Providing care to former refugees through mainstream general practice in Southern New Zealand: what are the perspectives of general practitioners and practice nurses?

Talk Code: 
1E.6a
Presenter: 
Tim Stokes
Twitter: 
Co-authors: 
Lauralie Richard, Georgia Richardson, Chrystal Jaye, Tim Stokes
Author institutions: 
University of Otago

Problem

Health systems face growing pressure to respond effectively to the needs of refugees, internationally and in New Zealand (NZ). Primary health care (PHC) professionals are faced with the challenging task of endeavouring to meet these needs, often with limited support. Research investigating refugee health delivery from the viewpoint of service providers is critical to identify opportunities for service improvement and transformative change of local health systems, yet NZ evidence is lacking for PHC. This study explored the perspectives of general practitioners (GPs) and practice nurses caring for refugees through mainstream general practice in NZ.

Approach

This study relied on a qualitative exploratory design. Fifteen semi-structured interviews were conducted with GPs and practice nurses from general practices enrolled in the Dunedin Refugee Resettlement programme, in the Southern health region of NZ’s South Island. Interviews were audio recorded, transcribed and validated. Transcripts were subjected to thematic analysis.

Findings

Three themes relating to PHC for refugees were identified: relational engagement with refugees, refugee health care delivery, and providers’ professional role shaped by complexity. Building meaningful relational connections involved acknowledging refugees’ journeys by “getting to know them as people” and listening to their stories of dislocation, resilience and success. Putting aside professional assumptions about “what is best to do” and avoiding “treating everybody the same” reflected cultural sensitivity and a rich understanding of cultural difference. Participants encountered challenges in providing care to refugees with respect to time-limited consultations, variable use of interpreter services, fragmentation of care, adaptability of delivery arrangements and lack of appropriate health infrastructure. The business model of NZ general practice was also perceived as compromising the system’s responsivity to refugees and equity of access to services. Addressing the complex needs of refugees across the determinants of health led providers to engage further with the social dimension of their role. Providing care to refugees involved a lot of “behind the scenes” work which often remained invisible and contributed to a perceived lack of value. Challenges of complexity were managed through adapting delivery arrangements to make things work for refugee patients, but this would rely on the variable commitment of each general practice and providers’ willingness to help based on moral responsibility. Sustaining these efforts in the long run was expressed as a concern.

Consequences

This study provides rich context-specific findings that will benefit the local health system and inform practice improvement to enhance responsiveness to the needs of refugees. These findings highlight the importance of relationship-centred care to foster culturally appropriate practice. The findings raise concerns about the fit of the mainstream general practice model to meet the complex needs of refugees. Providers’ goodwill to adapt services as best they can without appropriate resources can lead to professional distress and practice disempowerment.

Submitted by: 
Lauralie Richard
Funding acknowledgement: 
This study was supported by a Dean’s Bequest Research grant, Dunedin School of Medicine, University of Otago.