The OPTIMISE project: protocol for a mixed methods, pragmatic, quasi-experimental trial to improve primary care delivery to refugees in Australia

Abstract

Background Australia is one of many nations struggling with the challenges of delivering quality primary health care (PHC) to increasing numbers of refugees. The OPTIMISE project represents a collaboration between 12 organisations to generate a model of integrated refugee PHC suitable for uptake throughout Australia. This paper describes the methodology of one component; an outreach practice facilitation intervention, directed towards improving the quality of PHC received by refugees in Australian general practices. Methods Our mixed methods study will use a cluster stepped wedge randomised controlled trial design set in 3 urban regions of high refugee resettlement in Australia. The intervention was build upon regional partnerships of policy advisors, clinicians, academics and health service managers. Following a regional needs assessment, the partnerships reached consensus on four core areas for intervention in general practice (GP): recording of refugee status; using interpreters; conducting comprehensive health assessments; and referring to refugee specialised services. Refugee health staff trained in outreach practice facilitation techniques will work with GP clinics to modify practice routines relating to the four core areas. 36 general practice clinics with no prior involvement in a refugee health focused practice facilitation will be randomly allocated into early and late intervention groups. The primary outcome will be changes in number of claims for Medical Benefit Service reimbursed comprehensive health assessments among patients identified as being from a refugee background. Changes in practice performance for this and 3 secondary outcomes will be evaluated using multilevel mixed effects models. Baseline data collection will comprise (i) pre-intervention provider survey; (ii) two surveys documenting each practices’ structure and approaches to delivery of care to refugees. De-identified medical record data will be collected at baseline, at the end of the intervention and 6 and 12 months following completion. Discussion OPTIMISE will test whether a regionally oriented practice facilitation initiative can improve the quality of PHC delivered to refugees. Findings have the potential to influence policy and practice in broader primary care settings. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12618001970235 , 05/12/2018, Retrospectively registered. Protocol Version 1, 21/08/2017. Electronic supplementary material The online version of this article (10.1186/s12913-019-4235-6) contains supplementary material, which is available to authorized users.

Response to language barriers with patients from refugee background in general practice in Australia: findings from the OPTIMISE study

“…This study is a mixed-method analysis of quantitative and qualitative data collected at particular time points by the OPTIMISE study. In this section, we describe briefly the methodology of the study as its protocol has been published [ 26 ].…”

“…The OPTIMISE study [ 26 ] aimed to improve the primary care management of people from refugee backgrounds with outreach facilitation delivered to general practices. It involved a quality improvement process addressing interpreter engagement as one of four core intervention areas.…”

OPTIMISE: a pragmatic stepped wedge cluster randomised trial of an intervention to improve primary care for refugees in Australia

“…OPTIMISE was a pragmatic, stepped wedge cluster randomised controlled trial with blind allocation to early and late intervention groups 12 . A detailed protocol has been published; 11 variations to the published protocol are included in the online (part A). Our reporting of the study conforms with the Template for Intervention Description and Replication (TIDieR) checklist and guide 13 and the CONSORT checklist for stepped wedge cluster randomised trials 14 .…”

“…Primary care outreach facilitation improves the management of chronic disease and preventive care, and promotes system change 10 . The OPTIMISE study was a mixed methods evaluation of an outreach facilitation intervention to improve care for people from refugee backgrounds in general practices in three Australian areas with high levels of refugee settlement 11 . We assessed whether outreach facilitation increased the conduct and documentation of health assessments for people from refugee backgrounds.…”

“… 10 The OPTIMISE study was a mixed methods evaluation of an outreach facilitation intervention to improve care for people from refugee backgrounds in general practices in three Australian areas with high levels of refugee settlement. 11 We assessed whether outreach facilitation increased the conduct and documentation of health assessments for people from refugee backgrounds. We also assessed the recording of refugee status, the use of credentialed interpreters in consultations, and the use of refugee‐specific referral pathways by practice staff.…”