Can a practice facilitation intervention improve primary care delivery to refugees in Australia? Early findings from the OPTIMISE project.

Problem

Australia is one of the many nations struggling with the challenges of delivering quality primary health care (PHC) to increasing numbers of refugees. OPTIMISE is a participatory research project that builds on a collaboration between 12 organisations responsible for delivering PHC to refugees. This paper describes the methodology and early insights from one component of the project. It asks whether an outreach facilitation based quality improvement intervention can improve the quality of primary care received by refugees within Australian general practices.

Approach

Our mixed methods study uses a pragmatic, cluster quasi-experimental design and is set in 3 areas of high refugee resettlement in Melbourne and Sydney.The intervention began by creating Regional Partnerships of clinicians, academics, policy advisors and health service managers in each area. Following a regional needs assessment, Partnerships prioritised targets for GP improvement: recording of refugee status; use of interpreters; conduct of comprehensive health assessments and timely referral to external services. We then trained expert refugee health clinicians as outreach facilitators to work with practices for 6 months to improve care in each of the 4 target areas.We recruited 36 general practices (12 from each region), excluding practices exposed to significant prior refugee training. Practices were randomly allocated into early and late intervention groups. The evaluation of the intervention will ascertain whether practice facilitation a) can improve the quality of primary care delivered to recently arrived refugees, b) could be scaled to other jurisdictions within Australia. Baseline data collection comprises a) a pre-intervention provider survey (collected from participating clinical staff); b) two practice surveys: one documenting practice organisation, and a “refugee health care survey” assessing the practice’s delivery of care to refugees; and c) de-identified data from medical records using PENCS CAT4™ software. PENCS CAT4™ data and readminister the provider survey and refugee health survey at the end of the intervention, and 6 months after it concludes. The primary outcome will be changes in the proportion of refugee patient consultations with documented use of credentialed interpreter. Changes in practice performance relating to this and other outcome measures will be evaluated using multilevel mixed effects models.

Findings

We reached our practice recruitment target quickly and practices have found the facilitation for intervention acceptable. Early performance data reveals large discrepancies between practice self reported performance and that obtained from the medical record extracts.

Consequences

Our baseline data shows that the concerns about the quality of GP care of refugees are well foundedThe acceptability of the intervention suggests that it may be a promising way to develop the primary health care system’s capacity to facilitate ongoing improvement to the system of caring for refugees in the community.