ORIGINAL PAPER Health Care Utilization of Refugee Children After Resettlement Delma-Jean Watts • Jennifer F. Friedman • Patrick M. Vivier • Christine E. A. Tompkins • Anthony J. Alario Published online: 20 September 2011 Ó Springer Science+Business Media, LLC 2011 Abstract Refugee children can have significant health problems. Our objective was to describe health status and health care utilization of refugee children after resettle- ment. A retrospective chart review of refugee children was performed. Initial laboratory data was extracted. Primary care visits, emergency room visits, and subspecialty referrals in the first 15 months from arrival were recorded. The sample included 198 refugees, many with positive initial screening tests. After arrival, 21% had an emergency department visit, 40% had a primary care sick visit, and 71% had a primary care follow-up. Mean number of visits ranged from 0.3 for emergency department to 1.9 for fol- low-up. Fifty-seven percent were referred to at least one subspecialist. Refugee children had substantial disease burden at arrival. Most had primary care follow-up visits and subspecialty referral after resettlement. These visits were largely for problems identified on initial screening and for general pediatric illnesses. Keywords Refugee Á Emergency department Á Primary care Á Health care utilization Introduction Many refugees experience war, hunger, and poor sanitation prior to resettlement to a third country. Given this, refugee children are often not surprisingly found to have substantial disease burden at initial medical screening appointments upon arrival to the United States. For example, rates of positive purified protein derivative (PPD) tests have ranged from 20% in Buffalo, NY to 35% in Portland, Maine [1–3]. Eleven percent of newly arrived refugee children in Mas- sachusetts were found to have elevated lead levels [4]. When the authors looked specifically at African children, 27% had elevated lead levels. Of children returning stool samples, studies have shown rates of pathogenic parasites from 21 to 46% [2, 3, 5]. Significant rates of anemia, malnutrition, positive hepatitis B surface antigen, and dental caries have also been found [1–3, 5, 6]. Although many studies have characterized the health status of newly arrived refugees, less is known about how their health care needs are addressed and their utilization of health care services after resettlement. Previous research addressing health care utilization in this population has focused on adult usage of primary care and emergency care services [7–9]. The frequency of, and indications for, health care utilization by refugees, particularly children, is still unclear. The few studies that have been done have had mixed findings. For example, Weinstein et al. found that adult D.-J. Watts (&) Á C. E. A. Tompkins Department of Pediatrics, Rhode Island Hospital and Alpert Medical School of Brown University, Potter Suite 200, 593 Eddy Street, Providence, RI 02903, USA e-mail: Delma-Jean_Watts@brown.edu J. F. Friedman Department of Pediatrics, Rhode Island Hospital and Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903, USA J. F. Friedman Lifespan Center for International Health Research, Providence, RI, USA P. M. Vivier Departments of Community Health and Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA A. J. Alario Department of Pediatrics, UMass Memorial Children’s Medical Center, Worcester, MA, USA 123 J Immigrant Minority Health (2012) 14:583–588 DOI 10.1007/s10903-011-9530-1