Follow‐up of Indigenous‐specific health assessments ‐ a socioecological analysis

Bailie, Jodie; Schierhout, Gill; Kelaher, Margaret; Laycock, Alison; Percival, Nikki; O'Donoghue, Lynette R.; McNeair, Tracy; Chakraborty, Amal; Beacham, Barbara; Bailie, Ross

doi:10.5694/mja13.00256

Cited by 30 publications

(35 citation statements)

References 12 publications

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“…Medicare-funded Indigenous-specific health assessments were introduced in 1999 and progressive expansion of these services has resulted in a substantial increase in the delivery of assessments over the past 15 years [8–10]. Unfortunately, these efforts have had no clear effect on improving mortality and morbidity [11, 12] and follow-up from health assessments has been disproportionally low [8, 9]. This has called into question the effectiveness of health assessments as a way to ensure Indigenous Australians get preventive health services [8, 13].…”

Section: Introductionmentioning

confidence: 99%

Improving preventive health care in Aboriginal and Torres Strait Islander primary care settings

et al. 2017

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BackgroundLike other colonised populations, Indigenous Australians experience poorer health outcomes than non-Indigenous Australians. Preventable chronic disease is the largest contributor to the health differential between Indigenous and non-Indigenous Australians, but recommended best-practice preventive care is not consistently provided to Indigenous Australians. Significant improvement in health care delivery could be achieved through identifying and minimising evidence-practice gaps. Our objective was to use clinical audit data to create a framework of the priority evidence-practice gaps, strategies to address them, and drivers to support these strategies in the delivery of recommended preventive care.MethodsDe-identified preventive health clinical audit data from 137 primary health care (PHC) centres in five jurisdictions were analysed (n = 17,108 audited records of well adults with no documented major chronic disease; 367 system assessments; 2005–2014), together with stakeholder survey data relating to interpretation of these data, using a mixed-methods approach (n = 152 responses collated in 2015–16). Stakeholders surveyed included clinicians, managers, policy officers, continuous quality improvement (CQI) facilitators and academics. Priority evidence-practice gaps and associated barriers, enablers and strategies to address the gaps were identified and reported back through two-stages of consultation. Further analysis and interpretation of these data were used to develop a framework of strategies and drivers for health service improvement.ResultsStakeholder identified priorities were: following-up abnormal test results; completing cardiovascular risk assessments; timely recording of results; recording enquiries about living conditions, family relationships and substance use; providing support for clients identified with emotional wellbeing risk; enhancing systems to enable team function and continuity of care. Drivers identified for improving care in these areas included: strong Indigenous participation in the PHC service; appropriate team structure and function to support preventive care; meaningful use of data to support quality of care and CQI; and corporate support functions and structures.ConclusionThe framework should be useful for guiding development and implementation of barrier-driven, tailored interventions for primary health care service delivery and policy contexts, and for guiding further research. While specific strategies to improve the quality of preventive care need to be tailored to local context, these findings reinforce the requirement for multi-level action across the system. The framework and findings may be useful for similar purposes in other parts of the world, with appropriate attention to context in different locations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-017-0267-z) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Improving preventive health care in Aboriginal and Torres Strait Islander primary care settings

et al. 2017

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“…9 Existing literature on care for Aboriginal people highlights the importance of primary care, integrated care and care that provides a culturally safe environment for management of chronic disease. [10][11][12] Yet while health assessments on Aboriginal people have increased in primary care settings, follow-up treatment for identified problems is poor 13 and unacceptably large gaps exist between evidence and practice. 12 Stigma, discrimination and racism are experienced by Aboriginal people in health service contexts 10,14 and power imbalances between…”

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confidence: 99%

Theory that explains an Aboriginal perspective of learning to understand and manage diabetes

Webster

Johnson

Kemp

et al. 2017

Australian and New Zealand Journal of Public Health

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Objective: To use grounded theory and participatory research methodology to explain how Aboriginal people learn to understand and manage type 2 diabetes. Methods:Aboriginal people with diabetes were invited to participate in one of five focus groups (n=25, male=12, female=13). Focus groups and education sessions were conducted by Aboriginal members of the research team. Focus groups were audio recorded and transcribed, with coding and first level analysis undertaken by all members of the research team.Results: Participants described colonisation and dislocation from Country and family members' experiences with diabetes as significant historical influences which, in conjunction with the model of care experienced and the type of interaction with health services, shaped how they came to understand and manage their diabetes. Conclusions: Patient experience of a model of care alone is not what influences understanding and management of diabetes in Aboriginal people.Implications for Public Health: Health service improvements should focus on understanding past experiences of Aboriginal patients, improving interactions with health services and supporting holistic family centred models of care. Focusing on just the model of care in absence of other improvements is unlikely to deliver health benefits to Aboriginal people.

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“…There is emerging evidence that taking basic measurements and screening of patients are done relatively well (such as taking a patient's blood pressure or ordering tests), but the adequacy of follow up is less well-documented in patient records (Bailie et al 2014. Failure to follow up abnormal test results is an important patient safety issue and requires urgent attention.…”

Section: Received 3 August 2017 Accepted 19 December 2017 Publishedmentioning

confidence: 99%

Rigorous follow-up systems for abnormal results are essential to improve health outcomes for Aboriginal and Torres Strait Islander people

Bailie

Matthews

Laycock

et al. 2018

Aust. J. Prim. Health

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Follow‐up of Indigenous‐specific health assessments ‐ a socioecological analysis

Abstract: Work is required across various levels of the system to address barriers to follow-up care. Enhancing follow-up care is vital to achieving health benefits from the large financial and human resource investment in health assessments.

Cited by 30 publications

References 12 publications

Improving preventive health care in Aboriginal and Torres Strait Islander primary care settings

Improving preventive health care in Aboriginal and Torres Strait Islander primary care settings

Theory that explains an Aboriginal perspective of learning to understand and manage diabetes

Rigorous follow-up systems for abnormal results are essential to improve health outcomes for Aboriginal and Torres Strait Islander people

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