1
|
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.
Collapse
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
| |
Collapse
|
2
|
Usher K, Jackson D, Kabir H, Jones R, Miller J, Peake R, Smallwood R. Preventative health assessments and indigenous people of Australia: a scoping review. Front Public Health 2023; 11:1168568. [PMID: 37736086 PMCID: PMC10509761 DOI: 10.3389/fpubh.2023.1168568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/24/2023] [Indexed: 09/23/2023] Open
Abstract
Given that Indigenous populations globally are impacted by similar colonial global legacies, their health and other disaprities are usually worse than non-indigenous people. Indigenous peoples of Australia have been seriously impacted by colonial legacies and as a result, their health has negatively been affected. If Indigenous health and wellbeing are to be promoted within the existing Australian health services, a clear understanding of what preventive health means for Indigenous peoples is needed. The aim of this scoping review was to explore the available literature on the uptake/engagement in health assessments or health checks by Indigenous Australian peoples and to determine the enablers and barriers and of health assessment/check uptake/engagement. Specifically, we aimed to: investigate the available evidence reporting the uptake/engagement of health checks/assessments for Australian Indigenous; assess the quality of the available evidence on indigenous health checks/assessments; and identify the enablers or barriers affecting Indigenous persons' engagement and access to health assessment/health checks. A systematic search of online databases (such as Cinhl, Scopus, ProQuest health and medicine, PubMed, informit, google scholar and google) identified 10 eligible publications on Indigenous preventive health assessments. Reflexive thematic analysis identified three major themes on preventive health assessments: (1) uptake/engagement; (2) benefits and limitations; and (3) enablers and barriers. Findings revealed that Indigenous peoples' uptake and/or engagement in health assessments/check is a holistic concept varied by cultural factors, gender identity, geographical locations (living in regional and remote areas), and Indigenous clinical leadership/staff's motivational capacity. Overall, the results indicate that there has been improving rates of uptake of health assessments by some sections of Indigenous communities. However, there is clearly room for improvement, both for aboriginal men and women and those living in regional and remote areas. In addition, barriers to uptake of health asessments were identified as length of time required for the assessment, intrusive or sensitive questions and shame, and lack of access to health services for some. Indigenous clinical leadership is needed to improve services and encourage Indigenous people to participate in routine health assessments.
Collapse
Affiliation(s)
- Kim Usher
- School of Health, University of New England, Armidale, NSW, Australia
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia
| | - Debra Jackson
- Faculty of Medicine and Health, School of Nursing, University of Sydney, Sydney, NSW, Australia
| | - Humayun Kabir
- School of Health, University of New England, Armidale, NSW, Australia
- Department of Sociology, University of Dhaka, Dhaka, Bangladesh
| | - Rikki Jones
- School of Health, University of New England, Armidale, NSW, Australia
| | - Joe Miller
- Aboriginal Advisory Group Member, University of New England, Wollongong, NSW, Australia
| | - Rachel Peake
- Stroke Coordinator, Hunter New England Health, Newcastle, NSW, Australia
| | - Reakeeta Smallwood
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia
| |
Collapse
|
3
|
Redman-MacLaren M, Turner Anmatyerre/Jaru NN, Taylor J, Laycock A, Vine K, Thompson Gurindji Q, Larkins S, Carlisle K, Thompson S, Bailie R, Matthews Quandamooka V. Respect Is Central: A Critical Review of Implementation Frameworks for Continuous Quality Improvement in Aboriginal and Torres Strait Islander Primary Health Care Services. Front Public Health 2021; 9:630611. [PMID: 34336752 PMCID: PMC8322579 DOI: 10.3389/fpubh.2021.630611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Primary health care (PHC) services are complex systems, shaped by an interplay of factors at individual, organisational and broader system levels. For Aboriginal and Torres Strait Islander PHC services, closer relationships with the people they serve, local knowledge of community, and cultural awareness are critical. Continuous quality improvement (CQI) has proven to be an effective process for identification of priority issues in health care delivery and for instigating the design, implementation and evaluation of improvement interventions in these settings. However, wide-scale variation in care quality persists partly due to the mismatch between CQI interventions and context. Methods: This critical review of implementation frameworks for CQI in Aboriginal and Torres Strait Islander primary health care was conducted in two phases: (1) a review of primary published implementation frameworks used in PHC contexts, and (2) a comparison of key features of these frameworks with quality concepts identified by high-improving Aboriginal and Torres Strait Islander PHC services in remote Australia. Results: We found nine primary implementation frameworks previously used in PHC contexts guiding interventions within and between macro (broader contextual) level; meso (health service) level; and micro (community and inter-personal) level systems. There was commonality between these frameworks and key quality concepts in Aboriginal and Torres Strait Islander PHC. However, none of the frameworks covered all concepts with rare consideration of communities driving health improvement, two-way learning (integrating cultural knowledge into healthcare provision), and caring staff-engendering trusting relationships with community enacted through respect. Conclusion: Respect, as a secret essence, privileges the importance of culture, and is an essential element of CQI implementation frameworks for positive change in Aboriginal and Torres Strait Islander PHC services. It is essential to work with communities to design workforce models that grow a caring stable workforce to ensure improvements in quality of care that are effective for their context.
Collapse
Affiliation(s)
| | | | - Judy Taylor
- College of Medicine and Dentistry, James Cook University, Townsville, OLD, Australia
| | - Alison Laycock
- University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - Kristina Vine
- College of Medicine and Dentistry, James Cook University, Townsville, OLD, Australia
| | | | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, OLD, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Townsville, OLD, Australia
| | - Sandra Thompson
- Western Australia Centre for Rural Health, University of Western Australia, Geraldton, WA, Australia
| | - Ross Bailie
- University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | | |
Collapse
|
4
|
Kong K, Cass A, Leach AJ, Morris PS, Kimber A, Su JY, Oguoma VM. A community-based service enhancement model of training and employing Ear Health Facilitators to address the crisis in ear and hearing health of Aboriginal children in the Northern Territory, the Hearing for Learning Initiative (the HfLI): study protocol for a stepped-wedge cluster randomised trial. Trials 2021; 22:403. [PMID: 34134736 PMCID: PMC8207498 DOI: 10.1186/s13063-021-05215-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 03/21/2021] [Indexed: 02/03/2023] Open
Abstract
Background Almost all Aboriginal children in remote communities have persistent bilateral otitis media affecting hearing and learning throughout early childhood and school years, with consequences for social and educational outcomes, and later employment opportunities. Current primary health care and specialist services do not have the resources to meet the complex needs of these children. Method/design This stepped-wedge cluster randomised trial will allocate 18 communities to one of five 6-monthly intervention start dates. Stratification will be by region and population size. The intervention (Hearing for Learning Initiative, HfLI) consists of six 20-h weeks of training (delivered over 3 months) that includes Certificate II in Aboriginal Primary Health Care (3 modules) and competencies in ear and hearing data collection (otoscopy, tympanometry and hearScreen), plus 3 weeks of assisted integration into the health service, then part-time employment as Ear Health Facilitators to the end of the trial. Unblinding will occur 6 months prior to each allocated start date, to allow Community Reference Groups to be involved in co-design of the HfLI implementation in their community. Relevant health service data will be extracted 6-monthly from all 18 communities. The primary outcome is the difference in proportion of children (0 to 16 years of age) who have at least one ear assessment (diagnosis) documented in their medical record within each 6-month period, compared to control periods (no HfLI). Secondary outcomes include data on sustainability, adherence to evidence-based clinical guidelines for otitis media, including follow-up and specialist referrals, and school attendance. Structured interviews with staff working in health and education services, Ear Health Trainees, Ear Health Facilitators and families will assess process outcomes and the HfLI broader impact. Discussion The impact of training and employment of Ear Health Facilitators on service enhancement will inform the health, education and employment sectors about effectiveness of skills and job creation that empowers community members to contribute to addressing issues of local importance, in this instance ear and hearing health of children. Trial registration ClinicalTrials.gov NCT03916029. Registered on 16 April 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05215-7.
Collapse
Affiliation(s)
- Kelvin Kong
- University of Newcastle, John Hunter Children's Hospital, Newcastle, NSW, 2300, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, 58 Rocklands Drive, Darwin, NT, 0810, Australia
| | - Amanda Jane Leach
- Menzies School of Health Research, Charles Darwin University, 58 Rocklands Drive, Darwin, NT, 0810, Australia.
| | - Peter Stanley Morris
- Menzies School of Health Research, Charles Darwin University, 58 Rocklands Drive, Darwin, NT, 0810, Australia.,Royal Darwin Hospital, Darwin, NT, Australia
| | - Amy Kimber
- Menzies School of Health Research, Charles Darwin University, 58 Rocklands Drive, Darwin, NT, 0810, Australia
| | - Jiunn-Yih Su
- Menzies School of Health Research, Charles Darwin University, 58 Rocklands Drive, Darwin, NT, 0810, Australia
| | - Victor Maduabuchi Oguoma
- Menzies School of Health Research, Charles Darwin University, 58 Rocklands Drive, Darwin, NT, 0810, Australia.,Health Research Institute, University of Canberra, Canberra, ACT, Australia
| |
Collapse
|
5
|
Gotis-Graham A, Macniven R, Kong K, Gwynne K. Effectiveness of ear, nose and throat outreach programmes for Aboriginal and Torres Strait Islander Australians: a systematic review. BMJ Open 2020; 10:e038273. [PMID: 33243792 PMCID: PMC7692829 DOI: 10.1136/bmjopen-2020-038273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To examine the ability of ear, nose and throat (ENT) outreach programmes to improve health outcomes among Aboriginal and Torres Strait Islander people. METHODS We conducted a systematic literature search of nine databases (Medline, CINAHLS, PsycINFO, Embase, Cochrane, Scopus, Global health, Informit Rural health database and Indigenous collection) and grey literature sources for primary studies evaluating ENT outreach services for Aboriginal and Torres Strait Islander people. This review included English language studies of all types, published between 2000 and 2018, that supplied ENT outreach services to Aboriginal and Torres Strait Islander Australians and provided data to evaluate their aims. Two authors independently evaluated the eligible articles and extracted relevant information. Risk of bias was assessed using the Mixed Methods Assessment Tool. RESULTS Of the 506 studies identified, 15 were included in this review. These 15 studies evaluated eight different programs/activities. Studies were heterogeneous in design so a meta-analysis could not be conducted. Seven studies measured health-related outcomes in middle ear or hearing status; six reported overall positive changes one reported no clinically significant improvements. Five programmes/activities and their corresponding studies involved Aboriginal and Torres Strait Islander people and organisations in delivery and evaluation, but involvement in programme or study design was unclear. CONCLUSION While some studies demonstrated improved outcomes, the overall ability of ENT programmes to improve health outcomes for Aboriginal and Torres Strait Islander children is unclear. The impact of ENT outreach may be limited by a lack of quality evidence, service coordination and sustainability. Community codesign and supporting and resourcing local capacity must be a component of outreach programmes and ongoing evaluation is also recommended. Improvements in these areas would likely improve health outcomes. PROSPERO REGISTRATION NUMBER CRD42019134757.
Collapse
Affiliation(s)
- Anna Gotis-Graham
- Poche Centre for Indigenous Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
| | - Rona Macniven
- Poche Centre for Indigenous Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Kelvin Kong
- The University of Newcastle, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Kylie Gwynne
- Poche Centre for Indigenous Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, New Lambton Heights, New South Wales, Australia
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
Mitchinson C, Strobel N, McAullay D, McAuley K, Bailie R, Edmond KM. Anemia in disadvantaged children aged under five years; quality of care in primary practice. BMC Pediatr 2019; 19:178. [PMID: 31164108 PMCID: PMC6547444 DOI: 10.1186/s12887-019-1543-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 05/20/2019] [Indexed: 01/07/2023] Open
Abstract
Background Anemia rates are over 60% in disadvantaged children yet there is little information about the quality of anemia care for disadvantaged children. Methods Our primary objective was to assess the burden and quality of anemia care for disadvantaged children and to determine how this varied by age and geographic location. We implemented a cross-sectional study using clinical audit data from 2287 Indigenous children aged 6–59 months attending 109 primary health care centers between 2012 and 2014. Data were analysed using multivariable regression models. Results Children aged 6–11 months (164, 41.9%) were less likely to receive anemia care than children aged 12–59 months (963, 56.5%) (adjusted odds ratio [aOR] 0.48, CI 0.35, 0.65). Proportion of children receiving anemia care ranged from 10.2% (92) (advice about ‘food security’) to 72.8% (728) (nutrition advice). 70.2% of children had a hemoglobin measurement in the last 12 months. Non-remote area families (115, 38.2) were less likely to receive anemia care compared to remote families (1012, 56.4%) (aOR 0.34, CI 0.15, 0.74). 57% (111) aged 6–11 months were diagnosed with anemia compared to 42.8% (163) aged 12–23 months and 22.4% (201) aged 24–59 months. 49% (48.5%, 219) of children with anemia received follow up. Conclusions The burden of anemia and quality of care for disadvantaged Indigenous children was concerning across all remote and urban locations assessed in this study. Improved services are needed for children aged 6–11 months, who are particularly at risk.
Collapse
Affiliation(s)
- Casey Mitchinson
- Perth Children's Hospital, Child and Adolescent Health Service, Government of Western Australia, Perth, Western Australia, Australia
| | - Natalie Strobel
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Daniel McAullay
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Kimberley McAuley
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Ross Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Karen M Edmond
- Medical School, The University of Western Australia, Perth, Western Australia, Australia.
| |
Collapse
|
9
|
Edmond KM, Tung S, McAuley K, Strobel N, McAullay D. Improving developmental care in primary practice for disadvantaged children. Arch Dis Child 2019; 104:372-380. [PMID: 30087151 DOI: 10.1136/archdischild-2018-315164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/18/2018] [Accepted: 07/20/2018] [Indexed: 11/04/2022]
Abstract
Our primary objective was to assess if sustained participation in continuous quality improvement (CQI) activities could improve delivery of 'basic developmental care' to disadvantaged children in primary care settings. Secondary objectives were to assess if delivery of developmental care differed by age and geographic location.Data were analysed using multivariable logistic regression and generalised estimating equations. 109 indigenous primary care centres across Australia from 2012 to 2014 and2466 client files from indigenous children aged 3-59 months were included. Outcome measures were delivery of basic developmental care.We found that the proportion of children who received basic developmental care ranged from 55% (advice about physical and mental stimulation of child) (1279, 55.1%) to 74% (assessment of developmental milestones) (1510, 73.7%). Ninety-three per cent (92.6%, 88) of children received follow-up care. Centres with sustained CQI participation (completed three or more consecutive audit cycles) (508, 53.9%) were twofold more likely to deliver basic developmental care compared with centres without sustained CQI (completed less than three consecutive audit cycles) (118, 31.0%) (adjusted OR (aOR) 2.37, 95% CI 1.33 to 4.23). Children aged 3-11 months (229, 54.9%) were more likely to receive basic developmental care than children aged 24-59 months (151, 38.5%) (aOR 2.42, 95% CI 1.67 to 3.51). Geographic location had little effect (aOR 0.68, 95% CI 0.30 to 1.53). Overall our study found that sustained CQI can improve basic developmental care in primary care settings. However, many disadvantaged children are not receiving services. Improved resourcing of developmental care and CQI in primary care centres is needed.
Collapse
Affiliation(s)
| | - Scarlette Tung
- Child and Adolescent Health Service, Government of Western Australia, Perth, Western Australia, Australia
| | - Kimberley McAuley
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Natalie Strobel
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Daniel McAullay
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
10
|
Strobel NA, McAuley K, Matthews V, Richardson A, Agostino J, Bailie R, Edmond KM, McAullay D. Understanding the structure and processes of primary health care for young indigenous children. J Prim Health Care 2018; 10:267-278. [DOI: 10.1071/hc18006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTION
Primary health care organisations need to continuously reform to more effectively address current health challenges, particularly for vulnerable populations. There is growing evidence that optimal health service structures are essential for producing positive outcomes.
AIM
To determine if there is an association between process of care indicators (PoCIs) for important young indigenous child health and social issues and: (i) primary health-care service and child characteristics; and (ii) organisational health service structures.
METHODS
This was a cross-sectional study of 1554 clinical child health audits and associated system assessments from 74 primary care services from 2012 to 2014. Composite PoCIs were developed for social and emotional wellbeing, child neurodevelopment and anaemia. Crude and adjusted logistic regression models were fitted, clustering for health services. Odds ratios and 95% confidence intervals were derived.
RESULTS
Overall, 32.0% (449) of records had a social and emotional wellbeing PoCI, 56.6% (791) had an anaemia PoCI and 49.3% (430) had a child neurodevelopment PoCI. Children aged 12–23 months were significantly more likely to receive all PoCIs compared to children aged 24–59 months. For every one point increase in assessment scores for team structure and function (aOR 1.14, 95% CI 1.01–1.27) and care planning (aOR 1.14, 95% CI 1.01–1.29) items, there was a 14% greater odds of a child having an anaemia PoCI. Social and emotional wellbeing and child neurodevelopment PoCIs were not associated with system assessment scores.
DISCUSSION
Ensuring young indigenous children aged 24–59 months are receiving quality care for important social and health indicators is a priority. Processes of care and organisational systems in primary care services are important for the optimal management of anaemia in indigenous children.
Collapse
|
11
|
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
| | | |
Collapse
|