Innovative community health partnerships improve access to care for refugees

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December 16, 2013 by ceris

For many residents trying to find a primary care provider in Ontario the process can be long and frustrating. In 2011, Health Quality Ontario reported that around 7% of us don’t have a family physician. That number bumps to 34% amongst government assisted refugees (GARs) trying to find a family physician.

Under the Immigration and Refugee Protection Act (2002) rules, these newcomers arrive in Ontario with more complex physical and mental health care needs than in the past. In addition to the barriers that individual refugees face just navigating our healthcare system, they also encounter systemic barriers such as a lack of trained professionals and inadequate funding, and institutional barriers such as providers who want to avoid the administrative paperwork that comes with refugee care and thus reject them.

In 2008, staff at the Reception House in Kitchener, which welcomes almost 300 newly arrived GARs each year, were becoming increasingly frustrated trying to find local family physicians for their clients. Resourceful and connected, they approached a local physician, Dr. Neil Arya, whom they knew had an interest in global public health, to get help with trying to connect their clients with family physicians in the local community. Within months the dedicated refugee health clinic was started. Today that clinic sees each and every GAR who arrives at Reception House and provides culturally appropriate assessments and referrals in their own language where possible, using specially trained staff who follow recommended guidelines and best-practices. The network of care providers now extends beyond the boundaries of the medical clinic and Reception House, and includes others such as optometrists and pharmacists.

By 2011, Dr Arya was eager to understand what sort of impact the clinic was having on shutterstock_227121-2his client’s access to the care they so desperately needed. I met Dr Arya as a doctoral student helping him to develop content for a global public health course. Our research team (that included an accountant and an epidemiologist) crafted an evaluative design that would avoid the use of clinical records (many clinic clients had moved on and so couldn’t authorize their use). Using administrative databases, exit interviews,  and non-medical logs of activities we were able to gather data on the type and frequency of care received, as well as individuals’ demographic data and responses to questions such as how well they understood the healthcare system after a year.

What we found was predictable in some cases, and in others unexpected. Not surprisingly we were able to measure a 30% decrease in wait times to see a healthcare provider. We also found that after the clinic there was an 18% increase in the number of refugees finding a permanent family physician in the community – this at a time when Kitchener was designated as an “under-serviced” community. The clinic staff had developed strong relationships with the local physician community, and provided ongoing consultation after the refugees were transferred into their care and transitioned the clients with comprehensive assessment and treatment records.

Surprisingly we found that fewer refugees were being referred to specialists for care- clinic docs were better equipped to diagnose and treat conditions that many refugees experienced. However, the clinic model is dependent upon case workers from Reception House accompanying clients to appointments, arranging language support and helping clients navigate the health system in their first year in Canada. This navigator role is not funded by the healthcare system, yet is as critical to accessing care as the dedicated refugee clinic. We’re hopeful that our study will catch the eye of policy makers – this innovative community-based refugee health initiative is funding neutral, relying instead on the capacity of a community of medical and non-medical providers to organize and deliver integrated care to some of our most vulnerable new Canadian citizens.

If you’re interested in reading more about the study it can be accessed here.

You can find a research summary of this study here.

Note: The study focusses on government-assisted refugees who were at the last hour were not included in the June 2012 cuts to the Interim Federal Health Program that deny access to basic healthcare for many refugee claimants, and have been roundly criticized as inhumane and inequitable. Since then, many activist physicians and healthcare providers have worked to expose the human cost of the cuts, and the downloading of expenses from a federal program to the province, healthcare providers, and the refugees themselves. On December 9th, 2012, the Ontario provincial government announced a Temporary Health Program which will provide access to essential healthcare services for refugee claimants. They intend to “send the federal government the bill to pay for the program”.

About the blog author

SBE picJosephine McMurray is an Assistant Professor at Wilfrid Laurier University’s School of Business and Economics. She recently received her doctorate from the School of Public Health & Health Systems at the University of Waterloo, Ontario. Her research interests include the evaluation of health service models to at-risk populations, health system information exchange and interoperability, and technology-enabled measurement and management of the patient experience.

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