Connecting with primary care
Video: The importance of making an early connection to primary care in the post-migration context
With Dr. Vanessa Reddit (Physician, Crossroads Clinic, Women's College Hospital)
We feel that it's really important to make an early connection to primary care for a variety of reasons. Oftentimes people have a lot of competing priorities when they first arrive. They're getting ready for their hearing, they're trying to find housing, getting registered in school. They may feel ok on arrival, and some do not. For many people, they may not have had access to health care services for a period of time and various conditions may have gone undetected or unmanaged over that period. So connecting to the primary care is an opportunity for us to engage in comprehensive medical history, examination and do screening for infectious diseases as well as chronic conditions, many of which are treatable. And by addressing early, we can prevent longer term complications. Primary care is also the place where people can have their acute and chronic conditions managed, engaging in prenatal care for people that may arrive at different stages of pregnancy or access contraception and family planning options. Primary care offers services for well-baby and well-child visits to ensure that children are growing and developing and receiving adequate nutrition. And also, engaging in preventive care such as immunization, which are required for kids in order to participate in school. So getting them connected early on can prevent delays in getting them into schools, for example. It's also the first connection point for addressing mental health concerns. And we really feel that when people have established a connection with a primary care provider, with someone that they know and trust, if or when a problem arises, it's often easier to turn to somebody that you know and trust rather than trying to seek a new care provider.
It is important to connect immigrants and refugees to primary health care as soon as possible after arrival. Research has found that newcomers are more likely to use health services in an acute manner as opposed to a preventive manner, meaning they are more likely to use the emergency room as the first point of contact with the health care system rather than seeing a general practitioner (Tiagi, 2016). In general, immigrants and refugees are less likely than their Canadian counterparts to use a mental health service in primary care or specialty health care settings (Durbin et al., 2014, 2015 (Ng & Zhang, 2021). Being connected with a primary care provider is essential as primary care providers have a better understanding of the needs of their clients compared to the shorter-term, problem-specific interactions clients encounter in acute care.
Primary care providers should familiarize themselves with insurance coverage options and discuss this matter early on with clients. This is important as clinical encounters with clients facing financial difficulties can be stressful and frustrating, and could affect health outcomes (Hardee et al, 2005).
The primary care connection allows for the development of a rapport and relationship that may better allow refugees and immigrants to feel comfortable disclosing any potential physical and/or mental health concerns, leading to appropriate diagnosis and treatment. For example, a client's report of particular symptoms may indicate a major psychiatric disorder, but only a health care provider with an adequate amount of time, connection and understanding of the client can properly screen and assess for this (Abbey, 2010). In addition, newcomers are less likely to seek care for mental health distress on their own and may be more likely to seek mental health services through their primary care provider (Kirmayer et al., 2011; MHCC, 2016 (Ng & Zhang, 2021)).
Newcomers needing mental health support usually have a common mental disorder (e.g., anxiety and depression) that can be treated by their family doctor. Those who have more severe or complex mental health problems, such as trauma-related disorders, may need specialized mental health interventions (MHCC, 2016).
Supporting newcomers with mental illnesses
Treatment for mental disorders often involves some form of intervention, such as pharmacotherapy, psychotherapy or psychosocial support. These interventions can occur at the individual, family and/or community level. The kind of intervention required, and where to start, are best decided by the health care provider and the client together; if the client wishes, their support network (close family, etc.) may also be included in making this decision.
Treatment support aims to address the client's most immediate needs and could also include more sensitive mental health issues. The client often directs treatment and providers should adapt a holistic approach to supporting clients.
These needs may include any or all of the following:
Referral to services that assist in documentation of torture or persecution for the refugee status determination decision
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Language classes
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Help in finding housing and work
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Addressing other health issues