Understanding the structure and processes of primary health care for young indigenous children

Abstract

INTRODUCTION Primary health care organisations need to continuously reform to more effectively address current health challenges, particularly for vulnerable populations. There is growing evidence that optimal health service structures are essential for producing positive outcomes. AIM To determine if there is an association between process of care indicators (PoCIs) for important young indigenous child health and social issues and: (i) primary health-care service and child characteristics; and (ii) organisational health service structures. METHODS This was a cross-sectional study of 1554 clinical child health audits and associated system assessments from 74 primary care services from 2012 to 2014. Composite PoCIs were developed for social and emotional wellbeing, child neurodevelopment and anaemia. Crude and adjusted logistic regression models were fitted, clustering for health services. Odds ratios and 95% confidence intervals were derived. RESULTS Overall, 32.0% (449) of records had a social and emotional wellbeing PoCI, 56.6% (791) had an anaemia PoCI and 49.3% (430) had a child neurodevelopment PoCI. Children aged 12–23 months were significantly more likely to receive all PoCIs compared to children aged 24–59 months. For every one point increase in assessment scores for team structure and function (aOR 1.14, 95% CI 1.01–1.27) and care planning (aOR 1.14, 95% CI 1.01–1.29) items, there was a 14% greater odds of a child having an anaemia PoCI. Social and emotional wellbeing and child neurodevelopment PoCIs were not associated with system assessment scores. DISCUSSION Ensuring young indigenous children aged 24–59 months are receiving quality care for important social and health indicators is a priority. Processes of care and organisational systems in primary care services are important for the optimal management of anaemia in indigenous children.

Anemia in disadvantaged children aged under five years; quality of care in primary practice

“…We are also focusing on ‘structures of care’ such as education and training, capacity building and improvements in the organisation of health systems. [14, 48]…”

How Barunga Aboriginal community implemented and sustained an anaemia program – A case study evaluation

“…26,31,65,[69][70][71] Furthermore, a study published in 2018 utilising child health audit data from 1,554 Aboriginal children in primary health services also found that leadership styles, defining roles and responsibilities and capacity building combined with alignment to guidelines improved anaemia treatment. 72 A range of policy, systemic and organisational factors also con- improve practice support implementation 48 as was found with the Barunga Program. CQI was the main monitoring approach used in the Program, which has been shown to be culturally acceptable and has resulted in positive outcomes in other Aboriginal communities.…”

“…CQI was the main monitoring approach used in the Program, which has been shown to be culturally acceptable and has resulted in positive outcomes in other Aboriginal communities. 72,73 When staff capacity was limited, a task-orientated approach dominated, prioritising Iron Run clinical tasks. A more holistic approach, however, was favoured when the Program team was wellresourced, allowing for more counselling and health promotion by the Health Centre, and through external partnerships with other organisations working to support community development and well-being.…”

Emerging evidence of the value of health assessments for Aboriginal and Torres Strait Islander people in the primary healthcare setting

“…anaemia and child neurodevelopment if they had received an Indigenous-specific health assessment than those children who received acute care (2466 client records of children aged 3-59 months, from 109 Indigenous PHC centres, 2012-14) (Strobel et al 2018). These findings are consistent with other Australian research that has found Indigenous-specific health assessments to be useful for identifying new health issues, including chronic disease risk factors for individuals and for service populations (Miller et al 2002;Spurling et al 2009;Coleman et al 2011;Bailie et al 2013;Dutton et al 2016).…”