Lost in translation: addressing the barriers to refugees receiving access to optimal medicines management

Aim: To implement a structured process for improving newly settled refugees’ concordance with their tuberculosis regimen.

Background: On two occasions newly settled refugees were inadvertently turned away from the Pharmacy causing them to receive an incomplete treatment course for latent tuberculosis. This highlighted various problems including but not limited to communication.

Methods: Responding to such difficulties in providing pharmaceutical care to this unique patient group, the senior technician introduced a structured process to dispense, monitor and follow up refugee patients’ tuberculosis medications. Education was provided to the whole Pharmacy Department by the Refugee Health Clinical Nurse Consultant (CNC) in order to increase awareness of the significance of the misadventure. Understanding the issues surrounding communication and cultural sensitivity was paramount to improving the service Pharmacy provides to refugees. The components of the structured process were: instructions for the use of interpreter services; sighting each Refugee Health identity card (hospital-provided) before the medications are handed out; a streamlined dispensing process; liaison with the Refugee Health CNC if a patient fails to collect the medications on time, or on completion of the course.

Results: The system was welcomed by all pharmacy staff, refugee patients, the CNC and medical staff. Pharmacists found the structured process efficient and compatible with their workflow. The Interpreter service was successfully used on two occasions in the nine month follow up period. The streamlined dispensing system generated concordance alerts on seven occasions. All alerts were communicated to the CNC taking care of refugee patients in a timely manner. All patients collected the required treatment course for latent tuberculosis.

Conclusion: The structured process to improve refugee patients’ concordance with tuberculosis medications resulted in significant improvement in communication and follow up of refugee patients. The growing refugee population in Australia will require hospital pharmacy departments to be proactive in addressing the pharmaceutical needs of this unique patient population.