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.

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.

scholarly journals Cooperation in the mental health treatment of patients with outpatient commitment

2020 ◽  
Vol 8 ◽  
pp. 205031212092641
Author(s):  
Maria Løvsletten ◽  
Tonje Lossius Husum ◽  
Elisabeth Haug ◽  
Arild Granerud
Keyword(s):  
Health Service ◽  
Health Services ◽  
Mental Health Treatment ◽  
Healthcare Professionals ◽  
Focus Group Interviews ◽  
Outpatient Commitment ◽  
Service Levels ◽  
Group Interviews ◽  
Municipal Health

Background: Patients with outpatient commitment have a decision on coercive treatment from the specialist health services even if they are in their own home and receive municipal health services. Objective: The aim of this study is to gain more knowledge about how the outpatient commitment system works in the municipal health service and specialist health services, and how they collaborate with patients and across service levels from the perspectives of healthcare professionals. Methods: This is a qualitative study collecting data through focus group interviews with health personnel from the municipal health service and specialist health services. Results: The results describe the health personnel’s experiences with follow-up and interactions with the patients with outpatient commitment decisions, and their experiences with collaboration between service levels. Conclusion: The study show that outpatient commitment makes a difference in the way patients with this decision are followed up. The legislative amendment with new requirements for consent competence was challenging. Collaboration between services levels was also challenging.

scholarly journals Internal migration and health in South Africa: determinants of healthcare utilisation in a young adult cohort

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carren Ginsburg ◽  
Mark A. Collinson ◽  
F. Xavier Gómez-Olivé ◽  
Mark Gross ◽  
Sadson Harawa ◽  
...  
Keyword(s):  
South Africa ◽  
Relative Risk ◽  
Health Service ◽  
Health Services ◽  
Urban Areas ◽  
Multinomial Logistic Regression ◽  
Healthcare Utilisation ◽  
Geographic Mobility ◽  
Service Utilisation ◽  
Multinomial Regression

Abstract Background In South Africa, human geographic mobility is high as people engage in both permanent and temporary relocation, predominantly from rural to urban areas. Such mobility can compromise healthcare access and utilisation. The objective of this paper is to explore healthcare utilisation and its determinants in a cohort of internal migrants and permanent residents (non-migrants) originating from the Agincourt sub-district in South Africa’s rural northeast. Methods A 5-year cohort study of 3800 individuals aged 18 to 40 commenced in 2017. Baseline data have been collected from 1764 Agincourt residents and 1334 temporary, mostly urban-based, migrants, and are analysed using bivariate analyses, logistic and multinomial regression models, and propensity score matching analysis. Results Health service utilisation differs sharply by migrant status and sex. Among those with a chronic condition, migrants had 0.33 times the odds of non-migrants to have consulted a health service in the preceding year, and males had 0.32 times the odds of females of having used health services. Of those who utilised services, migration status was further associated with the type of healthcare utilised, with 97% of non-migrant rural residents having accessed government facilities, while large proportions of migrants (31%) utilised private health services or consulted traditional healers (25%) in migrant destinations. The multinomial logistic regression analysis indicated that, in the presence of controls, migrants had 8.12 the relative risk of non-migrants for utilising private healthcare (versus the government-services-only reference category), and 2.40 the relative risk of non-migrants for using a combination of public and private sector facilities. These findings of differential utilisation hold under statistical adjustment for relevant controls and for underlying propensity to migrate. Conclusions Migrants and non-migrants in the study population in South Africa were found to utilise health services differently, both in overall use and in the type of healthcare consulted. The study helps improve upon the limited stock of knowledge on how migrants interface with healthcare systems in low and middle-income country settings. Findings can assist in guiding policies and programmes to be directed more effectively to the populations most in need, and to drive locally adapted approaches to universal health coverage.

scholarly journals Protocol for a non-randomised feasibility study evaluating a codesigned patient safety guide in primary care

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e039752
Author(s):  
Rebecca L Morris ◽  
Kay Gallacher ◽  
Mark Hann ◽  
Carly Rolfe ◽  
Nicola Small ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Safety ◽  
Health Service ◽  
Healthcare Professionals ◽  
Patient Empowerment ◽  
Service Utilisation ◽  
Two Phase ◽  
Ethical Approval ◽  
General Practices ◽  
The Uk

IntroductionPatients and carers should be active partners in patient safety with healthcare professionals and be empowered to use personalised approaches to identify safety concerns and work together to prevent them. This protocol paper details a study to examine the feasibility of a multicomponent intervention to involve patients and/or carers in patient safety in primary care in the UK.Methods and analysisThis is a two-phase, non-randomised feasibility mixed methods pragmatic study of a patient safety guide for primary care (PSG-PC). 8 general practices will recruit 120 patient and/or carer participants. All patient and/or carer participants will receive the PSG-PC. It will examine the feasibility and acceptability of the PSG-PC in primary care settings in patients aged 18 years or older who attend appointments at general practice with health professionals four or more times per year as either patients or carers. It will identify secondary outcomes for improving patient safety, health status and patient empowerment, and reducing health service utilisation over 6 months between baseline and 6-month follow-ups. The findings will inform whether a main effectiveness trial is feasible and, if so, how it should be designed, and how many patients and practices will be needed. The study will be undertaken between January 2020 and September 2021.Ethics and disseminationEthical approval was obtained from the National Health Service London-West London and Gene Therapy Advisory Committee Research Ethics Committee (reference: 19/LO/1289). Research findings will be disseminated with participating general practices and shared in a range of different ways to engage different audiences, including presenting at international and national conferences, publishing in open-access, peer-reviewed journals and facilitating dissemination workshops within local communities with patients, carers and healthcare professionals.Trial registration numberISRCTN90222092.

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 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.

English Language Ability and Mental Health Service Utilisation: A Census

1996 ◽  
Vol 30 (2) ◽  
pp. 270-277 ◽  
Author(s):  
Geoffrey W. Stuart ◽  
I. Harry Minas ◽  
Steven Klimidis ◽  
Siobhan O'connell
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Health Service ◽  
Health Services ◽  
Language Proficiency ◽  
English Language ◽  
Psychiatric Care ◽  
English Language Proficiency ◽  
Service Utilisation

Objective: To explore the relationship between English language proficiency and mental health service utilisation. Methods: In September 1993, a sample census was conducted of all mental health services in the State of Victoria, including public and private hospital wards, outpatient consultations provided by psychiatrists and clinical psychologists, and primary mental health care provided by general practitioners. Response rates ranged from 37% for monolingual general practitioners (GPs) to 96% for inpatient units. Particular emphasis was placed on patients' English language proficiency and the role played by bilingual clinicians. Results: Over 80% of inpatients received a diagnosis of either dementia or psychosis. This proportion was even greater in the case of patients with English language difficulties. The latter group of patients underutilised specialist outpatient services, and those using these services were less likely to receive psychotherapy than fluent English speakers. They utilised GPs for mental disorder at at least the same rate as other patients. There was a marked preference for bilingual GPs, with 80% of patients with poor English language skills consulting GPs who spoke their native language. Conclusion: There appears to be considerable underutilisation of specialist mental health services by patients who are not fluent in English. The liaison-consultation model of psychiatric care may be an effective way of addressing this problem, given the important role already played by bilingual GPs in the psychiatric care of those whose native language is not English.

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