Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada.
ICES, Toronto, Canada.
PLoS One. 2023 Jul 26;18(7):e0287437. doi: 10.1371/journal.pone.0287437. eCollection 2023.
Canada's approach to refugee resettlement includes government sponsorship, a pioneering private sponsorship model and a third blended approach. Refugees are selected and supported differently in each approach including healthcare navigation. Little is known about how well private sponsors facilitate primary care navigation and whether this changed during the large-scale 2015 Syrian resettlement initiative characterized by civic and healthcare systems engagement.
Population-based cohort study of resettled refugees arriving in Ontario between April 1, 2008 and March 31, 2017, with one-year follow-up, using linked health and demographic administrative databases. We evaluated associations of resettlement model (GARs, Privately Sponsored Refugees [PSRs], and Blended-Visa Office Referred [BVORs]) by era of arrival (pre-Syrian and Syrian era) and by country cohort, on measures of primary care (PC) navigation using adjusted Cox proportional hazards and logistic regression. There were 34,591 (pre-Syrian) and 24,757 (Syrian era) resettled refugees, approximately half of whom were GARs. Compared with the reference group pre-Syrian era PSRs, Syrian PSRs had slightly earlier PC visits (mean = 116 days [SD = 90]) (adjusted hazard ratios [aHR] = 1.19, 95% CI 1.14-1.23). Syrian GARs (mean = 72 days [SD = 65]) and BVORs (mean = 73 days [SD = 76]) had their first PC visit sooner than pre-Syrian era PSRs (mean = 149 days [SD = 86]), with respective aHRs 2.27, 95% CI 2.19-2.35 and 1.89, 95% CI 1.79-1.99. Compared to pre-Syrian PSRs, Syrian GARs and BVORs had much greater odds of a CHC visit (adjusted odds ratios 14.69, 95% CI 12.98-16.63 and 14.08, 95% 12.05-16.44 respectively) and Syrian PSRs had twice the odds of a CHC visit.
Less timely primary care and lower odds of a CHC visit among PSRs in the first year may be attributed to selection factors and gaps in sponsors' knowledge of healthcare navigation. Improved primary care navigation outcomes in the Syrian era suggests successful health systems engagement.
加拿大的难民重新安置方法包括政府赞助、开创性的私人赞助模式和第三种混合方法。在每种方法中，难民的选择和支持方式都不同，包括医疗保健导航。对于私人赞助商在促进初级保健导航方面的效果如何，以及在以公民和医疗保健系统参与为特征的大规模 2015 年叙利亚重新安置倡议期间，这种效果是否发生了变化，人们知之甚少。
这是一项基于人群的队列研究，研究对象为 2008 年 4 月 1 日至 2017 年 3 月 31 日期间抵达安大略省的重新安置难民，随访一年，使用链接的健康和人口统计行政数据库。我们通过调整后的 Cox 比例风险和逻辑回归，根据到达时代（叙利亚前时代和叙利亚时代）和国家队列，评估了重新安置模式（政府安置的难民、私人赞助的难民和混合签证办公室推荐的难民）对初级保健（PC）导航的关联。有 34591 名（叙利亚前时代）和 24757 名（叙利亚时代）重新安置的难民，其中大约一半是政府安置的难民。与叙利亚前时代 PSR 的参考组相比，叙利亚 PSR 的 PC 就诊时间稍早（平均 = 116 天[SD = 90]）（调整后的危险比[aHR] = 1.19，95%CI 1.14-1.23）。叙利亚 GAR（平均 = 72 天[SD = 65]）和 BVOR（平均 = 73 天[SD = 76]）的首次 PC 就诊时间早于叙利亚前时代 PSR（平均 = 149 天[SD = 86]），相应的 aHR 分别为 2.27、95%CI 2.19-2.35 和 1.89、95%CI 1.79-1.99。与叙利亚前时代 PSR 相比，叙利亚 GAR 和 BVOR 到 CHC 就诊的可能性大得多（调整后的优势比分别为 14.69、95%CI 12.98-16.63 和 14.08、95%CI 12.05-16.44），而叙利亚 PSR 到 CHC 就诊的可能性是前者的两倍。
在第一年中，PSR 中初级保健的及时性较差和到 CHC 就诊的可能性较低，可能归因于选择因素和赞助商对医疗保健导航知识的差距。叙利亚时代初级保健导航结果的改善表明卫生系统参与取得了成功。
