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 and Harris, Mark F. (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 1: 88.1-88.14. doi:10.1186/1475-9276-12-88

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Author 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.
Title A narrative synthesis of the impact of primary health care delivery models for refugees in resettlement countries on access, quality and coordination
Journal name International Journal for Equity in Health   Check publisher's open access policy
ISSN 1475-9276
Publication date 2013-11-07
Sub-type Article (original research)
DOI 10.1186/1475-9276-12-88
Open Access Status DOI
Volume 12
Issue 1
Start page 88.1
End page 88.14
Total pages 14
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Formatted abstract
Introduction: Refugees have many complex health care needs which should be addressed by the primary health care services, both on their arrival in resettlement countries and in their transition to long-term care. The aim of this narrative synthesis is to identify the components of primary health care service delivery models for such populations which have been effective in improving access, quality and coordination of care.

Methods: A systematic review of the literature, including published systematic reviews, was undertaken. Studies between 1990 and 2011 were identified by searching Medline, CINAHL, EMBASE, Cochrane Library, Scopus, Australian Public Affairs Information Service -- Health, Health and Society Database, Multicultural Australian and Immigration Studies and Google Scholar. A limited snowballing search of the reference lists of all included studies was also undertaken. A stakeholder advisory committee and international advisers provided papers from grey literature. Only English language studies of evaluated primary health care models of care for refugees in developed countries of resettlement were included.

Results: Twenty-five studies met the inclusion criteria for this review of which15 were Australian and 10 overseas models. These could be categorised into six themes: service context, clinical model, workforce capacity, cost to clients, health and non-health services. Access was improved by multidisciplinary staff, use of interpreters and bilingual staff, no-cost or low-cost services, outreach services, free transport to and from appointments, longer clinic opening hours, patient advocacy, and use of gender-concordant providers. These services were affordable, appropriate and acceptable to the target groups. Coordination between the different health care services and services responding to the social needs of clients was improved through case management by specialist workers. Quality of care was improved by training in cultural sensitivity and appropriate use of interpreters.

Conclusion: The elements of models most frequently associated with improved access, coordination and quality of care were case management, use of specialist refugee health workers, interpreters and bilingual staff. These findings have implications for workforce planning and training.
Keyword Access
Health care models
Primary health care
Quality of care
Health services evaluation
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Discipline of General Practice Publications
Official 2014 Collection
School of Medicine Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 9 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 18 times in Scopus Article | Citations
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Created: Wed, 13 Nov 2013, 21:57:48 EST by Shani Lamb on behalf of Discipline of General Practice