Cost of best‐practice primary care management of chronic disease in a remote Aboriginal community

IntroductionThere is a 10-year gap in life expectancy between Aboriginal and non-Aboriginal Australians. The leading cause of death for Aboriginal Australians is cardiovascular disease, including myocardial infarction and stroke. Although atrial fibrillation (AF) is a known precursor to stroke there are no published studies about the prevalence of AF for Aboriginal people and limited evidence about AF in indigenous populations globally.Methods and analysisThis mixed methods study will recruit and train Aboriginal health workers to use an iECG device attached to a smartphone to consecutively screen 1500 Aboriginal people aged 45 years and older. The study will quantify the proportion of people who presented for follow-up assessment and/or treatment following a non-normal screening and then estimate the prevalence and age distribution of AF of the Australian Aboriginal population. The study includes semistructured interviews with the Aboriginal health workers about the effectiveness of the iECG device in their practice as well as their perceptions of the acceptability of the device for their patients. Thematic analysis will be undertaken on the qualitative data collected in the study. If the device and approach are acceptable to the Aboriginal people and widely adopted, it may help prevent the effects of untreated AF including ischaemic stroke and early deaths or impairment in Aboriginal people.Ethics and disseminationThis mixed methods study received ethics approval from the Aboriginal Health and Medical Research Council (1135/15) and the Australian Health Council of Western Australia (HREC706). Ethics approval is being sought in the Northern Territory. The findings of this study will be shared with Aboriginal communities, in peer reviewed publications and at conferences. There are Aboriginal investigators in each state/territory where the study is being conducted who have been actively involved in the study. They will also be involved in data analysis, dissemination and research translation.Trial registration numberACTRN12616000459426.

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“…There is some evidence in the peer-reviewed literature for the efficacy of each of the study design elements with Aboriginal people 2729–31 42…”

Section: Methods and Analysismentioning

confidence: 99%

Opportunistic screening to detect atrial fibrillation in Aboriginal adults in Australia

et al. 2016

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“…For example, in 1993 per capita expenditure ranged from US$575 in Oklahoma to US$1906 in Alaska. In Australia, a recent study identified a 44% margin, or an average shortfall of A$1733 (∼US$1630) per Indigenous person with diabetes or ESRD to provide optimal management, as defined by Australian diabetes standards of care [88].…”

Section: Barriers To Prevention and Interventionmentioning

confidence: 99%

Diabetic foot disease in Indigenous people

Schoen

Norman²

2014

Diabetes Management

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This article will examine what is known about the epidemiology of diabetic foot disease in Indigenous people and what strategies have been used to manage the problem. The prevalence of diabetes is several-fold higher in Indigenous people compared with non-Indigenous people. The prevalence of diabetic peripheral neuropathy varies but in general it appears to be more common and start at a younger age in Indigenous compared with non-Indigenous people. Peripheral artery disease is also more prevalent and the incidence of lower extremity amputation is higher. Various strategies have been shown to be effective in the delivery healthcare for diabetic foot disease in Indigenous people. There are, however, social and political barriers to the implementation and success of these interventions.

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“…Although a bottom-up approach is a more precise and reliable approach to costing health services [32], it is time consuming and expensive [33]. Ultimately decisions about selecting a costing method involve a trade-off between accuracy and resources available.…”

Section: Discussionmentioning

confidence: 99%

Equitable resourcing of primary health care in remote communities in Australia’s Northern Territory: a pilot study

et al. 2017

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BackgroundImproved Primary Health Care (PHC) utilisation is central to reducing the unacceptable morbidity and mortality rates characterising populations living in remote communities. Despite poorer health, significant inequity characterises the funding of PHC services in Australia’s most remote areas. This pilot study sought to ascertain what funding is required to ensure equitable access to sustainable, high quality primary health care irrespective of geographical remoteness of communities.MethodsHigh performing remote Primary Health Care (PHC) services were selected using improvement measures from the Australian Primary Care Collaboratives Program and validated by health experts. Eleven PHC services provided data relating to the types of services provided, level of service utilisation, human resources, operating and capital expenses. A further four services that provide visiting PHC to remote communities provided information on the level and cost of these services. Demographic data for service catchment areas (including estimated resident population, age, Indigenous status, English spoken at home and workforce participation) were obtained from the Australian Bureau of Statistics 2011 census. Formal statistical inference (p-values) were derived in the linear regression via the nonparametric bootstrap.ResultsA direct linear relationship was observed between the total cost of resident PHC services and population, while cost per capita decreased with increasing population. Services in smaller communities had a higher number of nursing staff per 1000 residents and provided more consultations per capita than those in larger communities. The number of days of visiting services received by a community each year also increased with population. A linear regression with bootstrapped statistical inference predicted a significant regression equation where the cost of resident services per annum is equal to $1,251,893.92 + ($1698.83 x population) and the cost of resident and visiting services is equal to $1,378,870.85 + ($2600.00 x population).ConclusionsThe research findings provide empirical evidence based on real costs to guide funding for remote PHC services that takes into account the safety and equity requirements for a minimum viable service. This method can be used as a transparent, coordinated approach to ensure the equitable delivery of sustainable, high quality PHC in remote communities. This will in turn contribute to improved health outcomes.

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Cost of best‐practice primary care management of chronic disease in a remote Aboriginal community

Cited by 20 publications

References 11 publications

Opportunistic screening to detect atrial fibrillation in Aboriginal adults in Australia

Opportunistic screening to detect atrial fibrillation in Aboriginal adults in Australia

Diabetic foot disease in Indigenous people

Equitable resourcing of primary health care in remote communities in Australia’s Northern Territory: a pilot study

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