‘We can work together, talk together’: an Aboriginal Health Care Home
Greg Smith A B , Renae Kirkham B , Charlie Gunabarra A , Valda Bokmakarray A and C. Paul Burgess B C D EA c/o Maningrida Community Health Centre, PMB 185, via Winnellie, NT 0822, Australia. Email: gpsmithy@gmail.com; Charlie.Gunabarra@nt.gov.au, Valda.Bokmakarray@nt.gov.au
B Menzies School of Health Research, Charles Darwin University, PO Box 1096, Casuarina, NT 0811, Australia. Email: Renae.Kirkham@menzies.edu.au
C Flinders University, Northern Territory Clinical School, Darwin, Australia.
D Northern Territory Department of Health, Top End Health Service, PO Box 40596, Casuarina, NT 0811, Australia.
E Corresponding author. Email: Paul.Burgess@nt.gov.au
Australian Health Review 43(5) 486-491 https://doi.org/10.1071/AH18107
Submitted: 23 May 2018 Accepted: 17 August 2018 Published: 25 October 2018
Journal Compilation © AHHA 2019 Open Access CC BY-NC-ND
Abstract
Objective The aim of this study was to identify an Aboriginal community’s aspirations for health service improvement during implementation of the Commonwealth’s Health Care Homes (HCH) reform.
Methods This study was a qualitative study consisting of Aboriginal-controlled phenomenological enquiry in a large Aboriginal community in north-central Arnhem Land.
Results A representative sample of 60 Aboriginal health service users identified shortcomings in their current experience of primary health care, including low cultural security. These shortcomings reduced access to care. Participants described several ways that care could be reorientated to match their needs during HCH implementation. Principally, patients voiced the need for: (1) restructuring care teams to foster culturally secure relationship-based care; and (2) reorientating the Aboriginal Health Practitioner role from acute care to strength-based competencies as the focal point of care continuity: self-management support, care coordination and navigation, health coaching and cultural mentorship for non-Aboriginal staff.
Conclusions For HCH to be successful, service providers need to engage with service users to identify and implement patient-centred strategies to improve access, acceptability and patient activation.
What is known about the topic? Success of the Commonwealth’s HCH reform is contingent on improving care access and patient activation to better manage chronic conditions
What does this paper add? This is the first opportunity that this Aboriginal community has had to articulate their aspirations for high quality healthcare. Beyond the strong alignment with the HCH building blocks, their care preferences posit practical and achievable workforce and delivery system reforms that may improve primary health care in other remote Aboriginal communities.
What are the implications for practitioners? The long-term success of the HCH reform will require iterative engagement with service users to identify and implement patient-centred strategies to improve access and acceptability of care. Service model alignment with patient care preferences will improve patient activation and is particularly important when working with vulnerable populations.
Additional keywords: health reform, health service co-design, Indigenous health, patient-centred care, primary health care.
References
[1] Jackson CL, Hambleton SJ. Australia’s Health Care Homes: laying the right foundations. Med J Aust 2017; 206 380–1.| Australia’s Health Care Homes: laying the right foundations.Crossref | GoogleScholarGoogle Scholar |
[2] Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med 2014; 12 573–6.
| From triple to quadruple aim: care of the patient requires care of the provider.Crossref | GoogleScholarGoogle Scholar |
[3] Australian Government Department of Health. Health Care Homes participating practices. 2018. Available at: https://www.health.gov.au/internet/main/publishing.nsf/Content/health-care-homes-cp/$File/Health-Care-Homes-participating-practices-13June2018.pdf [verified 24 August 2018].
[4] Bodenheimer T, Ghorob A, Willard-Grace R, Grumbach K. The 10 building blocks of high-performing primary care. Ann Fam Med 2014; 12 166–71.
| The 10 building blocks of high-performing primary care.Crossref | GoogleScholarGoogle Scholar |
[5] Tilton E, Thomas D. Core functions of primary health care: a framework for the Northern Territory. Darwin: Northern Territory Aboriginal Health Forum; 2011.
[6] Christie MJ, Greatorex J. Social capital in the contexts of Yolngu life. Learning Communities: International Journal Of Learning In Social Contexts 2004; 2004 38–51.
[7] Russell DJ, Zhao Y, Guthridge S, Ramjan M, Jones MP, Humphreys JS, Wakerman J. Patterns of resident health workforce turnover and retention in remote communities of the Northern Territory of Australia, 2013–2015. Hum Resour Health 2017; 15 52
| Patterns of resident health workforce turnover and retention in remote communities of the Northern Territory of Australia, 2013–2015.Crossref | GoogleScholarGoogle Scholar |
[8] Collins B. Intentional whole health system redesign: Southcentral Foundation’s ‘Nuka’ system of care. London: The Kings Fund; 2015.
[9] Country B, Wright S, Suchet-Pearson S, Lloyd K, Burarrwanga L, Ganambarr R, Ganambarr-Stubbs M, Ganambarr B, Maymuru D, Sweeney J. Co-becoming Bawaka: towards a relational understanding of place/space. Prog Hum Geogr 2016; 40 455–75.
| Co-becoming Bawaka: towards a relational understanding of place/space.Crossref | GoogleScholarGoogle Scholar |
[10] Wakerman J, Chalmers EM, Humphreys JS, Clarence CL, Bell AI, Larson A, Lyle D, Pashen DR. Sustainable chronic disease management in remote Australia. Med J Aust 2005; 183 S64–8.
[11] The Royal Australian College of General Practitioners (RACGP). Standards for Patient-Centred Medical Homes: Patient-centred, comprehensive, coordinated, accessible and quality care. Melbourne: RACGP; 2016. Available at: https://www.racgp.org.au/download/Documents/Standards/RACGP-Standards-for-Patient-Centred-Medical-Homes.pdf [verified 24 September 2018]
[12] Jabbarpour Y, DeMarchis E, Bazemore A, Grundy P. The Impact of Primary Care Practice Transformation on Cost, Quality, and Utilization: A Systematic Review of Research Published in 2016. Washington, DC: Patient-Centered Primary Care Collaborative and Robert Graham Center; 2017. Available at: https://www.pcpcc.org/sites/default/files/resources/pcmh_evidence_report_08-1-17%20FINAL.pdf [verified 24 September 2018]
[13] Royal Australian College of General Practitioners (RACGP). Standards for patient-centred medical homes: patient-centred, comprehensive, coordinated, accessible and quality care. Melbourne: RACGP; 2016.
[14] Jabbarpour Y, DeMarchis E, Bazemore A, Grundy P. The impact of primary care practice transformation on cost, quality, and utilization: a systematic review of research published in 2016. Washington, DC: Patient Centered Primary Care Collaborative; 2017. Available at: https://www.graham-center.org/content/dam/rgc/documents/publications-reports/reports/ImpactPrimaryCarePracticeTransformationCostQualityUtilization.PDF [verified 26 August 2018].
[15] Tregenza JD, Abbott K. Rhetoric and reality: perceptions of the roles of Aboriginal health workers in central Australia. Alice Springs: Central Australian Aboriginal Congress; 1995.
[16] Riddout L, Pilbeam V. Final report: Aboriginal health worker profession review. Thornleigh: Human Capital Alliance and HK Training & Consultancy; 2009.
[17] Genat B, Bushby S, McGuire M, Taylor E, Walley Y, Weston T. Aboriginal healthworkers: primary health care at the margins. Crawley: University of West Australia Press; 2006.
[18] Abbott P, Gordon E, Davison J. Expanding roles of Aboriginal health workers in the primary care setting: seeking recognition. Contemp Nurse 2008; 27 157–64.
| Expanding roles of Aboriginal health workers in the primary care setting: seeking recognition.Crossref | GoogleScholarGoogle Scholar |
[19] Australian Commission on Safety and Quality in Health Care (ACSQHC). National safety and quality health service standards. Sydney: ACSQHC; 2012.
[20] Australian Commission on Safety and Quality in Health Care (ACSQHC). Setting safety and quality goals for Aboriginal and Torres Strait Islander people in health service organisations. Canberra: ACSQHC; 2016.
