Aboriginal community controlled health services: leading the way in primary care

Abstract

Summary The national Closing the Gap framework commits to reducing persisting disadvantage in the health of Aboriginal and Torres Strait Islander people in Australia, with cross‐government‐sector initiatives and investment. Central to efforts to build healthier communities is the Aboriginal community controlled health service (ACCHS) sector; its focus on prevention, early intervention and comprehensive care has reduced barriers to access and unintentional racism, progressively improving individual health outcomes for Aboriginal people. There is now a broad range of primary health care data that provides a sound evidence base for comparing the health outcomes for Indigenous people in ACCHSs with the outcomes achieved through mainstream services, and these data show: ➢models of comprehensive primary health care consistent with the patient‐centred medical home model; ➢coverage of the Aboriginal population higher than 60% outside major metropolitan centres; ➢consistently improving performance in key performance on best‐practice care indicators; and ➢superior performance to mainstream general practice. ACCHSs play a significant role in training the medical workforce and employing Aboriginal people. ACCHSs have risen to the challenge of delivering best‐practice care and there is a case for expanding ACCHSs into new areas. To achieve the best returns, the current mainstream Closing the Gap investment should be shifted to the community controlled health sector.

Exploration of funding models to support hybridisation of Australian primary health care organisations

“…7 These strategies have become an integral component of PHN and aboriginal Community Controlled PHC services because of conditions associated with Federal Government funding. [4][5][6]9 annual plans of these organisations are to clearly demonstrate annual goals with key performance indicators such that progress can be monitored. 4,5,9,10 also, the goals are to be based on a needs assessment of the community served.…”

“…[4][5][6]9 annual plans of these organisations are to clearly demonstrate annual goals with key performance indicators such that progress can be monitored. 4,5,9,10 also, the goals are to be based on a needs assessment of the community served. These features align with features of hybrid organisations, where mission orientation and the creation of social value is coupled with the creation of economic value.…”

“…1 There is some evidence that the adoption of best practice models and key performance indicators in aboriginal Community Controlled health services has resulted in the improvement of health outcomes. 9 adoption of a community driven patient-centred medical home model, but funded by the australian Government, in these health services has led to improvement in access to PHC services and in sexual health, maternal and child health and cardiovascular health outcomes among the aboriginal population. 9 While it is too early to determine the effectiveness or the impact on health outcomes by the PHNs in australia, evidence from New Zealand Primary Health Organisations, which are funded on a capitation basis associated with key performance indicators, has shown improvement in access and health outcomes for enrolled patients.…”

“…9 adoption of a community driven patient-centred medical home model, but funded by the australian Government, in these health services has led to improvement in access to PHC services and in sexual health, maternal and child health and cardiovascular health outcomes among the aboriginal population. 9 While it is too early to determine the effectiveness or the impact on health outcomes by the PHNs in australia, evidence from New Zealand Primary Health Organisations, which are funded on a capitation basis associated with key performance indicators, has shown improvement in access and health outcomes for enrolled patients. 8,11 While there has been criticism of hybrid organisations having confused principles, and having set themselves up to face contradictory pressures and be unpredictable in their behaviour, 12 noting the acute challenges PHC in australia faces like increasing patient expectations for high-quality health care, disparity in access, and an uncertain economic climate; hybridisation, which mixes features of agency and enterprise, seems to hold great promise in addressing these challenges.…”

Healing at home: Developing a model for ambulatory alcohol "detox" in an Aboriginal community controlled health service

“…ACCHSs can reduce barriers to health care and improve health outcomes for Aboriginal people (Panaretto, Wenitong, Button, & Ring, 2014). Establishing a model of outpatient detox within an ACCHS could potentially offer accessible, culturally secure, and community-prioritized health care (Gray, Stearne, et al, 2010).…”