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Potts B, Doran CM, Begg SJ. A Comparison of an Australian First Nations Primary Healthcare Data Specification with Potentially Preventable Hospitalisations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1192. [PMID: 39338075 PMCID: PMC11431243 DOI: 10.3390/ijerph21091192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/26/2024] [Accepted: 09/03/2024] [Indexed: 09/30/2024]
Abstract
Potentially Preventable Hospitalisations (PPH) is a widely used indicator of the effectiveness of non-hospital care. Specified using the International Classification of Diseases (ICD) coding, PPH comprises a suite of health conditions that could have potentially been prevented with appropriate care. The most recent edition of the National Guide to a Preventative Health Assessment for First Nations People documents the health conditions of interest to providers of primary care, many of which are not represented in PPH. Given the National Guide has been developed specifically with First Nations in mind, the aim of this research is twofold. The first aim is to formally posit the question of whether a summative measure of hospitalisations aligned diagnostically to the National Guide has value either as an alternative or complement to PPH in the context of First Nations primary health information. The second aim is to develop and present a prototype ICD-10 data specification for such a measure, referred to as the First Nations primary healthcare (FNPHC) data specification, and examine the age-standardised hospitalisation rates for FNPHC and PPH for correlations and/or differences. Age-standardised hospitalisation rates from 2016-17 to 2019-20 using both classifications were examined to assess the usefulness and relevance of summative measures of hospitalisations for informing primary care. Rates of FNPHC for principal diagnoses were between 1.5 and 2.5 times higher than those of PPH and approximately between 6 and 12 times higher for additional diagnoses. There was a strong correlation with PPH when rates were compared across all observations: jurisdictions with higher rates of PPH tended to have higher rates of hospitalisations according to the custom specification. Findings support its application as a summary measure for First Nations primary care providers. Given the policy landscape in Australia that aims to close the gap, it is imperative that measures of primary health take advantage of the concepts and application of First Nations data sovereignty and governance. The validity and cultural appropriateness of the First Nations primary health data specification needs to be further researched.
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Affiliation(s)
- Boyd Potts
- Cluster for Resilience and Wellbeing, Appleton and Manna Institutes, Central Queensland University, Brisbane, QLD 4701, Australia
| | - Christopher M Doran
- Cluster for Resilience and Wellbeing, Appleton and Manna Institutes, Central Queensland University, Brisbane, QLD 4701, Australia
| | - Stephen J Begg
- Violet Vines Marshman Centre for Rural Health Research, La Trobe University, Bendigo, VIC 3550, Australia
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Yadav UN, Davis JM, Bennett-Brook K, Coombes J, Wyber R, Pearson O. A 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. Health Res Policy Syst 2024; 22:34. [PMID: 38509612 PMCID: PMC10956197 DOI: 10.1186/s12961-024-01121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/10/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND More than 35% of Aboriginal and Torres Strait Islander adults live with cardiovascular disease, diabetes, or chronic kidney disease. There is a pressing need for chronic disease prevention and management among Aboriginal and Torres Strait Islander people in Australia. Therefore, this review aimed to synthesise a decade of contemporary evidence to understand the barriers and enablers of chronic disease prevention and management for Aboriginal and Torres Strait Islander People with a view to developing policy and practice recommendations. METHODS We systematically searched for peer-reviewed published articles between January 2014 to March 2023 where the search was performed using subject headings and keywords related to "Aboriginal and Torres Strait Islander peoples," "Chronic Disease," and "Primary Health Care". Quality assessment for all included studies was conducted using the Aboriginal and Torres Strait Islander Quality Appraisal Tool. The data were extracted and summarised using a conventional content analysis approach and applying strength-based approaches. RESULTS Database searches identified 1653 articles where 26 met inclusion criteria. Studies varied in quality, primarily reporting on 14 criteria of the Aboriginal and Torres Strait Islander Quality Appraisal Tool. We identified six key domains of enablers and barriers of chronic disease prevention and management programs and implied a range of policy and practice options for improvement. These include culturally acceptable and safe services, patient-provider partnerships, chronic disease workforce, primary health care service attributes, clinical care pathways, and accessibility to primary health care services. This review also identified the need to address social and cultural determinants of health, develop the Aboriginal and Torres Strait Islander and non-Indigenous chronic disease workforce, support multidisciplinary teams through strengthening clinical care pathways, and engage Aboriginal and Torres Strait Islander communities in chronic disease prevention and management program design and delivery. CONCLUSION Enabling place-based partnerships to develop contextual evidence-guided strategies that align with community priorities and aspirations, with the provision of funding mechanisms and models of care through policy and practice reforms will strengthen the chronic disease prevention and management program for Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Uday Narayan Yadav
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, ACT, Australia.
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
| | | | | | | | - Rosemary Wyber
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, ACT, Australia
- Telethon Kids Institute, Perth, WA, Australia
| | - Odette Pearson
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Faculty of Health and Medical Science, University of Adelaide, Adelaide, SA, Australia
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3
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McGlacken-Byrne SM, Murphy NP, Barry S. A realist synthesis of multicentre comparative audit implementation: exploring what works and in which healthcare contexts. BMJ Open Qual 2024; 13:e002629. [PMID: 38448042 PMCID: PMC10916097 DOI: 10.1136/bmjoq-2023-002629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/20/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Multicentre comparative clinical audits have the potential to improve patient care, allow benchmarking and inform resource allocation. However, implementing effective and sustainable large-scale audit can be difficult within busy and resource-constrained contemporary healthcare settings. There are little data on what facilitates the successful implementation of multicentre audits. As healthcare environments are complex sociocultural organisational environments, implementing multicentre audits within them is likely to be highly context dependent. OBJECTIVE We aimed to examine factors that were influential in the implementation process of multicentre comparative audits within healthcare contexts-what worked, why, how and for whom? METHODS A realist review was conducted in accordance with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards reporting standards. A preliminary programme theory informed two systematic literature searches of peer-reviewed and grey literature. The main context-mechanism-outcome (CMO) configurations underlying the implementation processes of multicentre audits were identified and formed a final programme theory. RESULTS 69 original articles were included in the realist synthesis. Four discrete CMO configurations were deduced from this synthesis, which together made up the final programme theory. These were: (1) generating trustworthy data; (2) encouraging audit participation; (3) ensuring audit sustainability; and (4) facilitating audit cycle completion. CONCLUSIONS This study elucidated contexts, mechanisms and outcomes influential to the implementation processes of multicentre or national comparative audits in healthcare. The relevance of these contextual factors and generative mechanisms were supported by established theories of behaviour and findings from previous empirical research. These findings highlight the importance of balancing reliability with pragmatism within complex adaptive systems, generating and protecting human capital, ensuring fair and credible leadership and prioritising change facilitation.
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Affiliation(s)
| | - Nuala P Murphy
- Department of Paediatric Endocrinology, Children's Health Ireland at Temple Street, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Sarah Barry
- RCSI School of Population Health, Dublin, Ireland
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Longworth GR, Erikowa-Orighoye O, Anieto EM, Agnello DM, Zapata-Restrepo JR, Masquillier C, Giné-Garriga M. Conducting co-creation for public health in low and middle-income countries: a systematic review and key informant perspectives on implementation barriers and facilitators. Global Health 2024; 20:9. [PMID: 38233942 PMCID: PMC10795424 DOI: 10.1186/s12992-024-01014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND There has been an increase in the use of co-creation for public health because of its claimed potential to increase an intervention's impact, spark change and co-create knowledge. Still, little is reported on its use in low-and-middle-income countries (LMICs). This study offers a comprehensive overview of co-creation used in public-health-related interventions, including the interventions' characteristics, and reported implementation barriers and facilitators. METHODS We conducted a systematic review within the Scopus and PubMed databases, a Google Scholar search, and a manual search in two grey literature databases related to participatory research. We further conducted eight interviews with first authors, randomly selected from included studies, to validate and enrich the systematic review findings. RESULTS Through our review, we identified a total of twenty-two studies conducted in twenty-four LMIC countries. Majority of the interventions were designed directly within the LMIC setting. Aside from one, all studies were published between 2019 and 2023. Most studies adopted a co-creation approach, while some reported on the use of co-production, co-design, and co-development, combined either with community-based participatory research, participatory action research or citizen science. Among the most reported implementation barriers, we found the challenge of understanding and accounting for systemic conditions, such as the individual's socioeconomic status and concerns related to funding constraints and length of the process. Several studies described the importance of creating a safe space, relying on local resources, and involving existing stakeholders in the process from the development stage throughout, including future and potential implementors. High relevance was also given to the performance of a contextual and/or needs assessment and careful tailoring of strategies and methods. CONCLUSION This study provides a systematic overview of previously conducted studies and of reported implementation barriers and facilitators. It identifies implementation barriers such as the setting's systemic conditions, the socioeconomic status and funding constrains along with facilitators such as the involvement of local stakeholders and future implementors throughout, the tailoring of the process to the population of interest and participants and contextual assessment. By incorporating review and interview findings, the study aims to provide practical insights and recommendations for guiding future research and policy.
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Affiliation(s)
| | | | - Ebuka Miracle Anieto
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- School of Health and Sports Sciences, University of Suffolk, Ipswich, UK
| | | | - Jorge Raul Zapata-Restrepo
- Faculty of Psychology, Education and Sport Sciences, Universitat Ramon Llul, Blanquerna, Barcelona, Spain
| | - Caroline Masquillier
- Family Medicine and Population Health'- FAMPOP, Faculty of Medical and Health Sciences & 'Centre for Family, Population and Health, Faculty of Social sciences, University of Antwerp, Belgium, Belgium
| | - Maria Giné-Garriga
- Faculty of Psychology, Education and Sport Sciences, Universitat Ramon Llul, Blanquerna, Barcelona, Spain
- Faculty of Health Sciences, Universitat Ramon Llull, Blanquerna, Barcelona, Spain
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Conte KP, Laycock A, Bailie J, Walke E, Onnis LA, Feeney L, Langham E, Cunningham F, Matthews V, Bailie R. Producing knowledge together: a participatory approach to synthesising research across a large-scale collaboration in Aboriginal and Torres Strait Islander health. Health Res Policy Syst 2024; 22:3. [PMID: 38172892 PMCID: PMC10765661 DOI: 10.1186/s12961-023-01087-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Despite that stakeholder participation in evidence synthesis could result in more useful outcomes, there are few examples of processes that actively involve them in synthesis work. Techniques are needed that engage diverse stakeholders as equal partners in knowledge co-production. The aims of this paper are to describe an innovative participatory process of synthesising a large body of academic research products and compare the findings of the participatory process against two traditional approaches to synthesis: a rapid review and a structured review. METHODS First, a rapid synthesis of all research outputs (n = 86) was conducted by researchers with in-depth knowledge of the collaboration's research. Second, a team of researchers and service providers conducted a structured synthesis of seventy-eight peer-reviewed articles and reports generated by the collaboration. Fifty-five publications were brought forward for further synthesis in part three, a facilitated participatory synthesis. Finally, we explored the value added by the participatory method by comparing findings generated across the three synthesis approaches. RESULTS Twelve researchers and 11 service providers/policy partners-8 self-identified as Aboriginal and/or Torres Strait Islander-participated in two facilitated workshops (totalling 4 h). Workshop activities engaged participants in reviewing publication summaries, identifying key findings, and evoked review, discussion and refinement. The process explicitly linked experiential knowledge to citations of academic research, clearly connecting the two knowledge types. In comparing the findings generated across all three methods we found mostly consistencies; the few discrepancies did not contradict but gave deeper insights into statements created by the other methods. The participatory synthesis generated the most, detailed, and unique findings, and contextual insights about the relevance of the key messages for practice. CONCLUSION The participatory synthesis engaged stakeholders with diverse backgrounds and skillsets in synthesising a large body of evidence in a relatively short time. The participatory approach produced findings comparable to traditional synthesis methods while extending knowledge and identifying lessons most relevant for the participants who, ultimately, are the end users of the research. This process will interest other large-scale research collaborations seeking to engage stakeholders in evidence synthesis.
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Affiliation(s)
- Kathleen P Conte
- University Centre for Rural Health, The University of Sydney, Camperdown, Australia.
- Oregon Health Sciences University-Portland State University School of Public Health, Portland State University, Portland, USA.
| | - Alison Laycock
- University Centre for Rural Health, The University of Sydney, Camperdown, Australia
| | - Jodie Bailie
- University Centre for Rural Health, The University of Sydney, Camperdown, Australia
- School of Public Health, The University of Sydney, Camperdown, Australia
| | - Emma Walke
- University Centre for Rural Health, The University of Sydney, Camperdown, Australia
| | - Leigh-Ann Onnis
- College of Business, Law and Governance, James Cook University, Cairns, Australia
| | - Lynette Feeney
- University Centre for Rural Health, The University of Sydney, Camperdown, Australia
| | - Erika Langham
- Poche Centre for Indigenous Health, University of Queensland, Brisbane, Australia
| | - Frances Cunningham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | - Veronica Matthews
- University Centre for Rural Health, The University of Sydney, Camperdown, Australia
| | - Ross Bailie
- Sydney Medical School, The University of Sydney, Camperdown, Australia
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Hornby-Turner YC, Russell SG, Quigley R, Matthews V, Larkins S, Hayman N, Lakhan P, Flicker L, Smith K, McKeown D, Cadet-James D, Cass A, Garvey G, LoGiudice D, Miller G, Strivens E. Safeguarding against Dementia in Aboriginal and Torres Strait Islander Communities through the Optimisation of Primary Health Care: A Project Protocol. Methods Protoc 2023; 6:103. [PMID: 37888035 PMCID: PMC10609630 DOI: 10.3390/mps6050103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/30/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
This protocol describes the methodology and methods for a collaborative project with eight Aboriginal and Torres Strait Islander primary health care (PHC) organisations, across three Australian states and one territory, to increase clinical service performance and access to preventive health and health promotion services for preventing, identifying, treating, and managing dementia risk in Aboriginal and Torres Strait Islander communities. Aboriginal participatory action research (APAR) methodology will be the framework for this project, incorporating continuous quality improvement (CQI), informed by research yarning with stakeholder groups, comprising community members and PHC staff and service providers and data collected from the auditing of client health records and the mapping of existing clinical processes and health services at each partnering PHC organisation. The qualitative and quantitative data will be summarised and discussed with stakeholder groups. Priorities will be identified and broken down into tangible PHC organisation deliverable strategies and programs, which will be co-developed with stakeholder groups and implemented cyclically over 24 months using the Plan, Do, Study, Act model of change. Key project outcome measures include increased clinical service performance and availability of preventive health and health promotion services for safeguarding against dementia. Project implementation will be evaluated for quality and transparency from an Indigenous perspective using an appropriate appraisal tool. The project processes, impact, and sustainability will be evaluated using the RE-AIM framework. A dementia safeguarding framework and accompanying tool kit will be developed from this work to support Aboriginal and Torres Strait Islander PHC organisations to identify, implement, and evaluate dementia safeguarding practice and service improvements on a broader scale.
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Affiliation(s)
- Yvonne C. Hornby-Turner
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Sarah G. Russell
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Veronica Matthews
- University Centre for Rural Health, University of Sydney, Lismore, NSW 2145, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, Inala, QLD 4077, Australia (P.L.)
| | - Prabha Lakhan
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, Inala, QLD 4077, Australia (P.L.)
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, University of Western Australia, Crawley, WA 6009, Australia;
| | - Kate Smith
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Crawley, WA 6009, Australia
| | | | - Diane Cadet-James
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia;
| | - Gail Garvey
- School of Public Health, The University of Queensland, Herston, Brisbane, QLD 4006, Australia
| | - Dina LoGiudice
- Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC 3050, Australia
| | - Gavin Miller
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, QLD 4870, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, QLD 4870, Australia
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Krakouer J, Savaglio M, Taylor K, Skouteris H. Community-based models of alcohol and other drug support for First Nations peoples in Australia: A systematic review. Drug Alcohol Rev 2022; 41:1418-1427. [PMID: 35546281 PMCID: PMC9542511 DOI: 10.1111/dar.13477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 12/01/2022]
Abstract
Issues The transgenerational impacts of colonisation—inclusive of dispossession, intergenerational trauma, racism, social and economic exclusion and marginalisation—places First Nations peoples in Australia at significant risk of alcohol and other drug (AOD) use and its associated harms. However, knowledge and evidence supporting community‐based AOD treatment for First Nations adults is limited. Therefore, this review aimed to examine the impact and acceptability of community‐based models of AOD support for First Nations adults in Australia. Approach A systematic search of the empirical literature from the past 20 years was conducted. Key Findings Seventeen studies were included. Nine studies evaluated the program's impact on substance use and 10 studies assessed program acceptability (two studies evaluated both). Only three out of nine studies yielded a statistically significant reduction in substance use. Acceptable components included cultural safety, First Nations AOD workers, inclusion of family and kin, outreach and group support. Areas for improvement included greater focus on holistic wrap‐around psychosocial support, increased local community participation and engagement, funding and breaking down silos. Implications Culturally safe, holistic and integrated AOD outreach support led by First Nations peoples and organisations that involves local community members may support First Nations peoples experiencing AOD concerns. These findings may inform the (re)design and (re)development of community‐based AOD services for First Nations peoples. Conclusion There is a limited evidence‐base for community‐based AOD programs for First Nations peoples. First Nations‐led research that is controlled by and co‐produced with First Nations peoples is necessary to extend our understanding of community‐based programs within First Nations communities.
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Affiliation(s)
- Jacynta Krakouer
- Health and Social Care Unit, School of Public and Preventive Medicine, Monash University, Melbourne, Australia
| | - Melissa Savaglio
- Health and Social Care Unit, School of Public and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karinda Taylor
- First Peoples' Health and Wellbeing, Thomastown and Frankston, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public and Preventive Medicine, Monash University, Melbourne, Australia.,Warwick Business School, University of Warwick, Conventry, UK
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Yoon J, O'Bryan CM, Maclachlan L, Redmond M. Intracranial infected collections and epidemiology in the top end, Northern Territory, Australia. A 10-year case series. ANZ J Surg 2021; 91:2793-2799. [PMID: 34580966 DOI: 10.1111/ans.17202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/28/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The incidence of intracranial infected collections (IIC) ranges between 0.4 and 1.2/100 000 persons per year. There is anecdotal evidence that residents in Top End of the Northern Territory are at a greater risk of infections with protracted clinical presentations. To our knowledge, there is no study to date to explore IIC in the Top End. METHODS Retrospective observational analysis of IIC in the Top End, Northern Territory, Australia from 2009 to 2019. International classification of disease code G06 was used to identify cases diagnosed at Royal Darwin, Gove District and Katherine Hospital with no restriction of age or gender. RESULTS A total of 51 cases were identified. This equated to an incidence of 2.9 (95% CI 2.2-3.8) in 100 000 PPY. When separated into Indigenous and non-Indigenous populations, the respective incidences were 8.65 (95% CI 6.2-12.1) and 1.1 (95% CI 0.7-1.9) in 100 000 PPY. The Indigenous population was at a significantly higher risk of IIC compared with non-Indigenous Australians with a relative risk of 7.3 (P < 0.0001 95% CI 4.0-13.3). The most common aetiology was otogenic infections with all cases being identified in the Indigenous population. Comparison of other clinical parameters between the two populations were not statistically significant. CONCLUSIONS Within the limitations of a retrospective study, the incidence of IICs is higher in the Top End than reported elsewhere in the literature. This is particularly true for the Indigenous population.
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Affiliation(s)
- Joseph Yoon
- Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Neurosurgery Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Claire Maree O'Bryan
- College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia
| | - Liam Maclachlan
- Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Michael Redmond
- Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Neurosurgery Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Adily A, Girgis S, D Este C, Matthews V, Ward JE. Syphilis testing performance in Aboriginal primary health care: exploring impact of continuous quality improvement over time. Aust J Prim Health 2021; 26:178-183. [PMID: 32007130 DOI: 10.1071/py19070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 10/01/2019] [Indexed: 11/23/2022]
Abstract
Data from 110 primary healthcare clinics participating in two or more continuous quality improvement (CQI) cycles in preventive care, which included syphilis testing performance (STP) for Aboriginal and Torres Strait Islander people aged between 15 and 54 years, were used to examine whether the number of audit cycles including syphilis testing was associated over time with STP improvement at clinic level in this specific measure of public health importance. The number of cycles per clinic ranged from two to nine (mode 3). As shown by medical record audit at entry to CQI, only 42 (38%) clinics had tested or approached 50% or more of their eligible clients for syphilis in the prior 24 months. Using mixed effects logistic regression, it was found that the odds of a clinic's STP relative to its first cycle increased only modestly. Counterintuitively, clinics undertaking the most preventive health CQI cycles tended to have the lowest STP throughout. Participation in a general preventive care CQI tool was insufficient to achieve and sustain high rates of STP for Aboriginal and Torres Strait Islander people required for public health benefit. Improving STP requires dedicated effort and greater understanding of barriers to effective CQI within and beyond clinic control.
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Affiliation(s)
- Armita Adily
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW 2052, Australia; and Corresponding author.
| | - Seham Girgis
- S&K Girgis Medical Service, 1/13-15 Kingsway, Cronulla, NSW 2230, Australia
| | - Catherine D Este
- National Centre for Epidemiology and Population Health, The Australian National University, 62 Mills Road, Canberra, ACT 0200, Australia
| | - Veronica Matthews
- University Centre for Rural Health, The University of Sydney, 61 Uralba Street, Lismore, NSW 2480, Australia
| | - Jeanette E Ward
- Nulungu Research Institute, University of Notre Dame, 88 Guy Street, Broome, WA 6725, Australia
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Parikh DR, Diaz A, Bernardes C, De Ieso PB, Thachil T, Kar G, Stevens M, Garvey G. The utilization of allied and community health services by cancer patients living in regional and remote geographical areas in Australia. Support Care Cancer 2020; 29:3209-3217. [DOI: 10.1007/s00520-020-05839-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/16/2020] [Indexed: 12/11/2022]
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Bailie J, Laycock A, Matthews V, Peiris D, Bailie R. Emerging evidence of the value of health assessments for Aboriginal and Torres Strait Islander people in the primary healthcare setting. Aust J Prim Health 2019; 25:1-5. [PMID: 30636669 DOI: 10.1071/py18088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/06/2018] [Indexed: 11/23/2022]
Abstract
The launch of the third edition of the National guide to preventive health assessment for Aboriginal and Torres Strait Islander people in March 2018 heralds a renewed commitment to improving the delivery of preventive care, and should reinvigorate discussions on the effectiveness of Indigenous-specific health assessments and how best to implement them. A substantial body of evidence on adherence to guideline-recommended care has been generated through a research-based continuous quality improvement (CQI) initiative conducted between 2010 and 2014. The research, which involved clinical audits of more than 17000 client records and 119 systems assessments relating to preventive care in 137 Indigenous primary healthcare centres across Australia, shows that a structured CQI program can improve the delivery of preventive health assessments and use of evidence-based guidelines. However, program implementation has also seen the emergence of new challenges. This paper reflects on four major lessons from this collaborative program of applied research that will lead to more effective delivery of preventive care.
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Affiliation(s)
- Jodie Bailie
- University Centre for Rural Health, The University of Sydney, 61 Uralba Street, Lismore, NSW 2480, Australia; and Corresponding author.
| | - Alison Laycock
- University Centre for Rural Health, The University of Sydney, 61 Uralba Street, Lismore, NSW 2480, Australia
| | - Veronica Matthews
- University Centre for Rural Health, The University of Sydney, 61 Uralba Street, Lismore, NSW 2480, Australia
| | - David Peiris
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW 2000, Australia
| | - Ross Bailie
- University Centre for Rural Health, The University of Sydney, 61 Uralba Street, Lismore, NSW 2480, Australia
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Diaz A, Vo B, Baade PD, Matthews V, Nattabi B, Bailie J, Whop LJ, Bailie R, Garvey G. Service Level Factors Associated with Cervical Screening in Aboriginal and Torres Strait Islander Primary Health Care Centres in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193630. [PMID: 31569670 PMCID: PMC6801551 DOI: 10.3390/ijerph16193630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/23/2019] [Indexed: 12/02/2022]
Abstract
Aboriginal and Torres Strait Islander women have significantly higher cervical cancer incidence and mortality than other Australian women. In this study, we assessed the documented delivery of cervical screening for women attending Indigenous Primary Health Care (PHC) centres across Australia and identified service-level factors associated with between-centre variation in screening coverage. We analysed 3801 clinical audit records for PHC clients aged 20–64 years from 135 Indigenous PHC centres participating in the Audit for Best Practice in Chronic Disease (ABCD) continuous quality improvement (CQI) program across five Australian states/territories during 2005 to 2014. Multilevel logistic regression models were used to identify service-level factors associated with screening, while accounting for differences in client-level factors. There was substantial variation in the proportion of clients who had a documented cervical screen in the previous two years across the participating PHC centres (median 50%, interquartile range (IQR): 29–67%), persisting over years and audit cycle. Centre-level factors explained 40% of the variation; client-level factors did not reduce the between-centre variation. Screening coverage was associated with longer time enrolled in the CQI program and very remote location. Indigenous PHC centres play an important role in providing cervical screening to Aboriginal and Torres Strait Islander women. Thus, their leadership is essential to ensure that Australia’s public health commitment to the elimination of cervical cancer includes Aboriginal and Torres Strait Islander women. A sustained commitment to CQI may improve PHC centres delivery of cervical screening; however, factors that may impact on service delivery, such as organisational, geographical and environmental factors, warrant further investigation.
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Affiliation(s)
- Abbey Diaz
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, Australia.
| | - Brenda Vo
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, Australia.
| | - Peter D Baade
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, Australia.
- Cancer Research Centre, Cancer Council Queensland, Herston 4006, Australia.
| | - Veronica Matthews
- University Centre for Rural Health, The University of Sydney, Lismore 2480, Australia.
| | - Barbara Nattabi
- School of Population and Global Health, The University of Western Australia, Crawley 6009, Australia.
| | - Jodie Bailie
- University Centre for Rural Health, The University of Sydney, Lismore 2480, Australia.
| | - Lisa J Whop
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, Australia.
| | - Ross Bailie
- University Centre for Rural Health, The University of Sydney, Lismore 2480, Australia.
| | - Gail Garvey
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, Australia.
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13
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Gunaratnam P, Schierhout G, Brands J, Maher L, Bailie R, Ward J, Guy R, Rumbold A, Ryder N, Fairley CK, Donovan B, Moore L, Kaldor J, Bell S. Qualitative perspectives on the sustainability of sexual health continuous quality improvement in clinics serving remote Aboriginal communities in Australia. BMJ Open 2019; 9:e026679. [PMID: 31061040 PMCID: PMC6502047 DOI: 10.1136/bmjopen-2018-026679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 02/20/2019] [Accepted: 04/04/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To examine barriers and facilitators to sustaining a sexual health continuous quality improvement (CQI) programme in clinics serving remote Aboriginal communities in Australia. DESIGN Qualitative study. SETTING Primary health care services serving remote Aboriginal communities in the Northern Territory, Australia. PARTICIPANTS Seven of the 11 regional sexual health coordinators responsible for supporting the Northern Territory Government Remote Sexual Health Program. METHODS Semi-structured in-depth interviews conducted in person or by telephone; data were analysed using an inductive and deductive thematic approach. RESULTS Despite uniform availability of CQI tools and activities, sexual health CQI implementation varied across the Northern Territory. Participant narratives identified five factors enhancing the uptake and sustainability of sexual health CQI. At clinic level, these included adaptation of existing CQI tools for use in specific clinic contexts and risk environments (eg, a syphilis outbreak), local ownership of CQI processes and management support for CQI. At a regional level, factors included the positive framing of CQI as a tool to identify and act on areas for improvement, and regional facilitation of clinic level CQI activities. Three barriers were identified, including the significant workload associated with acute and chronic care in Aboriginal primary care services, high staff turnover and lack of Aboriginal staff. Considerations affecting the future sustainability of sexual health CQI included the need to reduce the burden on clinics from multiple CQI programmes, the contribution of regional sexual health coordinators and support structures, and access to and use of high-quality information systems. CONCLUSIONS This study contributes to the growing evidence on how CQI approaches may improve sexual health in remote Australian Aboriginal communities. Enhancing sustainability of sexual health CQI in this context will require ongoing regional facilitation, efforts to build local ownership of CQI processes and management of competing demands on health service staff.
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Affiliation(s)
| | - Gill Schierhout
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jenny Brands
- Menzies School of Health Research, Brisbane, Queensland, Australia
| | - Lisa Maher
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - Ross Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - James Ward
- South Australian Health and Medical Research Centre, Adelaide, South Australia, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Alice Rumbold
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Nathan Ryder
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Pacific Clinic Newcastle, HNE Sexual Health, Newcastle, New South Wales, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Basil Donovan
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia
| | - Liz Moore
- Aboriginal Medical Services Alliance Northern Territory, Darwin, Northern Territory, Australia
| | - John Kaldor
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Stephen Bell
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
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14
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Bailie J, Matthews V, Laycock A, Connors C, Bailie R. Rigorous follow-up systems for abnormal results are essential to improve health outcomes for Aboriginal and Torres Strait Islander people. Aust J Prim Health 2019; 24:1-3. [PMID: 29362025 DOI: 10.1071/py17103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/19/2017] [Indexed: 11/23/2022]
Affiliation(s)
- Jodie Bailie
- The University of Sydney, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW 2480, Australia
| | - Veronica Matthews
- The University of Sydney, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW 2480, Australia
| | - Alison Laycock
- Charles Darwin University, Menzies School of Health Research, Level 1, 147 Wharf Street, Brisbane, Qld 4000, Australia
| | - Christine Connors
- Northern Territory Department of Health, 87 Mitchell Street, Darwin, NT 0800, Australia
| | - Ross Bailie
- The University of Sydney, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW 2480, Australia
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Laycock AF, Bailie J, Percival NA, Matthews V, Cunningham FC, Harvey G, Copley K, Patel L, Bailie R. Wide-Scale Continuous Quality Improvement: A Study of Stakeholders' Use of Quality of Care Reports at Various System Levels, and Factors Mediating Use. Front Public Health 2019; 6:378. [PMID: 30687690 PMCID: PMC6338065 DOI: 10.3389/fpubh.2018.00378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 12/19/2018] [Indexed: 01/25/2023] Open
Abstract
Introduction: Increasing the use of evidence in healthcare policy and practice requires greater understanding of how stakeholders use evidence to inform policy, refine systems and change practice. Drawing on implementation theory, we have used system-focused participatory research to engage diverse stakeholders in using aggregated continuous quality improvement (CQI) data from Australian Indigenous primary health care settings to identify priority evidence-practice gaps, barriers/enablers and strategies for improvement. This article reports stakeholders' use or intended use of evidence at various levels of the system, and factors mediating use. Material and Methods: Interviews were undertaken with a purposeful sample of 30 healthcare stakeholders in different roles, organization types and settings in one Australian jurisdiction and with national participants, as part of the project's developmental evaluation. Qualitative data were analyzed to identify themes and categories relating to use of evidence. Results: Context-specific aggregated CQI data that were relatable to the diverse professional roles and practices provided an effective starting point for sharing perspectives, generating practice-based evidence and mobilizing evidence-use. Interviewees perceived the co-produced findings as applicable at different levels and useful for planning, policy development, supporting best practice and reflection, capacity strengthening and developing new research. Factors mediating use were commitment to best practice; the credibility of the evidence and its perceived relevance to work roles, contexts and decision needs; report format and language; facilitation and communication; competing work pressures and the organizational environment for change. Conclusions: This study found that primary health care stakeholders used evidence on quality of care for a variety of purposes. This could be linked to the interactive research processes used to engage stakeholders in different roles and settings in interpreting data, sharing and generating knowledge. Findings indicate that system-based participatory research using CQI data and iterative, interactive and systematic CQI-based methods can be applied at scale to support concurrent action for healthcare improvement at different system levels. Factors known to influence implementation should be addressed within the research design to optimize evidence use. Further research is needed to explore the utility of interactive dissemination for engaging healthcare stakeholders in informing policy and system change.
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Affiliation(s)
- Alison F Laycock
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Jodie Bailie
- University Centre for Rural Health, The University of Sydney, Sydney, NSW, Australia
| | - Nikki A Percival
- The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, NSW, Australia
| | - Veronica Matthews
- University Centre for Rural Health, The University of Sydney, Sydney, NSW, Australia
| | - Frances C Cunningham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Gillian Harvey
- Adelaide Nursing School, The University of Adelaide, Adelaide, SA, Australia
| | - Kerry Copley
- Aboriginal Medical Services Alliance Northern Territory, Darwin, NT, Australia
| | - Louise Patel
- Aboriginal Medical Services Alliance Northern Territory, Darwin, NT, Australia
| | - Ross Bailie
- University Centre for Rural Health, The University of Sydney, Sydney, NSW, Australia
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Bailie R, Bailie J, Larkins S, Broughton E. Editorial: Continuous Quality Improvement (CQI)-Advancing Understanding of Design, Application, Impact, and Evaluation of CQI Approaches. Front Public Health 2017; 5:306. [PMID: 29218305 PMCID: PMC5703697 DOI: 10.3389/fpubh.2017.00306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/03/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ross Bailie
- The University of Sydney, The University Centre for Rural Health, Lismore, NSW, Australia
| | - Jodie Bailie
- The University of Sydney, The University Centre for Rural Health, Lismore, NSW, Australia
| | - Sarah Larkins
- James Cook University, College of Medicine and Dentistry, Townsville, QLD, Australia
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Bailie J, Matthews V, Laycock A, Schultz R, Burgess CP, Peiris D, Larkins S, Bailie R. Improving preventive health care in Aboriginal and Torres Strait Islander primary care settings. Global Health 2017; 13:48. [PMID: 28705223 PMCID: PMC5512740 DOI: 10.1186/s12992-017-0267-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Like other colonised populations, Indigenous Australians experience poorer health outcomes than non-Indigenous Australians. Preventable chronic disease is the largest contributor to the health differential between Indigenous and non-Indigenous Australians, but recommended best-practice preventive care is not consistently provided to Indigenous Australians. Significant improvement in health care delivery could be achieved through identifying and minimising evidence-practice gaps. Our objective was to use clinical audit data to create a framework of the priority evidence-practice gaps, strategies to address them, and drivers to support these strategies in the delivery of recommended preventive care. METHODS De-identified preventive health clinical audit data from 137 primary health care (PHC) centres in five jurisdictions were analysed (n = 17,108 audited records of well adults with no documented major chronic disease; 367 system assessments; 2005-2014), together with stakeholder survey data relating to interpretation of these data, using a mixed-methods approach (n = 152 responses collated in 2015-16). Stakeholders surveyed included clinicians, managers, policy officers, continuous quality improvement (CQI) facilitators and academics. Priority evidence-practice gaps and associated barriers, enablers and strategies to address the gaps were identified and reported back through two-stages of consultation. Further analysis and interpretation of these data were used to develop a framework of strategies and drivers for health service improvement. RESULTS Stakeholder identified priorities were: following-up abnormal test results; completing cardiovascular risk assessments; timely recording of results; recording enquiries about living conditions, family relationships and substance use; providing support for clients identified with emotional wellbeing risk; enhancing systems to enable team function and continuity of care. Drivers identified for improving care in these areas included: strong Indigenous participation in the PHC service; appropriate team structure and function to support preventive care; meaningful use of data to support quality of care and CQI; and corporate support functions and structures. CONCLUSION The framework should be useful for guiding development and implementation of barrier-driven, tailored interventions for primary health care service delivery and policy contexts, and for guiding further research. While specific strategies to improve the quality of preventive care need to be tailored to local context, these findings reinforce the requirement for multi-level action across the system. The framework and findings may be useful for similar purposes in other parts of the world, with appropriate attention to context in different locations.
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Affiliation(s)
- Jodie Bailie
- The University of Sydney, University Centre for Rural Health - North Coast, Lismore, NSW, Australia.
| | - Veronica Matthews
- The University of Sydney, University Centre for Rural Health - North Coast, Lismore, NSW, Australia
| | - Alison Laycock
- Charles Darwin University, Menzies School of Health Research, Darwin, NT, Australia
| | - Rosalie Schultz
- Flinders University, Centre for Remote Health, Alice Springs, NT, Australia
| | - Christopher P Burgess
- Charles Darwin University, Menzies School of Health Research, Darwin, NT, Australia.,Department of Health, Northern Territory Government, Darwin, NT, Australia
| | - David Peiris
- The University of New South Wales, George Institute for Global Health, Sydney, NSW, Australia
| | - Sarah Larkins
- James Cook University, College of Medicine and Dentistry, Townsville, QLD, Australia
| | - Ross Bailie
- The University of Sydney, University Centre for Rural Health - North Coast, Lismore, NSW, Australia
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