The challenge
People with refugee background arrive with complex mental and physical health needs. After initial health assessment by Refugee Focused Health Services, new arrivals are managed within mainstream primary care. However, many struggle to access general practitioners, specialists, community health and other services. Provision of quality care to refugee background patients in mainstream primary care has been found to be inconsistent, with many providers having incomplete knowledge of refugee health requirements.
The solution
The OPTIMISE Partnership Project brought research teams at Monash and Latrobe Universities with CPHCE at the University of NSW, in collaboration with 12 leading Victorian, NSW and National organisations focusing on refugee health. This aimed to improve the quality of care provided to the patients with refugee background at General practices in recording of refugee status, using credentialed interpreters, conducting comprehensive health assessments and referring to refugee specialised services, through practice facilitation intervention. Thirty-one general practices participated in two states, 13,371 patients records and were analysed. Results indicated the proportion of patients with a refugee health assessment, increased from 19.1% to 27.3%. This positive change was brought about through our low-intensity outreach facilitation program which improved several key markers of quality primary care for refugees, namely recording of refugee status, utilization of interpreters, and awareness of refugee relevant services.
The impact
The research added to body of evidence on practice facilitation towards improving access to primary care by refugee populations. The OPTIMISE intervention provides a starting point for how support can be provided to practices by Primary Health Network to improve refugee access. This includes practice tools and systems to ensure that patients language preferences are considered and that credentialed interpreters are used where needed. It has also informed state and national policies relating to interpreter use and the adequacy of funding for consultations where they are used. While the Telephone Interpreter Service (TIS National) provides free of charge interpreter service for GPs for Medicare funded consultations in Australia, the opportunity cost for GPs in terms of the available time is a significant barrier and needs to be addressed at a system level. Optimise and its publications have been cited in the NSW Refugee Health Plan 2022-27 in its strategies to support general practices to improve care for refugees and respond to language barriers.
Related links
- G. Russell et al, 2019,The OPTIMISE project: protocol for a mixed methods, pragmatic, quasi-experimental trial to improve primary care delivery to refugees in Australia
- G.Russell et al, 2021, OPTIMISE: a pragmatic stepped wedge cluster randomisation trial of an intervention to improve primary care for refugees in Australia
- S.Saito et al. 2021, Response to language barriers with patients from refugee background in general practice in Australia: findings from the OPTIMISE study