Enhancing general practice referrals for women of refugee background to maternity care
Dannielle Vanpraag A , Wendy Dawson A , Bianca Bell B , Elisha Riggs A C , Jo Szwarc D , Stephanie Brown A C E , John Furler C , Sue Casey D , Glyn Teale B and Jane Yelland A C F
+ Author Affiliations
- Author Affiliations
A Healthy Mothers Healthy Families Research Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Flemington Road, Parkville, Vic. 3052, Australia.
B Sunshine Hospital, Western Health, Furlong Road, St Albans, Vic. 3021, Australia.
C Department General Practice, The University of Melbourne, Vic. 3010, Australia.
D Victorian Foundation for Survivors of Torture, 6 Gardiner Street, Brunswick, Vic. 3056, Australia.
E Department of Paediatrics, The University of Melbourne, Vic. 3010, Australia.
F Corresponding author. Email: jane.yelland@mcri.edu.au
Australian Journal of Primary Health 24(2) 123-129 https://doi.org/10.1071/PY17105
Submitted: 9 August 2017 Accepted: 15 December 2017 Published: 3 April 2018
Abstract
This paper presents the findings from a quality improvement project implemented by a maternity hospital located in a region of high refugee settlement. The project was designed to improve the completeness of general practice referral information to enable triage to maternity care that would best meet the needs of women of refugee background. Referral information included four data items – country of birth, year of arrival in Australia, language spoken and interpreter required – used in combination to provide a proxy measure of refugee background. A communication strategy and professional development activity engaged general practitioners (GPs) in the rationale for collecting the four data items on a new referral form. Audits of referrals to the maternity hospital before, and at two time points following the quality improvement activity, indicated that very few referrals were completed on the new form. There were modest improvements in the recording of two items – country of birth and interpreter required. Overall, two-thirds of referrals did not contain information on interpreter requirements. Changing practice will require a more cohesive approach involving GPs in the co-design of the form and development of the quality improvement strategy.
References
Akbari A, Mayhew A, Al-Alawi MA, Grimshaw J, Winkens R, Glidewell E, Pritchard C, Thomas R, Fraser C (2008) Interventions to improve outpatient referrals from primary care to secondary care. Cochrane Database of Systematic Reviews CD005471| Interventions to improve outpatient referrals from primary care to secondary care.Crossref | GoogleScholarGoogle Scholar |
Cheng IH, Vasi S, Wahidi S, Russell G (2015) Rites of passage: improving refugee access to general practice services. Australian Family Physician 44, 503–507.
Drysdale H, Ranasinha S, Kendall A, Knight M, Wallace EM (2012) Ethnicity and the risk of late-pregnancy stillbirth. The Medical Journal of Australia 197, 278–281.
| Ethnicity and the risk of late-pregnancy stillbirth.Crossref | GoogleScholarGoogle Scholar |
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 |
Flores G (2005) The impact of medical interpreter services on the quality of health care: a systematic review. Medical Care Research and Review : MCRR 62, 255–299.
| The impact of medical interpreter services on the quality of health care: a systematic review.Crossref | GoogleScholarGoogle Scholar |
Gibson-Helm M, Teede H, Block A, Knight M, East C, Wallace EM, Boyle J (2014) Maternal health and pregnancy outcomes among women of refugee background from African countries: a retrospective, observational study in Australia. BMC Pregnancy and Childbirth 14, 392
| Maternal health and pregnancy outcomes among women of refugee background from African countries: a retrospective, observational study in Australia.Crossref | GoogleScholarGoogle Scholar |
Kelaher M, Parry A, Day S, Paradies Y, Lawlor J, Solomon L (2010) ‘Improving the Identification of Aboriginal and Torres Strait Islander People in Mainstream General Practice.’ (The Lowitja Institute: Melbourne, Vic., Australia)
Langley G, Moen R, Nolan K, Nolan T, Norman C, Provost L (2009) ‘The Improvement Guide: a Practical Approach to Enhancing Organizational Performance.’ (Jossey-Bass: San Francisco, CA, USA)
Mander S, Miller YD (2016) Perceived safety, quality and cultural competency of maternity care for culturally and linguistically diverse women in Queensland. Journal of Racial and Ethnic Health Disparities 3, 83–98.
| Perceived safety, quality and cultural competency of maternity care for culturally and linguistically diverse women in Queensland.Crossref | GoogleScholarGoogle Scholar |
Paxton GA, Kay MP, Correa-Velez I (2012) Lost and found: improving ascertainment of refugee-background Australians in population datasets. The Medical Journal of Australia 197, 552–553.
| Lost and found: improving ascertainment of refugee-background Australians in population datasets.Crossref | GoogleScholarGoogle Scholar |
Riggs E, Davis E, Gibbs L, Block K, Szwarc J, Casey S, Duell-Piening P, Waters E (2012) Accessing maternal and child health services in Melbourne, Australia: reflections from refugee families and service providers. BMC Health Services Research 12, 117
| Accessing maternal and child health services in Melbourne, Australia: reflections from refugee families and service providers.Crossref | GoogleScholarGoogle Scholar |
Small R, Roth C, Raval M, Shafiei T, Korfker D, Heaman M, McCourt C, Gagnon A (2014) Immigrant and non-immigrant women’s experiences of maternity care: a systematic and comparative review of studies in five countries. BMC Pregnancy and Childbirth 14, 152
| Immigrant and non-immigrant women’s experiences of maternity care: a systematic and comparative review of studies in five countries.Crossref | GoogleScholarGoogle Scholar |
The Consultative Council on Obstetric and Paediatric Mortality and Morbidity (2014) ‘2010 and 2011 Victoria’s Mothers and Babies. Victoria’s Maternal, Perinatal, Child and Adolescent Mortality.’ (Victorian Department of Health: Melbourne, Vic., Australia)
Thomson A, Morgan S, O’Mara P, Tapley A, Henderson K, van Driel M, Oldmeadow C, Ball J, Scott J, Spike N, McArthur L, Magin P (2016) The recording of Aboriginal and Torres Strait Islander status in general practice clinical records: a cross-sectional study. Australian and New Zealand Journal of Public Health 40, S70–S74.
| The recording of Aboriginal and Torres Strait Islander status in general practice clinical records: a cross-sectional study.Crossref | GoogleScholarGoogle Scholar |
Wåhlberg H, Valle PC, Malm S, Broderstad AR (2015) Impact of referral templates on the quality of referrals from primary to secondary care: a cluster randomised trial. BMC Health Services Research 15, 353
| Impact of referral templates on the quality of referrals from primary to secondary care: a cluster randomised trial.Crossref | GoogleScholarGoogle Scholar |
Western Health (2016) Western Health options for maternity care. (Western Health: Footscray, Vic., Australia) Available at http://www.westernhealth.org.au/Services/Womens_and_Children/MaternityServices/Pages/ Options-for-pregnancy-care.aspx [Verified 25 July 2017]
Western Health (2017) Our community. (Western Health: Footscray, Vic., Australia) Available at http://www.westernhealth.org.au/AboutUs/Pages/default.aspx [Verified 10 June 2017]
Yelland J, Riggs E, Wahidi S, Fouladi F, Casey S, Szwarc J, Duell-Piening P, Chesters D, Brown S (2014) How do Australian maternity and early childhood health services identify and respond to the settlement experience and social context of refugee background families? BMC Pregnancy and Childbirth 14, 348
| How do Australian maternity and early childhood health services identify and respond to the settlement experience and social context of refugee background families?Crossref | GoogleScholarGoogle Scholar |
Yelland J, Riggs E, Szwarc J, Casey S, Dawson W, Vanpraag D, East C, Wallace E, Teale G, Harrison B, Petschel P, Furler J, Goldfeld S, Mensah F, Biro MA, Willey S, Cheng IH, Small R, Brown S (2015) Bridging the Gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities. Implementation Science 10, 62
| Bridging the Gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities.Crossref | GoogleScholarGoogle Scholar |
Yelland J, Riggs E, Szwarc J, Casey S, Duell-Piening P, Chesters D, Wahidi S, Fouladi F, Brown S (2016) Compromised communication: a qualitative study exploring Afghan families and health professionals’ experience of interpreting support in Australian maternity care. BMJ Quality & Safety 25, e1
| Compromised communication: a qualitative study exploring Afghan families and health professionals’ experience of interpreting support in Australian maternity care.Crossref | GoogleScholarGoogle Scholar |
Yelland J, Riggs E, Szwarc J, Vanpraag D, Dawson W, Brown S (2017a) Improving the ascertainment of refugee-background people in health datasets and health services. Australian Health Review.
| Improving the ascertainment of refugee-background people in health datasets and health services.Crossref | GoogleScholarGoogle Scholar | [Published online early 2 February 2017].
Yelland J, Biro MA, Dawson W, Riggs E, Vanpraag D, Wigg K, Antonopoulos J, Morgans J, Szwarc J, East C, Brown S (2017b) Bridging the language gap: a co-designed quality improvement project to engage professional interpreters for women during labour. Australian Health Review 41, 499–504.
| Bridging the language gap: a co-designed quality improvement project to engage professional interpreters for women during labour.Crossref | GoogleScholarGoogle Scholar |
Zun LS, Sadoun T, Downey L (2006) English-language competency of self-declared English-speaking Hispanic patients using written tests of health literacy. Journal of the National Medical Association 98, 912–917.
