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New evidence suggests the healthcare gap is slowly closing
Greater engagement with health services, including for prevention, has seen a steady improvement for Aboriginal and Torres Strait Islander patients.
Culturally appropriate care has been shown to improve health outcomes for Aboriginal and Torres Strait Islander people.
A new report has reaffirmed the value of Aboriginal and Torres Strait Islander-specific primary healthcare services, highlighting increased engagement in most areas of health.
Aboriginal and Torres Strait Islander patients accounted for 85% of the 3.7 million episodes of care carried out by 210 culturally-specific services In 2018–19.
These episodes of care included the recording of smoking status (82%) and alcohol consumption (62%), the collection of cardiovascular disease risk assessments (50%), and women accessing cervical screening (43%).
For those aged 25 and over, 54% had a Medicare Benefits Schedule (MBS) health assessment claimed in the last two years.
Maternal and child health indicators were also marked as an improvement, including first antenatal visit in the first trimester (41%), MBS health assessments for 0–4 years of age (38%), and child immunisation rates (73%).
Chronic disease management indicators, specifically for type 2 diabetes, included General Practitioner Management Plans (56%) and Team Care Arrangements (53%). Immunisation against influenza for those patients with type 2 diabetes also improved at 36%.
The report’s data sources are part of the Indigenous Australians’ Health Programme (IAHP) – the Online Services Report (OSR) and the national Key Performance Indicators (nKPIs), both of which are designed to support continual quality improvement activity among IAHP-funded organisations.
Collected information also helps monitor progress against the Council of Australian Governments’ Closing the Gap targets, supporting national health goals.
Culturally appropriate care, including the space where it is received and identification of Aboriginal and Torres Strait Islander patients, has been shown to improve health outcomes through appropriate prevention, early intervention, education, and the timely identification and management of health issues.
GP Dr Tanya Schramm, a Palawa woman who lectures in Aboriginal and Torres Strait Islander health at the University of Tasmania, says community-led approaches to healthcare are vital.
‘The reality is, if you sit down with the community and ask what their priorities and problems are and how can we address them, the community can give you some ideas that can be put into a program,’ she told newsGP at the 2019 RACGP Close the Gap Day event.
‘And because the community have had input into it, they have an interest in it as well, and therefore it’s more likely to succeed because it’s what they actually wanted.’
The 210 primary healthcare services included in the report receive funding from the IAHP, and are made up of Aboriginal Community Controlled Health Services (ACCHS), state, territory and local health services, and non-government organisations such as women’s health services.
These services employed almost 8000 full-time equivalent (FTE) staff in 2018–19, with 52% of the workforce Aboriginal and/or Torres Strait Islander. Of these who were employed as health staff:
- 51% were from an ACCHS
- 46% were from a government organisation
- 31% were from other organisations.
These percentages have remained steady – in 2013–14 there were 3798 Aboriginal and/or Torres Strait Islander FTE staff, followed by 4118 in 2015–16, 4254 in 2017–18, and a slight decrease to 4130 in 2018–19.
The majority of care delivered to Aboriginal and Torres Strait Islander patients was provided by an ACCHS. There were 6.1 million individual patient contacts, comprising:
- 31% with a nurse or midwife
- 29% with a GP
- 16% with an Aboriginal and Torres Strait Islander health worker
- 7% with transport contacts by drivers and field officers.
Dr Schramm
cited the strengths of ACCHS as community-controlled mechanisms of care.
‘They’re developed by the community, for the community,’ she said.
‘So that’s the power behind them – the community have a say in how their health service is run, the programs and how it’s all going to work ... [the ACCHS] set themselves up to address the needs of Aboriginal people and health, and they’re culturally safe, competent services for people to go to.’
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