A rapid review to inform the policy and practice for the implementation of chronic disease prevention and management programs for Aboriginal and Torres Strait Islander people in primary care

Abstract

Background More than 35% of Aboriginal and Torres Strait Islander adults live with cardiovascular disease, diabetes, or chronic kidney disease. There is a pressing need for chronic disease prevention and management among Aboriginal and Torres Strait Islander people in Australia. Therefore, this review aimed to synthesise a decade of contemporary evidence to understand the barriers and enablers of chronic disease prevention and management for Aboriginal and Torres Strait Islander People with a view to developing policy and practice recommendations. Methods We systematically searched for peer-reviewed published articles between January 2014 to March 2023 where the search was performed using subject headings and keywords related to “Aboriginal and Torres Strait Islander peoples,” “Chronic Disease,” and “Primary Health Care”. Quality assessment for all included studies was conducted using the Aboriginal and Torres Strait Islander Quality Appraisal Tool. The data were extracted and summarised using a conventional content analysis approach and applying strength-based approaches. Results Database searches identified 1653 articles where 26 met inclusion criteria. Studies varied in quality, primarily reporting on 14 criteria of the Aboriginal and Torres Strait Islander Quality Appraisal Tool. We identified six key domains of enablers and barriers of chronic disease prevention and management programs and implied a range of policy and practice options for improvement. These include culturally acceptable and safe services, patient-provider partnerships, chronic disease workforce, primary health care service attributes, clinical care pathways, and accessibility to primary health care services. This review also identified the need to address social and cultural determinants of health, develop the Aboriginal and Torres Strait Islander and non-Indigenous chronic disease workforce, support multidisciplinary teams through strengthening clinical care pathways, and engage Aboriginal and Torres Strait Islander communities in chronic disease prevention and management program design and delivery. Conclusion Enabling place-based partnerships to develop contextual evidence-guided strategies that align with community priorities and aspirations, with the provision of funding mechanisms and models of care through policy and practice reforms will strengthen the chronic disease prevention and management program for Aboriginal and Torres Strait Islander people.

Facilitators and Barriers to Implementing the 4Ms Framework of Age-Friendly Health Systems: A Scoping Review

“…This review suggested several strategies to overcome challenges to its implementation (e.g., securing buy-in from key clinician and administration stakeholders, desiring clearly defined management approaches that include triage, assessment of cancer case complexity, the roles of clinicians and clinical staff, and acknowledging that the standard of care cannot be universally applied without the consideration of the variations across hospitals and clinics) [ 33 ]. Another review [ 34 ] summarized the enablers of chronic disease prevention and management for the Aboriginal people in Australia (e.g., culturally acceptable and safe services, patient–provider partnerships, primary healthcare service attributes, and clinical care pathways). This review emphasized the need to enable place-based partnerships across patients, providers, and policymakers to develop strategies that align with local community priorities as another system factor [ 34 ].…”

“…Another review [ 34 ] summarized the enablers of chronic disease prevention and management for the Aboriginal people in Australia (e.g., culturally acceptable and safe services, patient–provider partnerships, primary healthcare service attributes, and clinical care pathways). This review emphasized the need to enable place-based partnerships across patients, providers, and policymakers to develop strategies that align with local community priorities as another system factor [ 34 ]. Further in-depth research is warranted to comprehend these identified system issues of implementing the 4Ms Framework.…”