Abstract
BackgroundThe disparities in health and life expectancy of Aboriginal and Torres Strait Islander peoples compared to non-Indigenous Australians are well documented. Chronic diseases are a leading contributor to these disparities. We aimed to determine the feasibility, acceptability and appropriateness of a case management approach to chronic disease care integrated within an urban Aboriginal and Torres Strait Islander primary health care service.MethodsThe Home-based, Outreach case Management of chronic disease Exploratory (HOME) Study provided holistic, patient centred multidisciplinary care for Aboriginal and Torres Strait Islander people with chronic disease. A developmental evaluation approach supported the implementation and ongoing adaptations in the delivery of the model of care, and ensured its alignment with Aboriginal and Torres Strait Islander peoples’ understandings of, and approaches to, health and wellbeing. In-depth, semi-structured interviews were conducted with nine patient participants (one interview also included a participant’s spouse) and 15 health service staff and key themes were identified through an iterative reflective process. Quantitative data were collected directly from patient participants and from their medical records at baseline, 3 and 6 months. Patient participants’ baseline characteristics were described using frequencies and percentages. Attrition and patterns of missing values over time were evaluated using binomial generalized estimating equation (GEE) models and mean differences in key clinical outcomes were determined using normal GEE models.ResultsForty-one patients were recruited and nine withdrew over the 6 month period. There was no evidence of differential attrition. All participants (patients and health service staff) were very positive about the model of care. Patient participants became more involved in their health care, depression rates significantly decreased (p = 0.03), and significant improvements in systolic blood pressure (p < 0.001) and diabetes control (p = 0.05) were achieved.ConclusionsThe exploratory nature of our study preclude any definitive statements about the effectiveness of our model of care. However, staff and patients' high levels of satisfaction and improvements in the health and wellbeing of patients are promising and suggest its feasibility, acceptability and appropriateness. Further research is required to determine its efficacy, effectiveness and cost-effectiveness in improving the quality of life and quality of care for Aboriginal and Torres Strait Islander peoples living with chronic disease.
Highlights
The disparities in health and life expectancy of Aboriginal and Torres Strait Islander peoples compared to non-Indigenous Australians are well documented
Aim and objectives of the HOME Study The Home-based, Outreach case Management of chronic disease Exploratory (HOME) Study aimed to implement a home-based, case management model of patient centred multidisciplinary care for Aboriginal and Torres Strait Islander people with complex CD that was integrated into a primary health care service
Further evaluation will explore the impact of the model of care on patient participants’ bio-psychosocial health at 12 months; how a primary health care service incorporates this model of care into its usual practice; identification of the key elements of this model of care and how they differ from usual chronic disease management in the primary health care service; and assessment of how participants’ social contexts affect their health, wellbeing and CD management
Summary
The disparities in health and life expectancy of Aboriginal and Torres Strait Islander peoples compared to non-Indigenous Australians are well documented. Morbidity and mortality due to these CDs remain significantly higher for Aboriginal and Torres Strait Islander peoples than their non-Indigenous counterparts [4]. The health inequalities experienced by Australia’s Aboriginal and Torres Strait Islander peoples compared to non-Indigenous Australians date from the time of white settlement and have been perpetuated by the continuing effects of colonisation, intergenerational trauma and widespread social and economic disadvantage [2, 5]. Consistent with the social determinants of health viewpoint, Aboriginal and Torres Strait Islander peoples have a holistic and collective understanding of health that encompasses the social, emotional and cultural wellbeing of the whole community. Reductionist compartmentalised and individualistic biomedical approaches to addressing health disparities often have significant limitations for Aboriginal and Torres Strait Islander peoples because these approaches are largely antithetical to their holistic conceptualisations of health
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