Determinants of access to chronic illness care

a mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians

Jodie Bailie, Gillian Schierhout, Alison Laycock, Margaret Kelaher, Nicole Ann Percival, Lynette Ruth O'donoghue, Tracy Lyn Mcneair, Ross Stewart Bailie

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    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.
    Original languageEnglish
    Article numbere008103
    Pages (from-to)1-11
    Number of pages11
    JournalBMJ Open
    Volume5
    Issue number11
    DOIs
    Publication statusPublished - Nov 2015

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    Chronic Disease
    Focus Groups
    Primary Health Care
    Organizations
    Interviews
    Cost of Illness
    Social Welfare
    Population Groups
    Population
    Guidelines
    Delivery of Health Care

    Cite this

    Bailie, J., Schierhout, G., Laycock, A., Kelaher, M., Percival, N. A., O'donoghue, L. R., ... Bailie, R. 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), 1-11. [e008103]. https://doi.org/10.1136/bmjopen-2015-008103
    Bailie, Jodie ; Schierhout, Gillian ; Laycock, Alison ; Kelaher, Margaret ; Percival, Nicole Ann ; O'donoghue, Lynette Ruth ; Mcneair, Tracy Lyn ; Bailie, Ross Stewart. / Determinants of access to chronic illness care : a mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians. In: BMJ Open. 2015 ; Vol. 5, No. 11. pp. 1-11.
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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",
    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.",
    author = "Jodie Bailie and Gillian Schierhout and Alison Laycock and Margaret Kelaher and Percival, {Nicole Ann} and O'donoghue, {Lynette Ruth} and Mcneair, {Tracy Lyn} and Bailie, {Ross Stewart}",
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    Bailie, J, Schierhout, G, Laycock, A, Kelaher, M, Percival, NA, O'donoghue, LR, Mcneair, TL & Bailie, RS 2015, 'Determinants of access to chronic illness care: a mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians', BMJ Open, vol. 5, no. 11, e008103, pp. 1-11. https://doi.org/10.1136/bmjopen-2015-008103

    Determinants of access to chronic illness care : a mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians. / Bailie, Jodie; Schierhout, Gillian; Laycock, Alison; Kelaher, Margaret; Percival, Nicole Ann; O'donoghue, Lynette Ruth; Mcneair, Tracy Lyn; Bailie, Ross Stewart.

    In: BMJ Open, Vol. 5, No. 11, e008103, 11.2015, p. 1-11.

    Research output: Contribution to journalArticleResearchpeer-review

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    T1 - Determinants of access to chronic illness care

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    AU - Schierhout, Gillian

    AU - Laycock, Alison

    AU - Kelaher, Margaret

    AU - Percival, Nicole Ann

    AU - O'donoghue, Lynette Ruth

    AU - Mcneair, Tracy Lyn

    AU - Bailie, Ross Stewart

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    N2 - 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.

    AB - 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.

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    DO - 10.1136/bmjopen-2015-008103

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    JF - BMJ Open

    SN - 2044-6055

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