Better health and ageing for all Australians

Aboriginal and Torres Strait Islander Health Performance Framework - 2010

3.15 Regular GP or health service

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Why is it important?:

Having a usual primary care provider, sometimes known as the ‘medical home’, is associated with good communication between the patient and provider, greater trust in the health care provider (Mainous et al. 2001), improved preventive care and better health outcomes (Starfield 1998; Starfield & Shi 2004). Effective communication between the patient and provider is particularly relevant in the health of Indigenous Australians where communication issues can lead to health care problems such as misdiagnosis and incorrect treatment. An ongoing relationship between the patient and provider assists in understanding long-term health needs and facilitates the coordination of care with other providers (e.g. specialists) to meet patient needs (Forrest & Starfield 1996). Having a usual primary care provider correlates with higher quality care (Christakis et al. 2002; Inkelas et al. 2004). The literature focuses on having a regular GP. Given the different models of care in Australia such as Aboriginal and Torres Strait Islander primary health care services and private GP practices, it may be difficult to draw clear conclusions about the relationships between having a regular health service and continuity of care.

One international survey found that 88% of Australians reported having a regular GP. Rates were higher in the UK and NZ at 91% and lower in Canada (86%) and the US (83%). In Australia, a further 6% reported they had no regular doctor but did have a usual place of care (Schoen et al. 2004).

Findings:

This measure is derived from the National Aboriginal and Torres Strait Islander Health Survey and has not been updated since the 2006 version of this report. In 2004–05, 91% of all Aboriginal and Torres Strait Islander people reported that they usually went to the same GP or medical service. This proportion is similar across age groups (with slightly higher rates for people aged 0–14 years and 55 years and over) and other socioeconomic dimensions including main language spoken at home, household income, remoteness region of residence and private health insurance status.

Sixty per cent of Aboriginal and Torres Strait Islander people went to a doctor if they had a problem with their health, and 30% reported they went to an ‘Aboriginal medical service’. Note that the next survey will include improved questions on this topic including preferences for care. ‘Aboriginal medical services’ were used as the regular source of health care for 15% of Aboriginal and Torres Strait Islander people in major cities rising to 76% in very remote areas. A higher use of hospitals for regular health care was reported in Queensland and Western Australia compared with other jurisdictions.

Seventy-eight per cent of Aboriginal and Torres Strait Islander people who usually went to the same GP or medical service reported that their treatment when seeking health care in the previous 12 months was the same as non-Indigenous people. Five per cent reported their treatment was better than non-Indigenous people and 4% that their treatment was worse than non-Indigenous people. However, 16% of Indigenous Australians reported that over the previous 12 months they felt treated badly by a health service provider because they were Indigenous. Up to a third of these people tried to avoid the situation, which suggests they may not have sought care when it was required.

Implications:

A high proportion of Aboriginal and Torres Strait Islander peoples have a usual source of health care. This finding is encouraging as access for a usual source of care is one of the foundations for a good primary care system.

The two major sources of care for Indigenous Australians are Aboriginal medical services and mainstream GPs. Aboriginal medical services play a more dominant role as the usual source of care in remote areas of Australia. The small number of services nationally limits their accessibility for some Indigenous Australians. Aboriginal medical services offer services in addition to primary medical care and remain the service of choice for many Aboriginal and Torres Strait Islander peoples. These services are controlled by the local community and have significant expertise in Aboriginal and Torres Strait Islander health. There is evidence that Aboriginal medical services treat patients with more complex problems (Larkins et al. 2006). Strengthening these services in areas of potentially high demand should remain a priority.

While mainstream general practice is a significant source of care, reports suggest a relatively small proportion of private GPs provide sensitive and appropriate services to their Indigenous patients and that these GPs tend to attract most Indigenous patients living locally (Heyman 2009, Andrews 2002). Unlike Aboriginal medical services, for most GPs Indigenous clients will remain a small proportion of their clients. This makes developing expertise in Aboriginal and Torres Strait Islander health issues challenging. Strategies are required to address lack of expertise in Indigenous health issues, lack of awareness of Aboriginal and Torres Strait Islander primary health care initiatives, cultural insensitivity and discrimination by mainstream providers. There is evidence that few mainstream GPs currently identify which of their patients are Aboriginal and Torres Strait Islander. Therefore they are not in a position to offer the additional MBS, PBS and immunisation programs available (Norris et al. 2004; Riley et al. 2004). However, some mainstream practices have implemented very successful strategies explicitly focused on their Indigenous patients (e.g. Hayman et al. 2009; Spurling et al. 2009).

Under the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes (COAG 2008b) Governments have agreed to initiatives to assist primary health care services to improve service delivery. The Australian Government is investing $474 million between 2009–10 and 2012–13 for this priority area. Initiatives include the new Practice Incentives Program (PIP) Indigenous Health Incentive which aims to support accredited general practices and Indigenous health services to provide better health care for Indigenous Australians. Under the Improving Indigenous Access to Mainstream Primary Care Program Indigenous Health Project Officer positions in Divisions of General Practice, NACCHO and its affiliates have been funded to improve the capacity of general practice to deliver culturally sensitive primary care services, increase the uptake of Indigenous specific MBS items including Indigenous health checks and follow-up items and support mainstream primary care services to identify Indigenous Australians.

Under the Indigenous Chronic Disease Package, 38 additional GP registrar training posts have also been established, together with expanded nurse scholarships and clinical placements in Indigenous health services.

While Aboriginal and Torres Strait Islander peoples may have a usual source of care, it is not clear that health care is always sought or accessible (see measure 3.12). Further data development is required to give a good indication as to whether, having sought care, Aboriginal and Torres Strait Islander peoples received appropriate follow-up care, are referred for specialist care, or are able to receive specialist care when this is required.

Figure 176 – Whether the person usually goes to same GP/medical service, by age group, Aboriginal and Torres Strait Islander peoples 2004–05


Figure 176 – Whether the person usually goes to same GP/medical service, by age group, Aboriginal and Torres Strait Islander peoples 2004–05
Source: ABS and AIHW analysis of 2004–05 National Aboriginal and Torres Strait Islander Health Survey
Text description of figure 176 (TXT 1KB)

Figure 177 – Where usually go if problem with health, by remoteness area, Aboriginal and Torres Strait Islander peoples 2004–05


Figure 177 – Where usually go if problem with health, by remoteness area, Aboriginal and Torres Strait Islander peoples 2004–05
Source: ABS and AIHW analysis of 2004–05 National Aboriginal and Torres Strait Islander Health Survey
Text description of figure 177 (TXT 1KB)

Table 69 – Perceptions of treatment when seeking health care, Aboriginal and Torres Strait Islander peoples 2004–05

Percentage
Treatment when seeking health care in last 12 months compared with non-Indigenous people
Worse than non-Indigenous people
4
The same as non-Indigenous people
77
Better than non-Indigenous people
5
Only encountered Indigenous people
2
Did not seek health care in last 12 months
5
Don't know/not sure
7
Total
100
Whether felt treated badly because Aboriginal or Torres Strait Islander in last 12 months
Yes
16
No
84
Total
100
What usually do when treated badly because Aboriginal/Torres Strait Islander (a) (b)
Try to avoid the person/situation
33
Try to change the way you are or things that you do
9
Try to do something about the people who did it
30
Talk to family or friends about it
38
Keep it to yourself
18
Just forget about it
28
Do anything else
5
No action
4
Source: ABS and AIHW analysis of 2004–05 National Aboriginal and Torres Strait Islander Health Survey

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