Katharine McBride

Enablers and barriers to the implementation of primary health care interventions for Indigenous people with chronic diseases: a systematic review

BackgroundAccess to appropriate, affordable, acceptable and comprehensive primary health care (PHC) is critical for improving the health of Indigenous populations. Whilst appropriate infrastructure, sufficient funding and knowledgeable health care professionals are crucial, these elements alone will not lead to the provision of appropriate care for all Indigenous people. This systematic literature review synthesised international evidence on the factors that enable or inhibit the implementation of interventions aimed at improving chronic disease care for Indigenous people.MethodsA systematic review using Medical Literature Analysis and Retrieval System Online (MEDLINE) (PubMed platform), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Excerpta Medica Database (EMBASE), ATSIHealth, Australian Indigenous HealthInfoNet via Informit Online and Primary Health Care Research and Information Service (PHCRIS) databases was undertaken. Studies were included if they described an intervention for one or more of six chronic conditions that was delivered in a primary health care setting in Australia, New Zealand, Canada or the United States. Attitudes, beliefs, expectations, understandings and knowledge of patients, their families, Indigenous communities, providers and policy makers were of interest. Published and unpublished qualitative and quantitative studies from 1998 to 2013 were considered. Qualitative findings were pooled using a meta-aggregative approach, and quantitative data were presented as a narrative summary.ResultsTwenty three studies were included. Meta-aggregation of qualitative data revealed five synthesised findings, related to issues within the design and planning phase of interventions, the chronic disease workforce, partnerships between service providers and patients, clinical care pathways and patient access to services. The available quantitative data supported the qualitative findings. Three key features of enablers and barriers emerged from the findings: (1) they are not fixed concepts but can be positively or negatively influenced, (2) the degree to which the work of an intervention can influence an enabler or barrier varies depending on their source and (3) they are inter-related whereby a change in one may effect a change in another.ConclusionsFuture interventions should consider the findings of this review as it provides an evidence-base that contributes to the successful design, implementation and sustainability of chronic disease interventions in primary health care settings intended for Indigenous people.

Essential service standards for equitable national cardiovascular care for Aboriginal and Torres Strait Islander people.

Cardiovascular diseases (CVD) constitute the largest cause of death for Aboriginal and Torres Strait Islander people and remain the primary contributor to life expectancy differentials between Aboriginal and Torres Strait Islander and non-Indigenous Australians. As such, CVD remains the most critical target for reducing the life expectancy gap. The Essential Service Standards for Equitable National Cardiovascular Care for Aboriginal and Torres Strait Islander people (ESSENCE) outline elements of care that are necessary to reduce disparity in access and outcomes for five critical cardiovascular conditions. The ESSENCE approach builds a foundation on which the gap in life expectancy between Aboriginal and Torres Strait Islander and non-Indigenous Australians can be reduced. The standards purposefully focus on the prevention and management of CVD extending across the continuum of risk and disease. Each of the agreed essential service standards are presented alongside the most critical targets for policy development and health system reform aimed at mitigating population disparity in CVD and related conditions.

A Strategy for Translating Evidence Into Policy and Practice to Close the Gap - Developing Essential Service Standards for Aboriginal and Torres Strait Islander Cardiovascular Care

The development and application of essential standards for cardiovascular care for Aboriginal and Torres Strait Islander people creates a strategic platform on which to systematically close the gap in the health outcomes and life expectancy between Aboriginal and Torres Strait Islander and non-Indigenous people in Australia. We outline six developmental stages that can be used to enhance the effective translation of evidence into practice that reduces life expectancy differentials. Focussing efforts where the biggest gain can be made; considering how to make a policy-relevant difference with an emphasis on translation into policy and practice; establishing a foundation for action by engaging with stakeholders throughout the process; developing a framework to guide action; drafting policy-relevant and framework-appropriate essential service standards; and defining standards that help policy decision makers achieve current priority policy targets.

Disparities in acute in-hospital cardiovascular care for Aboriginal and non-Aboriginal South Australians.

Objectives: To assess differences in the rates of angiography and subsequent revascularisation for Aboriginal and non‐Aboriginal South Australians who presented with an acute coronary syndrome (ACS); to explore the reasons for any observed differences.

In-hospital communication experiences of Aboriginal and Torres Strait Islander people: a systematic review protocol

REVIEW QUESTION/OBJECTIVE The objective of this systematic review is to identify and synthesize available qualitative evidence to understand the in-hospital communication experiences of Aboriginal and Torres Strait Islander adults, their family members and hospital staff, and the factors that impact on these experiences.Specifically, the review questions are as follows.