An evaluation of the development, implementation, feasibility and impact of a tailored intervention to improve the quality of care for Aboriginal and Torres Strait Islander peoples attending urban general practice.

Abstract

BACKGROUND: Aboriginal and Torres Strait Islander (Aboriginal) peoples have greater health needs than other Australians and those in urban areas experience greater disease. Approximately 60% of Aboriginal peoples use non-Aboriginal Community Controlled (mainstream) general practice. General practice may not provide culturally appropriate care to Aboriginal peoples, and few practices have effective systems in place to identify Indigenous status, resulting in inadequately targeted care.

AIM: To develop and evaluate a tailor-made practice facilitation model to improve the acceptability of health care provided to Aboriginal peoples who attend urban mainstream general practice.

METHODS: Set in two Medicare Local Areas in Sydney, a mixed-methods multiple-site case study was used, which was informed by an interpretivist constructionist paradigm. Data collection included focus groups with the two local Aboriginal communities; interviews with Medicare local staff (n=3); interviews and surveys with GPs, nurses and practice staff (n=29); a patient medical record audit, practice systems audit and Aboriginal unannounced standardised patient (USP) assessments at two time-points at seven general practices. The triangulated data were used to tailor quality improvement activities within each practice to improve their Indigenous-status recording systems and the quality of care offered to Aboriginal patients. The implementation of the intervention was evaluated using the Normalisation Process Theory (NPT).

FINDINGS: Feedback from the USPs, combined with education and clinical audits, enabled practices to implement an organisational response consistent with the processes described in the NPT. At follow-up most practices improved their Indigenous-status identification systems, with a doubling in Indigenous-identified patients in six practices; and there was an increase in the number of Aboriginal Health Assessments performed and enrolments into the Closing the Gap Health Initiative schemes. The method was acceptable to providers, staff and the local Aboriginal communities. A key factor in the uptake of the intervention and commitment to change by practitioners and staff was that the USPs were from the local Aboriginal communities, providing face validity to the methodology.

CONCLUSION: The innovative intervention used was acceptable, feasible and demonstrated some effectiveness as a quality improvement tool in general practice. It warrants further investigation and evaluation.