Providing care to refugees through mainstream general practice in the southern health region of New Zealand: a qualitative study of primary healthcare professionals’ perspectives

Abstract

ObjectiveTo explore the perspectives of primary healthcare (PHC) professionals providing care to refugees through mainstream general practice.DesignQualitative exploratory design with semistructured interviews subjected to inductive thematic analysis.Setting and participantsNine general practices enrolled in the Dunedin Refugee Resettlement Programme, in New Zealand (NZ)’s southern health region. Participants included nine general practitioners and six practice nurses.ResultsThree analytical constructs were identified: relational engagement with refugees, refugee healthcare delivery and providers’ professional role shaped by complexity. Building meaningful relational connections involved acknowledging refugees’ journeys by getting to know them as people. This was instrumental for the development of an empathetic understanding of the complex human trajectories that characterise refugees’ journeys to NZ. Participants encountered challenges in providing care to refugees with respect to time-limited consultations, variable use of interpreter services, fragmentation of care between agencies and need for improved health infrastructure to ensure a fluid interface between PHC, secondary care and community support services. The current business model of NZ general practice was perceived to interfere with value-driven care and discouraged tailoring of care to specific patient groups, raising concerns about the ‘fit’ of mainstream general practice to address the complex healthcare needs of refugees. Meeting the needs of refugees across the social determinants of health involved a lot of ‘behind the scenes work’ particularly in the absence of shared information systems and the lack of well-established referral pathways to connect refugees to services beyond the health sector. This led to providers feeling overwhelmed and uncertain about their ability to provide appropriate care to refugees.ConclusionsThis study provides rich context-specific findings that enhance PHC responsiveness to the needs of refugees in NZ.

General practitioners’ perspectives on the management of refugee health: a qualitative study

“…This study examined GPs’ perceptions of the factors that challenge and support the treatment of refugees in regional general practice. These centred around culture, language and resource provision, which is consistent with much of refugee healthcare literature 10 19 21–25. Nonetheless, these data provide novel insights into how these factors are compounded by regional resettlement.…”

“…Despite this, there has been limited study of clinicians’ experiences managing refugees’ needs in regional general practice. Those that have, have found that the ability to communicate effectively via interpreter services,21 22 limited local workforce capacity and refugees’ health literacy23 24 are key challenges to managing these patients who often have complex presentations that require longer consultations, which, in some instances, clinicians are not sufficiently remunerated for 19 20 25. Consistent with these barriers, additional clinical supports including access to interpreters, funded practice nurses and cultural training11 18 as well as the altruism of clinicians and local volunteers23 have each been found to support the management of refugees in general practice.…”

Vaccine hesitancy and its determinants among refugee parents resettled in Aotearoa New Zealand

“… 50 , 51 In New Zealand, although childhood vaccines are freely available, navigating an unfamiliar health care system can hinder refugees’ ability to access and utilize publicly available health care services. 52 , 53 Moreover, at an organizational and structural level, literature has called for additional support for general practices and providers to improve immunization timeliness. 54 , 55 These supports will be particularly important to improve services for refugees as providers have noted substantial barriers to vaccinating people with refugee backgrounds.…”

Meneroka Cabaran dan Isu dalam Adaptasi Antarabudaya Populasi Orang Pelarian serta Pencari Suaka di Negara Transit dan Penempatan Semula

“…Kang, Tomkow dan Farrington (2019) dalam kajian mereka pula mendapati terdapat orang pelarian di UK yang tidak dilayan atau diberi layanan yang buruk oleh staf sokongan kesihatan semasa mendaftar di pusat perubatan kerana status mereka sebagai imigran, serta kaum dan agama mereka. Keempat, kekurangan sumber turut menjadi halangan untuk mendapat akses kepada penjagaan kesihatan (Kiselev et al, 2020;Richard et al, 2019;Robertshaw, Dhesi & Jones, 2017). Di samping kemudahan atau fasiliti, kekurangan sumber dalam penjagaan kesihatan termasuklah kekurangan doktor dan kakitangan sokongan kesihatan, serta jurubahasa (Kiselev et al, 2020;Robertshaw, Dhesi & Jones, 2017).…”

“…Selain itu, kekurangan tenaga kerja dalam sektor penjagaan kesihatan secara tidak langsung menambah beban kerja dan memberi tekanan tambahan buat petugas kesihatan untuk menyediakan khidmat penjagaan kesihatan kepada orang pelarian dan pencari suaka (Robertshaw, Dhesi & Jones, 2017). Sebagai contoh, kajian Richard et al (2019) mendapati kurangya sumber menyebabkan tempoh menunggu yang lama untuk rawatan kesihatan. Hal ini menyebabkan orang pelarian di New Zealand tidak mendapat akses kepada rawatan pada waktu yang diperlukan.…”