General health care service utilisation: where, when and by whom in a socioeconomically disadvantaged population

Achat, Helen M; Thomas, Paul; Close, Graeme L.; Moerkerken, Leendert; Harris, Mark

doi:10.1071/py09066

Cited by 23 publications

(19 citation statements)

References 41 publications

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“…A common set of quantitative and qualitative measures will address the core themes of hauora and mana motuhake, mostly using scales validated from the previous KMM research [ 36 , 97 ]. For hauora (hinengaro [mental], tinana [physical], wairua [spiritual], and whanaunga [social]), the following items/scales will be used: self-reported health [ 98 , 99 ], mental/physical health-related quality of life (HRQOL) [ 100 , 101 ], spiritual wellbeing [ 102 ], loneliness [ 2 , 103 ], perceived and desired social support [ 104 ], and cultural connection [ 40 ]. Mana motuhake will be measured via perceived autonomy [ 105 ], life satisfaction [ 106 ], sense of purpose [ 107 ], and historical trauma [ 65 ].…”

Section: Methods and Designmentioning

confidence: 99%

Kaumātua Mana Motuhake Pōi: a study protocol for enhancing wellbeing, social connectedness and cultural identity for Māori elders

et al. 2020

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Background The Aotearoa New Zealand population is ageing accompanied by health and social challenges including significant inequities that exist between Māori and non-Māori around poor ageing and health. Although historically kaumātua (elder Māori) faced a dominant society that failed to realise their full potential as they age, Māori culture has remained steadfast in upholding elders as cultural/community anchors. Yet, many of today’s kaumātua have experienced ‘cultural dissonance’ as the result of a hegemonic dominant culture subjugating an Indigenous culture, leading to generations of Indigenous peoples compelled or forced to dissociate with their culture. The present research project, Kaumātua Mana Motuhake Pōī (KMMP) comprises two interrelated projects that foreground dimensions of wellbeing within a holistic Te Ao Māori (Māori epistemology) view of wellbeing. Project 1 involves a tuakana-teina/peer educator model approach focused on increasing service access and utilisation to support kaumātua with the greatest health and social needs. Project 2 focuses on physical activity and cultural knowledge exchange (including te reo Māori--Māori language) through intergenerational models of learning. Methods Both projects have a consistent research design and common set of methods that coalesce around the emphasis on kaupapa kaumatua; research projects led by kaumātua and kaumātua providers that advance better life outcomes for kaumātua and their communities. The research design for each project is a mixed-methods, pre-test and two post-test, staggered design with 2–3 providers receiving the approach first and then 2–3 receiving it on a delayed basis. A pre-test (baseline) of all participants will be completed. The approach will then be implemented with the first providers. There will then be a follow-up data collection for all participants (post-test 1). The second providers will then implement the approach, which will be followed by a final data collection for all participants (post-test 2). Discussion Two specific outcomes are anticipated from this research; firstly, it is hoped that the research methodology provides a framework for how government agencies, researchers and relevant sector stakeholders can work with Māori communities. Secondly, the two individual projects will each produce a tangible approach that, it is anticipated, will be cost effective in enhancing kaumātua hauora and mana motuhake. Trial registration Australia New Zealand Clinical Trial Registry (ACTRN12620000316909). Registered 6 March 2020.

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Section: Methods and Designmentioning

confidence: 99%

Kaumātua Mana Motuhake Pōi: a study protocol for enhancing wellbeing, social connectedness and cultural identity for Māori elders

et al. 2020

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“…20 For community members in a low socio-economic region of NSW, providers' skills and traits together with convenient and accessible clinics and bulk-billing were key considerations in their choice of a service provider. 21 For these populations, equity of access to CDM allied health services becomes an issue.…”

Section: Utilisation Of Allied Health Providers By Profession and By mentioning

confidence: 99%

Investing in big ideas: utilisation and cost of Medicare Allied Health services in Australia under the Chronic Disease Management initiative in primary care

Cant

Foster²

2011

Aust. Health Review

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Objective. To critically examine utilisation of the 13 allied health services provided through Medicare Chronic Disease Management program and related general practitioner (GP) care planning initiatives.Methods. Statistics generated from national billing data from July 2005 to June 2009 were extracted from Medicare data and compared by profession, State or Territory and population.Results. Most services grew over 4 years although nationally consistent service levels were not found for any allied health provider profession. On referral from GPs, podiatry, physiotherapy and dietetics provided most services (82%) Conclusion. Inequality of accessibility for patients was apparent. Five years into the program, a review of Medicare Allied Health CDM policy is warranted.Implications. Research and evaluation is needed to identify whether the program is meeting the needs of GPs, allied health providers and chronic disease patients.What is known about the topic? Since 2004, Medicare Chronic Disease Management program has offered Australian patients with chronic or complex disease access to 13 allied health professions via private clinics on referral from their general practitioner -with costs subsidised by Medicare. Little is known about the demographics of referred patients or which allied health services are utilised. What does this paper add? We take a multidisciplinary perspective to describe program use and find wide variation by profession nationally. Per capita State and Territory data indicate inequality of accessibility. Podiatry, physiotherapy and dietetics provided 82% of all services in 2008-09. Referrals initiated by GPs via patient care plans are increasing, but at present referrals per each GP are low. What are the implications for practitioners? More needs to be known about the dynamics that affect referral, the local accessibility of allied health providers and issues that affect uptake by patients.

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“…Fragmented service delivery, prolonged wait times, and geographical barriers to health care agencies have also been reported (Achat, Thomas, Close, Moerkerken, & Harris, 2010). Examination of these influential factors highlights a problem at both the interpersonal and structural levels of health care.…”

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confidence: 99%

Health Care Among Street-Involved Women

Bungay

2013

Qual Health Res

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I present the findings from a study that explored the experiences and decision making of street-involved women navigating the health care system. Data were drawn from a larger qualitative study situated in a western Canadian inner-city neighborhood that examined the health-management strategies of street-involved women with a history of crack cocaine use. Data were collected over a 17-month period and included ethnographic methods of participant observation, group interviews (n = 57), and in-depth interviews (n = 10). Inductive thematic analysis derived two major themes: power and punishment, and organization and delivery of care. The themes illustrate how women's experiences and decision making were located within a nexus of power relations that operated across women's shared social location as downtown eastsiders. Implications of the findings are discussed in relation to supporting women's efforts and improving health outcomes.

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General health care service utilisation: where, when and by whom in a socioeconomically disadvantaged population

Cited by 23 publications

References 41 publications

Kaumātua Mana Motuhake Pōi: a study protocol for enhancing wellbeing, social connectedness and cultural identity for Māori elders

Kaumātua Mana Motuhake Pōi: a study protocol for enhancing wellbeing, social connectedness and cultural identity for Māori elders

Investing in big ideas: utilisation and cost of Medicare Allied Health services in Australia under the Chronic Disease Management initiative in primary care

Health Care Among Street-Involved Women

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