Articlegold2015

Determinants of access to chronic illness care: a mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians

Jodie Bailie · Gill Schierhout · Alison Frances Laycock · Margaret Kelaher · Nikki Percival · Lynette O’Donoghue +2 more

47 citations0/0 files storedBMJ Open

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Indigenous Health, Education, and Rights Primary Care and Health Outcomes Chronic Disease Management Strategies

Abstract

OBJECTIVES: Indigenous Australians have a disproportionately high burden of chronic illness, and relatively poor access to healthcare. This paper examines how a national multicomponent programme aimed at improving prevention and management of chronic disease among Australian Indigenous people addressed various dimensions of access. DESIGN: Data from a place-based, mixed-methods formative evaluation were analysed against a framework that defines supply and demand-side dimensions to access. The evaluation included 24 geographically bounded 'sentinel sites' that included a range of primary care service organisations. It drew on administrative data on service utilisation, focus group and interview data on community members' and service providers' perceptions of chronic illness care between 2010 and 2013. SETTING: Urban, regional and remote areas of Australia that have relatively large Indigenous populations. PARTICIPANTS: 670 community members participated in focus groups; 374 practitioners and representatives of regional primary care support organisations participated in in-depth interviews. RESULTS: The programme largely addressed supply-side dimensions of access with less focus or impact on demand-side dimensions. Application of the access framework highlighted the complex inter-relationships between dimensions of access. Key ongoing challenges are achieving population coverage through a national programme, reaching high-need groups and ensuring provision of ongoing care. CONCLUSIONS: Strategies to improve access to chronic illness care for this population need to be tailored to local circumstances and address the range of dimensions of access on both the demand and supply sides. These findings highlight the importance of flexibility in national programme guidelines to support locally determined strategies.

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References

2013Patient-centred access to health care: conceptualising access at the interface of health systems and populations 2004Equity of access to health care: outlining the foundations for action 1983Equity in health care: confronting the confusion.1986[Concept and measurement of accessibility].2003The health status of indigenous peoples and others 2009Improving Indigenous patients’ access to mainstream health services: the Inala experience 2014Aboriginal medical services cure more than illness: a qualitative study of how Indigenous services address the health impacts of discrimination in Brisbane communities 2013Improving the accessibility of health services in urban and regional settings for indigenous people

Cited by

2017Improving preventive health care in Aboriginal and Torres Strait Islander primary care settings 2018An “All Teach, All Learn” Approach to Research Capacity Strengthening in Indigenous Primary Health Care Continuous Quality Improvement 2021Reviewing Health Service and Program Evaluations in Indigenous Contexts: A Systematic Review 2024A rapid review to inform the policy and practice for the implementation of chronic disease prevention and management programs for Aboriginal and Torres Strait Islander people in primary care

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