Objectives: • To determine if refugees completing a Medical Orientation Program for New Americans are better with several aspects of medicine in the US, such as making appointments; knowing more about diet and hygiene; and understanding the implications of mental and chronic illnesses. • To determine if Medical Passports provided to these individuals to improve continuity of care are useful and effective. • To make recommendations for improvements to the Medical Orientation Program for New Americans to the Community Health Center of Burlington (CHCB).https://scholarworks.uvm.edu/comphp_gallery/1052/thumbnail.jp

Bourgo, Jon

Carney, Jan

French, Delia

Graf, Matthew

Korsh, Jeremy

Kreider, Harry

Maltby, Hendrika

Pasciullo, Erica

Shean, Katie

Wood, Emily

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University of VermontScholarWorks @ UVMPublic Health Projects, 2008-present Public Health Projects, University of VermontCollege of Medicine2-4-2011Removing Barriers to Health Care: Healthy Startsfor New AmericansDelia FrenchMatthew GrafJeremy KorshHarry KreiderErica PasciulloSee next page for additional authorsFollow this and additional works at: http://scholarworks.uvm.edu/comphp_galleryPart of the Community Health and Preventive Medicine Commons, and the Health ServicesResearch CommonsThis Article is brought to you for free and open access by the Public Health Projects, University of Vermont College of Medicine at ScholarWorks @UVM. It has been accepted for inclusion in Public Health Projects, 2008-present by an authorized administrator of ScholarWorks @ UVM. For moreinformation, please contact donna.omalley@uvm.edu.Recommended CitationFrench, Delia; Graf, Matthew; Korsh, Jeremy; Kreider, Harry; Pasciullo, Erica; Shean, Katie; Wood, Emily; Bourgo, Jon; Maltby,Hendrika; and Carney, Jan, "Removing Barriers to Health Care: Healthy Starts for New Americans" (2011). Public Health Projects,2008-present. Book 53.http://scholarworks.uvm.edu/comphp_gallery/53AuthorsDelia French, Matthew Graf, Jeremy Korsh, Harry Kreider, Erica Pasciullo, Katie Shean, Emily Wood, JonBourgo, Hendrika Maltby, and Jan CarneyThis article is available at ScholarWorks @ UVM: http://scholarworks.uvm.edu/comphp_gallery/53ReferencesChao S et al. Toward Health Equity and Patient Centeredness integrating health literacy, disparities reduction, and quality improvement. National Academic Press. 2009: 1-102., Culhane-Pera KA ,et al. Improving health through community-based participatory action research. Giving immigrants and refugees a voice. Minn Med. 2010; 93(4):54-7., de Anstiss H, et al. Help-seeking for mental health problems in young refugees: a review of the literature with implications for policy, practice, and research. Transcultural Society 2009; (46)4: 584-607., Dussán KB, et al. Effects of a refugee elective on medical student perceptions. BMC Medical Education 2009; (9):15., Fennely K. Listening to the experts: provider recommendations on the health needs of immigrants and refugees. Journal of Cultural Diversity 2006;13(4):1-90., Guendelman S, et al. Overcoming the Odds: Access to Care for Immigrant Children in Working Poor Families in California. Maternal and Child Health Journal 2005; 9(4): 351-362., Morris MD, et al. Healthcare Barriers of Refugees Post-resettlement. J Community Health 2009;(34):529–538., Probst JC, et al. Association between community health center and rural health clinic presence and county-level hospitalization rates for ambulatory care sensitive conditions: an analysis across eight US states. BMC Health Serv Res 2009 ;31(9):134., Refugee Health Program. Minnesota Department of Health. http://www.health.state.mn.us/divs/idepc/refugee/hcp/healthguidesom.pdf, Refugee Health Program.  Vermont Department of Health website. http://healthvermont.gov/local/rhealth/refugee.aspx#about, Rust G, et al. Presence of a community health center and uninsured emergency department visit rates in rural counties. J Rural Health. 2009, Winter;25(1):8-16.,Scherer TM, et al. Follow-up to a federally qualified health center and subsequent emergency department utilization. Acad Emerg Med. 2010;17(1):55-62., Simbiri KOA, et al. Access Impediments to Health Care and Social Services Between Anglophone and Francophone African Immigrants Living in Philadelphia with Respect to HIV/AIDS. Journal of Immigrant and Minority Health 2009;12(4):569-579., Smith SR. The case of a city where 1 in 6 residents is a refugee: ecological factors and host community adaptation in successful resettlement. Am J Community Psychol2008;42:328-342., Smith-Campbell B. Emergency department and community health center visits and costs in an uninsured population. J Nurs Scholarsh. 2005;37(1):80-6., Springer  PJ, et al. Somali Bantu refugees in southwest Idaho: assessment using participatory research. Advances in Nursing Science. 2010;33(2):170–181 ., Sullivan CH. Partnering with community agencies to provide nursing students with cultural awareness experiences and refugee health promotion access. Educational Innovations 2009;48(9)., Uba L. Cultural barriers to health care for southeast Asian refugees. Public Health Report 1992;107(5):544-8., Vahabi M. Knowledge of Breast Cancer and Screening Practices Among Iranian Immigrant Women in Toronto. Journal of Community Health 2010; 02 September., Weiss BD. Health Literacy and Patient Safety: Help Patients Understand; a manual for clinicians. American Medical Association  2007.Removing Barriers to Health Care: Healthy Starts for New Americans French D1, Graf M1, Korsh J1, Kreider H1, Pasciullo E1, Shean K1, Wood E1, Bourgo2, Maltby H1, Carney, J11. University of Vermont, 2. Community Health Center of BurlingtonMethods• Design a survey to determine whether the learning objectives of each of the Medical Orientation classes were met, and whether or not the Medical Passport met its goals.• Interview Bhutanese refugees individually with an interpreter, asking these survey questions.• Make recommendations to CHCB based on these findings.Medical Orientation Program for New Americans ExampleThe Patient-Provider Relationship, Confidentiality, and the Role of InterpretersObjectives for this Lesson:• Understand the roles of different health care professionals• Understand why it is important to talk openly with your doctor• Learn what “confidentiality” means for you and your doctor• Learn about “consent”• Understand the role of an interpreter• Discuss different methods of interpretation that may be used when you visit the doctorSurvey Example• When it’s not an emergency, who should you see when you’re sick? • What does patient-doctor confidentiality mean?• What does “informed consent” mean?Objectives• To determine if refugees completing a Medical Orientation Program for New Americans are better with several aspects of medicine in the US, such as making appointments; knowing more about diet and hygiene; and understanding the implications of mental and chronic illnesses.• To determine if Medical Passports provided to these individuals to improve continuity of care are useful and effective.• To make recommendations for improvements to the Medical Orientation Program for New Americans to the Community Health Center of Burlington (CHCB).  Background• Language barriers, cultural differences, and low health literacy in immigrant populations lead to decreased health care quality and outcomes (Chao, 2009; Morris, 2009).• Language barriers cause the treatment responsibility to shift heavily toward the patient (Weiss, 2007).• Community-based participatory action research (CBPAR) used by health care clinicians is shown to successfully identify the most pressing needs of community health center populations, and improve medical practices as well as overall patient health (Culhane-Pera et al, 2009).• CBPAR studies assessing Somali Bantu refugee populations in Southwest Idaho revealed a high degree of vulnerability and increased risk for health disparities (Springer et al, 2010).• Clinics for refugees can be held for patient education when appropriate medical translation staff is present (Smith, 2008).• Refugee communities rely on community health centers for health care, as those centers provide for uninsured and underserved communities where refugees are disproportionately represented (Probst et al, 2009).Conclusion• The CHCB is dedicated to providing care to people who have a limited English language and reduced ability to pay. • Assuring that New Americans receive necessary health care, including primary and preventative care, is challenging. • Barriers to care may include administrative, cultural, language, knowledge, and transportation. • Efforts to improve health care access must focus on the specific needs of diverse populations.  • Though it is clear that this population benefited from the Orientation, there are improvements that could be made for future sessions. Results• Majority (12/21 = 57%) knew to make an appointment with their own doctors if they are sick (versus going to the emergency room)• Majority (16/21 = 76%) knew the meaning of chronic disease • Majority receive help from English-speaking relatives in making appointments (14/21 = 67%) Recommendations• Better differentiation about what does constitute an emergency • Decrease the size of the medical passports (already done) • Remind people that while many may not be curable, they are treatable • Encourage more practice with verbal (English) assertions about health (making an appointment; or, saying “I am a diabetic”) so that New Americans have basic skills to inform people about their health when they do not have access to a translator• Make the clinical vignettes in the surveys (e.g. chests pain, child vomiting) more clearer• Clarify the consequences of a chronic diseaseLessons Learned• Interpreters have different styles that may influence a  survey• Survey could be provided ahead of time so that the interpreters can coordinate their explanation of difficult concepts• Pressure to get answers correct: some of us stated “it’s okay if you don’t know the answers”, but it is not clear that this message was conveyed consistently# of respondents

Removing Barriers to Health Care: Healthy Starts for New Americans

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Removing Barriers to Health Care: Healthy Starts for New Americans

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