None listed
Conditions
Brief summary
Abstract: Background: Australia is one of many nations struggling with the challenges of delivering quality primary health care (PHC) to an increasing number of refugees. OPTIMISE is a project that builds on the collaboration of 12 organisations involved in delivering PHC to refugees. This trial relates to an outreach facilitation based quality improvement intervention, directed towards improving the quality of PHC received by refugees within Australian general practices. Methods: Our mixed methods study involves a quasi-experimental design and is set in 3 regions of high refugee resettlement in Australia. We began by creating Regional Partnerships Teams (RPTs) consisting of policy advisors, clinicians, academics, health service managers and community members. Following a regional needs assessment, stakeholders participated in a deliberative process to reach consensus on four core areas for the general practice based intervention. These were: recording of refugee status; use of interpreters; conduction of comprehensive health assessments and timely referral to refugee specialised services. The intervention involves training expert refugee health staff in outreach facilitation techniques enabling them to engage primary care practices in quality improvement activities. Facilitators will aid practices to identify and address gaps in current routines relating to the four core areas. We aim to recruit 36 general practices with no prior involvement in a refugee health focused practice facilitation. Practices will be randomly allocated into early and late intervention groups. The primary outcomes will be changes related to the four core areas identified. Changes in practice performance relating to these outcome measures will be evaluated using multilevel mixed effects models. Quantitative collection will comprise of (i) a provider survey (ii) two practice surveys: one documenting internal systems of the practice; the other assessing the practice’s current approaches to delivery of care to refugees; and (iii) de-identified data from medical records. Data collection time points are baseline, post-intervention and at 6 months follow up. Qualitative data collection includes semi-structured interviews with intervention participants, reflective diaries and document analysis. Discussion: OPTIMISE will test whether a regionally oriented practice facilitation initiative can improve the quality of PHC delivered to our vulnerable refugee population. Findings have the potential to influence policy and practice in other primary care settings.
Interventions
Procedures: a primary care practice based quality improvement intervention built on the principles of outreach practice facilitation where an experienced, external change agent visits the practice to provide support in change management that targets improvements in the delivery of evidence based care to patients.
Who: a refugee health fellow or refugee health nurse with extensive experience in refugee health matters
Mode of delivery: face to face and phone/email
Intervention: each practice wil
Procedures: a primary care practice based quality improvement intervention built on the principles of outreach practice facilitation where an experienced, external change agent visits the practice to provide support in change management that targets improvements in the delivery of evidence based care to patients. Who: a refugee health fellow or refugee health nurse with extensive experience in refugee health matters Mode of delivery: face to face and phone/email Intervention: each practice will receive a minimum of 6 contacts with the practice facilitator. This includes 3x 1 hour face to face visits and 3 phone calls over the 6 month intervention period. Visits will be in months 1, 3 and 5; phone calls will be made in months 2, 4 and 6. Location: Primary care practice Materials: Evidence based guidelines for refugee health (Victorian Refugee Health Network, Australasian Society for Infectious Diseases and others) with a focus on refugee identification, interpreter use, conduct of comprehensive health assessments and referral.
Sponsors
Southern Academic Primary Care Research Unit, Department of General Practice, Monash University
Study design
Allocation
Randomised controlled trial
Intervention model
Other
Primary purpose
Educational / counselling / training
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
To be eligible, primary care practices will: • Be located in the identified priority catchment areas; • Provide general primary care services including private (solo, group or corporate practices) or public community health centres; • Plan to be in operation for at least the next two years without substantial change to governance or management; • Be using electronic medical records and billing software compatible with PENCS CAT4™ de-identified data extraction software, namely Best Practice and Medical Director; • Be willing to see patients of refugee background; • Have at least 50% of GPs willing to participate in a practice facilitation intervention; • Have no objection from other staff at the practice to the practice facilitation intervention or a de-identified medical record audit; To be eligible, primary care practice staff will be: aged over 18 years, fluent in English and willing to see patients from a refugee background.
Exclusion criteria
• Have participated in an intensive practice facilitation intervention to improve refugee primary care in the last 12 months.
Outcome results
None listed