Abstract
BackgroundAustralian federal and jurisdictional governments are implementing ambitious policy initiatives intended to improve health care access and outcomes for Aboriginal and Torres Strait Islander people. In this qualitative study we explored Aboriginal Medical Service (AMS) staff views on factors needed to improve chronic care systems and assessed their relevance to the new policy environment.MethodsTwo theories informed the study: (1) ‘candidacy’, which explores “the ways in which people’s eligibility for care is jointly negotiated between individuals and health services”; and (2) kanyini or ‘holding’, a Central Australian philosophy which describes the principle and obligations of nurturing and protecting others. A structured health systems assessment, locally adapted from Chronic Care Model domains, was administered via group interviews with 37 health staff in six AMSs and one government Indigenous-led health service. Data were thematically analysed.ResultsStaff emphasised AMS health care was different to private general practices. Consistent with kanyini, community governance and leadership, community representation among staff, and commitment to community development were important organisational features to retain and nurture both staff and patients. This was undermined, however, by constant fear of government funding for AMSs being withheld. Staff resourcing, information systems and high-level leadership were perceived to be key drivers of health care quality. On-site specialist services, managed by AMS staff, were considered an enabling strategy to increase specialist access. Candidacy theory suggests the above factors influence whether a service is ‘tractable’ and ‘navigable’ to its users. Staff also described entrenched patient discrimination in hospitals and the need to expend considerable effort to reinstate care. This suggests that Aboriginal and Torres Strait Islander people are still constructed as ‘non-ideal users’ and are denied from being ‘held’ by hospital staff.ConclusionsSome new policy initiatives (workforce capacity strengthening, improving chronic care delivery systems and increasing specialist access) have potential to address barriers highlighted in this study. Few of these initiatives, however, capitalise on the unique mechanisms by which AMSs ‘hold’ their users and enhance their candidacy to health care. Kanyini and candidacy are promising and complementary theories for conceptualising health care access and provide a potential framework for improving systems of care.
Highlights
Australian federal and jurisdictional governments are implementing ambitious policy initiatives intended to improve health care access and outcomes for Aboriginal and Torres Strait Islander people
The format of the Health Systems Assessment was informed by our review of candidacy theory; concepts of kanyini; the findings from Improving Access to Kidney Transplants Study and the Audit and Best Practice for Chronic Disease program; and informal observations of health service systems that were made during the conduct of the Kanyini Audit [8]
Five core themes were identified: (1) Aboriginal Medical Service (AMS) are different from private general practice; (2) AMSs are under threat; (3) a pressured workforce; (4) drivers for quality care; (5) candidacy to hospital and specialised care
Summary
Australian federal and jurisdictional governments are implementing ambitious policy initiatives intended to improve health care access and outcomes for Aboriginal and Torres Strait Islander people. Key themes included difficulty in attracting and retaining skilled staff in remote areas; inadequate resources to comprehensively engage with patients to discuss treatment options and to assist them in making informed decisions regarding their health and wellbeing; poor communication between hospital and primary care providers leading to lack of coordination of care; and the need for more Aboriginal and Torres Strait Islander staff, in senior decision-making roles. Overall these issues led to patients feeling poorly informed, confused and frustrated with being unable to effectively communicate their concerns [4]. Weaknesses across all domains were predominantly related to grossly inadequate human and financial resources [7]
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have