Experiences and observations from a care point for displaced Ukrainians: a community case study in Antwerp, Belgium

Background 7307 Ukrainians refugees moved to Antwerp, Belgium during the study period (01/04/2023-31/12/2023). The city’s administration set up three care centers where these people were introduced in the Belgian primary care system, a medical file was created, and acute/preventive/chronic care was delivered. This community case study analyses the organization and contents of care and reflects upon its meaning for the mainstream health care system. Methods This is an observational study using routine electronic medical record data to measure uptake of care. For a sample of 200 subjects, a retrospective chart review was conducted in order to extract data from patient records. Participants all refugees with a medical file at one of the three participating care centers. Main Outcomes For the observational study, 2261 patients were reached (30% of the potential users) and 6450 contacts were studied. The nurses (including midwives) did 4929/6450 (76%) of all consultations, the GPs 1521/6450 (24%). Out of the 4929 nurse consultations, 955 (19%) were followed by another nurse consultation and 866 (18%) by a GP consultation. In the structured case reviews most contacts concerned acute problems (609/1074, 57%). The most prevalent reasons for encounter and diagnoses concerned typical primary care issues. The nurses were able to manage half of the cases independently (327, 55%), referred to the GP in 37% (N=217), and consulted a GP (live, by telephone or a dedicated app) for 8% (48). GPs mostly prescribed drugs, referred to a medical specialist and advised over-the-counter drugs while nurses more often advised over-the-counter drugs (mostly paracetamol, nose sprays and anti-inflammatory drugs), gave non-medical advice or ordered lab tests. Discussion The medical care points delivered mostly typical acute primary care in this first phase, with a key role for nurses. These results will inform policy makers on the use of primary care centers for newly arriving patients in times of crisis. A nurse first model seems feasible and efficient, but evaluation of safety and quality of care are needed. Once the acute phase of this crises fades away, questions about the comprehensiveness, continuity, and integration of care for migrants remain relevant. ### Competing Interest Statement Authors VV and SM received a single payment by the city of Antwerp for a previous analysis of similar data. Author KM works as a nurse and health expert for the city of Antwerp, department of Health. She engaged in the set up and the coordination of the studied care points. She did not perform any clinical work related to this paper. The city of Antwerp was not involved in the design of the study, the analysis, and the decision to publish. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: TheAntwerp University hospital Institutional Review Board gave ethical approval for this work. The studies were conducted in accordance with the local legislation and institutional requirements. The ethics committee/institutional review board waived the requirement of written informed consent for participation from the participants or the participants' legal guardians/next of kin because pseudonymised files were used, individual consent was not possible. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes