AN innovative health services partnership in a remote Indigenous community has delivered “incredible improvement in access to care”, but reveals the difficulties of improving health outcomes in regions characterised by extremely poor socioeconomic circumstances, says a rural health expert.
Professor Dennis Pashen, Rural Doctors Association of Australia president, said the Fitzroy Valley health services partnership — a formal collaboration between an Aboriginal community-controlled health service, a hospital and a community health service in the Kimberley area of Western Australia — was nationally recognised as a successful model.
“It’s a model that solves one of the big problems, which is access to care, in these remote Indigenous communities”, Professor Pashen told MJA InSight.
He was commenting on a 6-year retrospective evaluation of the results of the formal partnership published this week in the MJA. (1)
It showed the community-initiated partnership had resulted in increases in health assessment uptake, with steep increases in the provision of services to very remote communities from 863 in 2006 to 11 338 in 2012.
There was also an increase in the uptake of health assessments from 13% to 61% of the eligible population over the same period, resulting in 73% of those identified with diabetes being placed on a care plan. The researchers reported improvements in quality-of-care indicators, such as the proportion of diabetes patients receiving antihypertensives and having glycated haemoglobin checks, and a downward trend in mortality.
However, they noted that there was no statistically significant improvement in glycated haemoglobin levels or in blood pressure levels reaching target values.
Professor Pashen told MJA InSIght the study showed an incredible improvement in the access to care. “But it also demonstrates that unless there’s something done about the socioeconomic circumstances in remote Indigenous communities, we don’t make a rapid shift in health improvements”, he said.
Dr Carole Reeve, lead author of the MJA study, agreed, saying the organisations in the partnership learnt to work well together to improve health service delivery, particularly primary care, to remote communities.
“But the biggest factor in determining health outcomes is actually socioeconomic and environmental circumstances”, she told MJA InSight.
“Although we do our best to overcome them and we advocate for change — like alcohol restrictions — health outcomes are largely determined by fundamental things like clean water, sanitation, employment and education, and those are things that are being addressed in a whole-of-government approach to closing the gap”, said Dr Reeve, who is based at the Flinders University Centre for Remote Health in Alice Springs.
“We are doing our best in terms of a health service, but obviously there are lots of other impacts on people’s health as well.”
Maureen Carter, a coauthor of the MJA study and CEO of Nindilingarri Cultural Health Services, one of the services involved in the study, said the partnership reflected the Aboriginal view of all things being connected and, importantly, ensured that the way in which government services were delivered reflected and respected Aboriginal culture.
She said an example was that previously Aboriginal people would stay away from the hospital after there had been a death. But in the purpose-built hospital, families are now able to “smoke the room”, enabling their return to the facility.
Ms Carter said efforts to address the very high rate of chronic illness in the community needed to be focused on families. “In the long term, if whole-of-family approaches are adopted, we will see real change”, she told MJA InSight. “It’s about empowering families before they get into crisis.”
Professor Jennifer Reath, foundation Peter Brennan Chair of General Practice at the University of Western Sydney, described the Fitzroy Valley health care model as “outstanding”, and applauded its respectful approach to traditional health care and investment in primary health care services.
“To see organisations working together, respecting each other’s expertise … it’s a rare thing to see, but it’s certainly the way of the future”, she said.
Professor Reath said such a model would “absolutely” be applicable to other areas, including some urban areas. She said a similar health partnership concept had been established in 2012 between Western Sydney Medicare Local and the Western Sydney Local Health District.
This partnership was on a much larger scale than the Fitzroy Valley model, but an early, yet-to-be published evaluation showed the importance of strong, trusting relationships between partnering organisations, input according to expertise, additional investment in primary care and long-term tracking of program benefits, she said.