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Determinants of access to chronic illness care: a mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians

Bailie, Jodie (nee Griffin), Schierhout, Gillian, Laycock, Alison F., Kelaher, Margaret, Percival, Nicole A., O'Donoghue, Lynette R., McNeair, Tracy L. and Bailie, Ross S. (2015). Determinants of access to chronic illness care: a mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians. BMJ Open,5(11 - Article No. e008103).

Document type: Journal Article
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Title Determinants of access to chronic illness care: a mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians
Author Bailie, Jodie (nee Griffin)
Schierhout, Gillian
Laycock, Alison F.
Kelaher, Margaret
Percival, Nicole A.
O'Donoghue, Lynette R.
McNeair, Tracy L.
Bailie, Ross S.
Journal Name BMJ Open
Publication Date 2015
Volume Number 5
Issue Number 11 - Article No. e008103
ISSN 2044-6055   (check CDU catalogue  open catalogue search in new window)
Total Pages 11
Place of Publication United Kingdom
Publisher B M J Group
HERDC Category C1 - Journal Article (DIISR)
Abstract Objectives
Indigenous Australians have a disproportionately high burden of chronic illness, and relatively poor access to healthcare. This paper examines how a national multicomponent programme aimed at improving prevention and management of chronic disease among Australian Indigenous people addressed various dimensions of access.

Design

Data from a place-based, mixed-methods formative evaluation were analysed against a framework that defines supply and demand-side dimensions to access. The evaluation included 24 geographically bounded ‘sentinel sites’ that included a range of primary care service organisations. It drew on administrative data on service utilisation, focus group and interview data on community members’ and service providers’ perceptions of chronic illness care between 2010 and 2013.

Setting

Urban, regional and remote areas of Australia that have relatively large Indigenous populations.

Participants

670 community members participated in focus groups; 374 practitioners and representatives of regional primary care support organisations participated in in-depth interviews.

Results
The programme largely addressed supply-side dimensions of access with less focus or impact on demand-side dimensions. Application of the access framework highlighted the complex inter-relationships between dimensions of access. Key ongoing challenges are achieving population coverage through a national programme, reaching high-need groups and ensuring provision of ongoing care.

Conclusions
Strategies to improve access to chronic illness care for this population need to be tailored to local circumstances and address the range of dimensions of access on both the demand and supply sides. These findings highlight the importance of flexibility in national programme guidelines to support locally determined strategies.
DOI http://dx.doi.org/10.1136/bmjopen-2015-008103   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
Additional Notes This is an Open Access article distributed under the terms of the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Description for Link Link to CC Attribution 4.0 License
URL https://creativecommons.org/licenses/by/4.0/au


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