Characteristics of Indigenous primary health care models of service delivery: a scoping review protocol.

Barriers to expanding primary care roles for chiropractors: the role of chiropractic as primary care gatekeeper

Background: Indigenous primary health services have been addressing the gap in life expectancy between Indigenous and non-Indigenous people for some time now. In addition to treating and managing the health of Indigenous peoples, these services often incorporate strength-based approaches to the delivery of care, such as focusing on a holistic definition of health and an acknowledgement of the importance of upholding people's connectedness with families, communities, Country, culture and spirituality. Objective: The objective of the research was to identify the characteristics, value and principles that underpin Indigenous primary healthcare models of service delivery. Methods: We conducted a scoping review of the international literature. Databases were searched for peer-reviewed and grey literature. Four reviewers were involved in the appraising of studies and charting of data. A unique feature of the methods employed was the use of QSR International's NVivo 10 software to thematically analyse the extracted findings, and identify characteristics of Indigenous primary healthcare models of services delivery. Results: The scoping review identified nine overarching characteristics of Indigenous primary health care models of service delivery: accessible health services, appropriate funding and resources, continuous quality improvement, culture, flexible approach to care, self-determination and empowerment, strong community participation, types of services, and workforce. Discussion/Conclusion: Findings from the review will inform the development of a best practice service delivery framework intended to support Aboriginal primary healthcare services to not only evaluate but also advocate for the unique services they provide.

The national Closing the Gap framework commits to reducing persisting disadvantage in the health of Aboriginal and Torres Strait Islander people in Australia, with cross-government-sector initiatives and investment. Central to efforts to build healthier communities is the Aboriginal community controlled health service (ACCHS) sector; its focus on prevention, early intervention and comprehensive care has reduced barriers to access and unintentional racism, progressively improving individual health outcomes for Aboriginal people. There is now a broad range of primary health care data that provides a sound evidence base for comparing the health outcomes for Indigenous people in ACCHSs with the outcomes achieved through mainstream services, and these data show: models of comprehensive primary health care consistent with the patient-centred medical home model; coverage of the Aboriginal population higher than 60% outside major metropolitan centres; consistently improving performance in key performance on best-practice care indicators; and superior performance to mainstream general practice. ACCHSs play a significant role in training the medical workforce and employing Aboriginal people. ACCHSs have risen to the challenge of delivering best-practice care and there is a case for expanding ACCHSs into new areas. To achieve the best returns, the current mainstream Closing the Gap investment should be shifted to the community controlled health sector.

Despite increasing national attention and emphasis on primary health care, there has been little impetus to define or specify the content of primary oral health care. This paper defines primary oral health care and the scope of services it includes, using an adaptation of a Health Resources and Services Administration definition of primary health care and its attributes as its model. The proposed scope of services encompassed by primary oral health care is a set of basic dental services used by the Indian Health Service. Policy recommendations are presented to improve the integration of primary oral health services with primary health care and primary health care delivery.

BackgroundChlamydia infections are notified at much higher rates in Aboriginal and/or Torres Strait Islander people compared to non-Indigenous people. The Australian Collaboration Chlamydia Enhanced Sentinel Surveillance System (ACCESS) was established to complement population-based surveillance.MethodsWe describe patient demographics, completeness of recording of Aboriginal and/or Torres Strait Islander (‘Aboriginal’) status, chlamydia testing rates and positivity rates from the Aboriginal Community Controlled Health Service (ACCHSs), General Practice (GP) clinics and Sexual Health Services (SHSs) networks in ACCESS during 2009. Data were extracted from electronic medical records of each participating health service for consultations with patients aged 16–29 years and for chlamydia testing and positivity.ResultsData were included from 16–29 year olds attending six ACCHSs (n = 4,950); 22 SHSs (n = 20,691) and 25 GP clinics (n = 34,462). Aboriginal status was unknown for 79.3% of patients attending GP clinics, 4.5% attending SHSs and 3.8% of patients attending ACCHSs. Chlamydia testing rates among Aboriginal patients were 19.8% (95%CI:18.6%-21.0%) at ACCHSs, 75.5% (95% CI:72.5%-78.4%) at SHSs and 4.3% (95% CI: 2.6%-6.6%) at GP clinics. Positivity rates were highest in Aboriginal patients tested at SHSs at 22.7% (95% CI:19.5%-26.2%), followed by 15.8% (95% CI:3.8%-43.4%) at GP clinics and 8.6% at ACCHSs (95% CI:7.9%-12.4%). This compared with non-Indigenous patients positivity rates at SHSs of 12.7% (95% CI:12.2-13.2%); 8.6% (7.2%-11.3%) at GP clinics and 11.3% at ACCHSs (95% CI:15.4%-24.9%).ConclusionsHigher chlamydia positivity in Aboriginal people across a range of clinical services is reflected in national notification data. Targeted efforts are required to improve testing rates in primary care services; to improve identification of Aboriginal patients in mainstream services such as GP clinics; and to better engage with young Aboriginal Australians.

Is the Australian primary healthcare system ready for the Rheumatic Heart Disease Endgame strategy? Data synthesis and recommendations

This paper deals with the some of the important variable factors relating to health care in Saudi Arabia, with special emphasis on primary health. Other aspects considered are the financial influen...

Enablers and barriers to non-dispensing pharmacist integration into the primary health care teams of Aboriginal community-controlled health services.

Australia has a complex health system with policy and funding responsibilities divided across federal and state/territory boundaries and service provision split between public and private providers. General practice is largely funded through the federal government. Other primary health care services are provided by state/territory public entities and private allied health practitioners. Indigenous health services are specifically funded by the federal government through a series of Aboriginal Community Controlled Organisations. NATIONAL POLICY AND MODELS: The dominant primary health care model is federally-funded private "small business" general practices. Medicare reimbursement items have incrementally changed over the last decade to include increasing support for chronic disease care with both generic and disease specific items as incentives. Asthma has received a large amount of national policy attention. Other respiratory diseases have not had similar policy emphasis. Australia has a high prevalence of asthma. Respiratory-related encounters in general practice, including acute and chronic respiratory illness and influenza immunisations, account for 20.6% of general practice activity. Lung cancer is a rare disease in general practice. Tuberculosis is uncommon and most often found in people born outside of Australia. Aboriginal and Torres Strait Islanders have higher rates of asthma, smoking and tuberculosis. Access to care is positively influenced by substantial public funding underpinning both the private and public sectors through Medicare. Access to general practice care is negatively influenced by workforce shortages, the ongoing demands of acute care, and the incremental way in which system redesign is occurring in general practice. Most general practice operates from privately-owned rooms. The Australian Government requires general practice facilities to be accredited against certain standards in order for the practice to receive income from a number of government programs. These standards require GPs to have ready access to spirometry, but do not require every practice to have a spirometer. The initial assessment and management of acute respiratory illnesses currently seen in primary health care settings will continue, but for this to occur the sector may have to adapt traditional workforce roles because of workforce shortages. In the longer term, climate change and migration patterns may result in changes in the epidemiology of regions and populations. The health system will continue to reform incrementally in order to deliver improved chronic disease care, including care of people with asthma and COPD. The incoming Labor Government's National Primary Health Care Strategy provides the high level policy opportunity to drive reform. Australia's complex primary health care system is incrementally changing from one of exclusive acute- and episodic-care orientation in both the public and private sectors to a system that delivers effective anticipatory chronic disease care as well. From a national policy perspective, asthma has received most attention. COPD and possibly other respiratory diseases may now receive focus.

A nursing minimum dataset for documenting nutritional care for adults in primary healthcare: a scoping review protocol

The integration of primary oral health care has a pivotal role in improving oral health outcomes and providing accessible and affordable health care. This article contributes to the deep understanding of the cultural aspects of the integration of oral health into primary health care at an Indigenous health organization. Proceeding from a collaborative and interdisciplinary research project evaluating the integration of oral health care within primary care in Eeyou Istchee, this research is based on group discussions (6) and individual interviews (36) with 74 participants (care providers, administrators, and patients) held in four Eastern James Bay Cree communities. This study anthropologically explored participants’ perceptions about primary health care conceptualizations, culturally based approaches, and experiences of oral care services at this organization using a “two-eyed seeing” Indigenous framework. The study identified three key factors related to the integration of primary oral health care: Cree perception of primary health and oral health care, cultural safety, and health provider–patient communication and the role of silence. Study findings reflected a dichotomy of perception of primary health care and the relevant units of care between the Cree structural and cultural perspective and the non-Cree professional perspective. The Cree people perceived “household” as a unit of care in comparison to non-Cree who viewed “health care services” as units of care. Our results also underline the role of cultural safety agents to address the needs for cultural competence and the role of silence as implicit cultural protocol. Our anthropological analysis illustrates the potential for increasing the level of appreciation for both users and workers in oral care in the future by ameliorating communication skills and intercultural knowledge.

Primary health care is not just a service delivery platform

This paper is concerned with the emergence of Indigenous primary health care organizations in Canada, Australia and New Zealand. In Canada, the adoption of the 1989 Health Transfer Policy promoted the transfer of on-reserve health services from the federal government to First Nations. In Australia, Aboriginal Community-Controlled Health Services first appeared in the 1970s because of community mobilization. It aims to provide some access to free health care to Aboriginal People. A more recent model, the Primary Health Care Access Program, aims at guaranteeing Aboriginal access to comprehensive primary health care services under the authority of Regional Aboriginal Health Boards. In New Zealand, Maori providers emerged because of the market-like conditions implemented in the 1990s. This study compares the policy and contractual environment put in place to support Indigenous health providers in Canada, Australia and New Zealand, using a case study approach. Results show that the contractual environment does not necessarily match declared policy objectives, especially where competitive models for accessing funding have been implemented.

The oral health care experiences of NSW Aboriginal Community Controlled Health Services

Shoulder patients in primary and specialist health care. A cross-sectional study