Primary care
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Developing an integrated model of health care for refugees, asylees, immigrants, and special immigrant visa holders requires a multifaceted approach due to their unique and complex health care needs. This article provides an in-depth understanding of the components necessary to develop a model of care addressing the needs of immigrants and to share opportunities and challenges associated with these models. This includes highlighting population- and individual-level factors important to caring for immigrant populations, providing guidance on creating a model of care that addresses these factors, and describing established clinics that exemplify various models of care.
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Circumstances forcing individuals and families to flee set the stage for disruptions in mental health and forge resilience. Individual characteristics and conditions premigration, perimigration, and postmigration influence health, mental health, care-seeking behavior, and stages of well-being and successful resettlement. ⋯ Integrated or collaborative care models are ideal for delivering optimum care for refugee and immigrant communities. Connecting primary and behavioral care promotes a team approach; provides comprehensive, whole-person care; and relies on participation of patients and families.
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This article describes hematologic, nutritional, allergic/asthmatic conditions, lead screening, and management of these among immigrants and refugees. Some of these conditions present more frequently or differently in the newcomer population. ⋯ Screening and treatment suggested in this article are based on current guidelines and are intended for primary care providers who are caring for refugee and immigrant patients, especially within a medical home. Special considerations include level of education, instruction, demonstration, and cultural humility.
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Immigrant and refugee patients may have limited English proficiency. Effective use of professional interpreter services reduces clinically significant errors and increases the quality of care. ⋯ Children less than 18 years of age should only be used as interpreters in emergency situations. Professional telephonic, video, or in-person interpreters each have distinct advantages in specific clinical situations.
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This article describes the different ways culture affects health care, in terms of patient-related factors, health care provider-related factors, and health care system-related factors. This article also reviews interventions and best practices that draw on the incorporation of culture into health care and that thus may be effective for building cross-cultural understanding between providers and their immigrant and refugee patients.