Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

Improving the efficacy of healthcare services for Aboriginal Australians

Kylie Gwynne A D , Thomas Jeffries Jr B and Michelle Lincoln C
+ Author Affiliations
- Author Affiliations

A Poche Centre for Indigenous Health, Room 223, Edward Ford Building A27, The University of Sydney, Camperdown, NSW 2006, Australia.

B Syndey Medical School, Edward Ford Building A27, The University of Sydney, Camperdown, NSW 2006, Australia. Email: tjef4752@uni.sydney.edu.au

C Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, NSW 2141, Australia. Email: michelle.lincoln@sydney.edu.au

D Corresponding author. Email: kylie.gwynne@sydney.edu.au

Australian Health Review - https://doi.org/10.1071/AH17142
Submitted: 22 June 2017  Accepted: 5 December 2017   Published online: 16 January 2018

Abstract

Objective The aim of the present systematic review was to examine the enablers for effective health service delivery for Aboriginal Australians.

Methods This systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Papers were included if they had data related to health services for Australian Aboriginal people and were published between 2000 and 2015. The 21 papers that met the inclusion criteria were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Seven papers were subsequently excluded due to weak methodological approaches.

Results There were two findings in the present study: (1) that Aboriginal people fare worse than non-Aboriginal people when accessing usual healthcare services; and (2) there are five enablers for effective health care services for Australian Aboriginal people: cultural competence, participation rates, organisational, clinical governance and compliance, and availability of services.

Conclusions Health services for Australian Aboriginal people must be tailored and implementation of the five enablers is likely to affect the effectiveness of health services for Aboriginal people. The findings of the present study have significant implications in directing the future design, funding, delivery and evaluation of health care services for Aboriginal Australians.

What is known about the topic? There is significant evidence about poor health outcomes and the 10-year gap in life expectancy between Aboriginal and non-Aboriginal people, and limited evidence about improving health service efficacy.

What does this paper add? This systematic review found that with usual health care delivery, Aboriginal people experience worse health outcomes. This paper identifies five strategies in the literature that improve the effectiveness of health care services intended for Aboriginal people.

What are the implications for practitioners? Aboriginal people fare worse in both experience and outcomes when they access usual care services. Health services intended for Aboriginal people should be tailored using the five enablers to provide timely, culturally safe and high-quality care.

Additional keywords: health outcomes, Indigenous health, service delivery, service design.


References

[1]  Australian Bureau of Statistics. Census of population and housing – counts of Aboriginal and Torres Strait Islander Australians, 2011. 2012. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/2075.0main+features32011 [verified 1 September 2015].

[2]  Holland C. Progress and priorities report. Closing the gap. 2016. Available at: https://www.humanrights.gov.au/sites/default/files/document/publication/Progress_priorities_report_CTG_2016_0.pdf [verified 21 December 2017].

[3]  Australian Government. Closing the gap Prime Minister’s report – 2016. 2016. Available at: https://www.dpmc.gov.au/resource-centre/indigenous-affairs/closing-gap-prime-ministers-report-2016 [verified 21 December 2017].

[4]  Steering Committee for the Review of Government Service Provision. Overcoming Indigenous disadvantage. Key indicators 2014. Canberra: Productivity Commission; 2014.

[5]  Holland C. Progress and priorities report 2015. 2015. Available at: https://www.humanrights.gov.au/sites/default/files/document/publication/CTG_progress_and_priorities_report_2015.pdf [verified 21 December 2017].

[6]  Marmot M, Friel S, Bell R, Houweling TJA, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet 2008; 372 1661–9.
Closing the gap in a generation: health equity through action on the social determinants of health.CrossRef |

[7]  Purdie N, Dudgeon P, Walker R. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. Canberra: Commonwealth of Australia; 2010.

[8]  Australian Government. Closing the gap on Indigenous disadvantage: the challenge for Australia. Canberra: Australian Government; 2009. Available at: https://www.dss.gov.au/sites/default/files/documents/05_2012/closing_the_gap.pdf [verified 21 December 2017]

[9]  Blas E, Gilson L, Kelly MP, Labonté R, Lapitan J, Muntaner C, Östlin P, Popay J, Sadana R, Sen G, Schrecker T, Vaghri Z. Addressing social determinants of health inequities: what can the state and civil society do? Lancet 2008; 372 1684–9.
Addressing social determinants of health inequities: what can the state and civil society do?CrossRef |

[10]  Li IW, Mahuteau SM, Dockery PN, Mavromaras K. Labour market outcomes of Australian University graduates from equity groups. 2016. Available at: https://www.ncsehe.edu.au/wp-content/uploads/2016/03/Labour-Market-Outcomes-of-Australian-University-Graduates-from-Equity-Groups.pdf [verified 21 December 2017].

[11]  Australian Government. Closing the gap Prime Minister’s report 2017. 2017. Available at: http://closingthegap.pmc.gov.au/sites/default/files/ctg-report-2017.pdf [verified 21 December 2017].

[12]  Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. PLoS Med 2009; 6 e1000097
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement.CrossRef |

[13]  Lowitja Institute. Llt.search frequently asked questions. 2013. Available at: http://www.lowitja.org.au/litsearch-faq#q11 [verified 1 September 2015].

[14]  Effective Public Health Practice Project. Quality assessment tool for quantitative studies. 2009. Available at: http://www.ephpp.ca/tools.html [verified 21 December 2017].

[15]  Barclay L, Kruske S, Bar-Zeev S, Steenkamp M, Josif C, Narjic CW, Wardaguga M, Belton S, Gao Y, Dunbar T, Kildea S. Improving Aboriginal maternal and infant health services in the ‘Top End’ of Australia; synthesis of the findings of a health services research program aimed at engaging stakeholders, developing research capacity and embedding change. BMC Health Serv Res 2014; 14 241
Improving Aboriginal maternal and infant health services in the ‘Top End’ of Australia; synthesis of the findings of a health services research program aimed at engaging stakeholders, developing research capacity and embedding change.CrossRef |

[16]  Bar-Zeev SJ, Barclay L, Farrington C, Kildea S. From hospital to home: the quality and safety of a postnatal discharge system used for remote dwelling Aboriginal mothers and infants in the top end of Australia. Midwifery 2012; 28 366–73.
From hospital to home: the quality and safety of a postnatal discharge system used for remote dwelling Aboriginal mothers and infants in the top end of Australia.CrossRef |

[17]  Steenkamp M, Rumbold A, Barclay L, Kildea S. A population-based investigation into inequalities amongst Indigenous mothers and newborns by place of residence in the Northern Territory, Australia. BMC Pregnancy Childbirth 2012; 12 44
A population-based investigation into inequalities amongst Indigenous mothers and newborns by place of residence in the Northern Territory, Australia.CrossRef |

[18]  Kildea S, Stapleton H, Murphy R, Low NB, Gibbons K. The Murri clinic: a comparative retrospective study of an antenatal clinic developed for Aboriginal and Torres Strait Islander women. BMC Pregnancy Childbirth 2012; 12 159
The Murri clinic: a comparative retrospective study of an antenatal clinic developed for Aboriginal and Torres Strait Islander women.CrossRef |

[19]  Bailie RS, Si D, Robinson GW, Togni SJ, D’Abbs PH. A multifaceted health-service intervention in remote Aboriginal communities: 3-year follow-up of the impact on diabetes care. Med J Aust 2004; 181 195–200.

[20]  Bailie RS, Togni SJ, Si D, Robinson G, d’Abbs PH. Preventive medical care in remote Aboriginal communities in the Northern Territory: a follow-up study of the impact of clinical guidelines, computerised recall and reminder systems, and audit and feedback. BMC Health Serv Res 2003; 3 15
Preventive medical care in remote Aboriginal communities in the Northern Territory: a follow-up study of the impact of clinical guidelines, computerised recall and reminder systems, and audit and feedback.CrossRef |

[21]  Reibel T, Walker R. Antenatal services for Aboriginal women: the relevance of cultural competence. Qual Prim Care 2010; 18 65–74.

[22]  Gador-Whyte APWJ, Campbell D, Lenthall S, Struber J, Hope A, Watson C. Cost of best-practice primary care management of chronic disease in a remote Aboriginal community. Med J Aust 2014; 200 663–6.
Cost of best-practice primary care management of chronic disease in a remote Aboriginal community.CrossRef |

[23]  Si D, Bailie R, Connors C, Dowden M, Stewart A, Robinson G, Cunningham J, Weeramanthri T. Assessing health centre systems for guiding improvement in diabetes care. BMC Health Serv Res 2005; 5 56
Assessing health centre systems for guiding improvement in diabetes care.CrossRef |

[24]  Turner AW, Xie J, Arnold AL, Dunn RA, Taylor HR. Eye health service access and utilization in the National Indigenous Eye Health Survey. Clin Exp Ophthalmol 2011; 39 598–603.
Eye health service access and utilization in the National Indigenous Eye Health Survey.CrossRef |

[25]  Gao Y, Gold L, Josif C, Bar-Zeev S, Steenkamp M, Barclay L, Yuejen Z, Tracy S, Kildea S. A cost-consequences analysis of a midwifery group practice for Aboriginal mothers and infants in the Top End of the Northern Territory, Australia. Midwifery 2014; 30 447–55.
A cost-consequences analysis of a midwifery group practice for Aboriginal mothers and infants in the Top End of the Northern Territory, Australia.CrossRef |

[26]  Bailie RS, Robinson G, Kondalsamy-Chennakesavan SN, Halpin S, Wang Z. Investigating the sustainability of outcomes in a chronic disease treatment programme. Soc Sci Med 2006; 63 1661–70.
Investigating the sustainability of outcomes in a chronic disease treatment programme.CrossRef |

[27]  Lower T, Durham G, Bow D, Larson A. Implementation of the Australian core public health functions in rural Western Australia. Aust N Z J Public Health 2004; 28 418–25.
Implementation of the Australian core public health functions in rural Western Australia.CrossRef | 1:STN:280:DC%2BD2M%2FnvVajsA%3D%3D&md5=473360b18b7d24485ffefd91e80186a9CAS |

[28]  Kruger E, Perera I, Tennant M. Primary oral health service provision in Aboriginal Medical Services-based dental clinics in Western Australia. Aust J Prim Health 2010; 16 291–5.
Primary oral health service provision in Aboriginal Medical Services-based dental clinics in Western Australia.CrossRef |

[29]  Taylor K, Guerin P. Health care and Indigenous Australians: cultural safety in practice. 2nd edn. Melbourne: Palgrave MacMillan; 2014.

[30]  Vass A, Mitchell A, Dhurrkay Y. Health literacy and Australian Indigenous peoples: an analysis of the role of language and worldview. Health Promot J Austr 2011; 22 33–7.

[31]  Lambert M, Luke J, Downey B, Krengle S, Kelaher M, Reid S, Smylie J. Health literacy: health professionals’ understandings and their perceptions of the barriers that Indigenous patients encounter. BMC Health Serv Res 2014; 14 614
Health literacy: health professionals’ understandings and their perceptions of the barriers that Indigenous patients encounter.CrossRef |

[32]  Australian Commission on Safety and Quality in Health Care. Health literacy: taking action to improve safety and quality. 2014. Available at: https://www.safetyandquality.gov.au/wp-content/uploads/2014/08/Health-Literacy-Taking-action-to-improve-safety-and-quality.pdf [verified 21 December 2017].

[33]  Australian Institute of Health and Welfare. Access to health services for Aboriginal and Torres Strait Islander people. 2011. Available at: https://www.aihw.gov.au/getmedia/196cb4a7-969b-45cc-8b87-0f75ac837342/12263.pdf.aspx?inline=true [verified 21 December 2017].



Export Citation

View Altmetrics