Monash University, Melbourne, VIC.
Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, VIC.
Med J Aust. 2021 Nov 1;215(9):420-426. doi: 10.5694/mja2.51278. Epub 2021 Sep 28.
To examine whether primary care outreach facilitation improves the quality of care for general practice patients from refugee backgrounds.
Pragmatic, cluster randomised controlled trial, with stepped wedge allocation to early or late intervention groups.
SETTING, PARTICIPANTS: 31 general practices in three metropolitan areas of Sydney and Melbourne with high levels of refugee resettlement, November 2017 - August 2019.
Trained facilitators made three visits to practices over six months, using structured action plans to help practice teams optimise routines of refugee care.
Change in proportion of patients from refugee backgrounds with documented health assessments (Medicare billing). Secondary outcomes were refugee status recording, interpreter use, and clinician-perceived difficulty in referring patients to appropriate dental, social, settlement, and mental health services.
Our sample comprised 14 633 patients. The intervention was associated with an increase in the proportion of patients with Medicare-billed health assessments during the preceding six months, from 19.1% (95% CI, 18.6-19.5%) to 27.3% (95% CI, 26.7-27.9%; odds ratio, 1.88; 95% CI, 1.42-2.50). The impact of the intervention was greater in smaller practices, practices with larger proportions of patients from refugee backgrounds, recent training in refugee health care, or higher baseline provision of health assessments for such patients. There was no impact on refugee status recording, interpreter use increased modestly, and reported difficulties in refugee-specific referrals to social, settlement and dental services were reduced.
Low intensity practice facilitation may improve some aspects of primary care for people from refugee backgrounds. Facilitators employed by local health services could support integrated approaches to enhancing the quality of primary care for this vulnerable population.
Australian New Zealand Clinical Trials Registry, ACTRN12618001970235 (retrospective).
考察初级保健外展促进是否能提高难民背景的全科实践患者的护理质量。
实用、聚类随机对照试验，采用逐步楔形分配法将早期或晚期干预组分组。
地点、参与者：2017 年 11 月至 2019 年 8 月，悉尼和墨尔本三个大都市地区的 31 个有大量难民安置的全科实践，
经过培训的促进者在六个月内对实践进行了三次访问，使用结构化行动计划帮助实践团队优化难民护理常规。
有记录的健康评估（医疗保险计费）的难民背景患者比例变化。次要结果是难民身份记录、口译员使用情况以及临床医生认为将患者转介到适当的牙科、社会、安置和心理健康服务的难度。
我们的样本包括 14 633 名患者。该干预措施与前六个月有医疗保险计费健康评估的患者比例增加有关，从 19.1%（95%CI，18.6-19.5%）增加到 27.3%（95%CI，26.7-27.9%；比值比，1.88；95%CI，1.42-2.50）。该干预措施在规模较小的实践、难民背景患者比例较大的实践、最近接受难民保健培训或为这些患者提供更多健康评估的实践中，效果更大。这对难民身份记录没有影响，口译员的使用略有增加，难民特定的社会、安置和牙科服务转介报告的困难减少。
低强度的实践促进可能会改善难民背景人群的初级保健的某些方面。当地卫生服务机构聘请的促进者可以支持加强这一弱势群体初级保健质量的综合方法。
澳大利亚新西兰临床试验注册中心，ACTRN12618001970235（回顾性）。
