Quality management systems in Aboriginal Community Controlled Health Services: a review of the literature.

Background: A national accreditation policy for the Australian primary healthcare (PHC) system was initiated in 2008. While certification standards are mandatory, little is known about their effects on the efficiency and sustainability of organisations, particularly in the Aboriginal Community Controlled Health Service (ACCHS) sector.

Aim: The literature review aims to answer the following: to what extent does the implementation of the International Organisation for Standardization 9001:2008 quality management system (QMS) facilitate efficiency and sustainability in the ACCHS sector?

Methods: Thematic analysis of peer-reviewed and grey literature was undertaken from Australia and New Zealand PHC sector with a focus on First Nations people.

Drivers of general practice-type presentations to the emergency department in a remote outback community.

Objective: To estimate the number of general practice-appropriate attendances in a remote emergency department and explore the reasons for patients' choice of service.

Design: A four-step case study approach was adopted, focusing on hospital emergency department (ED) attendances that were potentially manageable in general practice.

Setting: A large, remote community with substantial populations of Indigenous peoples and fly-in, fly-out mining industry workers.

Predictors and reasons for quitting smoking in remote Aboriginal and Torres Strait Islander communities.

Issue Addressed: National smoking prevalence is decreasing among Aboriginal and Torres Strait Islander people. In remote areas, Aboriginal and Torres Strait Islander smoking prevalence remains higher than in nonremote areas and is not improving.

Methods: We analysed data from 539 daily and weekly smokers from remote areas who completed baseline surveys at either Wave 1 (April 2012-October 2013) or Wave 2 (August 2013-August 2014), including 157 from Wave 1 who also completed Wave 2, from the Talking About The Smokes project.

A computer-guided quality improvement tool for primary health care: cost-effectiveness analysis based on TORPEDO trial data.

Objective: To assess the cost-effectiveness of a computer-guided quality improvement intervention for primary health care management of cardiovascular disease (CVD) in people at high risk.

Design: Modelled cost-effectiveness analysis of the HealthTracker intervention and usual care for people with high CVD risk, based on TORPEDO trial data on prescribing patterns, changes in intermediate risk factors (low-density lipoprotein cholesterol, systolic blood pressure), and Framingham risk scores.

Participants: Hypothetical population of people with high CVD risk attending primary health care services in a New South Wales primary health network (PHN) of mean size.

Do stress, life satisfaction, depression and alcohol use predict quitting among Aboriginal and Torres Strait Islander smokers?

Objective: To examine whether baseline measures of stress, life satisfaction, depression and alcohol use predict making or sustaining quit attempts in a national cohort of Aboriginal and Torres Strait Islander smokers.

Methods: We analysed data from the nationally representative quota sample of 1,549 Aboriginal and Torres Strait Islander adults who reported smoking at least weekly in the Talking About The Smokes baseline survey (April 2012-October 2013) and the 759 who completed a follow-up survey a year later (August 2013-August 2014).

Results: More smokers who reported negative life satisfaction, feeling depressed, higher stress or drinking heavily less often than once a week at baseline made a quit attempt between the baseline and follow-up surveys.

What drives adoption of a computerised, multifaceted quality improvement intervention for cardiovascular disease management in primary healthcare settings? A mixed methods analysis using normalisation process theory.

Background: A computerised, multifaceted quality improvement (QI) intervention for cardiovascular disease (CVD) management in Australian primary healthcare was evaluated in a cluster randomised controlled trial. The intervention was associated with improved CVD risk factor screening but there was no improvement in prescribing rates of guideline-recommended medicines. The aim of this study was to conduct a process evaluation to identify and explain the underlying mechanisms by which the intervention did and did not have an impact.

Impact of Sustained Use of a Multifaceted Computerized Quality Improvement Intervention for Cardiovascular Disease Management in Australian Primary Health Care.

Background: We evaluated a multifaceted, computerized quality improvement intervention for management of cardiovascular disease (CVD) risk in Australian primary health care. After completion of a cluster randomized controlled trial, the intervention was made available to both trial arms. Our objective was to assess intervention outcomes in the post-trial period and any heterogeneity based on original intervention allocation.

Cannabis use among two national samples of Aboriginal and Torres Strait Islander tobacco smokers.

Introduction And Aims: There is a concern that cannabis use is an important barrier to reducing Aboriginal and Torres Strait Islander smoking. We investigate the associations of cannabis use and tobacco smoking and quitting in two large national samples.

Design And Methods: The 2012-2013 National Aboriginal and Torres Strait Islander Health Survey was a national stratified random household survey conducted between April 2012 and February 2013, and included 2580 adult Aboriginal and Torres Strait Islander smokers.

The social determinants and starting and sustaining quit attempts in a national sample of Aboriginal and Torres Strait Islander smokers.

Objective: To assess whether social, economic and demographic measures are associated with initiating and sustaining quit attempts in a national sample of Aboriginal and Torres Strait Islander smokers.

Methods: We analysed data from 759 adults who reported smoking at least weekly in the Talking About The Smokes baseline survey (April 2012 - October 2013) and completed a follow up survey a year later (August 2013 - August 2014).

Results: Almost none of the standard baseline socioeconomic indicators predicted making or sustaining quit attempts.

Implementation of a consumer-focused eHealth intervention for people with moderate-to-high cardiovascular disease risk: protocol for a mixed-methods process evaluation.

Introduction: Technology-mediated strategies have potential to engage patients in modifying unhealthy behaviour and improving medication adherence to reduce morbidity and mortality from cardiovascular disease (CVD). Furthermore, electronic tools offer a medium by which consumers can more actively navigate personal healthcare information. Understanding how, why and among whom such strategies have an effect can help determine the requirements for implementing them at a scale.

Smoking among a national sample of Aboriginal and Torres Strait Islander health service staff.

Objective: To examine smoking among Aboriginal and Torres Strait Islander staff of Aboriginal community-controlled health services (ACCHSs).

Design, Setting And Participants: The Talking About The Smokes (TATS) project surveyed 374 Aboriginal and Torres Strait Islander staff at a national sample of 31 ACCHSs, from April 2012 to October 2013. We made comparisons with adult participants in the 2008 National Aboriginal and Torres Strait Islander Social Survey (NATSISS) and with 1643 smokers in a community sample of 2522 Aboriginal and Torres Strait Islander people also surveyed in the TATS project.

Use of nicotine replacement therapy and stop-smoking medicines in a national sample of Aboriginal and Torres Strait Islander smokers and ex-smokers.

Objective: To examine the use of nicotine replacement therapy (NRT) and the stop-smoking medicines (SSMs) varenicline and bupropion in a national sample of Aboriginal and Torres Strait Islander smokers and recent ex-smokers.

Design, Settings And Participants: The Talking About The Smokes (TATS) project used a quota sampling design to recruit a nationally representative sample of 1721 smokers and ex-smokers who had quit ≤ 12 months before from communities served by 34 Aboriginal community-controlled health services and one community in the Torres Strait. Baseline surveys were conducted from April 2012 to October 2013.

Smoking cessation advice and non-pharmacological support in a national sample of Aboriginal and Torres Strait Islander smokers and ex-smokers.

Objectives: To describe recall among a national sample of Aboriginal and Torres Strait Islander smokers and recent ex-smokers of having received advice to quit smoking and referral to non-pharmacological cessation support from health professionals, and their association with quit attempts.

Design, Setting And Participants: The Talking About The Smokes project used a quota sampling design to recruit 1721 smokers and ex-smokers who had quit ≤ 12 months previously from communities served by 34 Aboriginal community-controlled health services and one community in the Torres Strait. Baseline surveys were conducted from April 2012 to October 2013.

Research methods of Talking About The Smokes: an International Tobacco Control Policy Evaluation Project study with Aboriginal and Torres Strait Islander Australians.

Objective: To describe the research methods and baseline sample of the Talking About The Smokes (TATS) project.

Design: The TATS project is a collaboration between research institutions and Aboriginal community-controlled health services (ACCHSs) and their state and national representative bodies. It is one of the studies within the International Tobacco Control Policy Evaluation Project, enabling national and international comparisons.

Dependence in a national sample of Aboriginal and Torres Strait Islander daily smokers.

Objectives: To examine indicators of nicotine dependence in a national sample of Aboriginal and Torres Strait Islander daily smokers and their association with sustaining a quit attempt for at least 1 month, and to make comparisons with a national sample of Australian daily smokers.

Design, Setting And Participants: The Talking About The Smokes project used a quota sampling design to recruit 1392 daily smokers from communities served by 34 Aboriginal community-controlled health services and one community in the Torres Strait from April 2012 to October 2013. These were compared with 1010 daily smokers from the general Australian population surveyed by the International Tobacco Control Policy Evaluation Project from September 2011 to February 2012.

Smoke-free homes and workplaces of a national sample of Aboriginal and Torres Strait Islander people.

Objective: To examine Aboriginal and Torres Strait Islander people's protection from second-hand smoke at home and work.

Design, Setting And Participants: The Talking About The Smokes project surveyed 2522 Aboriginal and Torres Strait Islander people from communities served by 34 Aboriginal community-controlled health services and one community in the Torres Strait, using quota sampling, from April 2012 to October 2013. We made comparisons with data from Australian smokers in the International Tobacco Control Policy Evaluation Project (ITC Project), collected from either July 2010 to May 2011 or September 2011 to February 2012.

Effect of a computer-guided, quality improvement program for cardiovascular disease risk management in primary health care: the treatment of cardiovascular risk using electronic decision support cluster-randomized trial.

Background: Despite effective treatments to reduce cardiovascular disease risk, their translation into practice is limited.

Methods And Results: Using a parallel arm cluster-randomized controlled trial in 60 Australian primary healthcare centers, we tested whether a multifaceted quality improvement intervention comprising computerized decision support, audit/feedback tools, and staff training improved (1) guideline-indicated risk factor measurements and (2) guideline-indicated medications for those at high cardiovascular disease risk. Centers had to use a compatible software system, and eligible patients were regular attendees (Aboriginal and Torres Strait Islander people aged ≥ 35 years and others aged ≥ 45 years).

Aboriginal community controlled health services: leading the way in primary care.

The national Closing the Gap framework commits to reducing persisting disadvantage in the health of Aboriginal and Torres Strait Islander people in Australia, with cross-government-sector initiatives and investment. Central to efforts to build healthier communities is the Aboriginal community controlled health service (ACCHS) sector; its focus on prevention, early intervention and comprehensive care has reduced barriers to access and unintentional racism, progressively improving individual health outcomes for Aboriginal people. There is now a broad range of primary health care data that provides a sound evidence base for comparing the health outcomes for Indigenous people in ACCHSs with the outcomes achieved through mainstream services, and these data show: models of comprehensive primary health care consistent with the patient-centred medical home model; coverage of the Aboriginal population higher than 60% outside major metropolitan centres; consistently improving performance in key performance on best-practice care indicators; and superior performance to mainstream general practice.

The transformative potential of young motherhood for disadvantaged Aboriginal and Torres Strait Islander women in Townsville, Australia.

Objective: To explore attitudes to pregnancy and parenthood among a group of Indigenous young people in Townsville, Australia.

Design And Participants: Mixed methods and a cross-sectional design involving Indigenous women from a Young Mums Group designing the research instruments and acting as peer interviewers. Data were collected in 2004 from young Indigenous people who had never been pregnant (171 students at three high schools and 15 people at a homeless youth shelter) using a computer-assisted self-administered survey; from 59 of this group who also participated in single sex focus group discussions; and from 10 pregnant and parenting young women in individual semi-structured interviews.

Assessing the accuracy of self-reported smoking status and impact of passive smoke exposure among pregnant Aboriginal and Torres Strait Islander women using cotinine biochemical validation.

Introduction And Aims: A significant level of misreport or error occurs during questionnaire-based assessment of smoking behaviour. Failure to measure environmental tobacco smoke, and participant's inclination to under-report their smoking raise questions as to the accuracy of assessment. In order to establish an estimation of the possible error associated with such assessment, the accuracy of self-reported smoking status among a group of pregnant Aboriginal and Torres Strait Islander women was examined.

Tobacco use and measuring nicotine dependence among urban Indigenous pregnant women.

Objectives: To examine patterns of nicotine dependence, the value of the Fagerström Test for Nicotine Dependence (FTND) and its correlation with self-reported tobacco use and urinary cotinine concentrations among pregnant Indigenous women in Townsville.

Design, Participants And Setting: Cross-sectional study of 201 consecutive women who self-reported tobacco use at their first antenatal visit to Townsville Aboriginal and Islander Health Service (TAIHS) between 1 November 2005 and 31 October 2007. All smokers were to be assessed by FTND, and 108 women participating in the Tilly's Tracks project (a randomised trial of an intervention to reduce smoking in pregnant Aboriginal and Torres Strait Islander women) were to have a comprehensive smoking history taken and urinary cotinine samples collected.

Sustainable antenatal care services in an urban Indigenous community: the Townsville experience.

Objective: To evaluate the impact of a sustained, community-based collaborative approach to antenatal care services for Indigenous women.

Design: Prospective quality improvement intervention, the Mums and Babies program, in a cohort of women attending Townsville Aboriginal and Islanders Health Service, 1 January 2000 - 31 December 2005 (MB group), compared with a historical control group (PreMB group), 1 January 1998 - 30 June 1999.

Main Outcome Measures: Proportion of women having inadequate antenatal care and screening; perinatal indicators.

Attitudes and behaviours of young Indigenous people in Townsville concerning relationships, sex and contraception: the "U Mob Yarn Up" project.

Objective: To gain some understanding of the attitudes and behaviours of Indigenous young people in Townsville concerning relationships, contraception and safe sex.

Design: Cross-sectional study using a computer-assisted self-administered survey and single-sex focus group discussions designed by a Young Mums' Group operating on participatory action principles and acting as peer interviewers.

Participants And Setting: 171 Indigenous students in Years 9-11 at three high schools and 15 residents of a homeless youth shelter in Townsville, Queensland, 27 April - 8 December 2004.

Consultations in general practice and at an Aboriginal community controlled health service: do they differ?

Introduction: Despite the widely acknowledged health disparities between Indigenous and non-Indigenous Australians, little is known about consultations in primary care with Indigenous people. In particular, the nature of consultations in the Aboriginal Community Controlled Health Service (ACCHS) sector has been rarely studied. Data collection about consultations in primary care has been steadily improving, with good quality data now available on an ongoing basis about patient demographics, risk factors and consultation content in private general practice.