Characteristics and utilization of primary care services in a torture rehabilitation center

We conducted a retrospective chart review to look into the utilization of healthcare services of refugees. Between December 1998 and June 2001, 146 refugees received care at the Boston Center for Refugee Health and Human Rights. The mean age was 39 ± 1 years; 57% were males, and 84% were survivors of torture. A significant number of patients were diagnosed with major depression (70%), post-traumatic stress disorder (58%), past hepatitis A infection (77%), and tuberculosis classes 2 and 3 (42%). Patients had on average 2.3 ± 0.1 initial health assessments visits and 3.6 ± 0.3 primary care follow-up visits during a mean follow-up period of 12.8 ± 0.8 months. Subjects with two or fewer initial health assessment visits were less likely to be undergoing psychological counseling (OR: 0.22; 95%CI:0.08-0.58), less likely to be seeking asylum (OR: 0.16; 95%CI: 0.06-0.43), and more likely to be self-referred (OR: 9.6; 95%CI:2.4-39.6). Four or fewer primary care follow-up visits were more likely in subjects who had no health insurance (OR: 7.2; 95%CI:2.0-25.5) and less likely in those referred for psychological counseling (OR: 0.017; 95%CI:0.05-0.54). Patients had a higher prevalence of mental health conditions than that reported in other studies and often declined diagnostic and therapeutic interventions.