Closing the indigenous health gap in Canada: Results from the TransFORmation of IndiGEnous PrimAry HEAlthcare delivery (FORGE AHEAD) program

Hayward, Mariam Naqshbandi; Pace, Romina; Zaran, Harsh; Dyck, Roland; Hanley, Anthony J.; Green, Michael E.; Bhattacharyya, Onil; Zwarenstein, Merrick; Emond, Joelle; Benoit, Cynthia; Jebb, Marie; Harris, Stewart B.; Team, Forge Ahead Program

doi:10.1016/j.diabres.2020.108066

Cited by 12 publications

(23 citation statements)

References 22 publications

(29 reference statements)

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“…Indeed, the high prevalence of DR in Australian Aboriginal and Torres Strait Islander people is also seen in remote‐dwelling Canadian indigenous people 23 and American Indians 33 . As in the present study, this is likely to reflect relatively suboptimal glycaemic control and suboptimal retinal screening through factors such as logistic difficulties and cultural acceptability issues 34,35 …”

Section: Discussionsupporting

confidence: 54%

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Differences in retinopathy prevalence and progression between Anglo‐Celt and Aboriginal Australians: the Fremantle Diabetes Study Phase II

Drinkwater

Davis

Turner

et al. 2022

Internal Medicine Journal

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Background: Indigenous populations have higher rates of diabetes and diabetic complications, yet there is a paucity of contemporary data on diabetic retinopathy (DR) prevalence and incidence in urban dwelling Aboriginal Australians. Aims:The aim of the study was to compare the prevalence of DR and incidence of new or worsening DR between Aboriginal Australians and Anglo-Celts with Type 2 diabetes.Methods: Participants from the community-based Fremantle Diabetes Study Phase II (817 Anglo-Celts, 94 Aboriginal people) recruited between 2008 and 2011 underwent fundus photography at baseline and biennial reviews. The prevalence of any DR and moderate non-proliferative DR (NPDR), and the incidence of new or worsening DR were ascertained using baseline and 4-year follow-up data.Results: Compared with Anglo-Celts, the Aboriginal participants had a higher prevalence of any DR (33.0% vs 52.1%) and moderate NPDR or worse (5.1% vs 24.4%), and new or worsening DR during follow up (6.7% vs 23.5%). The unadjusted odds ratios (95% confidence interval) of any DR and moderate NPDR at baseline were 2.21 (1.43, 3.39) and 5.98 (3.40, 10.50), respectively, and of new or worsening DR 4.32 (1.33, 13.98). In adjusted models, Aboriginal ethnicity was only associated with the prevalence of moderate NPDR or worse (5.58 (2.44, 12.76)).Conclusions: Aboriginal participants had a higher prevalence of DR and new or worsening DR, reflecting conventional risk factors including suboptimal glycaemic control. Their significantly higher odds of moderate NPDR or worse in adjusted models suggest ethnic-specific determinants of DR severity. These findings highlight the need for equitable, culturally appropriate diabetes/ophthalmic care.

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Section: Discussionsupporting

confidence: 54%

“…33 As in the present study, this is likely to reflect relatively suboptimal glycaemic control and suboptimal retinal screening through factors such as logistic difficulties and cultural acceptability issues. 34,35…”

Section: Ethnic Differences In Retinopathymentioning

confidence: 99%

Differences in retinopathy prevalence and progression between Anglo‐Celt and Aboriginal Australians: the Fremantle Diabetes Study Phase II

Drinkwater

Davis

Turner

et al. 2022

Internal Medicine Journal

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“…52 53 Three described the integration of eye care into comprehensive diabetic services in Australia 54 55 and Canada. 56 One focused specifically on cataract services in Australia, 57 and two described general eye care programmes in Australia. 58 59 Another described model was the use of outreach services (n=5).…”

Section: Characteristics Of Implemented Service Delivery Modelsmentioning

confidence: 99%

Eye care delivery models to improve access to eye care for Indigenous peoples in high-income countries: a scoping review

et al. 2021

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PurposeGlobally, there are ~370 million Indigenous peoples. Indigenous peoples typically experience worse health compared with non-Indigenous people, including higher rates of avoidable vision impairment. Much of this gap in eye health can be attributed to barriers that impede access to eye care services. We conducted a scoping review to identify and summarise service delivery models designed to improve access to eye care for Indigenous peoples in high-income countries.MethodsSearches were conducted on MEDLINE, Embase and Global Health in January 2019 and updated in July 2020. All study designs were eligible if they described a model of eye care service delivery aimed at populations with over 50% Indigenous peoples. Two reviewers independently screened titles, abstracts and full-text articles and completed data charting. We extracted data on publication details, study context, service delivery interventions, outcomes and evaluations, engagement with Indigenous peoples and access dimensions targeted. We summarised findings descriptively following thematic analysis.ResultsWe screened 2604 abstracts and 67 studies fulfilled our eligibility criteria. Studies were focused on Indigenous peoples in Australia (n=45), USA (n=11), Canada (n=7), New Zealand (n=2), Taiwan (n=1) and Greenland (n=1). The main disease focus was diabetic retinopathy (n=30, 45%), followed by ‘all eye care’ (n=16, 24%). Most studies focused on targeted interventions to increase availability of services. Fewer than one-third of studies reported involving Indigenous communities when designing the service. 41 studies reflected on whether the model improved access, but none undertook rigorous evaluation or quantitative assessment.ConclusionsThe geographical and clinical scope of service delivery models to improve access to eye care for Indigenous peoples in high-income countries is narrow, with most studies focused on Australia and services for diabetic retinopathy. More and better engagement with Indigenous communities is required to design and implement accessible eye care services.

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“…Although a QI methodology could prioritise non-managerial concerns, in practice this is unlikely to happen without a fundamental shift in the way that QI is used as a tool in healthcare. More holistic, 'systems approaches' to QI have been employed, with success, in the context of Indigenous healthcare provision, where community engagement and cross-sector working is imperative, and where there is a pressing need to address social determinants of health [46][47][48]. Such efforts have involved substantial changes in policy and healthcare infrastructure, which underpin participatory approaches to QI with genuine decision-making power with respect to healthcare delivery and evaluation.…”

Section: Qi and The Constraint Of Healthcare Valuementioning

confidence: 99%

Pushing poverty off limits: quality improvement and the architecture of healthcare values

et al. 2021

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Background Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social context of people’s lives can face a range of ethical challenges. We summarise and consider a case in which clinicians introduced a poverty screening initiative (PSI) into paediatric practice using the discourse and methodology of healthcare quality improvement (QI). Discussion Whilst suggesting that interventions like the PSI are a potentially valuable extension of clinical roles, which take advantage of the unique affordances of clinical settings, we argue that there is a tendency for such settings to continuously reproduce a narrower set of norms. We illustrate how the framing of an initiative as QI can help legitimate and secure funding for practical efforts to help address social ends from within clinical service, but also how it can constrain and disguise the value of this work. A combination of methodological emphases within QI and managerialism within healthcare institutions leads to the prioritisation, often implicitly, of a limited set of aims and governing values for healthcare. This can act as an obstacle to a genuine broadening of the clinical agenda, reinforcing norms of clinical practice that effectively push poverty ‘off limits.’ We set out the ethical dilemmas facing clinicians who seek to navigate this landscape in order to address poverty and the social determinants of health. Conclusions We suggest that reclaiming QI as a more deliberative tool that is sensitive to these ethical dilemmas can enable managers, clinicians and patients to pursue health-related values and ends, broadly conceived, as part of an expansive range of social and personal goods.

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Closing the indigenous health gap in Canada: Results from the TransFORmation of IndiGEnous PrimAry HEAlthcare delivery (FORGE AHEAD) program

Cited by 12 publications

References 22 publications

Differences in retinopathy prevalence and progression between Anglo‐Celt and Aboriginal Australians: the Fremantle Diabetes Study Phase II

Differences in retinopathy prevalence and progression between Anglo‐Celt and Aboriginal Australians: the Fremantle Diabetes Study Phase II

Eye care delivery models to improve access to eye care for Indigenous peoples in high-income countries: a scoping review

Pushing poverty off limits: quality improvement and the architecture of healthcare values

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