Improving Delivery of Primary Care for Vulnerable Migrants: Delphi Consensus to Prioritize Innovative Practice Strategies

Overview

Journal Can Fam Physician

Specialties General Medicine
Public Health

Date 2014 Jan 24

PMID 24452576

Citations 21

Authors

Kevin Pottie

Ricardo Batista

Maureen Mayhew

Lorena Mota

Karen Grant

Affiliations

Soon will be listed here.

Abstract

Objective: To identify and prioritize innovative strategies to address the health concerns of vulnerable migrant populations.

Design: Modified Delphi consensus process.

Setting: Canada.

Participants: Forty-one primary care practitioners, including family physicians and nurse practitioners, who provided care for migrant populations.

Methods: We used a modified Delphi consensus process to identify and prioritize innovative strategies that could potentially improve the delivery of primary health care for vulnerable migrants. Forty-one primary care practitioners from various centres across Canada who cared for migrant populations proposed strategies and participated in the consensus process.

Main Findings: The response rate was 93% for the first round. The 3 most highly ranked practice strategies to address delivery challenges for migrants were language interpretation, comprehensive interdisciplinary care, and evidence-based guidelines. Training and mentorship for practitioners, intersectoral collaboration, and immigrant community engagement ranked fourth, fifth, and sixth, respectively, as strategies to address delivery challenges. These strategies aligned with strategies coming out of the United States, Europe, and Australia, with the exception of the proposed evidence-based guidelines.

Conclusion: Primary health care practices across Canada now need to evolve to address the challenges inherent in caring for vulnerable migrants. The selected strategies provide guidance for practices and health systems interested in improving health care delivery for migrant populations.

Citing Articles

"She held my hand and advised me": Young migrants' experiences of individual peer support to access health and social services in two small towns in southwestern Uganda.

Tumwesige E, Kawuma R, Asiimwe A, Nabimanya P, Nakate S, Bernays S PLOS Glob Public Health. 2024; 4(11):e0003713.

PMID: 39576777 PMC: 11584103. DOI: 10.1371/journal.pgph.0003713.

Assessing primary health care provider and organization readiness to address family violence in Alberta, Canada: development of a Delphi consensus readiness tool.

Montesanti S, Sehgal A, Zaeem L, McManus C, Squires S, Silverstone P BMC Prim Care. 2024; 25(1):146.

PMID: 38684969 PMC: 11059610. DOI: 10.1186/s12875-024-02396-3.

Refugee and migrants' involvement in participatory spaces in a US practice-based research network study: Responding to unanticipated priorities.

LeMaster J, Lutgen C, Matharoo J, MacFarlane A Health Expect. 2023; 26(4):1596-1605.

PMID: 37078650 PMC: 10349241. DOI: 10.1111/hex.13764.

Personalizing the BioPsychoSocial Approach: "Add-Ons" and "Add-Ins" in Generalist Practice.

Ventres W, Frankel R Front Psychiatry. 2021; 12:716486.

PMID: 34899410 PMC: 8652412. DOI: 10.3389/fpsyt.2021.716486.

Understanding the health and housing experiences of refugees and other migrant populations experiencing homelessness or vulnerable housing: a systematic review using GRADE-CERQual.

Kaur H, Saad A, Magwood O, Alkhateeb Q, Mathew C, Khalaf G CMAJ Open. 2021; 9(2):E681-E692.

PMID: 34145051 PMC: 8248559. DOI: 10.9778/cmajo.20200109.

References

Newbold B . Health status and health care of immigrants in Canada: a longitudinal analysis. J Health Serv Res Policy. 2005; 10(2):77-83. DOI: 10.1258/1355819053559074. View

Arya N, McMurray J, Rashid M . Enter at your own risk: government changes to comprehensive care for newly arrived Canadian refugees. CMAJ. 2012; 184(17):1875-6. PMC: 3503898. DOI: 10.1503/cmaj.120938. View

Setia M, Quesnel-Vallee A, Abrahamowicz M, Tousignant P, Lynch J . Access to health-care in Canadian immigrants: a longitudinal study of the National Population Health Survey. Health Soc Care Community. 2010; 19(1):70-9. PMC: 3762743. DOI: 10.1111/j.1365-2524.2010.00950.x. View

Jacobs E, Shepard D, Suaya J, Stone E . Overcoming language barriers in health care: costs and benefits of interpreter services. Am J Public Health. 2004; 94(5):866-9. PMC: 1448350. DOI: 10.2105/ajph.94.5.866. View

Baltussen R, Niessen L . Priority setting of health interventions: the need for multi-criteria decision analysis. Cost Eff Resour Alloc. 2006; 4:14. PMC: 1560167. DOI: 10.1186/1478-7547-4-14. View

McKenna H . The Delphi technique: a worthwhile research approach for nursing?. J Adv Nurs. 1994; 19(6):1221-5. DOI: 10.1111/j.1365-2648.1994.tb01207.x. View

Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M . Evidence-based clinical guidelines for immigrants and refugees. CMAJ. 2010; 183(12):E824-925. PMC: 3168666. DOI: 10.1503/cmaj.090313. View

Dean J, Wilson K . "My health has improved because I always have everything I need here...": A qualitative exploration of health improvement and decline among immigrants. Soc Sci Med. 2010; 70(8):1219-28. DOI: 10.1016/j.socscimed.2010.01.009. View

Gushulak B, Pottie K, Hatcher Roberts J, Torres S, DesMeules M . Migration and health in Canada: health in the global village. CMAJ. 2010; 183(12):E952-8. PMC: 3168671. DOI: 10.1503/cmaj.090287. View

10.

Rasanathan K, Montesinos E, Matheson D, Etienne C, Evans T . Primary health care and the social determinants of health: essential and complementary approaches for reducing inequities in health. J Epidemiol Community Health. 2009; 65(8):656-60. DOI: 10.1136/jech.2009.093914. View

11.

Swinkels H, Pottie K, Tugwell P, Rashid M, Narasiah L . Development of guidelines for recently arrived immigrants and refugees to Canada: Delphi consensus on selecting preventable and treatable conditions. CMAJ. 2010; 183(12):E928-32. PMC: 3168668. DOI: 10.1503/cmaj.090290. View

12.

Murray S, Skull S . Hurdles to health: immigrant and refugee health care in Australia. Aust Health Rev. 2005; 29(1):25-9. DOI: 10.1071/ah050025. View

13.

Manchikanti L . Evidence-based medicine, systematic reviews, and guidelines in interventional pain management, part I: introduction and general considerations. Pain Physician. 2008; 11(2):161-86. View

14.

Adeleye O, Ofili A . Strengthening intersectoral collaboration for primary health care in developing countries: can the health sector play broader roles?. J Environ Public Health. 2010; 2010:272896. PMC: 2862317. DOI: 10.1155/2010/272896. View

15.

Rootman I, Ronson B . Literacy and health research in Canada: where have we been and where should we go?. Can J Public Health. 2005; 96 Suppl 2:S62-77. PMC: 6975604. View

16.

Howard M, Goertzen J, Kaczorowski J, Hutchison B, Morris K, Thabane L . Emergency Department and Walk-in Clinic Use in Models of Primary Care Practice with Different After-Hours Accessibility in Ontario. Healthc Policy. 2009; 4(1):73-88. PMC: 2645201. View

17.

Keeney S, Hasson F, McKenna H . A critical review of the Delphi technique as a research methodology for nursing. Int J Nurs Stud. 2001; 38(2):195-200. DOI: 10.1016/s0020-7489(00)00044-4. View

18.

Chan B . The declining comprehensiveness of primary care. CMAJ. 2002; 166(4):429-34. PMC: 99351. View

19.

Caulford P, Vali Y . Providing health care to medically uninsured immigrants and refugees. CMAJ. 2006; 174(9):1253-4. PMC: 1435973. DOI: 10.1503/cmaj.051206. View

20.

Wilson K, Rosenberg M . Accessibility and the Canadian health care system: squaring perceptions and realities. Health Policy. 2004; 67(2):137-48. DOI: 10.1016/s0168-8510(03)00101-5. View