Investigating the feasibility, acceptability and appropriateness of outreach case management in an urban Aboriginal and Torres Strait Islander primary health care service: a mixed methods exploratory study

Abstract

BackgroundThe disparities in health and life expectancy of Aboriginal and Torres Strait Islander peoples compared to non-Indigenous Australians are well documented. Chronic diseases are a leading contributor to these disparities. We aimed to determine the feasibility, acceptability and appropriateness of a case management approach to chronic disease care integrated within an urban Aboriginal and Torres Strait Islander primary health care service.MethodsThe Home-based, Outreach case Management of chronic disease Exploratory (HOME) Study provided holistic, patient centred multidisciplinary care for Aboriginal and Torres Strait Islander people with chronic disease. A developmental evaluation approach supported the implementation and ongoing adaptations in the delivery of the model of care, and ensured its alignment with Aboriginal and Torres Strait Islander peoples’ understandings of, and approaches to, health and wellbeing. In-depth, semi-structured interviews were conducted with nine patient participants (one interview also included a participant’s spouse) and 15 health service staff and key themes were identified through an iterative reflective process. Quantitative data were collected directly from patient participants and from their medical records at baseline, 3 and 6 months. Patient participants’ baseline characteristics were described using frequencies and percentages. Attrition and patterns of missing values over time were evaluated using binomial generalized estimating equation (GEE) models and mean differences in key clinical outcomes were determined using normal GEE models.ResultsForty-one patients were recruited and nine withdrew over the 6 month period. There was no evidence of differential attrition. All participants (patients and health service staff) were very positive about the model of care. Patient participants became more involved in their health care, depression rates significantly decreased (p = 0.03), and significant improvements in systolic blood pressure (p < 0.001) and diabetes control (p = 0.05) were achieved.ConclusionsThe exploratory nature of our study preclude any definitive statements about the effectiveness of our model of care. However, staff and patients' high levels of satisfaction and improvements in the health and wellbeing of patients are promising and suggest its feasibility, acceptability and appropriateness. Further research is required to determine its efficacy, effectiveness and cost-effectiveness in improving the quality of life and quality of care for Aboriginal and Torres Strait Islander peoples living with chronic disease.

A state‐of‐the‐art review of the experience of care coordination interventions for people living with multimorbidity

“…The nature of the participant population varied across age, ethnicity, number of chronic conditions, risk of future high use of health services and other socioeconomic indicators. Two studies were focused on specific cultural populations in Australia, Canada and New Zealand (Askew et al, 2016; Sheridan et al, 2019). Eight articles focused on older adults living with multimorbidity (Brown, Stainer, Stewart, Clacy, & Parker, 2008; Greenfield et al, 2014; Hjelm, Holst, Willman, Bohman, & Kristensson, 2015; Newbould et al, 2012; Scholz Mellum, Martsolf, Glazer, Tobias, & Martsolf, 2018; Sefcik et al, 2018; Spoorenberg et al, 2015; Yeager et al, 2018).…”

“…Six articles in this review reported participants experiencing a sense of safety or security (Askew et al, 2016; Grinberg et al, 2016; Hjelm et al, 2015; Hudon et al, 2018; Sheridan et al, 2019; Spoorenberg et al, 2015). This appeared to be linked to Theme 1: a relationship built on trust preceded participants feeling safe and secure.…”

“…Participants described the support, monitoring, information and encouragement they received as part of Embrace provided them with a sense of safety and security. Embrace was a home‐based model of care, as was the Home‐based Outreach case management of chronic disease Exploratory (HOME) Study in Australia (Askew et al, 2016). While targeted at a different population (Aboriginal and Torres Strait Islander people with complex chronic disease), care coordination in the HOME Study also enabled participants to have a similar sense of safety.…”

“…Four of the included articles reported participants feeling being cared for and respected during the care coordination intervention (Askew et al, 2016; Greenfield et al, 2014; Scholz Mellum et al, 2018; Sheridan et al, 2019). The phenomenological study of participants enrolled in the Northwest London Integrated Care Pilots focused on their perceptions of person‐centredness in the pilots (Greenfield et al, 2014).…”

“…The conceptual frameworks or models underlying the interventions varied considerably. For example, three of the articles (Askew et al, 2016; Hudon et al, 2015, 2018) referred to their conceptual model as patient‐centred. In reporting the experiences of V1SAGES participants, Hudon et al (2015) refer to a patient‐centred conceptual model and evaluation approach.…”