Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
Int J Equity Health. 2013 Nov 7;12:88. doi: 10.1186/1475-9276-12-88.
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.
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.
Twenty-five studies met the inclusion criteria for this review of which 15 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.
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.
难民有许多复杂的医疗保健需求，这些需求应该由初级卫生保健服务来满足，无论是在他们抵达重新安置国家时，还是在他们过渡到长期护理时。本叙述性综述的目的是确定为这些人群提供的初级卫生保健服务提供模式的组成部分，这些模式在改善获得、护理质量和协调方面是有效的。
对文献进行了系统回顾，包括已发表的系统评价。通过搜索 Medline、CINAHL、EMBASE、Cochrane 图书馆、Scopus、澳大利亚公共事务信息服务-健康、健康与社会数据库、多元文化澳大利亚和移民研究以及 Google Scholar，确定了 1990 年至 2011 年之间的研究。还对所有纳入研究的参考文献进行了有限的滚雪球式搜索。利益相关者咨询委员会和国际顾问提供了来自灰色文献的论文。仅包括在发达国家重新安置的难民的评估初级卫生保健模式的英语语言研究。
本综述共纳入 25 项研究，其中 15 项来自澳大利亚，10 项来自海外。这些可以分为六个主题：服务背景、临床模式、劳动力能力、客户成本、卫生和非卫生服务。通过多学科工作人员、使用口译员和双语工作人员、无成本或低成本服务、外展服务、预约往返免费交通、延长诊所开放时间、患者宣传以及使用性别一致的提供者，可以改善获得机会。这些服务对目标群体来说是负担得起的、合适的和可接受的。通过专门工作人员的病例管理，可以改善不同卫生保健服务之间以及满足客户社会需求的服务之间的协调。通过文化敏感性培训和适当使用口译员，可以提高护理质量。
与改善获得、协调和护理质量最相关的模式要素是病例管理、使用专门的难民卫生工作者、口译员和双语工作人员。这些发现对劳动力规划和培训具有启示意义。
