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Follow-up of Indigenous-specific health assessments - a socioecological analysis

Med J Aust 2014; 200 (11): 653-657. || doi: 10.5694/mja13.00256

Summary

Objectives: To describe patterns of uptake of Indigenous-specific health assessments and associated follow-up items, and examine the barriers and enablers to delivery and billing of follow-up over the first 3 years of implementation of the Indigenous Chronic Disease Package (ICDP).

Design, setting and participants: We used a socioecological approach to analyse data derived from the Sentinel Sites Evaluation of the ICDP — with data from 24 sites across Australia. Administrative data (1 May 2009 to 30 May 2012) and program data (1 March 2010 to 30 May 2012) were provided by the Department of Health. Data on barriers and enablers to follow-up of health assessments were obtained from community focus groups, in-depth interviews and discussions with key informants (1 November 2010 to 30 December 2012).

Main outcome measures: Monthly number of Medicare Benefits Schedule items claimed for Indigenous-specific health services and follow-up; qualitative data on enablers and barriers categorised according to patient, patient–health service relationship, health service or organisation, community and policy environment levels or influence.

Results: There was an increase in the uptake of health assessments, but relatively limited delivery of follow-up care and billing for Indigenous-specific follow-up items. Follow-up was constrained by factors that operated at various levels: patient, interpersonal, health service, community and policy. Constraints included practitioners' lack of awareness of item numbers, staffing, poor state of clinical information systems, billing against non-Indigenous-specific items or more general follow-up items, emphasis on health assessments with less attention to requirements for follow-up, limited capacity to arrange and facilitate follow-up, and communication and transport challenges for patients.

Conclusions: Work is required across various levels of the system to address barriers to follow-up care. Enhancing follow-up care is vital to achieving health benefits from the large financial and human resource investment in health assessments.

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  • Jodie Bailie1
  • Gill H Schierhout1
  • Margaret A Kelaher2
  • Alison F Laycock1
  • Nikki A Percival1
  • Lynette R O’Donoghue1
  • Tracy L McNeair1
  • Amal Chakraborty1
  • Barbara D Beacham1
  • Ross S Bailie3

  • 1 Centre for Primary Health Care Systems, Menzies School of Health Research, Charles Darwin University, Brisbane, QLD.
  • 2 Centre for Health Policy, Programs and Economics, University of Melbourne, Melbourne, VIC.
  • 3 Menzies School of Health Research, Charles Darwin University, Brisbane, QLD.


Acknowledgements: 

The SSE was conceived and funded by the Department of Health and Ageing. The evaluation was able to be conducted successfully through the active support and commitment of key stakeholder organisations, community members and individuals who participated in the evaluation, and through the contributions made by the broader evaluation team and Department staff. Ross Bailie is supported by an Australian Research Council Future Fellowship (#FT100100087).

Competing interests:

The SSE was conducted by the Menzies School of Health Research under contract to the Department of Health and Ageing. We have no other competing interests.

  • 1. Krogsboll L, Jorgensen K, Larsen C, et al. General health checks for adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ 2012; 345: e7191.
  • 2. Deparment of Health. MBS online [website]. http://www.mbsonline.gov.au/ (accessed Oct 2013).
  • 3. Burgess CP. Where the Dreaming changed shape: the Aboriginal and Torres Strait Islander adult health check in a remote Aboriginal community [unpublished doctoral dissertion]. Darwin, NT: Menzies School of Health Research, 2011.
  • 4. Mayers NR, Couzos S. Towards health equity through an adult health check for Aboriginal and Torres Strait Islander people. Med J Aust 2004; 181: 531-532. <MJA full text>
  • 5. Bailie R, Griffin J, Kelaher M, et al. Sentinel Sites Evaluation: final report. Menzies School of Health Research, 2013.
  • 6. Spurling GK, Hayman NE, Cooney AL. Adult health checks for Indigenous Australians: the first year's experience from the Inala Indigenous Health Service. Med J Aust 2009; 190: 562-564. <MJA full text>
  • 7. Jennings W, Spurling GK, Askew DA. Yarning about health checks: barriers and enablers in an urban Aboriginal medical service. Aust J Prim Health 2013; Apr 4 [Epub ahead of print]. doi: 10.1071/PY12138.
  • 8. Department of Health and Ageing. Fact sheet. Higher utilisation costs for MBS and PBS. http://www.health.gov.au/internet/ctg/publishing.nsf/Content/meeting-the-costs/$file/Copy%20of%20DHA6136%20B2%20Factsheet.pdf (accessed May 2014).
  • 9. KPMG. National monitoring and evaluation of the Indigenous Chronic Disease Package First Monitoring Report 2010-11. Commonwealth of Australia, 2013. http://www.health.gov.au/internet/ctg/publishing.nsf/Content/publications (accessed Mar 2014).
  • 10. Russell L. Closing the gap on Indigenous disadvantage: an analysis of provisions in the 2013-14 Budget and implementation of the Indigenous Chronic Disease Package. Sydney: Menzies Centre for Health Policy, University of Sydney, 2013.
  • 11. Russell L. Indigenous health checks: a failed policy in need of scrutiny. Sydney: Menzies Centre for Health Policy, University of Sydney, 2010.
  • 12. Coleman JJ, Spurling GK, Askew DA, Hayman NE. Indigenous child health checks: the view from the city. Med J Aust 2011; 194: 535-536. <MJA full text>
  • 13. McLeroy K, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q 1988; 15: 351-377.
  • 14. Green LW, Richard L, Potvin L. Ecological foundations of health promotion. Am J Health Promot 1996; 10: 270-281.
  • 15. Bailie RS, Si D, Dowden MC, et al. Delivery of child health services in Indigenous communities: implications for the federal government's emergency intervention in the Northern Territory. Med J Aust 2008; 188: 615-618. <MJA full text>
  • 16. Allen and Clarke. Evaluation of the child health check initiative and the expanding health service delivery initiative: summary report. Canberra: Department of Health and Ageing, 2011.
  • 17. Kehoe H, Lovett R. Aboriginal and Torres Strait Islander health assessments: barriers to improving uptake. Aust Fam Physician 2008; 37: 1033-1038.
  • 18. Digiacomo M, Abbott P, Davison J, et al. Facilitating uptake of Aboriginal adult health checks through community engagement and health promotion. Qual Prim Care 2010; 18: 57-64.
  • 19. Lau P, Pyett P, Burchill M, et al. Factors influencing access to urban general practices and primary health care by Aboriginal Australians - a qualitative study. AlterNative: An International Journal of Indigenous peoples 2012; 8: 66-84.
  • 20. Dryden R, Williams B, McCowan C, et al. What do we know about who does and does not attend general health checks? Findings from a narrative scoping review. BMC Public Health 2012; 12: 723.
  • 21. Hart TJ. The inverse care law. Lancet 1971; 297: 405-412.
  • 22. Johnston L, Doyle J, Morgan B, et al. A review of programs that targeted environmental determinants of Aboriginal and Torres Strait Islander health. Int J Environ Res Public Health 2013; 10: 3518-3542.

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