Barriers to and facilitators of health services utilisation by refugees in resettlement countries: an overview of systematic reviews

2020 ◽  
Vol 44 (1) ◽  
pp. 132 ◽  
Author(s):  
Jamuna Parajuli ◽  
Dell Horey
Keyword(s):  
Health Care ◽  
Health Service ◽  
Health Services ◽  
Systematic Reviews ◽  
Health Professionals ◽  
Health Service Utilisation ◽  
Barriers And Facilitators ◽  
Service Utilisation ◽  
Knowledge And Skills ◽  
Overview Of Systematic Reviews

Objective The aim of this study was to provide an overview of the previously reviewed research literature to identify barriers and facilitators to health service utilisation by refugees in resettlement countries. Methods An overview of systematic reviews was conducted. Seven electronic databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest Central, Scopus, EBSCO and Google Scholar) were searched for systematic reviews of barriers and facilitators to health-seeking behaviour and utilisation of health services by refugees following resettlement. The two authors independently undertook data selection, data extraction and quality assessment using a validated tool. Results Nine systematic reviews covered a range of study areas and refugee populations. Barriers to health service utilisation fell into three broad areas: (1) issues related to refugees, including refugee characteristics, sociocultural factors and the effects of previous experiences; (2) issues related to health services, including practice issues and the knowledge and skills of health professionals; and (3) issues related to the resettlement context, including policies and practical issues. Few facilitators were identified or evaluated, but these included approaches to care, health service responses and behaviours of health professionals. Conclusions Barriers to accessing health care include refugee characteristics, practice issues in health services, including the knowledge and skills of health professionals, and the resettlement context. Health services need to identify barriers to culturally sensitive care. Improvements in service delivery are needed that meet the needs of refugees. More research is needed to evaluate facilitators to improving health care accessibility for these vulnerable groups. What is known about the topic? Refugee health after resettlement is poor, yet health service use is low. What does this paper add? Barriers to accessing health services in resettlement countries are related not only to refugees, but also to issues regarding health service practices and health professionals’ knowledge and skill, as well as the context of resettlement. Few facilitators to improving refugee access to health services have been identified. What are the implications for practitioners? The barriers associated with health professionals and health services have been linked to trust building, and these need to be addressed to improve accessibility of care for refugees.

How can healthcare professionals address poor health service utilisation among refugees after resettlement in Australia? A narrative systematic review of recent evidence

2019 ◽  
Vol 25 (3) ◽  
pp. 205
Author(s):  
Jamuna Parajuli ◽  
Dell Horey
Keyword(s):  
Health Service ◽  
Health Services ◽  
Cultural Competency ◽  
Communication Skills ◽  
Healthcare Professionals ◽  
Qualitative Studies ◽  
Service Utilisation ◽  
Knowledge And Skills ◽  
Service Barriers ◽  
Synthesis Approach

This systematic narrative review of qualitative studies examined health service barriers and facilitators in Australia for refugees after resettlement. Twelve qualitative studies published between 2006 and 2017 involving more than 500 participants were included in the review. Approximately half of all participants were healthcare professionals. A meta-synthesis approach was used to compare and combine findings from across studies. Few facilitators were identified. Barriers to accessing health services were commonly attributed to refugees, but several barriers were associated with healthcare professionals and health services. Barriers attributed to healthcare professionals included gaps in knowledge and skills; poor cultural competency; poor communication skills; and time constraints. Understanding such barriers is the first step in developing strategies to overcome them. The skills and knowledge of healthcare professionals are important to facilitating access to healthcare among this vulnerable population.

scholarly journals Healthcare utilisation after discharge in patients admitted with gout in Western Australia

2021 ◽  
Author(s):  
Erin Kelty ◽  
Philip Robinson ◽  
Catherine Hill ◽  
Johannes Nossent ◽  
Warren Raymond ◽  
...  
Keyword(s):  
Health Care ◽  
Health Service ◽  
Health Care Costs ◽  
Linear Models ◽  
Hospital Admissions ◽  
Healthcare Utilisation ◽  
Health Service Utilisation ◽  
Service Utilisation ◽  
Median Cost ◽  
Care Costs

Abstract Objectives Evidence suggests that gout is associated with high health care costs and that many inpatient admissions are preventable. Understanding the drivers of health care costs in patients with gout will allow more targeted intervention. The objective was to examine factors associated with high health service utilisation and costs in patients admitted to hospital with gout. Methods Hospital and emergency department data was obtained for patients who had been admitted to hospital with a diagnosis of gout for the first time between 2002 and 2009. The total number, cost and potentially preventable events for the follow-up period was calculated for up to five years post the initial gout hospitalisation. The association between patient characteristics with health service utilisation and health care costs was examined using generalised linear models. Results The cohort included 4,379 individuals, that had 22,222 ED attendances (median cost: $1,826 per patient, IQR: $433 - $4,414), and 58,920 hospital admissions (median cost: $25,009 per patient, IQR: $6,844 - $60,535). Gout was not a primary driver of ED attendances or hospitalisations. A history of smoking and comorbidities including cardiovascular disease, diabetes and mental health disorders were associated with an increase health service utilisation and costs. Conclusion The presence of comorbidities play an important role the risk of health service utilization in people with gout and represents an opportunity to both improve the health-related outcomes for these patients and reduce re-presentations and associated health care costs for the health care system.

scholarly journals Using Linked Data to Estimate the True Number of Individuals Impacted by Residential Fire

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Nargess Ghassempour ◽  
Lara A Harvey ◽  
W. Kathy Tannous
Keyword(s):  
Emergency Department ◽  
Health Service ◽  
Health Services ◽  
Hospital Admissions ◽  
Population Based ◽  
Health Service Utilisation ◽  
Service Utilisation ◽  
Residential Fire ◽  
True Number ◽  
Residential Fires

IntroductionResidential fires remain a significant global public health problem. It is recognised that the reported number of residential fires, fire-related injuries and deaths significantly underestimate the true number. Australian population-based surveys show that around two-thirds of respondents who experience a residential fire are unwilling to call fire services, and studies from the US and New Zealand highlight that many individuals who access medical treatment for fire-related injuries do not have an associated fire incident report. Objectives and ApproachThis population-based study aimed to quantify the total number of residential fires, fire-related injuries and associated health service utilisation. The cohort included all persons residing at a residential address in New South Wales, Australia, which experienced a fire between 1 January 2005 - 31 December 2014. The cohort comprised linked person-level data from eight administrative datasets and includes information about nature of fire, first responder use (Fire and Rescue (FRNSW) and ambulance services), health service utilisation (emergency department, hospital and burns outpatient clinic) and health outcomes. ResultsOver the study period, FRNSW responded to 42,491 residential-fire incidents, involving 42,160 individuals with some individuals reporting multiple times. In total, 3,382 individuals used one or more health service and 154 individuals died. Of individuals who contacted FRNSW, 1,661 (3.9%) used health services;ambulance (n=1,101), emergency department (n=1,114), hospital admissions (n=168). There were 95 deaths. There were 1,721 (51%) additional individuals who used one or more health service as a result of a residential-fire that did not contact FRNSW and 59 additional deaths were identified. Conclusion / ImplicationsThis study found that more than half of individuals who used health services for residential fire-related injuries did not have an associated fire report, highlighting the importance of data linkage for accurate communication to policy makers and the public on the prevalence and impact of residential-fires.

scholarly journals What are the effects of teaching Evidence-Based Health Care (EBHC) at different levels of health professions education? An updated overview of systematic reviews

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254191
Author(s):  
Malgorzata M. Bala ◽  
Tina Poklepović Peričić ◽  
Joanna Zajac ◽  
Anke Rohwer ◽  
Jitka Klugarova ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Outcomes ◽  
Systematic Reviews ◽  
Educational Interventions ◽  
Evidence Based ◽  
Knowledge And Skills ◽  
Overview Of Systematic Reviews ◽  
Mixed Populations ◽  
Evidence Based Health Care ◽  
Different Levels

Background Evidence-based healthcare (EBHC) knowledge and skills are recognised as core competencies of healthcare professionals worldwide, and teaching EBHC has been widely recommended as an integral part of their training. The objective of this overview of systematic reviews (SR) was to update evidence and assess the effects of various approaches for teaching evidence-based health care (EBHC) at undergraduate (UG) and postgraduate (PG) medical education (ME) level on changes in knowledge, skills, attitudes and behaviour. Methods and findings This is an update of an overview that was published in 2014. The process followed standard procedures specified for the previous version of the overview, with a modified search. Searches were conducted in Epistemonikos for SRs published from 1 January 2013 to 27 October 2020 with no language restrictions. We checked additional sources for ongoing and unpublished SRs. Eligibility criteria included: SRs which evaluated educational interventions for teaching EBHC compared to no intervention or a different strategy were eligible. Two reviewers independently selected SRs, extracted data and evaluated quality using standardised instrument (AMSTAR2). The effects of strategies to teach EBHC were synthesized using a narrative approach. Previously published version of this overview included 16 SR, while the updated search identified six additional SRs. We therefore included a total of 22 SRs (with a total of 141 primary studies) in this updated overview. The SRs evaluated different educational interventions of varying duration, frequency, and format to teach various components of EBHC at different levels of ME (UG, PG, mixed). Most SRs assessed a range of EBHC related outcomes using a variety of assessment tools. Two SRs included randomised controlled trials (RCTs) only, while 20 reviews included RCTs and various types of non-RCTs. Diversity of study designs and teaching activities as well as aggregated findings at the SR level prevented comparisons of the effects of different techniques. In general, knowledge was improved across all ME levels for interventions compared to no intervention or pre-test scores. Skills improved in UGs, but less so in PGs and were less consistent in mixed populations. There were positive changes in behaviour among UGs and PGs, but not in mixed populations, with no consistent improvement in attitudes in any of the studied groups. One SR showed improved patient outcomes (based on non-randomised studies). Main limitations included: poor quality and reporting of SRs, heterogeneity of interventions and outcome measures, and short-term follow up. Conclusions Teaching EBHC consistently improved EBHC knowledge and skills at all levels of ME and behaviour in UGs and PGs, but with no consistent improvement in attitudes towards EBHC, and little evidence of the long term influence on processes of care and patient outcomes. EBHC teaching and learning should be interactive, multifaceted, integrated into clinical practice, and should include assessments. Study registration The protocol for the original overview was developed and approved by Stellenbosch University Research Ethics Committee S12/10/262. Update of the overview Young T, Rohwer A, Volmink J, Clarke M. What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS One. 2014;9(1):e86706. doi: 10.1371/journal.pone.0086706.

scholarly journals Health service utilisation associated with chronic breathlessness: random population sample

2021 ◽  
pp. 00415-2021
Author(s):  
David C. Currow ◽  
Sungwon Chang ◽  
Magnus Ekström ◽  
Ann Hutchinson ◽  
Tim Luckett ◽  
...  
Keyword(s):  
Health Service ◽  
Health Services ◽  
Hospital Admission ◽  
Demographic Data ◽  
Population Sample ◽  
Health Service Utilisation ◽  
Self Report ◽  
Systematic Sampling ◽  
Service Utilisation ◽  
Cross Sectional

Most health service utilisation studies are of people with specific diagnoses or demographic characteristics, and rarely of specific chronic symptoms. Does population-level health service utilisation increase in people with chronic breathlessness?MethodsCross-sectional analysis of the South Australian Health Omnibus Survey (HOS) 2017, a multi-stage, clustered area systematic sampling survey of adults where questions are administered face-to-face in respondents’ homes. Self-report of health service utilisation in the previous 3 months (medical consultations, ED, hospital admission), chronic breathlessness (severity, duration; modified Medical Research Council (mMRC) breathlessness scale) and demographic data were used to predict self-reported health service utilisation.ResultsA total of 2898 people were included (49.0% men; median age 48.0 years (IQR 32.0, 63.0); 64.1% educated beyond school; 55.4% in work; 73.5% had outpatient contact; 6.3% had a hospital admission in the previous three months). Chronic breathlessness (mMRC ≥1) was reported by 8.8% of respondents. In bivariable analyses, people with greater contact with health services were older, and a higher proportion were overweight/obese and had more severe chronic breathlessness. In multivariable analyses, chronic breathlessness and older age were positively associated with outpatient care and inpatient care, and people with chronic breathlessness were hospitalised for longer, incidence rate ratio 2.5 (95%CI: 1.4, 4.5).AnswerThere is a significant association between worse chronic breathlessness and increased health service utilisation. There is a need for greater understanding of factors that initiate contact with health services.

Patterns of health service utilisation among the Australian population with cancer compared with the general population

2020 ◽  
Vol 44 (3) ◽  
pp. 470 ◽  
Author(s):  
Huah Shin Ng ◽  
Bogda Koczwara ◽  
David Roder ◽  
Raymond Javan Chan ◽  
Agnes Vitry
Keyword(s):  
General Population ◽  
Health Service ◽  
Health Services ◽  
Chronic Diseases ◽  
Health Service Utilisation ◽  
Control Group ◽  
Service Utilisation ◽  
Australian Population ◽  
Delivery Of Care ◽  
Barriers And Enablers

Objective The aim of this study was to describe patterns of health service utilisation among the Australian population with cancer compared with the general population. Methods Data for all respondents aged ≥25 years from two successive National Health Surveys conducted between 2011 and 2014 were analysed. Respondents with a history of cancer were identified as the cancer group, whereas all other respondents who did not report having had a cancer were included in the non-cancer control group. Comparisons were made between the two groups using logistic regression models. Results The population with cancer was more likely to report having consulted their general practitioner, specialist, chemist, dietician, naturopath, nurse, optometrist, dentist, audiologist and other health professionals than the non-cancer population. The cancer population was also more likely to be admitted to hospital and to have visited an out-patient clinic, emergency department and day clinic. The presence of comorbidity and a current cancer were associated with a greater likelihood of receiving health services among the population with cancer. Conclusion The population with cancer used health services significantly more than the non-cancer population. Further studies are urgently needed to identify optimal approaches to delivery of care for this population, including barriers and enablers for their implementation. What is known about the topic? Multimorbidity is highly prevalent among the cancer population due to risk factors shared between cancer and other chronic diseases, and the development of new conditions resulting from cancer treatment and cancer complications. However, the Australian healthcare system is not set up optimally to address issues related to multimorbidity. What does this paper add? This study is the first step in quantifying health services use by the population with cancer compared with the general population without cancer. Cancer survivors have an increased need for specific health services, particularly among those with multimorbidity. What are the implications for practitioners? The development of integrated care models to manage multiple chronic diseases aligned with the Australian National Strategic Framework for Chronic Conditions is warranted. Further studies are urgently needed to identify optimal approaches to delivery of care for this population, including barriers and enablers for their implementation.

scholarly journals Low and unequal use of outpatient health services in public primary health care facilities in southern Ethiopia: a facility-based cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hiwot Abera Areru ◽  
Mesay Hailu Dangisso ◽  
Bernt Lindtjørn
Keyword(s):  
Health Service ◽  
Health Services ◽  
Health Facilities ◽  
Health Service Utilisation ◽  
Southern Ethiopia ◽  
Service Utilisation ◽  
Cross Sectional ◽  
Health Authorities ◽  
Utilisation Rate ◽  
Children Under 5

Abstract Background Outpatient department visits per individual for each year are one of the core indicators of healthcare delivery to assess accessibility or quality of services. In addition, this study aimed to assess health service utilisation and disease patterns in southern Ethiopia, by including the health authorities’ suggestions to improve the services. No study has assessed this in Ethiopia previously. Methods An institution-based cross-sectional design study was done in 65 primary health care units in Dale and Wonsho districts, in Sidama region, for all patients visiting health facilities from 1 July 2017 to 30 June 2018. We estimated the utilisation rate as visits per person per year, the odds ratio for health use and proportions of diseases’ diagnoses. The results of our study were presented to local health authorities, and their suggestions for improvements were incorporated into the analysis. Result A total of 81,129 patients visited the health facilities. The annual outpatient health service utilisation was 0.18 (95% CI: 0.18–0.19) new visits per person per year. The health service utilisation rate per year for the rural population was lower than the urban utilisation by 91% (OR = 0.09; 95% CI: 0.08–0.09). Children in the age group of 5–14 years had lower odds of health service utilisation by 78% (OR = 0.22; 95% CI: 0.21–0.23), compared to children under 5 years of age. Females were four times (OR = 4.17; 95% CI: 4.09–4.25) more likely to utilise health services than males. Febrile illness constituted 17.9% (14,847 of 83,148) of the diagnoses in all age groups. Almost half of the febrile cases, 46.5% (3827 of 8233), were among children under 5 years of age. There were very few cases of non-communicable diseases diagnosed in the health facilities. The health authorities suggested improving diagnostic capacities at health centres, enhancing health professionals’ skill and attitudes, and improving affordability and physical accessibility of the services. Conclusion The health service utilisation rate was low in Sidama. The use of health services was lower among rural residents, men, children and elderly, and health post users. Improving the quality, affordability and accessibility of the health services, by involving responsible stakeholders could increase service usage.

scholarly journals Barriers and Enablers of Health Service Utilisation for Childhood Skin Infections in Remote Aboriginal Communities of Western Australia

2020 ◽  
Vol 17 (3) ◽  
pp. 808 ◽  
Author(s):  
David Hendrickx ◽  
Ingrid Amgarth-Duff ◽  
Asha C Bowen ◽  
Jonathan R Carapetis ◽  
Robby Chibawe ◽  
...  
Keyword(s):  
Health Service ◽  
Health Services ◽  
Western Australia ◽  
Service Providers ◽  
Health Service Utilisation ◽  
Penicillin G ◽  
Service Utilisation ◽  
Skin Infections ◽  
Aboriginal Communities ◽  
Wide Range

In Australia, children living in remote Aboriginal communities experience high rates of skin infections and associated complications. Prompt presentation to primary care health services is crucial for early diagnosis and treatment. We performed a qualitative study in four remote Aboriginal communities in the Pilbara region of Western Australia to explore factors that affected health service utilisation for childhood skin infections in this setting. The study consisted of semistructured interviews and focus group discussions with parents and carers (n = 16), healthcare practitioners (n = 15) and other community service providers (n = 25). We used Andersen’s health service utilisation model as an analytical framework. Our analysis captured a wide range of barriers that may undermine timely use of health services for childhood skin infections. These included general factors that illustrate the importance of cultural competency amongst healthcare providers, patient-centred care and community engagement. Relating specifically to health service utilisation for childhood skin infections, we identified their apparent normalisation and the common use of painful benzathine penicillin G injections for their treatment as important barriers. Health service utilisation in this setting may be enhanced by improving general awareness of the significance of childhood skin infections, actively engaging parents and carers in consultation and treatment processes and strengthening community involvement in health service activities.

scholarly journals The Mixed Effect of China’s New Health Care Reform on Health Insurance Coverage and the Efficiency of Health Service Utilisation: A Longitudinal Approach

2020 ◽  
Vol 17 (5) ◽  
pp. 1782
Author(s):  
Jiaqi Chen ◽  
Song Xu ◽  
Jing Gao
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Service ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Coverage Rate ◽  
Health Service Utilisation ◽  
Service Utilisation ◽  
Mixed Effect ◽  
Utilisation Efficiency

In 2009, China launched a new health care reform as it endeavoured to develop a tiered system of disease diagnosis and treatment to promote the integration of medical resources. This was important for improving service capacity and building medical alliances that would eventually lead to improved health service utilisation efficiency. However, while the 2009 reform aimed to provide universal health insurance coverage to all citizens, its overall effect on health service utilisation efficiency remains unclear. We aimed to examine the new health care reform’s mixed effect by applying a longitudinal study using China Health and Nutrition Survey (CHNS) data and the difference-in-difference (DID) method to estimate the health reform’s impact on health insurance coverage rate. Then, we studied whether the increase in health insurance coverage rate affected health service utilisation efficiency in China. Our results showed that the increase in insurance coverage rate has indeed made expensive medical services available to low-income individuals. However, it also increased the likelihood of use of hospitals rather than primary care facilities, since there is more insurance cover for outpatient visits, which has led to an increased demand for quality services. This effect has generated a negative impact on health care utilisation which directly pertains to systemic inefficiency. This study thus indicates that China’s latest health reform requires further policies to improve its overall efficiency.

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