Comprehensive immigrant and refugee health guidelines new resource for physicians

The largest, most comprehensive evidence-based guidelines to immigrant health — designed to help Canadian physicians meet the unique needs of this group — are being published in CMAJ (Canadian Medical Association Journal).

Immigrant and refugee health needs may differ significantly from those of Canadian-born people as they may have been exposed to different diseases, environment and living conditions as well as genetic factors.

The guidelines, based on evidence from around the world, are focused on helping primary care physicians provide for the often complex health needs of immigrants and refugees. Created by the Canadian Collaboration for Immigrant and Refugee Health, the project involved more than 150 investigators, including 43 family doctors, 34 researchers, staff and nurse practitioners as well as other authors.

The size of Canada's immigrant population is growing but there is a lack of evidence-based information on approaches to immigrant health. Worldwide, there are more than 200 million international migrants whose movement across borders has significant health impacts for many countries. While health task forces in Canada and the US have developed clinical prevention recommendations, they are not directly tailored toward the unique backgrounds and needs of immigrants and refugees.

"Use of evidence-based methods has yet to substantially affect the field of migration medicine," writes Dr. Kevin Pottie, University of Ottawa, with coauthors. "Our evidence reviews synthesized data from around the world, and our recommendations focus on immigrants, refugees and refugee claimants, with special attention given to refugees, women and the challenges of integrating recommendations into primary care," he states.

"Our recommendations differ from other guidelines because of our insistence on finding evidence for clear benefits before recommending routine interventions," state the authors. For example, in the case of possible intestinal parasites but no symptoms, the guidelines recommend blood testing for certain parasites and forgoing traditional stool testing, marking a shift in practice.

The package includes a summary document, clinical guidelines to immigrant health, online case studies and detailed evidence and methodologies. Content focuses on four areas: infectious diseases; mental health and physical and emotional maltreatment; chronic and noncommunicable diseases; and women's health. Detailed indexes on specific illnesses and conditions including post-traumatic stress, mental health, pediatric issues and more make it easy for to find information.

The first few sections of the guidelines were published in CMAJ online in June 2010. This is now the comprehensive package of the full guidelines.

"More work must be done to improve immigrants' access to health services," conclude the authors. "We hope this evidence-based initiative will provide a foundation for improved preventive health care for immigrant populations."

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