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Table 1 Key definitions used in the review

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

Terms Definitions
Refugee A refugee is a person forced to flee his or her home due to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, and who is unable or unwilling to return to his or her country of origin [2]. This includes humanitarian refugees with permanent residency visas, refugee asylum seekers (in community and detention), refugees with temporary protection visas. This review is primarily focused on refugees whose time since arrival in their country of resettlement is less than10 years.
Primary health care Primary care is the level of the health service system “that provides entry into the system for all new needs and problems. Primary care provides person-centred care over the continuum of time, assistance for all common conditions, and co-ordinates and integrates care provided by others” [19]. We take PHC to include care provided in the community settings through general practice, private and publicly funded community, allied health and nursing services and non-government organisations. Activities carried out in PHC include:
• Assessment of health on arrival, including identification of infectious disease, mental health
• Ongoing management of acute or chronic illnesses, mental illnesses, psychosocial illnesses
• Provision of preventive care
• Referral to or links with more specialised medical services
• Referral, links to or provision of social care, housing, employment, education, or legal advice.
Model of care A model of care describes the way in which a complex range of health services are organised and delivered [20]. This may be defined by principles (such as equity, accessibility, comprehensiveness, coordination), care delivery systems (e.g. multidisciplinary, on-line, the nature of consumers and the pathway of care which they must negotiate (e.g. entry, referral, etc.) and the range of services provided (e.g. medical specialist, generalist). These are underpinned by organisational and infrastructural elements which include:
• health service funding/cost to clients/system: government, non-government organisation, private
• provider workforce: e.g. general practitioners, nurses, social workers, allied health
• organisation: team, network, integrated service
Access to the service Access is the opportunity or ease with which consumers or communities are able to use appropriate services in proportion to their need [21]. As such it is influenced by both provider and consumer characteristics. Andersen described a model in which health care utilisation was determined by population and health system characteristics and influenced by patient satisfaction and outcomes [22]. The characteristics of PHC which determine their accessibility have been described by Pechansky (1981) [23] and more recently by Gulliford et al. [24] as:
• Availability of a sufficient volume of services (including professionals, facilities and programmes) to match the needs of the population and the location of services close to those needing them
• Affordability (cost versus consumers’ ability to pay, impact of health care costs on socioeconomic circumstances of patients)
• Accommodation – the delivery of services in such a manner that those in need of them can use them without difficulty (e.g. appropriate hours of opening, accessible buildings)
• Appropriateness to socioeconomic, educational, cultural and linguistic needs of patients
• Acceptability in terms of consumer attitudes and demands
Coordination of care This involves coordination of care between multiple providers and services with the aim of achieving improved quality of care and common goals for patients [25]. It may involve
• Care planning
• Informal communication between workers or services
• Team meeting, case conferences, interagency meetings
• Shared assessments and records
• Coordination with non-health services including language services (interpreters, translated health information), formal settlement services, torture and trauma services
• Referral pathways and inter-service agreements
Quality of care We define quality of care as the consistency of clinical care with recommendations in evidence-based guidelines as well as the quality of interpersonal care [26]. This includes patients’ satisfaction with aspects of care [27]. The Institute of Medicine has defined health care quality as the extent to which health services provided to individuals and patient populations improve desired health outcomes. The care should be based on the strongest clinical evidence and provided in a technically and culturally competent manner with good communication and shared decision making [28]. It includes technical quality of primary and secondary prevention, and the management of chronic and acute conditions [29].
Case management Case management has been variously defined. In this study we defined it as a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality cost effective outcomes [30]