Community health workers as chronic care coordinators: evaluation of an Australian Indigenous primary health care program

Barbara Schmidt · Sandra Campbell · Robyn Anne McDermott

42 citations0/0 files storedAustralian and New Zealand Journal of Public Health

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Indigenous Health, Education, and Rights Nursing Roles and Practices Primary Care and Health Outcomes

Abstract

OBJECTIVES: To explore how a client-centred Chronic Care model was implemented by Indigenous Health Workers (IHWs) at participating sites in a trial of IHW-led case management. To understand the experiences of engaging with the model from the perspective of the IHWs, health team members and clients. METHODS: The review was conducted within a cluster randomised trial of the model in six remote Indigenous communities in north Queensland over 18 months. Content analysis was undertaken on 377 project records of health worker activity. Descriptive coding was used to classify issues that were grouped under key themes. Open-ended interviews were conducted with 21 stakeholders and analysed using the key themes. RESULTS: Implementation of all elements of the intervention was not achieved. Key themes identified that describe the issues affecting the IHWs' capacity to implement the model were: service management, training, client engagement, clarification of IHW role and infrastructure. CONCLUSIONS: Placing skilled and dedicated IHWs to improve care coordination is insufficient to improve chronic disease outcomes. A supportive and systematic service delivery system is also required. IMPLICATIONS: The PHC model in remote Indigenous communities needs to be re-oriented to actively support the unique contributions of IHWs to chronic care coordination.

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References

2009Indigenous health part 1: determinants and disease patterns 2008Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap 2012Strategic approaches to enhanced health service delivery for Aboriginal and Torres Strait Islander people with chronic illness: a qualitative study 2006Aboriginal health workers and diabetes care in remote community health centres: a mixed method analysis 2007Improving organisational systems for diabetes care in Australian Indigenous communities

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2019Working well: a systematic scoping review of the Indigenous primary healthcare workforce development literature 2022Review of diabetes among Aboriginal and Torres Strait Islander people 2019Making space for Aboriginal and Torres Strait Islander community health workers in health promotion 2019Geographical analysis of evaluated chronic disease programs for Aboriginal and Torres Strait Islander people in the Australian primary health care setting: a systematic scoping review 2017Enhancing the get healthy information and coaching service for Aboriginal adults: evaluation of the process and impact of the program 2022Building an understanding of Indigenous Health Workers’ role in oral health: A qualitative systematic review

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