Reconceptualising specialisation: integrating refugee health in primary care
Donata Sackey A B , Meryl Jones A and Rebecca Farley A
+ Author Affiliations
- Author Affiliations
A Mater Misericordiae Brisbane Ltd, Mater Refugee Health Service, Level 2 Quarters Building, College Hill Drive, South Brisbane, Qld 4101, Australia.
B Corresponding author. Email: donata.sackey@mater.org.au
Australian Journal of Primary Health 26(6) 452-457 https://doi.org/10.1071/PY20138
Submitted: 6 July 2020 Accepted: 15 September 2020 Published: 27 November 2020
Journal Compilation © La Trobe University 2020 Open Access CC BY-NC
Abstract
People from a refugee background have significant unmet health needs including complex physical and psycho-social presentations. They can experience low trust, unfamiliarity with the health system and reliance on family and friends to access care. To address these needs, Australia has specialised refugee health services in each state and territory. The majority of these services transition patients to primary care, but this transition, although necessary, is difficult. Most primary care and specialised health professionals share a high degree of commitment to refugee patients; however, despite best efforts, there are gaps. More integrated health services can start to address gaps and promote continuity of care. A previous study has described 10 principles that are associated with successful integration; this paper references five of those principles (continuum of care, patient focus, geographic coverage, information systems and governance) to describe and map out the outcomes of an integrated model of care designed to deliver specialist refugee health in primary care. The Co-location Model is a partnership between a refugee health service, Primary Health Networks, a settlement agency and general practices. It has the potential to deliver benefits for patients, greater satisfaction for health professionals and gains for the health system.
Keywords: delivery of health care: integrated, minority health, organisation: innovation, patient-centred care, primary health care.
References
Au M, Anandakumar AD, Preston R, Ray RA, Davis M (2019) A model explaining refugee experiences of the Australian healthcare system: a systematic review of refugee perceptions. BMC International Health and Human Rights 19, 22| A model explaining refugee experiences of the Australian healthcare system: a systematic review of refugee perceptions.Crossref | GoogleScholarGoogle Scholar | 31319819PubMed |
Bonciani M, Schäfer W, Barsanti S, Heinemann S, Groenewegen PP (2018) The benefits of co-location in primary care practices: the perspectives of general practitioners and patients in 34 countries. BMC Health Services Research 18, 132
| The benefits of co-location in primary care practices: the perspectives of general practitioners and patients in 34 countries.Crossref | GoogleScholarGoogle Scholar | 29466980PubMed |
Calder R, Dunkin R, Rochford C, Nichols T (2019) Australian Health Services: too complex to navigate. A review of the national reviews of Australia’s health service arrangements. Australian Health Policy Collaboration (AHPC), Policy Issues Paper No. 1. AHPC, Melbourne, Vic., Australia.
Farley R, Askew D, Kay M (2014) Caring for refugees in general practice: perspectives from the coalface. Australian Journal of Primary Health 20, 85–91.
| Caring for refugees in general practice: perspectives from the coalface.Crossref | GoogleScholarGoogle Scholar | 23257393PubMed |
Ghorob A, Bodenheimer T (2015) Building teams in primary care: a practical guide. Families, Systems & Health 33, 182–192.
| Building teams in primary care: a practical guide.Crossref | GoogleScholarGoogle Scholar |
Gill G, Stocks N, Powell K, Laurence C, Aylward P, May E (2017) Supports and hindrances to the integration of co-located services in multiple models of primary health care delivery Integration in co-located primary health care services. International Journal of Integrated Care 17, A95
| Supports and hindrances to the integration of co-located services in multiple models of primary health care delivery Integration in co-located primary health care services.Crossref | GoogleScholarGoogle Scholar |
Harding C, Seal A, Duncan G, Gilmour A (2019) General practitioner and registrar involvement in refugee health: exploring needs and perceptions. Australian Health Review 43, 92–97.
| General practitioner and registrar involvement in refugee health: exploring needs and perceptions.Crossref | GoogleScholarGoogle Scholar | 28867004PubMed |
Harris MF (2018) Integration of refugees into routine primary care in NSW, Australia. Public Health Research & Practice 28, e2811802
| Integration of refugees into routine primary care in NSW, Australia.Crossref | GoogleScholarGoogle Scholar |
Isaacs S, Valaitis R, Newbold KB, Black M, Sargeant J (2013) Brokering for the primary healthcare needs of recent immigrant families in Atlantic, Canada. Primary Health Care Research and Development 14, 63–79.
| Brokering for the primary healthcare needs of recent immigrant families in Atlantic, Canada.Crossref | GoogleScholarGoogle Scholar | 22784873PubMed |
Javadi D, Langlois EV, Ho S, Friberg P, Tomson G (2017) Intersectoral approaches and integrated services in achieving the right to health for refugees upon resettlement: a scoping review protocol. BMJ Open 7, e016638
| Intersectoral approaches and integrated services in achieving the right to health for refugees upon resettlement: a scoping review protocol.Crossref | GoogleScholarGoogle Scholar | 28855201PubMed |
Joshi C, Russell G, Cheng I-H, Kay M, Pottie K, Alston M, Smith M, Chan B, Vasi S, Lo W, Wahidi SS, Harris MF (2013) 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 12, 88
| A narrative synthesis of the impact of primary health care delivery models for refugees in resettlement countries on access, quality and coordination.Crossref | GoogleScholarGoogle Scholar | 24199588PubMed |
Kay M, Jackson C, Nicholson C (2010) Refugee health: a new model for delivering primary health care. Australian Journal of Primary Health 16, 98–103.
| Refugee health: a new model for delivering primary health care.Crossref | GoogleScholarGoogle Scholar | 21133306PubMed |
Kohler G, Holland T, Sharpe A, Irwin M, Sampalli T, MacDonell K, Kidd N, Edwards L, Gibson R, Legate A (2018) The newcomer health clinic in Nova Scotia: a beacon clinic to support the health needs of the refugee population. International Journal of Health Policy and Management 7, 1085–1089.
| The newcomer health clinic in Nova Scotia: a beacon clinic to support the health needs of the refugee population.Crossref | GoogleScholarGoogle Scholar | 30709083PubMed |
Lane R, Russell G, Bardoel EA, Advocat J, Zwar N, Davies PGP, Harris MF (2017) When colocation is not enough: a case study of General Practitioner Super Clinics in Australia. Australian Journal of Primary Health 23, 107–113.
| When colocation is not enough: a case study of General Practitioner Super Clinics in Australia.Crossref | GoogleScholarGoogle Scholar | 28442054PubMed |
Le Feuvre P (2001) How primary care services can incorporate refugee health care. Medicine, Conflict, and Survival 17, 131–136.
| How primary care services can incorporate refugee health care.Crossref | GoogleScholarGoogle Scholar | 11471914PubMed |
Manchikanti P, Cheng IH, Advocat J, Russell G (2017) Acceptability of general practice services for Afghan refugees in south-eastern Melbourne. Australian Journal of Primary Health 23, 87–91.
| Acceptability of general practice services for Afghan refugees in south-eastern Melbourne.Crossref | GoogleScholarGoogle Scholar | 27481064PubMed |
McMurray J, Breward K, Breward M, Alder R, Arya N (2014) Integrated primary care improves access to healthcare for newly arrived refugees in Canada. Journal of Immigrant and Minority Health 16, 576–585.
| Integrated primary care improves access to healthcare for newly arrived refugees in Canada.Crossref | GoogleScholarGoogle Scholar | 24293090PubMed |
Miller BF, Petterson S, Burke BT, Phillips RL, Green LA (2014) Proximity of providers: colocating behavioral health and primary care and the prospects for an integrated workforce. The American Psychologist 69, 443–451.
| Proximity of providers: colocating behavioral health and primary care and the prospects for an integrated workforce.Crossref | GoogleScholarGoogle Scholar | 24820692PubMed |
Phillips C, Hall S, Elmitt N, Bookallil M, Douglas K (2017) People-centred integration in a refugee primary care service: a complex adaptive systems perspective. Journal of Integrated Care 25, 26–38.
| People-centred integration in a refugee primary care service: a complex adaptive systems perspective.Crossref | GoogleScholarGoogle Scholar |
Robertshaw L, Dhesi S, Jones LL (2017) Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research. BMJ Open 7, e015981
| Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research.Crossref | GoogleScholarGoogle Scholar | 28780549PubMed |
Russell G, Harris M, Cheng I-H, Kay M, Vasi S, Joshi C, Chan B, Lo W, Wahidi S, Advocat J, Pottie K, Smith M, Furler J (2013) Coordinated primary health care for refugees: a best practice framework for Australia. Southern Academic Primary Care Research Unit, Melbourne, Vic., Australia.
Suter E, Oelke ND, Adair CE, Armitage GD (2009) Ten key principles for successful health systems integration Healthcare Quarterly 13, 16–23.
| Ten key principles for successful health systems integrationCrossref | GoogleScholarGoogle Scholar | 20057244PubMed |
Taylor J, Lamaro Haintz G (2018) Influence of the social determinants of health on access to healthcare services among refugees in Australia. Australian Journal of Primary Health 24, 14–28.
| Influence of the social determinants of health on access to healthcare services among refugees in Australia.Crossref | GoogleScholarGoogle Scholar | 29232545PubMed |
World Health Organization (WHO), United Nations Children’s Fund (UNICEF) (2018) A vision for primary health care in the 21st century: towards universal health coverage and the Sustainable Development Goals. WHO/HIS/SDS/2018.X. WHO, Geneva, Switzerland.
Zwi KJ, Woodland L, Kalowski J, Parmeter J (2017) The impact of health perceptions and beliefs on access to care for migrants and refugees. Journal of Cultural Diversity 24, 63–72.
