Research to inform a patient centred health system for refugees

harrisMark Harris is Foundation Professor of General Practice and Executive Director of the Centre for Primary Health Care and Equity at the University of New South Wales in Australia. Dr Harris will be speaking at the forthcoming North American Primary Care Research Group (NAPCRG) annual meeting.

 

After working with refugee populations resettled in the urban fringe of Sydney in the 1990s, I began volunteer clinical work in 2000 with an NGO working with asylum seekers.  Asylum seekers do not have access to the national health insurance system that funds primary care for all Australians and subsidizes medications.  Despite having greater health needs due a variety of acute and chronic physical and mental health problems, refugees often suffer worse access to health care in resettlement countries like Australia. The barriers they encounter in accessing health care are complex and associated with social and political factors that confront them every step of the way.  This is a daily challenge for many of us working in that health services that serve these populations.

The context of primary care for refugees varies greatly between countries related to the different population groups, their health social needs, the characteristics of the health systems and the policies of governments towards refugees.  For example Australia has been quite welcoming towards refugees brought to Australia as part of its humanitarian program, but quite in-humane in its treatment of asylum seekers especially those arriving on boats. These policies greatly affect the way care is provided and have a real impact on the health of refugees.

Research on primary care for refugees is still quite limited.  The special interest group on refugee health has met regularly at the NAPCRG annual meeting and exchanged experience both as clinicians and researchers.  This has been great.  However at these meetings it has become increasingly evident how little we know about each other's situation.

We need to find common ground and develop an international agenda for research.  In the SIG meetings the issue of interpreters has often come up.  It is clear that there is much variation in policy, availability and practice between states and countries.  We are currently pilot testing an international survey of physicians on use and availability of interpreters in primary clinical care of refugees to better understand this.  This will help inform advocacy for change and research evaluating the impact of different models of care.

In Australia we have begun conducting research on the coordination and continuity of care between specialist refugee focused health service and generalist family practice as part of the OPTIMISE project led by Monash University.  This is a major challenge as the number or refugees continues to rise.  For example although over half of family physicians in Sydney consult in a language other than English, they are not necessarily "optimally" attuned to the needs and problems of refugee patients and the other services involved in their care and support.  Refugee health nurses play a critical role in helping patients navigate the system but the number of these nurses is insufficient to deal with the demand.

There is much work to do to create truly people-centered primary health care for refugees.  It is often uncomfortable and gives rise to conflicts between clinicians and government.  Research can play a critical role in shaping the debate and reorienting health services.  We need to rise to the challenge.

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The North American Primary Care Research Group Annual Meeting is being held from November 12th to 16th 2016 in Colorado Springs, CO. CMAJ is a co-sponsor of the meeting.

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