A narrative synthesis of the impact of primary health care delivery models for refugees in resettlement countries on access, quality and coordination

Abstract

IntroductionRefugees have many complex health care needs which should be addressed by the primary health care services, both on their arrival in resettlement countries and in their transition to long-term care. The aim of this narrative synthesis is to identify the components of primary health care service delivery models for such populations which have been effective in improving access, quality and coordination of care.MethodsA systematic review of the literature, including published systematic reviews, was undertaken. Studies between 1990 and 2011 were identified by searching Medline, CINAHL, EMBASE, Cochrane Library, Scopus, Australian Public Affairs Information Service – Health, Health and Society Database, Multicultural Australian and Immigration Studies and Google Scholar. A limited snowballing search of the reference lists of all included studies was also undertaken. A stakeholder advisory committee and international advisers provided papers from grey literature. Only English language studies of evaluated primary health care models of care for refugees in developed countries of resettlement were included.ResultsTwenty-five studies met the inclusion criteria for this review of which 15 were Australian and 10 overseas models. These could be categorised into six themes: service context, clinical model, workforce capacity, cost to clients, health and non-health services. Access was improved by multidisciplinary staff, use of interpreters and bilingual staff, no-cost or low-cost services, outreach services, free transport to and from appointments, longer clinic opening hours, patient advocacy, and use of gender-concordant providers. These services were affordable, appropriate and acceptable to the target groups. Coordination between the different health care services and services responding to the social needs of clients was improved through case management by specialist workers. Quality of care was improved by training in cultural sensitivity and appropriate use of interpreters.ConclusionThe elements of models most frequently associated with improved access, coordination and quality of care were case management, use of specialist refugee health workers, interpreters and bilingual staff. These findings have implications for workforce planning and training.

Barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review of qualitative literature

“…33,77 It is known that language and cultural barriers are considerable obstacles in the access to health care. 75,[78][79][80][81][82][83] Therefore, care providers should have unlimited access to high-quality translation services; those are not readily available in many of the studied countries now. 75 Cross-cultural training of health care providers and the availability of bilingual, multidisciplinary teams may also be considered as these are associated with better health outcomes.…”

“…75 Cross-cultural training of health care providers and the availability of bilingual, multidisciplinary teams may also be considered as these are associated with better health outcomes. 81 This systematic review provides information regarding TB diagnosis and control in EU, EEA, and OECD countries, but mostly highlights the limited number of studies that have been conducted for specific hardto-reach populations. We identified knowledge gaps within the available qualitative literature on TB in EU, EEA, and OECD countries, and in middle and low-incidence countries in general.…”

Transition from an asylum seeker–specific health service to mainstream primary care for community-based asylum seekers: a qualitative interview study

“…6,7 The Status Resolution Support Services (SRSS) program, funded by the Australian Government Department of Home Affairs (DHA), provides services to asylum seekers while their claims are being resolved. These may include financial assistance, housing, case management and access to schooling.…”

“…6 The transition is often complicated by a lack of coordination between specialised and mainstream services 9 , reluctance among patients to transition 10 , difficulties in medical record transfer 11 , and the vulnerability of patients from a refugee background.…”

Canada’s response to refugees at the primary health care level

“…6 Encouraging and training community family physicians to accept refugees has been an ongoing challenge 7 ; this has also been documented in systematic reviews in Australia. 8 …”