Optimising primary care for refugees: findings from an Australian cluster randomised trial

Background: The health and wellbeing of people of refugee background is linked with their ability to access high quality, coordinated primary care. Aim/Objectives: We asked whether an outreach facilitation intervention could increase refugee status identification, interpreter use, and use of refugee specific referral pathways for general practice patients from refugee backgrounds. Methods: We conducted a pragmatic, stepped wedge cluster randomised controlled trial in 3 urban regions of high refugee resettlement in Australia. Trained facilitators made three visits to practices over 6 months, using structured action plans to help practice based improvement teams optimise routines of refugee care. Outcomes were assessed using data from: PENCS CAT4™ extracts from clinical practice software; Translating and Interpreting Service (National); and surveys of practice structure, practitioner characteristics and approaches to refugee care. Analysis used Chi-square, Wilcoxon matched-pair signed-rank and McNemar tests and adjusted for clustering by practice. Findings: 31/36 practices completed the intervention. Compared with controls, intervention practices had modest increases in the proportion of refugee patients with documented refugee status in the clinical record; and whose visits were assisted by credentialed interpreters (0.6% to 1.5%, z = 12.44, P < 0.001).
Providers found it easier to identify refugee relevant health and social support services and were twice as likely to have lists of bilingual (31.0% to 62.1%, P = 0.013) and bulk-billing specialists (35.7% to 75.0%, P = 0.035). Implications: Our low-intensity outreach facilitation program improved several key markers of quality primary care for refugees. Findings have implications for future improvement to the quality of primary care delivered to this vulnerable population.