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Response to language barriers with patients from refugee background in general practice in Australia: findings from the OPTIMISE study

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posted on 2021-09-20, 02:15 authored by S Saito, MF Harris, KM Long, Virginia LewisVirginia Lewis, S Casey, W Hogg, IH Cheng, J Advocat, Geraldine MarshGeraldine Marsh, N Gunatillaka, G Russell
Background: Language is a barrier to many patients from refugee backgrounds accessing and receiving quality primary health care. This paper examines the way general practices address these barriers and how this changed following a practice facilitation intervention. Methods: The OPTIMISE study was a stepped wedge cluster randomised trial set within 31 general practices in three urban regions in Australia with high refugee settlement. It involved a practice facilitation intervention addressing interpreter engagement as one of four core intervention areas. This paper analysed quantitative and qualitative data from the practices and 55 general practitioners from these, collected at baseline and after 6 months during which only those assigned to the early group received the intervention. Results: Many practices (71 %) had at least one GP who spoke a language spoken by recent humanitarian entrants. At baseline, 48 % of practices reported using the government funded Translating and Interpreting Service (TIS). The role of reception staff in assessing and recording the language and interpreter needs of patients was well defined. However, they lacked effective systems to share the information with clinicians. After the intervention, the number of practices using the TIS increased. However, family members and friends continued to be used to interpret with GPs reporting patients preferred this approach. The extra time required to arrange and use interpreting services remained a major barrier. Conclusions: In this study a whole of practice facilitation intervention resulted in improvements in procedures for and engagement of interpreters. However, there were barriers such as the extra time required, and family members continued to be used. Based on these findings, further effort is needed to reduce the administrative burden and GP’s opportunity cost needed to engage interpreters, to provide training for all staff on when and how to work with interpreters and discuss and respond to patient concerns about interpreting services.


The project was co-funded by the National Health and Medical Research Council (NHMRC) Partnerships for Better Health Scheme (Round 2, 2015, APP1106372) and funding and/or in-kind contributions from the following partner organisations: Monash Health, coHealth, enliven, Victorian Department of Health and Human Services, Victorian Refugee Health Network, NSW Refugee Health Service, South Eastern Health Providers Association, North Western Melbourne Primary Health Network, South Western Sydney Primary Health Network, AMES Australia, Settlement Services International and the Royal Australian College of General Practitioners. Study recruitment, management, analysis and publication were entirely independent of the funding agencies.


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BMC Health Services Research



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