Remote area health service delivery in central Australia: primary health care and participatory management

What Can Be Learned from the Early Stages of the COVID-19 Vaccination Rollout in Australia: A Case Study

This paper addresses the SARS-CoV-2 vaccination progress in Australia. Globally, Australia was initially praised for its national COVID-19 response, reflecting well with regard to case numbers and mortality rates. However, Australia's progress with its vaccine rollout has come under scrutiny. When compared globally, it fares very low in terms of the number of vaccine doses administered. This paper discusses the first three months of the vaccination process, and the challenges Australia faced during that time. Through an extensive literature review, data was collected on relevant topics concerning all aspects of the Australian COVID-19 situation. The following key points are discussed: the specific COVID-19 organisation at the federal vs. the state government levels, the Australian economy, the vaccine supply strategy, and the vaccine priority roll out. In conclusion, we highlight the impact of Australia initially relying heavily on the AstraZeneca vaccine, which subsequently came under fire regarding safety issues likely linking the vaccine to thrombosis with thrombocytopenia syndrome (TTS).

Characteristics of Indigenous primary health care service delivery models: a systematic scoping review

Background

Indigenous populations have poorer health outcomes compared to their non-Indigenous counterparts. The evolution of Indigenous primary health care services arose from mainstream health services being unable to adequately meet the needs of Indigenous communities and Indigenous peoples often being excluded and marginalised from mainstream health services. Part of the solution has been to establish Indigenous specific primary health care services, for and managed by Indigenous peoples. There are a number of reasons why Indigenous primary health care services are more likely than mainstream services to improve the health of Indigenous communities. Their success is partly due to the fact that they often provide comprehensive programs that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health. However, there are gaps in the evidence base including the characteristics that contribute to the success of Indigenous primary health care services in providing comprehensive primary health care. This systematic scoping review aims to identify the characteristics of Indigenous primary health care service delivery models.

Method

This systematic scoping review was led by an Aboriginal researcher, using the Joanna Briggs Institute Scoping Review Methodology. All published peer-reviewed and grey literature indexed in PubMed, EBSCO CINAHL, Embase, Informit, Mednar, and Trove databases from September 1978 to May 2015 were reviewed for inclusion. Studies were included if they describe the characteristics of service delivery models implemented within an Indigenous primary health care service. Sixty-two studies met the inclusion criteria. Data were extracted and then thematically analysed to identify the characteristics of Indigenous PHC service delivery models.

Results

Culture was the most prominent characteristic underpinning all of the other seven characteristics which were identified – accessible health services, community participation, continuous quality improvement, culturally appropriate and skilled workforce, flexible approach to care, holistic health care, and self-determination and empowerment.

Conclusion

While the eight characteristics were clearly distinguishable within the review, the interdependence between each characteristic was also evident. These findings were used to develop a new Indigenous PHC Service Delivery Model, which clearly demonstrates some of the unique characteristics of Indigenous specific models.

Electronic supplementary material

The online version of this article (10.1186/s12992-018-0332-2) contains supplementary material, which is available to authorized users.

Access to primary health care services for Indigenous peoples: A framework synthesis

Background

Indigenous peoples often find it difficult to access appropriate mainstream primary health care services. Securing access to primary health care services requires more than just services that are situated within easy reach. Ensuring the accessibility of health care for Indigenous peoples who are often faced with a vast array of additional barriers including experiences of discrimination and racism, can be complex. This framework synthesis aimed to identify issues that hindered Indigenous peoples from accessing primary health care and then explore how, if at all, these were addressed by Indigenous health care services.

Methods

To be included in this framework synthesis papers must have presented findings focused on access to (factors relating to Indigenous peoples, their families and their communities) or accessibility of Indigenous primary health care services. Findings were imported into NVivo and a framework analysis undertaken whereby findings were coded to and then thematically analysed using Levesque and colleague’s accessibility framework.

Results

Issues relating to the cultural and social determinants of health such as unemployment and low levels of education influenced whether Indigenous patients, their families and communities were able to access health care. Indigenous health care services addressed these issues in a number of ways including the provision of transport to and from appointments, a reduction in health care costs for people on low incomes and close consultation with, if not the direct involvement of, community members in identifying and then addressing health care needs.

Conclusions

Indigenous health care services appear to be best placed to overcome both the social and cultural determinants of health which hamper Indigenous peoples from accessing health care. Findings of this synthesis also suggest that Levesque and colleague’s accessibility framework should be broadened to include factors related to the health care system such as funding.

Electronic supplementary material

The online version of this article (doi:10.1186/s12939-016-0450-5) contains supplementary material, which is available to authorized users.

Prevalence of cicatricial trachoma in an indigenous population of Central Australia: the Central Australian Trachomatous Trichiasis Study (CATTS)

BACKGROUND

Trachoma is one of the leading causes of blindness worldwide, resulting from conjunctival scarring, upper lid entropion and trichiasis, leading to corneal scarring and opacification. This study was designed to investigate the current prevalence of cicatricial trachoma in an indigenous population within Central Australia and help determine whether trachoma remains a public health issue.

METHODS

Participants aged 40 and over were recruited from patients attending one of 16 remote ophthalmology clinics held at indigenous communities in Central Australia within the Northern Territory. Once informed consent had been obtained, each patient underwent examination for evidence of trachomatous scarring, trachomatous trichiasis and corneal opacities. Results were collated and compared with previous prevalence surveys.

RESULTS

Among the sample (n = 181), there were 97 patients (54%; 95% CI 46.7-61.3) with trachomatous scarring, 15 patients (8%; 95% CI 2.8-13.2) with trichiasis and 5 patients (3%; 95% CI 0.5-5.5) with corneal opacities.

CONCLUSION

This study suggests that, although the prevalence of the cicatricial and blinding consequences of trachoma may be decreasing in patients aged 40 years or greater, when compared with the current prevalence in other areas of Australia, trachoma still remains a public health issue in Central Australia.

Strengthening primary health care: building the capacity of rural communities to access health funding

Present health funding models can place onerous pressures on rural health services. Staff may lack the time, resources, access to data, and the expertise needed to complete complex and lengthy funding submissions. This present study describes an innovative capacity-building approach to working with Victorian rural communities seeking to access health care funding through the Regional Health Services Program. This approach used several strategies: engaging stakeholders in targeted rural communities, developing an information kit and running a workshop on preparing submissions to the Regional Health Services Program, facilitating community consultations, and providing ongoing support with submissions. Six rural communities were supported in this way. Four have been funded to date, with a combined annual recurrent budget for new primary health care services of over $2.5 million. Each community has developed a service delivery model that meets the particular needs of their local area. This capacity-building approach is both effective and replicable to other health funding opportunities.

Allied health in Central Australia: Challenges and rewards in remote area practice

The aim of this descriptive study, undertaken in 1997, was to examine the professional environment and work practices of physiotherapists, occupational therapists and speech pathologists in public sector positions in Central Australia. All therapists identified in these positions were interviewed. The study indicates that incumbents value specific professional benefits associated with remote area practice, particularly the opportunity to work with Aboriginal people. However these recruiting advantages are diminished by a lack of management support - a key factor in the high turnover of staff. The findings of this study have implications for the development of strategies to improve support, and thereby retention, of allied health professionals and other workers in remote areas.

Why paediatricians rural out going to the country but support opportunities for change

OBJECTIVES

To determine the knowledge of vacant country specialist positions, the main barriers to filling country specialist positions, the acceptance of hypothetical creative employment models and to gain understanding of what would it take for respondents to accept a country position.

METHODOLOGY

Mailed self-report questionnaires to all 103 Queensland paediatricians and finishing paediatric trainees (response rate 93.1%) to explore reasons for the long-term vacancy of the Staff Paediatrician position at the Mount Isa Base Hospital, North-west Queensland, Australia.

RESULTS

Of the respondents, 87.4% were aware of the vacant position. The lack of adequate locum cover for leave (97.8%), on-call load (92.2%), professional isolation (91.4%), and family commitments (91.4%) were identified as the four most frequently recognized recruitment barriers. Of the respondents, 30.2% said they could be attracted to such a position if they were guaranteed the ability to return to their present post in 2 years, 30.7% said they could be attracted to a rural exchange, and 73.1% suggested the position would be more attractive to new Fellows if at the end of a 2-year period they were guaranteed some Visiting Medical Officer sessions or a temporary Staff Paediatrician position at a tertiary centre. Significantly, fewer of the 30-39-years age group said available job opportunities for their spouse made it impossible for them to consider the advertised position, compared to older age groups (P = 0.003). In response to the question 'What would it take for you to consider such a position?', 22.6% answered a change in employment package, 22.6% a change in family commitments, 16.6% too subspecialized, and 7.1% could possibly consider a locum or exchange in the future.

CONCLUSIONS

Specialist positions, such as the advertised position, are well known, but remain unfilled because they are considered unsustainable. However, the response to hypothetical creative employment models suggests this could be changed, provided specialist training (e.g. paediatric training) is kept general and the younger consultant is given consideration.