BMC Health Services Research
Volume 19, Issue 1, 2019

The OPTIMISE project: Protocol for a mixed methods, pragmatic, quasi-experimental trial to improve primary care delivery to refugees in Australia (Article) (Open Access)

Russell G.* , Gunatillaka N. , Lewis V. , Cheng I.-H. , Enticott J. , Marsh G. , Vasi S. , Advocat J. , Song H. , Saito S. , Casey S. , Smith M. , Harris M.
  • a Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, 270 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia
  • b Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, 270 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia
  • c Australian Institute for Primary Care and Ageing, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
  • d Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, 270 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia, Enliven, Melbourne, VIC, Australia
  • e Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, 270 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia
  • f Australian Institute for Primary Care and Ageing, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
  • g Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, 270 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia
  • h Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, 270 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia
  • i Centre for Primary Health Care and Equity, Faculty of Medicine, UNSW, Sydney, NSW, Australia
  • j Centre for Primary Health Care and Equity, Faculty of Medicine, UNSW, Sydney, NSW, Australia
  • k Foundation House, Melbourne, VIC, Australia
  • l New South Wales Refugee Health Service, Sydney, NSW, Australia
  • m Centre for Primary Health Care and Equity, Faculty of Medicine, UNSW, Sydney, NSW, Australia

Abstract

Background: Australia is one of many nations struggling with the challenges of delivering quality primary health care (PHC) to increasing numbers of refugees. The OPTIMISE project represents a collaboration between 12 organisations to generate a model of integrated refugee PHC suitable for uptake throughout Australia. This paper describes the methodology of one component; an outreach practice facilitation intervention, directed towards improving the quality of PHC received by refugees in Australian general practices. Methods: Our mixed methods study will use a cluster stepped wedge randomised controlled trial design set in 3 urban regions of high refugee resettlement in Australia. The intervention was build upon regional partnerships of policy advisors, clinicians, academics and health service managers. Following a regional needs assessment, the partnerships reached consensus on four core areas for intervention in general practice (GP): recording of refugee status; using interpreters; conducting comprehensive health assessments; and referring to refugee specialised services. Refugee health staff trained in outreach practice facilitation techniques will work with GP clinics to modify practice routines relating to the four core areas. 36 general practice clinics with no prior involvement in a refugee health focused practice facilitation will be randomly allocated into early and late intervention groups. The primary outcome will be changes in number of claims for Medical Benefit Service reimbursed comprehensive health assessments among patients identified as being from a refugee background. Changes in practice performance for this and 3 secondary outcomes will be evaluated using multilevel mixed effects models. Baseline data collection will comprise (i) pre-intervention provider survey; (ii) two surveys documenting each practices' structure and approaches to delivery of care to refugees. De-identified medical record data will be collected at baseline, at the end of the intervention and 6 and 12 months following completion. Discussion: OPTIMISE will test whether a regionally oriented practice facilitation initiative can improve the quality of PHC delivered to refugees. Findings have the potential to influence policy and practice in broader primary care settings. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12618001970235, 05/12/2018, Retrospectively registered. Protocol Version 1, 21/08/2017. © 2019 The Author(s).

Author Keywords

Primary care Primary health care Refugee health Intervention trial Partnerships Migrant health

Index Keywords

general practice Needs Assessment Quality Improvement total quality management refugee Australia human clinical assessment Refugees clinician controlled study randomized controlled trial manager Humans male staff case report female patient referral medical record Referral and Consultation Ambulatory Care Facilities outpatient department clinical article Article organization and management intervention study adult New Zealand outcome assessment Delivery of Health Care facilitation primary health care health care delivery
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85067626675&doi=10.1186%2fs12913-019-4235-6&partnerID=40&md5=cc8ea49beacee301575b806166b96669
DOI: 10.1186/s12913-019-4235-6
ISSN: 14726963
Original Language: English