Care of minor refugees in Germany A survey in outpatient pediatric and adolescent medicine

Background: Since 2017 Germany has received more than 100,000 refugees per year. Approximately 40-50% of these were minor refugees. Recommendations for the medical care of these children and adolescents have been published. It is not yet clear how these recommendations are implemented in primary care.Objective: A survey was conducted to assess the current state of care for minor refugees in primary outpatient pediatrics in Germany. We evaluated how existing recommendations are implemented, aimed to identify obstacles and asked for measures that might improve the medical care of minor refugees in primary outpatient pediatrics.Methods: Data were obtained by an exploratory online survey. The questionnaire was developed based on current recommendations for primary outpatient care for minor refugees and on discussions within the German Society for General Primary Pediatrics (Deutsche Gesellschaft fur Allgemeine Ambulante Padiatrie, DGAAP).Results: Usual aspects of the medical history and physical examination are reliably assessed in primary care. Other aspects specific to displacement and flight are assessed only by a minority of primary care pediatricians. Furthermore, examinations like eyesight tests or audiometry are rarely conducted. Recommendations for the screening for infectious diseases are followed only in exceptional cases. A major obstacle in primary care is the language barrier and the significant physician working time required for a structured assessment of minor refugees. German pediatricians are not refunded either for the additional working time or for translation service. A vast majority of the survey participants agreed that a structured and defined standard of medical care with adequate financial funding should be developed for the outpatient care of newly arriving minor refugees.Conclusion: Further professionalization and standardization of care is desirable in view of the persistently high number of minor refugees in Germany.