"No One Manages It; We Just Sign Them Up and Do It": A Whole System Analysis of Access to Healthcare in One Remote Australian Community.

Eloise Osborn,Kate Hunter,Heather Finlayson,Katrina Ward,Rachael Moir,Rona Macniven,Vita Christie,Marida Ritha,Josephine Gwynn,Tim Agius,Robyn Martin,Kylie Gwynne,Donna Taylor,Susannah Tobin

doi:10.3390/ijerph19052939

Abstract

Objective: To assess the accessibility, availability and utilisation of a comprehensive range of community-based healthcare services for Aboriginal people and describe contributing factors to providing effective healthcare services from the provider perspective. Setting: A remote community in New South Wales, Australia. Participants: Aboriginal and non-Aboriginal health and education professionals performing various roles in healthcare provision in the community. Design: Case study. Methodology: The study was co-designed with the community. A mixed-methods methodology was utilised. Data were gathered through structured interviews. Descriptive statistics were used to analyse the availability of 40 health services in the community, whilst quotations from the qualitative research were used to provide context for the quantitative findings. Results: Service availability was mapped for 40 primary, specialised, and allied health services. Three key themes emerged from the analysis: (1) there are instances of both underservicing and overservicing which give insight into systemic barriers to interagency cooperation; (2) nurses, community health workers, Aboriginal health workers, teachers, and administration staff have an invaluable role in healthcare and improving patient access to health services and could be better supported through further funding and opportunities for specialised training; and (3) visiting and telehealth services are critical components of the system that must be linked to existing community-led primary care services. Conclusion: The study identified factors influencing service availability, accessibility and interagency cooperation in remote healthcare services and systems that can be used to guide future service and system planning and resourcing.

Highlights

The quantitative results of this study demonstrated the availability of primary, specialised, and allied health services by service delivery type (Table 1) and frequency (Table 2)
The qualitative analysis of interviews identified three key themes to guide the interpretation of these findings:
There are examples of both underservicing and overservicing which give insight into systemic barriers in interagency cooperation; Nurses, community health workers, Aboriginal health workers, teachers, and administration staff have an invaluable role in healthcare and improving patient access to health services and could be better supported through further funding and opportunities for specialised training; Visiting and telehealth services are critical components of the system that must be linked to existing community led primary care services

Summary

Methods

This study utilized a mixed methodology with a case study design and was conducted in a remote town in NSW, with a high (>65%) Aboriginal population. This remote town had two local schools and three local health services. This study involved a team of Aboriginal and non-Aboriginal researchers with an established rapport with each study community, working together over several years of co-designed research. Two non-Aboriginal female authors—a researcher (K.H.) and a project manager (R.M.)—conducted interviews. Both interviewers were experienced in conducting interviews in Aboriginal communities and had several years of experience working in Aboriginal health and ongoing cultural training and mentorship. The full protocol for the original mapping study is described elsewhere [23]

Results

Discussion

Conclusion