title: Quality of primary care for resettled refugees in the Netherlands with chronic mental and physical health problems: a cross-sectional analysis of medical records and interview data.
abstract: BACKGROUND
  A high prevalence of mental and physical ill health among refugees resettled in the Netherlands has been reported. With this study we aim to assess the quality of primary healthcare for resettled refugees in the Netherlands with chronic mental and non-communicable health problems, we examined: a) general practitioners' (GP) recognition of common mental disorders (CMD) (depression and anxiety, and post-traumatic stress disorder (PTSD) symptoms); b) patients' awareness of diabetes type II (DMII) and hypertension (HT); and c) GPs' adherence to guidelines for CMD, DMII and HT.
  
  
  METHODS
  From 172 refugees resettled in the Netherlands, interview data (2010-2011) and medical records (n = 106), were examined. Inclusion was based on medical record diagnoses for DMII and HT, and on questionnaire-based CMD measures (Hopkins Symptom Checklist for depression and anxiety; Harvard Trauma Questionnaire for PTSD). GP recognition of CMD was calculated as the number of CMD cases registered in the medical record compared with those found in interviews. Patient awareness of HT and DMII was scored as the percentage of subjects diagnosed by the GP who reported their condition during the interview. GPs' adherence to guidelines for CMD, DMII and HT was measured using established indicators.
  
  
  RESULTS
  We identified 37 resettled refugees with CMD of which 18 (49%) had been recognised by the GP. We identified 16 refugees with DMII and 14 with HT from the medical record; 24 (80%) were aware of their condition. Thirty-five out of these 53 (66%) resettled refugees with chronic mental and non-communicable disorders received guideline-adherent treatment.
  
  
  CONCLUSIONS
  This study shows that awareness in resettled refugees of GP diagnosed DMII and HT is high, whereas GP recognition of CMD and overall guideline adherence are moderate.
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.a.vanmelle-2@umcutrecht.nl.
authors.forename: Marije A
authors.initials: MA
authors.lastname: van Melle
authors.forename: Majda
authors.initials: M
authors.lastname: Lamkaddem
authors.forename: Martijn M
authors.initials: MM
authors.lastname: Stuiver
authors.forename: Annette A M
authors.initials: AA
authors.lastname: Gerritsen
authors.forename: Walter L J M
authors.initials: WL
authors.lastname: Devillé
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Essink-Bot
mesh_terms: D000328:Adult; D000346:Afghanistan / Q000208:ethnology; D001007:Anxiety / Q000453:epidemiology / Q000628:therapy*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy*; D007492:Iran / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D012036:Refugees / Q000523:psychology / Q000706:statistics & numerical data*; D012998:Somalia / Q000208:ethnology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000628:therapy*