Welcome to the 26th WONCA Europe Virtual Conference Programme Scheduling

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Background: The prevalence of hemoglobinopathies is increasing in The Netherlands due to migration, as in most North-European countries. The treatment options are limited and patients suffer from a severe chronic disease. If carriers were detected, couples at risk can make informed reproductive choices, such as termination of affected pregnancies or pre-implantation diagnosis.

Method: A mixed-method design was used to both evaluate the prevalence of hemoglobinopathies in the region of The Hague and explore the needs and wishes of patients, carriers and general practitioners. The quantitative part included patient and carrier registries from the hospital, laboratory and general practitioners. The qualitative part contained telephone interviews with ten of each general practitioners, patients and carriers. The interviews were audio-recorded, transcribed verbatim and analysed using content analysis to identify recurring themes.

Results: The highest prevalence of hemoglobinopathy coincided with immigrant neighborhoods in The Hague. This study revealed a gap between the estimated carrier prevalence and the registration of carriers. Three themes emerged illustrating the need for prevention of hemoglobinopathy in daily practice: (1) the need for more knowledge about hemoglobinopathy, (2) the need for indications when to refer for analyses and (3) insight into the organization and roles in hemoglobinopathy care. These themes reflect the need for more education for general practitioners to increase awareness for hemoglobinopathies.

Conclusion: Even though more research is needed to define which requirements are needed in our healthcare system, this study clearly shows the urgency of the problem and the need for action to increase informed reproductive decision making for the population at risk.

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Background

Primary healthcare practitioners (PHPs) are the first point of care for refugee and asylum seekers in Australia. Communication plays a vital role in their care and developing the PHP-patient relationship. This environmental scan identifies, appraises and synthesises online resources to improve communication during consultations with these patients.

Methods

A systematic environmental scan of online Australian resources, using Google search engine was conducted. The content of the resources was appraised, and they were evaluated for understandability and actionability, purpose and content.

Results

A total of 32 unique resources were identified. The identified resources on average scored better on understandability domains (mean 64%) than actionability (mean 49%). The resources each had between 2-5 purposes taxonomy types and the content relevant to communication with refugee and asylum seekers ranged from 5-100%.

Conclusions

Australian PHPs looking for resources to help guide their communication during consultations with refugee and asylum seeker patients have multiple options available to them. This scan synthesises the online resources with practical suggestions for implementation into practice. Markers of quality and usefulness of the various resources have yet to be established, which makes it difficult to assess the value and uptake of these resources in clinical practice.

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1. Background and purpose

During the COVID-19 pandemic, social distancing measures to prevent transmission of the virus have been implemented in most countries. The effect of these measures on loneliness and depressive symptoms especially for vulnerable groups remained unclear. Research questions: How are levels of loneliness and depressive symptoms during the COVID-19 pandemic measures in Germany? Do lesbian, gay, bisexual, trans, inter and asexual (LGBTIA) persons show higher levels of loneliness as compared to the cis-heterosexual persons?

2. Methods

We conducted an online survey in two waves (March/April 2020 and January/February 2021). Loneliness was measured by the De Jong Gierveld short scale. The survey contained additionally self-categorizations regarding sexual orientation and identity, questions on social contacts, depressive symptoms and health care. Descriptive and regression analysis was conducted using R.

3. Results

2641 participants from across Germany took part in first wave of the survey and 4143 participants in the second wave. The proportion of lonely people increased from the first to the second wave. Risk factors for loneliness were being without partner, living alone, not working and being LGBTIA. Especially, asexual, trans and non-binary persons had a strongly increased risk for loneliness (52% resp. 49% resp. 48%). Loneliness was associated with depressive symptoms.

4. Conclusions

The results are in line with minority stress models, however, it remains unclear if loneliness in asexual and trans person is in general increased or due to the measures. GPs should be aware of the sexual orientation and gender identity of their patients. GPs should not hesitate to ask patients from risk groups for loneliness.

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Background and purpose

Segregation is a known risk factor for health. In Hungary, 332,658 inhabitants are living in the segregated colonies of 937 settlements. The number of people living in these settlements’ non-segregated parts (complementary areas) is 7,370,949. This study investigated the effect of segregation on healthcare use.

Methods

A cross-sectional study included all Hungarian settlements with segregated colonies. Data on health care services usage in 2019 (on the frequency of GP visits, outpatient services’ usage, and hospital admissions) was provided by the National Health Insurance Fund. Dissimilarity index (DI) was computed for each settlement as the ratio of age, sex, and eligibility for exemption certificate standardized service delivery frequency for colony and complementary areas. The effect of settlement-level social environment (education, employment, income, crowdedness of households, ethnicity, and county by the last census of 2011) on healthcare usage was evaluated by multivariate linear regression.

Results

Dissimilarity index aggregated for the whole country was DI=1.27 for GP visits, DI=0.95 for outpatient services, and DI=1.21 for hospital admission. Settlement-level DI was positively associated with proportion of Roma for frequency of GP visit (b=0.160, p=0.002), outpatient care (b=0.155, p=0.004), and hospital admission (b=0.183, p=0.001) Higher level of employment raised the DI for GP visits (b=0.198, p=0.008) and hospital visits (b=0.308, p<0.001). Moreover, rise in income increased the DI for GP visits (b=0.214, p=0.007) and outpatient services’ use (b=0.176, p=0.037).

Conclusion:

Living in segregated colonies is a strong influencing factor for healthcare service use, which is partly determined significantly by the local socio-economic environment.

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Backround and purpose: Some 50% of refugees in Germany are affected by depression, anxiety or post-traumatic stress disorder as a result of their experience. Especially young children are impaired in their development. In this study we evaluate the impact of a psychological intervention performed by general practitioners (GP) to support the mental health problems (MHP) of this patient group.

Methods: 375 Arabic speaking parents in Germany with young children are included in a controlled trial, and randomly assigned to intervention or control group, rsp. The intervention group receives four 30 minutes sessions over a period of ten weeks, delivered by trained GPs, and an established online parenting program to improve mental health and parenting of the parents, whereas the control group is treated as usual. Data are collected of the parents and children before, directly after and six/twelve months after the intervention. Primary outcome are MHP of parents and children as indicated by using methods like the clinician severity rating, PSOC, Mini- or Infant–DIPS and CSR-P/ -C. Severity Ratings will be performed by blinded trained raters. All interventions and measurements were translated into Arabic and piloted to their cultural sensitivity. Cost-effectiveness analyses and culturally sensitive assessments will also be investigated next to guided qualitative expert interviews of GPs to analyze barriers of treatment.

Conclusion: Based on the outcome of our study we anticipate a potential for improvement in the primary care of refugee families, and a potential to support GPs to deal with cultural and language barriers with these patients.

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Background and Aim: The civil war in Syria forced millions of people to seek refuge in other regions. In 2015, Canada launched the Syrian Refugee Resettlement Initiative and resettled over 40,000 refugees. This study examined data collected for the Syrian Refugee Integration and Long-term Health Outcomes in Canada study (SyRIA.lth). The primary aim was to evaluate the prevalence of depression-level symptoms at baseline and one-year post-resettlement and analyze its predictors. Methods: Through a variety of community-based strategies, 1924 Syrian refugees were recruited. Structured interviews were administered in Arabic in 2017 and 2018. Depression symptoms were measured using Patient Health Questionnaire 9 (PHQ-9). Analysis for associated factors was executed using multinomial logistic regression. Results: Mean age was 38.5 years (SD 13.8). Sample included 49% males and 51% females settled in Ontario (48%), Quebec (36%) and British Columbia (16%). Over 74% always needed an interpreter, and only 23% were in employment. Prevalence of depression-level symptoms (i.e. PHQ-9 >/= 10) was 15% at baseline and 18% in year-2 (p<0.001). Out of 1519 participants who did not have depression-level symptoms at baseline (i.e. PHQ-9 < 10) and their measurements for year-2 were available, 185 (12.2%) changed to depression-level symptoms at year-2. Significant predictors of depression-level symptoms at year-2 were baseline depression, sponsorship program (government, private, blended visa), province, poor language skills, lack of satisfaction with housing conditions and with health services, lower perceived control, lower perceived social support and longer stay in Canada. Conclusion: Increase in depression-level symptoms deserves attention through focusing on identified predictors particularly baseline depression scores, social support, perceived control and language ability.