maine, but has not happened for last 3 yearsDr. John Lowery, Medical Director CMMC Family Medicine ResidencyCMMC recognized the increased need for providers to do these screeningsProviders and staff volunteered their time to help serve the communityScreenings are complex, require time, attention to detail, and education about refugee/international medicine5. Intervention/MethodologyLiterature review of CDC guidelines for domestic medical examination for newly arriving refugeesAttended International Clinic at Maine Medical Center to see example of established refugee health program in MaineCreated draft of reference and received feedback from providers at CMMC on ways to improve reference guideParticipated in two evening refugee clinics at CMMC Family Medicine Residency6. ResultsCreated a two page document consolidating the CDC guidelines Specific attention paid to key history and lab components that differ from typical domestic new patient encountersCopies of guideline were distributed to residents and attendings volunteering at the refugee clinics  Reference was used during the 9 clinic sessions held at the CMMC Family Medicine Residency6a. Refugee Screening Reference7. Effectiveness/LimitationsEffectivenessFeedback from CMMC: “I like the way it is organized…very easy to read and makes something that is complex fairly simple.”“These are very complex office visits with many moving parts.  The reference is an extremely helpful tool to navigate this office visit in an efficient and effective way, ensuring that all aspects of comprehensive evaluation are covered.”LimitationsBased on current guidelines, which will change over timeAimed at general guidelines for refugee health, but each individual and country of origin requires nuanced approachPaper guide, but user must input the information gathered into the electronic medical record8. Future InterventionsYearly training session during new intern orientation aimed at refugee health Interactive/role-playing activityEnsure all CMMC Family Medicine Residency staff are familiar with refugee needs, since these patients will be returning for their primary care needsEstablish template within the electronic medical record for new refugee patient visitsOrder sets (vaccinations, laboratory testing) that can be applied to refugee patientsOptimize interpreter services to ensure language needs of patients are being met9. References1. “A Portrait of Health Needs: Self-reported Health Needs Among New Americans In Lewiston-Auburn.”  Healthy Androscoggin.  October 2015.  2. Davis, Mary E. . "Economic Assessment of Children’s Health and the Environment in Maine." Maine Policy Review 19.1 (2010) : 36-44, http://digitalcommons.library.umaine.edu/mpr/vol19/iss1/6.3. “Domestic Refugee Health Guidelines: Malaria.” US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Disease, Division of Global Migration and Quarantine. November 13 2012.  4. “Frequently Asked Questions.”  Catholic Charities Refugee and Immigration Services. http://www.ccmaine.org/refugee-immigration-services/faqs. Web. 12 Nov 2016.  5. “General Refugee Health Guidelines.” US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Disease, Division of Global Migration and Quarantine. August 6 2012.  6. “Guidelines and Discussion of the History and Physical Examination.”  US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Disease, Division of Global Migration and Quarantine.  April 16 2012.  7. “Guidelines for Evaluating and Updating Immunizations During the Domestic Medical Examination for Newly Arrived Refugees.” US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Disease, Division of Global Migration and Quarantine.  June 11 2015.  8. “Guidelines for Evaluation of the Nutritional Status and Growth in Refugee Children During the Domestic Medical Screening Examination.” US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Disease, Division of Global Migration and Quarantine.  November 4 2013.  9. “Guidelines for Mental Health Screening During the Domestic Medical Examination for Newly Arrived Refugees.” US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Disease, Division of Global Migration and Quarantine.  June 11 2015.  10. “Guidelines for Screening for Tuberculosis Infection and Disease During the Domestic Medical Examination for Newly Arrived Refugees.” US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Disease, Division of Global Migration and Quarantine.  April 16 2012.  11. “Intestinal Parasite Guidelines for Domestic Medical Examination for Newly Arrived Refugees.” US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Disease, Division of Global Migration and Quarantine.  November 6 2013.  12. “Lead Screening During the Domestic Medical Examination for Newly Arrived Refugees.” US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Disease, Division of Global Migration and Quarantine.  September 18 2013.  13. “Screening for Hepatitis During the Domestic Medical Examination for Newly Arrived Refugees.” US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Disease, Division of Global Migration and Quarantine.  March 5 2014.  14. “Screening for HIV Infection During the Domestic Medical Examination for Newly Arrived Refugees.” US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Disease, Division of Global Migration and Quarantine.  April 16 2012.  15. “Screening for Sexually Transmitted Infections During the Domestic Medical Examination for Newly Arrived Refugees.” US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Disease, Division of Global Migration and Quarantine.  April 7 2014.  

Development of Guidelines for Refugee Screening at CMMC Family Medicine Residency, Lewiston, Maine

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Development of Guidelines for Refugee Screening at CMMC Family Medicine Residency, Lewiston, Maine

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