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International migrants frequently struggle to obtain access to local primary care practices. The purpose of this paper is to explore factors associated with rejecting and…
International migrants frequently struggle to obtain access to local primary care practices. The purpose of this paper is to explore factors associated with rejecting and accepting migrant patients into Canadian primary care practices.
Mixed methods study. Using a modified Delphi consensus approach among a network of experts on migrant health, the authors identified and prioritized factors related to rejecting and accepting migrants into primary care practices. From ten semi-structured interviews with the less-migrant-care experienced practitioners, the authors used qualitative description to further examine nuances of these factors.
Consensus was reached on practitioner-level factors associated with a reluctance of practitioners to accept migrants − communication challenges, high-hassle factor, limited availability of clinicians, fear of financial loss, lack of awareness of migrant groups, and limited migrant health knowledge – and on factors associated with accepting migrants − feeling useful, migrant health education, third party support, learning about other cultures, experience working overseas, and enjoying the challenge of treating diseases from around the world. Interviews supported use of interpreters, community resources, alternative payment methods, and migrant health education as strategies to overcome the identified challenges.
This Delphi network represented the views of practitioners who had substantive experience in providing care for migrants. Interviews with less-experienced practitioners were used to mitigate this bias.
This study identifies the facilitators and challenges of migrants’ access to primary care from the perspective of primary care practitioners, work that complements research from patients’ perspectives. Strategies to address these findings are discussed.
The purpose of this paper is to describe the patient level characteristics of government-assisted refugees (GARs) who had acquired family doctors after leaving specialized…
The purpose of this paper is to describe the patient level characteristics of government-assisted refugees (GARs) who had acquired family doctors after leaving specialized refugee clinics (RC).
A cross-sectional telephone survey of GARs households, three to six years after arrival to British Columbia, that used logistic regression to identify GAR characteristics associated with having a family doctor compared to having no family doctor or remaining at a RC.
Contact rate was 52 percent. Of 177 interviewed GARs who spoke 24 languages, only 61 percent had secured a family doctor. Only 57 percent were educated; 46 percent spoke English and 40 percent worked consistently. Central Asian or African origin was associated with having a family doctor (OR 10.6 (95 percent CI 3.1-36.8) for RC; OR 10.3 (95 percent CI 2.2-47.8) for no family doctor). Other significant characteristics in the comparison with GARs at a RC included English proficiency (OR 15.6 (95 percent CI 4.3-56.9)), and female sex (OR 4.0 (95 percent CI 1.4-1.1)). When compared to those with no family doctor, additional significant characteristics included Health Authority A compared to B (OR 8.9, 95 percent CI 1.4-55.6) and having recently visited a doctor (OR 7.7 (95 percent CI 1.9-30.7)).
The results of this study are limited to a specific environment and the low contact rate may have resulted in bias.
This study described characteristics of GARs who had successfully transitioned to a family doctor and those who had not. This population is rarely captured in studies because they are difficult to contact, ethnically diverse and not proficient in English.
– The purpose of this paper is to explore refugees’ experiences of the barriers and facilitators involved in finding a regular family doctor.
The purpose of this paper is to explore refugees’ experiences of the barriers and facilitators involved in finding a regular family doctor.
Hermeneutic phenomenology was used to produce an integrated description sensitive to the lifeworlds of refugees who came from multiple cultural perspectives. Participants consisted of refugees from Iran, Afghanistan, Myanmar, Vietnam, and Latin America who arrived in Canada between 2005 and 2007. Texts for analysis came from first language focus group discussions and interviews with the interpreters for those groups.
The principal themes that emerged from the experience of barriers were “futility,” “dependence,” and “relevance.” Themes related to the experience of facilitators were “inclusion,” “congruence,” and “benefit to family.” These themes provide key messages about sources of patient decisions to seek or not seek care, not comply, attend irregularly, and not disclose symptoms, which can be used by doctors and other health providers to enhance care planning.
The factors that facilitate refugees’ access to a regular family doctor have implications for the development of culturally appropriate healthcare information, policies that support adequate interpreter services, and cultural sensitivity training for physicians.
Previous research documents barriers such as lack of language access, differences in health beliefs, and lack of knowledge about western healthcare systems. However, little is known about how refugees experience these barriers, nor how they overcome them. This study contributes a rich and deeper understanding of how refugees experience these barriers and elucidates factors that facilitate their process of obtaining a regular family doctor.