Context: Since 2002, over 13,000 refugees have resettled in Wisconsin with two-thirds of that population residing in the city of Milwaukee. Healthcare providers that perform initial refugee health screenings may lack basic knowledge about the diverse backgrounds, expectations, and specific needs of this population. Understanding these gaps may provide guidance for the development of formal clinical protocols, trainings, and tools.
Objective: To gain insight into primary care team members' perceptions of existing barriers within the clinical encounter when delivering care to refugee patient populations.
Design: Multi-perspective, qualitative study. Setting: Primary care.
Participants: Physicians (faculty and residents), nurse practitioners, pharmacists, nurses, and medical assistants (n=12), who have been working with refugee patients for at least one year at two family medicine residency clinics and/or a community health center, were interviewed.
Methods: Semi-structured in-person interviews were conducted and audio-recorded, transcribed, and openly coded to identify emergent themes. Through an immersion/crystallization and consensus approach, data was categorized into domains and subthemes.
Results: Major domains and subthemes identified to date include: Markers of success in clinical encounters (improving communication, adaptation); Building relationships (over time, earning trust, cultural humility); Knowledge of or lack of clinical resources (barriers from unwritten languages, inefficient accessibility, refugee focused trainings, formal debriefs).
Conclusion: Perceptions of success in clinical encounters with refugee patients were primarily associated with communication as opposed to achievement in numeric metrics (e.g. hypertension control). The development of any formalized trainings, tools, and resources to support primary care providers working with refugee patient populations should take these goals into consideration. Lastly, potential solutions were identified to address existing barriers for primary care providers in clinical encounters with refugee patients, but further research and development is necessary to assess their efficacy and utility.
Waclawik G, Pandhi N, Kotovicz F (presenter). Delivering quality care to refugees within the clinical encounter: primary care team members’ perceptions in Milwaukee, Wisconsin. Presented at North American Primary Care Research Group 46th Annual Meeting; November 9-13, 2018; Chicago, IL.