Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012

Tier 3—Continuous—3.17 Regular GP or health service

The HPF was designed to measure the impact of the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH) and will be an important tool for developing the new National Aboriginal and Torres Strait Islander Health Plan (NATSIHP).

Page last updated: 15 November 2012

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 provider (Mainous et al. 2001), improved preventive care and better health outcomes (Starfield 1998; Starfield et al. 2004). Effective communication between the patient and provider is particularly relevant in the health of Indigenous Australians where poor communication 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 et al. 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. However, 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 97% of sicker adults in Australia reported having a regular doctor or place of care. Rates were higher in the Netherlands at 100% and lower in the US at 91%. In Australia, 79% reported that their regular doctor or place of care is accessible (Schoen et al. 2011).

Findings:

In 2004–05, 91% of Aboriginal and Torres Strait Islander peoples 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 peoples 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 2012–13 NATSIHS will include improved questions on this topic including preferences for care. In 2004–05, Aboriginal medical services were used as the regular source of health care for 15% of Aboriginal and Torres Strait Islander peoples in major cities rising to 76% in very remote areas

Nationally, 7% of Aboriginal and Torres Strait Islander peoples usually go to hospital if there is a problem with their health. See measure 3.07 for analysis of hospitalisation's for conditions which could be prevented if primary health care services were better able to meet the needs of Aboriginal and Torres Strait Islander peoples. A higher use of hospitals for regular health care was reported in Qld and WA than in other jurisdictions.

In 2004–05, 78% of Aboriginal and Torres Strait Islander peoples 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. Further analysis of this issue is discussed in the context of cultural competency (see measure 3.08).

In 2008, 80% of Indigenous Australians aged 15 years and over agreed that their doctor can be trusted, which correlates with the high proportion of Aboriginal and Torres Strait Islander peoples who have a usual source of health care. While Aboriginal and Torres Strait Islander peoples may have a usual source of health care, it is not clear that health care is always sought or accessible. Transport (see measure 2.13) is one example of a barrier to access and also to choice of provider. Top of Page

Implications:

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

The two main sources of care for Indigenous Australians are Aboriginal medical services and mainstream GPs. Aboriginal medical services are a more predominant usual source of care in remote areas of Australia, however 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. Aboriginal Community Controlled Health Services are Aboriginal medical services initiated and operated by the local Aboriginal community to deliver holistic, comprehensive, and culturally appropriate health care to the community which controls it (through a locally elected Board of Management). 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, 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 a priority (see measure 3.08). Some mainstream practices have implemented very successful strategies explicitly focused on their Indigenous patients (Hayman et al. 2009; Spurling et al. 2009).

Under the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes governments have agreed to initiatives to assist primary health care services to improve service delivery. Australian Government initiatives include the new Practice Incentives Program – 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 Medicare Locals, 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 and treat 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 placement's 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.Top of Page
Figure 188—Regular type of health care used by Indigenous Australians, by age group, 2004–05
Figure 188—Regular type of health care used by Indigenous Australians, by age group, 2004–05

Source: ABS and AIHW analysis of 2004–05 NATSIHS

Figure 189—Indigenous Australians who usually go to the same GP/medical service, by selected population characteristics, 2004–05
Figure 189—Indigenous Australians who usually go to the same GP/medical service, by selected population characteristics, 2004–05Top of Page

(a)lowest relative disadvantage
(b)highest relative disadvantage
Source: ABS and AIHW analysis of 2004–05 NATSIHS

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Figure 190—Types of regular health care used by Indigenous Australians, by remoteness, 2004–05
Figure 190—Types of regular health care used by Indigenous Australians, by remoteness, 2004–05

Source: ABS and AIHW analysis of 2004–05 NATSIHS

Figure 191—Type of regular health care used by Indigenous Australians, by number of long-term health conditions, 2004–05
Top of PageFigure 191—Type of regular health care used by Indigenous Australians, by number of long-term health conditions, 2004–05

Source: ABS and AIHW analysis of 2004–05 NATSIHS

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