Mental healthcare pathways for urban Aboriginal children

Social and emotional wellbeing problems are the chief health issue experienced by young Australians. The small amount of information available suggests that Aboriginal young people experience even higher levels of mental health related harm. Little is known about the pathways that Aboriginal children and adolescents with mental health concerns take when accessing specialized care and to what extent services are available, accessible and culturally appropriate. Further, although GPs are generally considered the gatekeepers to accessing specialist mental health services it is unclear the extent to which they feel confident and equipped to detect, assess and refer children for suspected mental health concerns, particularly in Aboriginal children. This compilation of work sought to understand whether current guidelines and treatment pathways meet the needs of Aboriginal young people presenting with SEWB-related concerns and the extent to which GPs, nurses and Aboriginal Health Workers feel confident and equipped to deal with the mental health concerns they see in the children they deal with in their work at the Aboriginal Community Controlled Health Services (ACCHSs). To gain this understanding two systematic reviews and a qualitative study were conducted.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy.This work was supported through grants to SEARCH from the Australian Primary Care Research Institute, the National Health and Medical Research Council of Australia (grant numbers 358457, 512685, 1023998 and 1035378), the NSW Ministry of Health, beyondblue and the Rio Tinto Aboriginal Fund. The CRE and SEARCH are conducted in partnership with the AH&MRC and four Aboriginal medical services across NSW: Awabakal Limited, Riverina Medical and Dental Aboriginal Corporation, Sydney West Aboriginal Health Service, and Tharawal Aboriginal Corporation

Inequalities in pediatric avoidable hospitalizations between Aboriginal and non-Aboriginal children in Australia: a population data linkage study

Background: Australian Aboriginal children experience a disproportionate burden of social and health disadvantage. Avoidable hospitalizations present a potentially modifiable health gap that can be targeted and monitored using population data. This study quantifies inequalities in pediatric avoidable hospitalizations between Australian Aboriginal and non-Aboriginal children. Methods: This statewide population-based cohort study included 1 121 440 children born in New South Wales, Australia, between 1 July 2000 and 31 December 2012, including 35 609 Aboriginal children. Using linked hospital data from 1 July 2000 to 31 December 2013, we identified pediatric avoidable, ambulatory care sensitive and non-avoidable hospitalization rates for Aboriginal and non-Aboriginal children. Absolute and relative inequalities between Aboriginal and non-Aboriginal children were measured as rate differences and rate ratios, respectively. Individual-level covariates included age, sex, low birth weight and/or prematurity, and private health insurance/patient status. Area-level covariates included remoteness of residence and area socioeconomic disadvantage. Results: There were 365 386 potentially avoidable hospitalizations observed over the study period, most commonly for respiratory and infectious conditions; Aboriginal children were admitted more frequently for all conditions. Avoidable hospitalization rates were 90.1/1000 person-years (95 % CI, 88.9–91.4) in Aboriginal children and 44.9/1000 person-years (44.8–45.1) in non-Aboriginal children (age and sex adjusted rate ratio = 1.7 (1.7–1.7)). Rate differences and rate ratios declined with age from 94/1000 person-years and 1.9, respectively, for children aged <2 years to 5/1000 person-years and 1.8, respectively, for ages 12- < 14 years. Findings were similar for the subset of ambulatory care sensitive hospitalizations, but in contrast, non-avoidable hospitalization rates were almost identical in Aboriginal (10.1/1000 person-years, (9.6–10.5)) and non-Aboriginal children (9.6/1000 person-years (9.6–9.7)). Conclusions: We observed substantial inequalities in avoidable hospitalizations between Aboriginal and non-Aboriginal children regardless of where they lived, particularly among young children. Policy measures that reduce inequities in the circumstances in which children grow and develop, and improved access to early intervention in primary care, have potential to narrow this gap

Thematic list of projects using linked data relating to Aboriginal and Torres Strait Islander people

This report contains an alphabetical listing and description of past (published since 1991), current and planned data linkage studies relating to Aboriginal and Torres Strait Islander people. The publication provides a brief listing of: the name of the projectthe names of the investigatorsthe date of the studythe jurisdiction where the study is basedthe datasets used in the studythe core issue, or theme, of the studythe method of analysisthe method or algorithms used or intended to be used to derive Indigenous status information, if required. This list should be read in conjunction with the National best practice guidelines for data linkage activities relating to Aboriginal and Torres Strait Islander People and its online attachment, Report on the use of linked data relating to Aboriginal and Torres Strait Islander people. The list was compiled from consultations with jurisdictional departments and researchers who use linked data relating to Aboriginal and Torres Strait Islander Australians and from reports and academic journal articles that describe the analysis of linked data relating to Aboriginal and Torres Strait Islander Australians

Assessing preventable hospitalisation indicators (APHID): protocol for a data-linkage study using cohort study and administrative data

Introduction Potentially preventable hospitalisation (PPH) has been adopted widely by international health systems as an indicator of the accessibility and overall effectiveness of primary care. The Assessing Preventable Hospitalisation InDicators (APHID) study will validate PPH as a measure of health system performance in Australia and Scotland. APHID will be the first large-scale study internationally to explore longitudinal relationships between primary care and PPH using detailed person-level information about health risk factors, health status and health service use. Methods and analysis APHID will create a new longitudinal data resource by linking together data from a large-scale cohort study (the 45 and Up Study) and prospective administrative data relating to use of general practitioner (GP) services, dispensing of pharmaceuticals, emergency department presentations, hospital admissions and deaths. We will use these linked person-level data to explore relationships between frequency, volume, nature and costs of primary care services, hospital admissions for PPH diagnoses, and health outcomes, and factors that confound and mediate these relationships. Using multilevel modelling techniques, we will quantify the contributions of person-level, geographic-level and service-level factors to variation in PPH rates, including socioeconomic status, country of birth, geographic remoteness, physical and mental health status, availability of GP and other services, and hospital characteristics. Ethics and dissemination Participants have consented to use of their questionnaire data and to data linkage. Ethical approval has been obtained for the study. Dissemination mechanisms include engagement of policy stakeholders through a reference group and policy forum, and production of summary reports for policy audiences in parallel with the scientific papers from the study.</p

Mortality after admission for acute myocardial infarction in Aboriginal and non-Aboriginal people in New South Wales, Australia: a multilevel data linkage study

Background - Heart disease is a leading cause of the gap in burden of disease between Aboriginal and non-Aboriginal Australians. Our study investigated short- and long-term mortality after admission for Aboriginal and non-Aboriginal people admitted with acute myocardial infarction (AMI) to public hospitals in New South Wales, Australia, and examined the impact of the hospital of admission on outcomes. Methods - Admission records were linked to mortality records for 60047 patients aged 25–84 years admitted with a diagnosis of AMI between July 2001 and December 2008. Multilevel logistic regression was used to estimate adjusted odds ratios (AOR) for 30- and 365-day all-cause mortality. Results - Aboriginal patients admitted with an AMI were younger than non-Aboriginal patients, and more likely to be admitted to lower volume, remote hospitals without on-site angiography. Adjusting for age, sex, year and hospital, Aboriginal patients had a similar 30-day mortality risk to non-Aboriginal patients (AOR: 1.07; 95% CI 0.83-1.37) but a higher risk of dying within 365 days (AOR: 1.34; 95% CI 1.10-1.63). The latter difference did not persist after adjustment for comorbid conditions (AOR: 1.12; 95% CI 0.91-1.38). Patients admitted to more remote hospitals, those with lower patient volume and those without on-site angiography had increased risk of short and long-term mortality regardless of Aboriginal status. Conclusions - Improving access to larger hospitals and those with specialist cardiac facilities could improve outcomes following AMI for all patients. However, major efforts to boost primary and secondary prevention of AMI are required to reduce the mortality gap between Aboriginal and non-Aboriginal people

An investigation into how Aboriginal Medical Services contribute to childhood immunisation

While there are diverse immunisation service providers, according to the Australian Childhood Immunisation Register (ACIR), less than 1% of all childhood vaccinations (equating to less than 10% of all Aboriginal children) are recorded as being delivered by an Aboriginal Medical Service (AMS). This is likely to be an under-estimate of the care provided. This study sought to determine to what extent AMS’s contribute to the immunisation of Aboriginal children in their local areas. Results The findings revealed that AMS’s in NSW are taking active steps to achieve an improvement in coverage and timeliness of immunisations that occur under NCIP for Aboriginal Children. In addition, the observations revealed various systematic processes in some AMS’s that directly contributed to up to 96% coverage of NCIP vaccines for regular clients. It also highlighted specific program implementation and community events that compliment immunisation through health promotion, reminders and follow up at different AMS’s. Conclusion This study showed that the ‘personality’ and commitment of individual AMS’s contributed significantly to the coverage rates of the children less than 5 years of age in the local areas of the AMS’s that participated in this study. Further investigation is needed to assess data collection at ACIR

Disparities in cataract surgery between Aboriginal and non-Aboriginal people in New South Wales, Australia

&lt;b&gt;Background:&lt;/b&gt; To investigate variation in rates of cataract surgery in New South Wales (NSW), Australia by area of residence for Aboriginal and non-Aboriginal adults.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Design:&lt;/b&gt; Observational data linkage study of hospital admissions.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Participants:&lt;/b&gt; 289 646 NSW residents aged 30 years and over admitted to NSW hospitals for 444 551 cataract surgery procedures between 2001 and 2008.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods:&lt;/b&gt; Analysis of linked routinely collected hospital data using direct standardisation and multilevel negative binomial regression models accounting for clustering of individuals within Statistical Local Areas (SLAs).&lt;p&gt;&lt;/p&gt; &lt;b&gt;Main outcome measures:&lt;/b&gt; Age-standardised cataract surgery rates and adjusted rate ratios (ARRs).&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results:&lt;/b&gt; Aboriginal people had lower rates of cataract procedures than non-Aboriginal people of the same age and sex, living in the same SLA (ARR 0.71, 95% CI 0.68-0.75). There was significant variation in cataract surgery rates across SLAs for both Aboriginal and non-Aboriginal people, with the disparity higher in major cities and less disadvantaged areas. Rates of surgery were lower for Aboriginal than non-Aboriginal people in most SLAs, but in a few, the rates were similar or higher for Aboriginal people.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions:&lt;/b&gt; Aboriginal people in NSW received less cataract surgery than non-Aboriginal people, despite evidence of higher cataract rates. This disparity was greatest in urban and wealthier areas. Higher rates of surgery for Aboriginal people observed in some specific locations are likely to reflect the availability of public ophthalmology services, targeted services for Aboriginal people and higher demand for surgery in these populations.&lt;p&gt;&lt;/p&gt

Knowledge exchange and research capacity building in urban Aboriginal health

The Centre for Research Excellence (CRE) on urban Aboriginal Child Health is linked to this unique base of information on 1600 children and their parents/ caregivers. The Centre is designed to: (a) increase the translation of knowledge arising from the SEARCH program and additional data collection undertaken as part of the CRE; (b) to enable ACCHSs to effectively use the information emerging from SEARCH to improve the quality of primary care, and; (c) enhance research capacity in primary health care within ACCHSs by increasing their capacity to undertake multidisciplinary research and knowledge translation in primary care. This work will provide evidence to support sustainable and transferable improvements in Aboriginal primary health care and, ultimately, health outcomes.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy