Australian Indigenous HealthInfoNet Research Articles

Curriculum Indigenization in oral health professions' education worldwide: A scoping review.

To explore the literature on Indigenous content within the oral health professions' education curricula. This scoping review included all types of literature on oral health care educational programs on Indigenous content, following the JBI (Joanna Briggs Institute) methodology. An initial search using "Indigenous," "education," and "oral health" as keywords informed a full search strategy for MEDLINE, CINAHL, Embase, Scopus, ERIC, EPPI, MedEdPORTAL, Google Scholar, ProQuest Dissertations and Theses Global, Australian Government Department of Health, and Australian Indigenous HealthInfoNet. The search included literature available until November 1, 2023, irrespective of language. Two reviewers independently screened the studies, and data were extracted and presented in tabular and narrative summary formats. A total of 948 records were identified, and 101 studies were chosen for full-text review. Twenty-three studies met the criteria for data extraction. Of all studies, 95.6% were published between 2007 and 2021, mostly from Australia and New Zealand. The most frequently covered content included Indigenous culture, followed by history, Indigenous oral health, and Indigenous Peoples' health. Rural and clinical placements were the most employed delivery methods, and evaluation surveys were the most employed assessment technique. Barriers to delivering an Indigenous curriculum included students' disinterest and limited interaction with Indigenous communities, while facilitators included cultural immersion and supportive mentorship. Despite progress in integrating Indigenous content into oral health education, challenges persist. Prioritizing Indigenous perspectives, community partnerships, and standardized assessment tools is needed. Future research should focus on long-term impacts and best practices for Indigenous curriculum development and delivery.

Editorial

In this issue of the Journal of the Australian Indigenous HealthInfoNet, we once again publish a diverse range of papers exploring important areas of Aboriginal and Torres Strait Islander health.

The commercial determinants of Indigenous health and well-being: a systematic scoping review

IntroductionHealth inequity within Indigenous populations is widespread and underpinned by colonialism, dispossession and oppression. Social and cultural determinants of Indigenous health and well-being are well described. Despite emerging literature on...

Editorial

Welcome to the latest edition of the Journal of the Australian Indigenous HealthInfoNet. This month we celebrate the 25th anniversary of the HealthInfoNet, which began in 1997 with the vision to ‘maintain the evidence base to inform practice and policy in the area of Aboriginal and Torres Strait Islander health’. We are pleased to continue this work through publication of our Journal, which facilitates access to information that supports those working in the Aboriginal and Torres Strait Islander health sector.

Equity in national policies for Australians with kidney disease

ObjectiveTo describe how the Australian Government Department of Health policies address equity in the management of chronic kidney disease (CKD). MethodsWe searched the websites of the Australian Government Department of Health, Kidney Health Australia, Australian Indigenous HealthInfoNet and the National Rural Health Alliance for policies using the search terms: kidney, renal and chronic. ResultsWe included 24 policies that addressed groups of people that experience health inequities: 23 addressed Aboriginal and Torres Strait Islander peoples, 18 rural/remote communities, 12 low socioeconomic status groups, six culturally and linguistically diverse communities and four addressed gender disparities. The scope of the policies ranged from broad national frameworks to subsidised access to health services and medicines. Only two policies explicitly addressed equity for patients with CKD. ConclusionCKD outcomes are highly variable across population groups yet Australian Government policies that address access to and the experience of care are limited in both number and their attention to equity issues. Implications for public healthIn Australia, some groups of people with CKD have a substantially higher risk of mortality and morbidity than the general CKD population. We advocate for the development and implementation of policies to attain equity for people with CKD.

Mass drug administration campaigns for scabies and impetigo: protocol for a systematic review and meta-analysis

IntroductionScabies is recognised as a neglected tropical disease, disproportionately affecting the most vulnerable populations around the world. Impetigo often occurs secondarily to scabies. Several studies have explored mass drug administration...

Virtual Care for Indigenous Populations in Canada, the United States, Australia, and New Zealand: Protocol for a Scoping Review.

BackgroundIndigenous people in Canada, the United States, Australia, and New Zealand experience an increased burden of chronic diseases compared to non-Indigenous people in these countries. Lack of necessary services and culturally relevant care for Indigenous people contributes to this burden. Many Indigenous communities have implemented systems, such as virtual care, to improve chronic disease management. Virtual care has extended beyond videoconferencing to include more advanced technologies, such as remote biometric monitoring devices. However, given the historical and ongoing Western intrusion into Indigenous day to day life, these technologies may seem more invasive and thus require additional research on their acceptability and utility within Indigenous populations.ObjectiveThe objective of this paper is to present the protocol for a scoping review, which aims to map existing evidence. This study is based on the following guiding research question: What are the characteristics of virtual care use by Indigenous adult populations in Canada, the United States, Australia, and New Zealand? The subquestions are related to the technology used, health conditions and nature of the virtual care, cultural safety, and key concepts for effective use.MethodsThis scoping review protocol is informed by the methodology described by the Joanna Briggs Institute and is supplemented by the frameworks proposed by Arksey and O’Malley and Levac et al. A search for published and gray literature, written in English, and published between 2000 and present will be completed utilizing electronic databases and search engines, including MEDLINE, CINAHL, Embase, Indigenous Peoples of North America, Australian Indigenous HealthInfoNet, Informit, and Native Health Database. Search results will be uploaded to the review software, Covidence, for title and abstract screening before full-text screening begins. This process will be repeated for gray literature. Upon completion, a data abstraction tool will organize the relevant information into categorical formations.ResultsThe search strategy has been confirmed, and the screening of titles and abstracts is underway. As of October 2020, we have identified over 300 articles for full-text screening.ConclusionsPrevious reviews have addressed virtual care within Indigenous communities. However, new virtual care technologies have since emerged; subsequently, additional literature has been published. Mapping and synthesizing this literature will inform new directions for research and discussion.International Registered Report Identifier (IRRID)PRR1-10.2196/21860

Community based programs to improve the oral health of Australian Indigenous adolescents: a systematic review and recommendations to guide future strategies

BackgroundTo review the international literature on community-based interventions aiming to improve the oral health of Indigenous adolescents and identify which demonstrate a positive impact.MethodsData sources were MEDLINE, EMBASE, CINAHL, SCOPUS, the COCHRANE library and the Australian Indigenous HealthInfoNet. Articles were included where they: were published in English from 1990 onwards; described oral health outcomes for Indigenous adolescents aged 10 to 19 years; implemented a community based oral health intervention. The Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project was applied.ResultsNine studies met inclusion criteria; two rated strong in quality; only one study was conducted with an urban community; five reported moderate community engagement. Five intervention strategies were identified, and schools were the most common setting reported. Statistically significant improvements were described in eight studies with the most frequently reported outcome being change in decayed missing or filled teeth.ConclusionsFew good quality peer reviewed international studies of community-based oral health interventions which address the needs of Indigenous adolescents exist. Studies must include strong Indigenous community leadership and governance at all stages of the research, adopt participatory action-based research approaches, and are required in urban communities.

A systematic review of approaches to improve practice, detection and treatment of unhealthy alcohol use in primary health care: a role for continuous quality improvement

BackgroundUnhealthy alcohol use involves a spectrum from hazardous use (exceeding guidelines but no harms) through to alcohol dependence. Evidence-based management of unhealthy alcohol use in primary health care has been recommended since 1979. However, sustained and systematic implementation has proven challenging. The Continuing Quality Improvement (CQI) process is designed to enable services to detect barriers, then devise and implement changes, resulting in service improvements.MethodsWe conducted a systematic review of literature reporting on strategies to improve implementation of screening and interventions for unhealthy alcohol use in primary care (MEDLINE EMBASE, PsycINFO, CINAHL, the Australian Indigenous Health InfoNet). Additional inclusion criteria were: (1) pragmatic setting; (2) reporting original data; (3) quantitative outcomes related to provision of service or change in practice. We investigate the extent to which the three essential elements of CQI are being used (data-guided activities, considering local conditions; iterative development). We compare characteristics of programs that include these three elements with those that do not. We describe the types, organizational levels (e.g. health service, practice, clinician), duration of strategies, and their outcomes.ResultsFifty-six papers representing 45 projects were included. Of these, 24 papers were randomized controlled trials, 12 controlled studies and 20 before/after and other designs. Most reported on strategies for improving implementation of screening and brief intervention. Only six addressed relapse prevention pharmacotherapies. Only five reported on patient outcomes and none showed significant improvement. The three essential CQI elements were clearly identifiable in 12 reports. More studies with three essential CQI elements had implementation and follow-up durations above the median; utilised multifaceted designs; targeted both practice and health system levels; improved screening and brief intervention than studies without the CQI elements.ConclusionUtilizing CQI methods in implementation research would appear to be well-suited to drive improvements in service delivery for unhealthy alcohol use. However, the body of literature describing such studies is still small. More well-designed research, including hybrid studies of both implementation and patient outcomes, will be needed to draw clearer conclusions on the optimal approach for implementing screening and treatment for unhealthy alcohol use. (PROSPERO registration ID: CRD42018110475).

Integrating pharmacists into care teams: a qualitative systematic review protocol.

This review will systematically examine the qualitative literature reporting on strategies that have been used (or could be developed) by health care services to integrate pharmacists into a multidisciplinary health care team. Delivery models of pharmaceutical care have been developed, trialed and refined since this concept was first defined more than 30 years ago. Delivery models that integrate pharmacists within a multidisciplinary team allow pharmacists to play a pivotal role in improving health outcomes for patients and contributing to patient self-management. Systematic reviews clearly demonstrate the effectiveness of these models; however, the attitudes, beliefs, expectations, understandings, perceptions and experiences of these multidisciplinary teams is less clear. The populations of interest in this review are health care providers, including hospital specialists, general practitioners, nurses, health workers, pharmacists, allied health workers, aged care workers, Indigenous health workers and health promotion workers. The phenomena of interest are attitudes, beliefs, expectations, understandings, perceptions and experiences of the populations of interest arising from experiencing, developing or implementing strategies that have or could support the integration of pharmacists into multidisciplinary health care teams. The databases to be searched include PubMed, Cochrane, EBSCO (CINAHL), Embase, MedNar, Trove and Australian Indigenous Health Infonet. Studies published from 2011 onwards and in English will be considered for inclusion. Selected studies will be assessed for methodological quality by two independent reviewers, using standardized critical appraisal instruments. Where possible, qualitative research findings will be pooled. Where textual pooling is not possible, the findings will be presented in narrative form.

A Pragmatic Review to Assist Planning and Practice in Delivering Nutrition Education to Indigenous Youth.

Many health promotion campaigns have incorporated multi-component nutrition interventions to promote healthy diet-related behaviours among Indigenous communities, particularly children and adolescents. However, these campaigns show mixed results and while research often describes outcomes of approaches and interventions, it does not extensively describe implementation processes and best practices for nutrition education for Indigenous youth. To enhance knowledge and understanding of best processes in nutritional education approaches with Indigenous youth, we conducted a search using multiple databases including PubMed, Google Scholar, the Australian Indigenous HealthInfoNet and Australian government research databases to identify relevant peer-reviewed and grey literature as well as educational resources, such as websites and handbooks for teachers, parents, and students. We list and describe common features of successful nutritional interventions in Indigenous settings, steps for nutrition education targeting youth, school-based nutrition education for different ages, and general guidelines for teaching Indigenous students. Current best practice and knowledge gaps for the delivery of nutrition education to Indigenous youth are described.

Online scan of FASD prevention and health promotion resources for Aboriginal and Torres Strait Islander communities.

Foetal Alcohol Spectrum Disorder (FASD) includes a range of life-long impairments caused by alcohol exposure in utero. Health professionals are vital to preventing FASD but many are hesitant to discuss FASD with clients due to their need for additional resources to aid the conversation. This scan sought to identify the scope and gaps in publicly available FASD prevention and health promotion resources, and assess their cultural appropriateness for use among five key groups of Indigenous Australian people including: (i) pregnant women, (ii) women of childbearing age, (iii) grandmothers and aunties, (iv) men, and (v) health professionals. Relevant resources published 1995-2017 were identified through the Australian Indigenous HealthInfoNet, FASD organisation websites, grey literature, Google searches, and field experts. Results were screened by inclusion and cultural appropriateness criteria developed and piloted by the research team, and further screened by health professionals attending FASD training workshops. 115 of the 2146 identified resources were eligible. Relevant resources were found for all five key groups; however, no resources were specifically designed for men, grandmothers or aunties. A range of high-quality, culturally appropriate resources were identified, however, health professionals attending the training workshops were not aware of their availability. Further resource development is suggested for men, grandmothers and aunties. SO WHAT?: Prioritisation of active dissemination and implementation strategies is suggested to increase awareness and use of future resource developments. The inclusion of a resource trial among health professionals is a recommended strategy to increase awareness and use of newly developed resources.

Abstract A17: The development of an Indigenous cancer network: Lessons learned

Abstract Cancer is the second leading cause of death among Indigenous Australians, and while non-Indigenous Australians have experienced greatly improved outcomes in cancer diagnosis, treatment and survival, this is not mirrored among Indigenous Australians. Advanced cancer at diagnosis, reduced uptake of and access to treatment, higher rates of comorbidities and language barriers are some of the factors leading to poorer cancer outcomes. A growing body of evidence indicates widespread failure of the health system to adequately prevent, diagnose and treat cancer among Indigenous Australians, and there is an increasing sense of urgency to escalate the effort to address these disparities. In response to this, the National Indigenous Cancer Network (NICaN) was developed and launched in 2013. This presentation will discuss the challenges and successes of developing a National Indigenous Cancer Network, aimed at encouraging and supporting collaboration in Indigenous cancer research and the delivery of services to Indigenous people with cancer. This national network was established as a partnership between Menzies School of Health Research, the Australian Indigenous HealthInfoNet (a national research institute specializing in translational research with a population health focus), the Lowitja Institute (Australia's national institute for Aboriginal and Torres Strait Islander health research), Cancer Council Australia (Australia's peak national non-government cancer control organization) and Indigenous audiences, consumers, researchers and health professionals, service providers, private sector and government organizations. NICaN aims to ensure that what's known about cancer in Indigenous Australians is available for use by people with cancer, their families, practitioners, policy makers and researchers. This is achieved by using existing information, identifying knowledge gaps and encouraging and supporting collaboration in research and service provision. Since its conception NICaN has grown in scope and membership and is a critical part of the translation of Indigenous cancer research into practice. Along with NICaN network meetings and roundtables, NICaN's resources (www.cancerinfonet.org.au) include: plain language information about cancer, state and national cancer policies and cancer care plans, cancer programs and research projects, a comprehensive depository of publications and conference presentations, and workforce and training opportunities. As NICaN has grown and evolved, there have been a number of lessons learned, challenges and successes. Key findings have included: the importance of developing and maintaining collaborative partnerships with other key players in the area; the role of cancer survivors as advocates and ambassadors; the significance of ensuring consumer buy-in, input and ongoing engagement; and the use of social media strategies to support and engage with a broader audience. NICaN has established itself as a credible, Indigenous-led, and independent (i.e., non-government, non-bureaucratic) organization aimed at increasing access to information about cancer for Indigenous people, and plays an integral role in facilitating community engagement and research translation to assist in improving cancer outcomes for Indigenous Australians. Citation Format: Bridget Kehoe, Joan Cunningham, Bronwyn Morris, Alana Gall, Brian Arley, Gail Garvey. The development of an Indigenous cancer network: Lessons learned. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A17.

Social and emotional wellbeing, natural helpers, critical health literacy and translational research: connecting the dots for positive health outcomes.

The tripartite framework for principled practice was developed as part of the Wundargoodie Aboriginal Youth and Community Wellbeing Programme. The programme engages natural helpers to enhance critical health literacy. This paper examines the importance of translational research to enhancing critical health literacy for this group of de facto health workers using the work of the Australian Indigenous HealthInfoNet as an example. Translational research provides workforce support for those who are time poor and overburdened. Connecting these concepts and natural helpers will make a positive difference to Aboriginal health outcomes. There is a need for the development of translational research products that enhance the critical health literacy of natural helpers. The tripartite framework for principled practice supports reflective and accountable practice in the intercultural space to build trust and confidence between Aboriginal and non-Aboriginal people to enhance the opportunity for authentic knowledge production and transfer.

Making the case for a more accurate cardiovascular disease risk assessment tool for Indigenous Australians.

Cardiovascular Disease (CVD) is the leading cause of premature death in Indigenous Australians (Australian Indigenous HealthInfoNet, 2014). Statistics show that the morbidity and mortality from CVD...

Enablers and barriers to the implementation of primary health care interventions for Indigenous people with chronic diseases: a systematic review.

BackgroundAccess to appropriate, affordable, acceptable and comprehensive primary health care (PHC) is critical for improving the health of Indigenous populations. Whilst appropriate infrastructure, sufficient funding and knowledgeable health care professionals are crucial, these elements alone will not lead to the provision of appropriate care for all Indigenous people. This systematic literature review synthesised international evidence on the factors that enable or inhibit the implementation of interventions aimed at improving chronic disease care for Indigenous people.MethodsA systematic review using Medical Literature Analysis and Retrieval System Online (MEDLINE) (PubMed platform), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Excerpta Medica Database (EMBASE), ATSIHealth, Australian Indigenous HealthInfoNet via Informit Online and Primary Health Care Research and Information Service (PHCRIS) databases was undertaken. Studies were included if they described an intervention for one or more of six chronic conditions that was delivered in a primary health care setting in Australia, New Zealand, Canada or the United States. Attitudes, beliefs, expectations, understandings and knowledge of patients, their families, Indigenous communities, providers and policy makers were of interest. Published and unpublished qualitative and quantitative studies from 1998 to 2013 were considered. Qualitative findings were pooled using a meta-aggregative approach, and quantitative data were presented as a narrative summary.ResultsTwenty three studies were included. Meta-aggregation of qualitative data revealed five synthesised findings, related to issues within the design and planning phase of interventions, the chronic disease workforce, partnerships between service providers and patients, clinical care pathways and patient access to services. The available quantitative data supported the qualitative findings. Three key features of enablers and barriers emerged from the findings: (1) they are not fixed concepts but can be positively or negatively influenced, (2) the degree to which the work of an intervention can influence an enabler or barrier varies depending on their source and (3) they are inter-related whereby a change in one may effect a change in another.ConclusionsFuture interventions should consider the findings of this review as it provides an evidence-base that contributes to the successful design, implementation and sustainability of chronic disease interventions in primary health care settings intended for Indigenous people.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0261-x) contains supplementary material, which is available to authorized users.

The experiences of Aboriginal health workers and non-Aboriginal health professionals working collaboratively in the delivery of health care to Aboriginal Australians: a systematic review

Background Effective partnership between Aboriginal health workers and non-Aboriginal health care providers is critical in reducing the health inequity facing Aboriginal Australians. Many factors can obstruct successful workplace partnerships causing them to be damaging and unproductive. Understanding the elements of best practice in forming and maintaining successful working partnerships between Aboriginal health workers and non-Aboriginal health professionals is essential. Objectives To systematically review the qualitative evidence on the lived experience of interprofessional collaboration between Aboriginal health workers and health professionals delivering care to Aboriginal Australians, with a view to identifying the perceived skills, knowledge, attitudes, management practices and institutional policies that enable successful interprofessional partnership. Inclusion criteria Types of participants The review considered qualitative studies that included Aboriginal health workers, Aboriginal liaison officers, Aboriginal community health workers and health professionals working collaboratively to deliver clinical care to Aboriginal Australians across a variety of Australian health care settings. These studies were conducted across a variety of rural, remote and urban Australian health care settings and included both Aboriginal community controlled and mainstream health organisations. Types of intervention(s)/phenomena of interest The review considered studies that described the experiences of delivering/receiving care from Aboriginal health workers and non-Aboriginal health care providers in collaborative work practices, told from the perspectives of non-Aboriginal health care providers, Aboriginal health workers and the Aboriginal clients receiving care. Types of studies Qualitative studies including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research were included in this review. There was adequate evidence in the qualitative studies included in this review, so text and opinion papers were not considered. Types of outcomes The review focussed on qualitative research findings reported as themes/categories in the included studies that related to the perspectives of the Aboriginal health workers, non-Aboriginal health care providers and Aboriginal clients regarding their experiences receiving/delivering care as a result of a clinical collaboration between an Aboriginal health workers and non-Aboriginal health care providers. It was also concerned with the experiences within the workplace, to identify those elements that support or obstruct collaboration between Aboriginal health workers and non-Aboriginal health care providers in order to enable the provision of culturally safe care. Search strategy Using a three-step search strategy, databases of CINAHL, Pub Med, Scopus, Embase, Mednar, TROVE, ProQuest dissertation and Thesis, NHMRC, Department of Health and Ageing, Australian Indigenous Health Infonet and Conference proceedings and Australian Digital Theses where searched for published and unpublished studies in English from 1995 to2012. Hand-searching the Aboriginal and Islander Health Worker Journal was also included in the searching process. Methodological quality Qualitative papers were assessed by two independent reviewers for methodological validity prior to inclusion in this review using standardised critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Data collection Qualitative data was extracted from papers included in this review using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (QARI). Data synthesis Qualitative research findings where pooled using QARI The process of meta-synthesis involved the extraction of qualitative findings of significance to the review question, which were grouped into categories, then analysed to generate synthesised findings. Results Thirteen qualitative papers met the inclusion criteria for this review. From these studies, 429 findings were extracted and aggregated to from 39 categories. Seven meta-syntheses were derived from the categories with key themes relating to the benefits of effective partnership for the practitioner, the health service and the Aboriginal community, negative experiences as a result of a disabling work environment, and empowering factors at the organisational, workforce and interpersonal/practitioner TRUNCATED AT 600 WORDS

An evaluation of the quality of evidence underpinning diabetes management models: a review of the literature.

There is a paucity of research on the quality of evidence relating to primary care workforce models. Thus, the aim of the present study was to evaluate the quality of evidence on diabetes primary care workforce models in Australia. The National Health and Medical Research Council of Australia's (National Health and Medical Reseach Council; 2000, 2001) frameworks for evaluating scientific evidence and economic evaluations were used to assess the quality of studies involving primary care workforce models for diabetes care involving Australian adults. A search of medical databases (MEDLINE, AMED, RURAL, Australian Indigenous HealthInfoNet and The Cochrane Institute), journals for diabetes care (Diabetes Research and Clinical Practice, Diabetes Care, Diabetic Medicine, Population Health Management, Rural and Remote Health, Australian Journal of Primary Health, PLoS Medicine, Medical Journal of Australia, BMC Health Services Research, BMC Public Health, BMC Family Practice) and Commonwealth and state government health websites was undertaken to acquire Australian studies of diabetes workforce models published 2005-13. Various diabetes workforce models were examined, including 'one-stop shops', pharmacy care, Aboriginal services and telephone-delivered interventions. The quality of evidence was evaluated against several criteria, including relevance and replication, strength of evidence, effect size, transferability and representativeness, and value for money. Of the 14 studies found, four were randomised controlled trials and one was a systematic review (i.e. Level II and I (best) evidence). Only three provided a replicable protocol or detailed intervention delivery. Eleven lacked a theoretical framework. Twelve reported significant improvements in clinical (patient) outcomes, commonly HbA1c, cholesterol and blood pressure; only four reported changes in short- and long-term outcomes (e.g. quality of life). Most studies used a small or targeted population. Only two studies assessed both benefits and costs of their intervention compared with usual care and cost effectiveness. More rigorous studies of diabetes workforce models are needed to determine whether these interventions improve patient outcomes and, if they do, represent value for money. WHAT IS KNOWN ABOUT THE TOPIC?: Although health systems with strong primary care orientations have been associated with enhanced access, equity and population health, the primary care workforce is facing several challenges. These include a mal-distribution of resources (supply side) and health outcomes (demand side), inconsistent support for teamwork care models, and a lack of enhanced clinical inter-professional education and/or training opportunities. These challenges are exacerbated by an ageing health workforce and general population, as well as a population that has increased prevalence of chronic conditions and multi-morbidity. Although several policy directions have been advocated to address these challenges, there is a lack of high-quality evidence about which primary care workforce models are best (and which models represent better value for money than current practice) and what the health effects are for patients. WHAT DOES THIS PAPER ADD?: This study demonstrated several strengths and weaknesses of Australian diabetes models of care studies. In particular, only five of the 14 studies assessed were designed in a way that enabled them to achieve a Level II or I rating (and hence the 'best' level of evidence), based on the NHMRC's (2000, 2001) frameworks for assessing scientific evidence. The majority of studies risked the introduction of bias and thus may have incorrect conclusions. Only a few studies described clearly what the intervention and the comparator were and thus could be easily replicated. Only two studies included cost-effectiveness studies of their interventions compared with usual care. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: Although there has been an increase in the number of primary care workforce models implemented in Australia, there is a need for more rigorous research to assess whether these interventions are effective in producing improved health outcomes and represent better value for money than current practice. Researchers and policymakers need to make decisions based on high-quality evidence; it is not obvious what effect the evidence is having on primary care workforce reform.

Australian Indigenous HealthInfoNet

Australian Indigenous HealthInfoNet