出版社：Utrecht University, Maastricht University, Groningen University
摘要：Introduction : There is a global agenda towards shared culture and practices between clinicians and a shift to integrated and more community-based healthcare. A crucial context in this agenda is clinicians’ practice with referral of vulnerable populations to community programs, as referral practices address necessary dimensions of integrated care (e.g. professional and normative integration). This study investigates clinicians’ referral practices for people attending diabetes outpatient clinics from culturally and linguistically diverse (CALD) backgrounds to identify possible challenges with making referrals to CALD specific programs. Methods : The study was conducted in four diabetes outpatient facilities in South Western Sydney Local Health District in Sydney, Australia. Fifty-three clinicians, including medical specialists, diabetes nurse educators and allied health professionals (e.g. dietitian, psychologist) participated by completing a questionnaire in June 2018. The response rate for the questionnaire was 75%. Data were analysed for frequency of health professional’s referral and rationale for referral and non-referral to three CALD specific programs. Results : Only twenty-five percent (13/53) of clinicians had referred to CALD specific education programs in the past 12 months. There were 10 referrals for the NSW Health Get Healthy Program (including an interpreter), three referrals for the community-based diabetes support group and nil referrals to the bilingual community educator diabetes education program run by the Health Promotion Department. The most common reason for non- referrals was clinician’s lack of awareness of the programs. Other rationales for non-referral were: inconvenience of the referral process (1 clinician), other health issues taking priority over making the referral (1 clinician) and the programs not being beneficial for the patient (1 clinician). Discussion : Clinicians’ lack of awareness of available community programs can be a bottleneck to integrating care for the vulnerable diabetes outpatients from CALD background. This situation is characteristic of lack of awareness of services outside of one’s own setting and indicate inadequacies in professional, functional and normative integration. As the study finds clinicians doubting benefits from CALD specific programs and not prioritising the referral, it is possible that multidisciplinary professionals in this setting are not convinced of the shared value of the CALD specific programs. Conclusions : Clinician’s referral to CALD specific community programs for diabetes outpatients of CALD background is not at a satisfactory level. The challenges are clinician’s lack of awareness of the program and vision of shared value of the programs. Shared culture and practices between the diabetes outpatient departments and providers of CALD specific education programs are necessary for integrating care for this cohort. Lessons learned : Clinician’s referral to CALD specific community programs was not at a satisfactory level, despite the programs being in operation for 3 or more years. Appropriate referral mechanisms and integration of care in multidisciplinary setting requires a long-term approach, addressing clinical governance, shared culture and practices of different professions. Limitations : This study was limited to the context of an outpatient service for people with type 2 diabetes. Suggestions for future research : Future research may investigate whether similar challenges in referral mechanisms occur in the case of other chronic conditions.
