Refugee patients in primary care

Key points

  • People from refugee backgrounds, including people seeking asylum, come from a diversity of backgrounds and experiences.
  • People from refugee backgrounds will have similar health concerns to their Australian-born counterparts, but may also have health issues specific to their country of origin and their migration and settlement experience.
  • People from refugee backgrounds have higher rates of long-term physical and psychological problems than other migrants, due in large part to their exposure to deprivation, persecution and human rights violations as well as post-migration stressors.
  • New arrivals from refugee backgrounds will typically be unfamiliar with Australian healthcare services systems and procedures, including the roles of general practice and other primary healthcare services, pharmacy, and hospital-based services.
  • An incremental, person-centred and trauma-informed approach is recommended for recovery and long-term care of people from refugee backgrounds.
  • General practice has a key role to play in undertaking post-arrival health assessments and providing ongoing care.
  • Refugee patients with complex needs may require assistance from other services. Primary care is ideally placed for managing referrals and coordinating multiple services.

Overview

Each year many thousands of people from refugee backgrounds settle in Australia from regions including the Middle East, Africa and South-East Asia, where they have endured conflict, persecution and dislocation from their homes, families and culture.

Reported prevalence of torture and war-related potentially traumatic experiences varies and is difficult to generalise across groups. A 2016 systematic review reported prevalence of torture ranged between 1–76% (median 27%) and that almost all participants across all studies had experienced war-related potentially traumatic experiences.1 This may include forced dislocation, prolonged political repression, refugee camp experiences and loss of, or separation from, family members in violent circumstances.

Many people from refugee backgrounds, including people seeking asylum, have higher rates of long-term physical and psychological problems than other migrants, due in large part to their pre-immigration experiences, which are compounded by post-migration factors. People from refugee backgrounds can experience barriers when accessing primary care and other services. These may be related to trauma symptoms associated with the refugee experience, language, culture, health system literacy, lack of appropriate services, socioeconomic disadvantage as well as policies that restrict eligibility to health and other services.2,3

Approach to care

Accessible primary care is ideally suited to providing an incremental, patient-directed approach to long-term care and recovery for refugee patients in Australia. Developing continuity of care for patients from refugee backgrounds can be promoted by a whole-of-practice approach with attention to trauma-informed care. See Whole-of-practice approaches, Approach to consultation and management.

Patients with complex needs may benefit from primary care with support from settlement, specialist refugee and medical services, mental health and trauma services. Primary care can play a valuable role in coordinating multiple services if these are required. See State and territory referrals.

Health assessments are useful for planning the care of all newly arrived people from refugee backgrounds, including people seeking asylum, even if they are not eligible for the MBS funded health assessment. They remain as useful principles for refugee patients who arrived some time ago, but are new to your care. See Refugee health assessment.

The time-based Medicare Benefits Schedule (MBS) items 701, 703, 705 and 707 can be used for the ‘Health Assessment for Refugees and other Humanitarian Entrants’. These MBS items enable GPs to undertake a complete history, examination, investigation, problem list and management plan for new arrivals, many of whom will not have had access to comprehensive health care for some years.

For information regarding eligibility for the MBS funded health assessment see the Department of Health Medicare Health Assessment Resource Kit.

Considerations

Many patients from refugee backgrounds may:

  • require a professional interpreter (accessible free of charge via the Translating and Interpreting Service National Doctors’ Priority Line on 1300 131 450). See Communication and interpreters for further information about working with interpreters.
  • not have undergone pre-departure screening or may have medical conditions that were not picked up prior to arrival in Australia
  • have physical and psychological effects associated with torture or other traumatic events
  • have spent extended periods in detention in Australia
  • be experiencing medical conditions that are uncommon in Australia
  • be struggling with the practical tasks of settling in Australia, particularly housing and financial problems
  • not know where to get assistance
  • require an approach to consultation and management that accommodates the impact of past trauma, prior experience of health care, cultural differences and the stresses of resettlement. See Approach to consultation and management.

Resources

For country background information:

References

  1. Sigvardsdotter E, Vaez M, Rydholm Hedman A-M, Saboonchi F. Prevalence of torture and other war-related traumatic events in forced migrants: A systematic review. Journal on Rehabilitation of Torture Victims and Prevention of Torture. 2016;26(2):41-73.
  2. Cheng I-H, Drillich A, Schattner P. Refugee experiences of general practice in countries of resettlement: a literature review. Br J Gen Pract. 2015;65(632):e171-e176.
  3. Li SS, Liddell BJ, Nickerson A. The relationship between post-migration stress and psychological disorders in refugees and asylum seekers. Current psychiatry reports. 2016;18(9):82.

Produced by

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Refugee Health Network of Australia

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The Australian Refugee Health Practice Guide received funding from the Australian Government.

Disclaimer

The information set out in the Australian Refugee Health Practice Guide (“the Guide”) is current at the date of first publication and is intended for use as a guide of a general nature only and may or may not be relevant to particular patients or circumstances. Nor is the Guide exhaustive of the subject matter. Persons implementing any recommendations contained in the Guide must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular circumstances when so doing. The statements or opinions that are expressed in the Guide reflect the views of the contributing authors and do not necessarily represent the views of the editors or Foundation House. Compliance with any recommendations cannot of itself guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional and the premises from which the health professional operates.

Whilst the information is directed to health professionals possessing appropriate qualifications and skills in ascertaining and discharging their professional (including legal) duties, it is not to be regarded as clinical advice and, in particular, is no substitute for a full examination and consideration of medical history in reaching a diagnosis and treatment based on accepted clinical practices.

Accordingly, Foundation House and its employees and agents shall have no liability (including without limitation liability by reason of negligence) to any users of the information contained in the Guide for any loss or damage (consequential or otherwise), cost or expense incurred or arising by reason of any person using or relying on the information contained in the Guide and whether caused by reason of any error, negligent act, omission or misrepresentation in the information. Although every effort has been made to ensure that drug doses and other information are presented accurately in the Guide, the ultimate responsibility rests with the prescribing clinician. For detailed prescribing information or instructions on the use of any product described herein, please consult the prescribing information issued by the manufacturer.