Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory – use of the Chronic Care Model (original) (raw)
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Setting up chronic disease programs: perspectives from Aboriginal Australia
Ethnicity & disease, 2006
To share some perspectives on setting up programs to improve management of hypertension, renal disease, and diabetes in high-risk populations, derived from experience in remote Australian Aboriginal settings. Regular integrated checks for chronic disease and their risk factors and appropriate treatment are essential elements of regular adult health care. Programs should be run by local health workers, following algorithms for testing and treatment, with back up from nurses. Constant evaluation is essential. COMPONENTS: Theses include testing, treatment, education for individuals and communities, skills and career development for staff, ongoing evaluation, program modification, and advocacy. Target groups, elements, and frequency of testing, as well as the reagents and treatment modalities must be designed for local circumstances, which include disease burden and impact, competing priorities, and available resources. Pilot surveys or record reviews can define target groups and condit...
Australian and New Zealand Journal of Public Health, 2021
hronic disease accounts for about 80% of the mortality gap between Aboriginal and Torres Strait Islander and non-Indigenous Australians aged 35-74 years. 1 Diabetes, cardiovascular disease (CVD), and chronic kidney disease (CKD) are major contributors to the chronic disease burden. 2 Common and modifiable risk factors for chronic disease include high blood pressure, high cholesterol, tobacco use, overweight and obesity, and diabetes. Other nontraditional risk factors, such as socioeconomic disadvantage and low education level attained, are also associated with these diseases. 3,4 The need to address risk factors for preventing chronic disease is wellrecognised. 5,6 A review of 71 Aboriginal and Torres Strait Islander health promotion programs in Australia found most programs addressed nutrition and focused on individual behaviour change, with target audiences ranging from whole-of-community to specific subgroups, such as women or youth. 7 Community-based chronic disease programs, such as the '1 Deadly Step' program, 8 have highlighted some key enablers for successful implementation, including a strong local working group, resourceful clinic managers and staff, access to operational support, being free of charge, and inclusion of family members. 8 However, barriers include lack of resources and community infrastructure, distance to travel to attend the program, and other family priorities. 9,10 In Australia, Aboriginal Community Controlled Health Services (ACCHSs) engage with their communities to deliver culturally appropriate comprehensive healthcare to Aboriginal and Torres Strait Islander people. This is achieved through the provision of primary care, allied health and preventive care services. 11 Although ACCHSs are more costly to run than mainstream GP practices, 12 they have shown greater benefits and outcomes for the Australian Indigenous population by improving access to health services and, critically, have communitycontrolled governance. 12-14 Despite evidence of the benefits of health promotion for the prevention of chronic disease and the importance of communitydriven healthcare, 15 there is yet to be a detailed description of chronic disease programs within the setting of ACCHSs in Australia. This study aimed to identify and describe community-based chronic disease prevention programs being conducted by
Australian Journal of Rural Health, 2008
Objective: To test an evaluation framework designed to evaluate implementation of the North Queensland Indigenous communities between August and December 2005.Setting: Both communities are located in Cape York, North Queensland. Community A has an estimated population of around 600 people; Community B has an enumerated population of 750, although health centre records indicate a higher number.Participants: Process evaluation involved health centre staff in both communities; clinical audits used random samples from the adult population (each sample n = 30); ethnographic fieldwork was conducted with resident population.Main outcome measures: Health centre scores and qualitative findings using a System Assessment Tool; clinical audits – extent to which scheduled services recorded; selected primary health performance indicators; qualitative ethnographic findings.Results: On almost all indicators, implementation of NQICDS had progressed further in Community A than in Community B; however, some common issues emerged, especially lack of linkages between health centres and other groups, and lack of support for client self-management.Conclusions: The evaluation framework is an effective and acceptable framework for monitoring implementation of the NQICDS at the primary health centre level.
This paper explores some of the history and rationale for the Aboriginal Community Controlled Health Services (ACCHS) model of service delivery, and why it is difficult to compare their effectiveness directly with that of other primary health care services in Australia. ACCHS were pioneered over 40 years ago. Since then, they have been established across Australia as a model of primary health care to meet the needs of Australia's disadvantaged Indigenous population which had been underserviced within mainstream health services. ACCHS are managed by Aboriginal boards, promote a model of holistic and comprehensive primary health care and are largely funded by government. Over recent years, additional funding has gone to ACCHS and mainstream services in an effort to close the gap in Aboriginal life expectancy. In this context, the authors were commissioned to examine the peer-reviewed literature to explore the question of the relative effectiveness of ACCHS compared with other primary health care services. In responding to the question, we were led to consider the historical experience of Aboriginal people, their social and economic disadvantage, the geographic distribution of Aboriginal people where there is market-failure of general practice, the predominant model of primary care in Australia, the complexity of Aboriginal people's health needs, and the limitations of peer-review studies. We argue that the provision of effective health services requires that they are accessible and attentive to the needs of their client, not just that they deliver evidence-based medicine. Services exist on a performance continuum, so quality improvement approaches with appropriate measures of quality to assess performance for Aboriginal people are needed. We argue that partnerships between ACCHS and mainstream health care providers are essential to improving Aboriginal health outcomes given the complex nature of modern health care and the myriad of health and social problems experienced by Aboriginal people.
BMC Health Services Research
Background Chronic diseases are the leading contributor to the excess morbidity and mortality burden experienced by Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) people, compared to their non-Indigenous counterparts. The Home-based Outreach case Management of chronic disease Exploratory (HOME) Study provided person-centred, multidisciplinary care for Indigenous people with chronic disease. This model of care, aligned to Indigenous peoples’ conceptions of health and wellbeing, was integrated within an urban Indigenous primary health care service. We aimed to determine the impact of this model of care on participants’ health and wellbeing at 12 months. Methods HOME Study participants were Indigenous, regular patients of the primary health care service, with a diagnosis of at least one chronic disease, and complex health and social care needs. Data were collected directly from participants and from their medical records at baseline, and 3, 6 and 12 months ...
Case Study of an Aboriginal Community Controlled Health Service in Australia
2016
Universal health coverage provides a framework to achieve health services coverage but does not articulate the model of care desired. Comprehensive primary health care includes promotive, preventive, curative, and rehabilitative interventions and health equity and health as a human right as central goals. In Australia, Aboriginal community-controlled health services have pioneered comprehensive primary health care since their inception in the early 1970s. Our five-year project on comprehensive primary health care in Australia partnered with six services, including one Aboriginal community-controlled health service, the Central Australian Aboriginal Congress. Our findings revealed more impressive outcomes in several areas—multidisciplinary work, community participation, cultural respect and accessibility strategies, preventive and promotive work, and advocacy and intersectoral collaboration on social determinants of health—at the Aboriginal community-controlled health service compared to the other participating South Australian services (state-managed and nongovernmental ones). Because of these strengths, the Central Australian Aboriginal Congress's community-controlled model of comprehensive primary health care deserves attention as a promising form of implementation of universal health coverage by articulating a model of care based on health as a human right that pursues the goal of health equity.