Identification, management and care of refugee patients at a metropolitan public health service: a healthcare worker perspective.

Abstract

Objective To describe the perceptions of healthcare workers employed at a metropolitan public health service, with respect to how they identify, manage and care for refugee patients. Methods This study surveyed healthcare workers using a cross-sectional, mixed methods descriptive design, which partially replicates a previous Australian study. A total of 215 responses to a brief online survey were received (n=48 medical, n=100 nursing and midwifery, n=50 allied health, n=4 other). Results Nurses and allied health respondents were more likely to record working with refugees rarely or never (P=0.00). Most respondents (70.3%) identified no negative effects from working with refugees, and perceived this patient group enhanced (71.3%) their work. Insufficient identification, interpreter availability, education, healthcare worker capacity and providing culturally specific treatment were all identified as potential service barriers. Allied health respondents were more likely to report low confidence about working with refugees in general (P=0.04). Respondents with more than 10 years' experience with refugees (P=0.02), and those with good self-perceived awareness of community services (P=0.01), were more confident in their ability to manage social issues. Conclusions This study suggests that contextual factors influence the perceptions of healthcare workers who provide care to refugee patients; however, communication, health literacy and healthcare worker capacity were consistently raised as key issues when working with refugees. What is known about the topic? Refugee and asylum seeker patients may present with complex health needs to any part of the Australian health system. The majority of previous research has occurred in primary care settings. What does this paper add? This study adds an acute and subacute perspective to the evidence base, and also includes medical respondents for the first time. Compared to previous research, respondents of this study saw refugee patients more frequently in their practice, and also reported fewer negative effects from working with them. Most demographic characteristics had no significant effect on worker-reported confidence in this study; however, greater experience of working with refugees and good self-perceived awareness of community services were both identified as positive influences. What are the implications for practitioners? Practitioners should prioritise remedying barriers that are consistently identified as affecting the service provided to refugee patients (communication, health literacy and healthcare worker capacity) as part of their quality and service improvement efforts.