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

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

doi:10.1186/1475-9276-12-88

International Journal for Equity in Health

Table 2 Characteristics of the models and their impacts

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

Study	Country of study	Components of the model	Impacts
Studies on access to health care only
Cheng et al. 2011	Australia	Staff: Refugee health nurse, volunteers, multidisciplinary, multilingual.	Increased utilisation of services.
Cheng et al. 2011	Australia	Services: Orientation on health care system, interpreting, mental health, dental health, eye health, audiology, outreach, health checks, referral pathways, partnership, case management, care plan, medical specialist referral, accommodation.	Increased utilisation of services.
Sypek et al. 2008	Australia	Services: Mental health, accommodation.	Barriers: cost, interpreter access, bulk billing doctors, unmet mental health needs, dental health and specialised auditory treatment.
Geltman and Cochran 2005	United States	Staff: Network of providers with enhanced knowledge on refugee health.	Timely health screening.
Geltman and Cochran 2005	United States	Services: health screening and specialised medical service.	Timely health screening.
Eytan et al. 2002	Switzerland	Services: Health screening and interpreting	Increased referral to medical and psychological care.
Ford 1995	United States	Staff: Bilingual staff,	Increased use of preventive and curative care.
Ford 1995	United States	Services: Outreach, referral pathway, no cost/subsidized, interpreting, health screening and immunization.	Increased use of preventive and curative care.
Studies on coordination of care only
Mitchell 1997	Australia	Staff: Multidisciplinary.	Good coordination among service providers.
Mitchell 1997	Australia	Services: Accommodation, patient advocacy, interpreting, health education and orientation about the Australian Healthcare system, mental health support, case management, outreach, medical specialist referral.	Good coordination among service providers.
Studies on quality of care only
Grigg-Saito et al. 2010	United States	Staff: Interpreting, cultural competency training to staff, outreach.	Improved physical and mental health status.
Grigg-Saito et al. 2010	United States	Services: bilingual community health workers, multidisciplinary.	Improved physical and mental health status.
Gould et al. 2010	Australia	Staff: Multidisciplinary, network of providers.	Timely medical care.
Gould et al. 2010	Australia	Service: Health screening, referral to specialists, interpreting, no cost, dental health, transport, orientation on health care system.	Timely medical care.
Birman et al. 2008	United States	Staff: Multidisciplinary and bilingual.	Improved mental health.
Birman et al. 2008	United States	Services: Mental health, case management, patient advocacy, referral, interpreting, transport, outreach.	Improved mental health.
Goodkind 2005	United States	Staff: Students.	Improved mental health.
Goodkind 2005	United States	Services: Mental health, interpreting, outreach.	Improved mental health.
Fox et al. 2005	United States	Staff: Bilingual.	Improved mental health.
Fox et al. 2005	United States	Services: Mental health.	Improved mental health.
Barrett et al. 2000	Australia	Staff: Bilingual.	Service culturally acceptable, reduced levels of anxiety.
Barrett et al. 2000	Australia	Services: Mental health, interpreting.	Service culturally acceptable, reduced levels of anxiety.
Clabots and Dolphin 1992	United States	Services: Multilingual video tapes to provide health education and information on how to access the health care system	Culturally sensitive and appropriate for clients.
Studies on access and coordination of care
Australian Resource Centre for Healthcare Innovations 2009	Australia	Staff: Network of providers with enhanced knowledge on refugee health, multidisciplinary, refugee health nurse.	Improved access to preventive care (health checks and immunisation), improved communication and coordination between providers.
Australian Resource Centre for Healthcare Innovations 2009	Australia	Services: Education and information, partnership, referral pathway, case management, health checks, medical specialist referral, immunization and preventive care.
Kelly 2008	Australia	Staff: Refugee health nurse.	Improved access to primary health care and specialist services, increased number of patients from refugee backgrounds, good coordination among services.
Kelly 2008	Australia	Services: Outreach, no or low cost, dental health, optometry, transport, patient advocacy.
Studies on access and quality of care
Department of Health and Human Services, 2010	Australia	Staff: multilingual staff, refugee health nurse.	Increased use of interpreters and culturally aware staff.
Department of Health and Human Services, 2010	Australia	Services: Education and information, interpreting, community advocacy, case management, mental health, health screening, referral pathways, specialist medical treatment.	Difficulty accessing refugee health nurse, bicultural workers, culturally appropriate interpreters and mental health services.
Companion House 2009	Australia	Services: Mental health.	Improvement in mental health, difficulty accessing medicines due to cost.
Sheikh and MacIntyre 2009	Australia	Services: Media awareness of health service, health education.	Increased clinic attendance and enhanced knowledge on preventive care.
Smith 2009	Australia	Staff: Refugee health nurse, multilingual staff, both male and female GPs.	Client satisfaction with multilingual staff. Ineffective referral to non-health services, lack of mental health service, non-representative interpreters.
Smith 2009	Australia	Services: Patient advocacy, interpreting, case management, outreach, health education, transport, education and information, partnership, dental health and allied health.
O’Donnell et al. 2007	United Kingdom	Staff: Asylum support nurse for coordination with health service and conducting health checks.	Increased GP registration, trust built between patients and health services.
Pottie and Hosland 2007	Canada	Staff: Medical students.	Patient satisfaction, increase in trust between patients and health care providers, increased knowledge of health system and easier access. Interpreter service was not reliable.
Pottie and Hosland 2007	Canada	Services: Orientation on health care system, outreach, health education, students trained in cultural sensitivity, health and social support.
Samaan 2004	Australia	Staff: Volunteers.	Client satisfaction with onsite interpreters and patient advocacy.
		Services: Outreach, interpreting services, transport, patient advocacy, longer consultation sessions with GP, partnership, health check, immunisation, mental health, dental health, eye health, allied health, case management, no cost, referral pathways.
			Barriers: cost, lack of local transport
			Interpreter access, non-representative interpreting, lack of bulk billing doctors, difficulty in physical access for people with disabilities and remote location.
Studies on access, coordination and quality of care
Department of Health 2011	Australia	Staff: Refugee health nurse.	Enhanced access to services, culturally appropriate service, good coordination among services and continuum of care.
Department of Health 2011	Australia	Services: Mental health, dental health, eye health, health assessment, referral to specialist services, English classes, interpreters, accommodation.
Robson 2011	Australia	Staff: Refugee health nurse.	Client satisfaction, staffs of other organisation confident on coordinating care with the centre, increased access to preventive care.
Robson 2011	Australia	Services: Outreach, patient advocacy, partnership, referral pathway, medical specialist referral, health screening, immunisation, case management, health education, optometry, audiology, mental health, dental health, allied health.
Western Region Health Centre 2001	Australia	Staff: Refugee health nurse.	Clients satisfied about information on accessing different services including transport.
		Services: Partnerships, orientation on the health care system, information on rights, entitlements and services available and how to access them, longer consultation, training in cultural sensitivity to staff, interpreting, referral pathway, allied health.	Problems with cultural competency in spite of receiving training, time management for staffs due to longer consultations and dissatisfaction with long waiting time, inadequate follow up, unnecessary referrals in absence of interpreters, interpreting service non-representative.
			Coordination with some service providers was good while there was a lack of coordination with many of them.

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ISSN: 1475-9276

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