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Building better systems of care for Aboriginal and Torres Strait Islander people: finding from the Kanyini health systems assessment

Peiris, David, Brown, Alexander, Howard, Michael, Rickards, Bernadette, Tonkin, Andrew, Ring, Ian, Hayman, Noel and Cass, Alan (2012). Building better systems of care for Aboriginal and Torres Strait Islander people: finding from the Kanyini health systems assessment. BMC Health Services Research,12(369):1-15.

Document type: Journal Article
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IRMA ID 11035xPUB13
NHMRC Grant No. 402797
Title Building better systems of care for Aboriginal and Torres Strait Islander people: finding from the Kanyini health systems assessment
Author Peiris, David
Brown, Alexander
Howard, Michael
Rickards, Bernadette
Tonkin, Andrew
Ring, Ian
Hayman, Noel
Cass, Alan
Journal Name BMC Health Services Research
Publication Date 2012
Volume Number 12
Issue Number 369
ISSN 1472-6963   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84867786271
Start Page 1
End Page 15
Total Pages 15
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
Australian federal and jurisdictional governments are implementing ambitious policy initiatives intended to improve health care access and outcomes for Aboriginal and Torres Strait Islander people. In this qualitative study we explored Aboriginal Medical Service (AMS) staff views on factors needed to improve chronic care systems and assessed their relevance to the new policy environment.

Methods
Two theories informed the study: (1) ‘candidacy’, which explores “the ways in which people’s eligibility for care is jointly negotiated between individuals and health services”; and (2) kanyini or ‘holding’, a Central Australian philosophy which describes the principle and obligations of nurturing and protecting others. A structured health systems assessment, locally adapted from Chronic Care Model domains, was administered via group interviews with 37 health staff in six AMSs and one government Indigenous-led health service. Data were thematically analysed.

Results

Staff emphasised AMS health care was different to private general practices. Consistent with kanyini, community governance and leadership, community representation among staff, and commitment to community development were important organisational features to retain and nurture both staff and patients. This was undermined, however, by constant fear of government funding for AMSs being withheld. Staff resourcing, information systems and high-level leadership were perceived to be key drivers of health care quality. On-site specialist services, managed by AMS staff, were considered an enabling strategy to increase specialist access. Candidacy theory suggests the above factors influence whether a service is ‘tractable’ and ‘navigable’ to its users. Staff also described entrenched patient discrimination in hospitals and the need to expend considerable effort to reinstate care. This suggests that Aboriginal and Torres Strait Islander people are still constructed as ‘non-ideal users’ and are denied from being ‘held’ by hospital staff.

Conclusions

Some new policy initiatives (workforce capacity strengthening, improving chronic care delivery systems and increasing specialist access) have potential to address barriers highlighted in this study. Few of these initiatives, however, capitalise on the unique mechanisms by which AMSs ‘hold’ their users and enhance their candidacy to health care. Kanyini and candidacy are promising and complementary theories for conceptualising health care access and provide a potential framework for improving systems of care.
DOI http://dx.doi.org/10.1186/1472-6963-12-369   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
Description for Link Link to published version
URL http://www.biomedcentral.com/1472-6963/12/369


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