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

International Journal for Equity in Health

Research

Mark F Harris¹  Bibiana Chan¹  Chandni Joshi¹  Kevin Pottie²  Margaret Alston³  Margaret Kay⁴  Mitchell Smith⁵  Winston Lo⁶  I-Hao Cheng⁷  Grant Russell⁷  Sayed Shukrullah Wahidi⁷  Shiva Vasi⁷ 

[1] Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia;Department of Family Medicine, and Department of Epidemiology & Community Medicine, The University of Ottawa, Canadian Collaboration for Immigrant and Refugee Health, Ottawa, Canada;Department of Social Work, Monash University, Melbourne, Australia;Discipline of General Practice, The University of Queensland, Brisbane, Australia;New South Wales Refugee Health Service, South Western Sydney Local Health District, Sydney, Australia;School of Public Health & Community Medicine, The University of New South Wales, Sydney, Australia;Southern Academic Primary Care Research Unit, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia;

关键词: Access;    Coordination;    Health care models;    Primary health care;    Quality of care;    Refugee;    Migrant;    Immigrant;    Health services evaluation;   

DOI  :  10.1186/1475-9276-12-88

 received in 2013-06-10, accepted in 2013-11-03,  发布年份 2013

来源: Springer

【 摘 要 】

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.

【 授权许可】

Unknown   
© Joshi et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.