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

Chandni Joshi,Margaret Kay,Margaret Alston,I-Hao Cheng,Sayed Shukrullah Wahidi,Mark F Harris,Winston Lo,Shiva Vasi,Grant Russell,Mitchell Smith,Kevin Pottie,Bibiana Chan

doi:10.1186/1475-9276-12-88

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.

Highlights

Refugees 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
This review focuses on primary health care (PHC) service delivery models for refugee populations and the impacts of components of these models on access, coordination and quality of care in countries of resettlement, with the aim of informing refugee health policy and its implementation
We found relatively few evaluated models of refugee health care in countries of resettlement

Summary

Introduction

Refugees 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. The refugee community in Australia is culturally and linguistically diverse, originating from more than 40 different countries [1]. PHC services need to be able to meet these challenges both on refugees’ arrival and in their transition to long-term care [3], providing culturally appropriate and timely care [6]

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