What works? A review of actions addressing the social and economic determinants of Indigenous health

Introduction: The purpose of this paper is to review evidence relating to ‘what works’ to influence the social and economic determinants of Indigenous health, in order to reduce health inequities, and ultimately contribute to closing the life expectancy gap between Indigenous and non-Indigenous Australians. We outline a conceptual framework for understanding how social and economic determinants influence health and wellbeing, and identify a number of key determinants of health. We review evidence relating to how each determinant is associated with Indigenous health and wellbeing, and then consider specific actions designed to improve Indigenous outcomes in each of these areas in order to determine the characteristics of successful initiatives. Based on our conceptual framework, we link successful actions which result in positive outcomes for Indigenous Australians in each of the key determinants to ultimately improving health and wellbeing and contributing towards ‘closing the gap’ in health and wellbeing. We note that many actions we consider only aim to improve the situation for Indigenous Australians in regard to that specific area (for example, education, housing) and were not devised to take direct action to improve health, even though the evidence indicates that those actions may be likely to contribute to improved health over the longer term

The contribution of Primary Health Care Research, Evaluation and Development-supported research to primary health care policy and practice

The importance of primary health care (PHC) research is well understood yet conducting this research can be challenging. Barriers include a lack of funding, support and opportunity. In 2000 the Australian government introduced the Primary Health Care Research, Evaluation and Development (PHCRED) Strategy to address the gap in high-quality research. One component of the strategy, the Research Capacity Building Initiative, provided funding to university departments of general practice and rural health, allowing them to expand their pool of researchers and produce more research relevant to policy and practice. This study investigates the impact of phase two of the PHCRED Strategy by analysing peer-reviewed publications from PHCRED-supported departments. Research output was recorded from 2006 to 2010 incorporating 661 publications in 212 journals. Rural departments often had fewer resources than urban departments yet demonstrated steady research contributions focusing on issues relevant to their community. Since its inception the PHCRED Strategy has enabled development of research capacity and contributed to the body of PHC knowledge. While PHC is a diverse field, reflected in the publications produced, the themes underlying much of this work were representative of current health reform and the priority areas and building blocks of the National PHC Strategy

PHC and integration with aged care services: Challenges and approaches in Australia

Recent Australian health reforms highlight the role of effective primary health care (PHC) in providing coordinated, person-centred care and keeping individuals out of hospital.1 In the context of an ageing population and rising rates of chronic and complex conditions, there is growing demand for health services. Collaboration is needed across all service providers who support older people, including integrating PHC with aged care services. This RESEARCH ROUNDup highlights current challenges and approaches to such integration in Australia

Complementary medicine use in chronic disease: What is the evidence?

The use of complementary and alternative medicine (CAM) is commonplace in people managing chronic disease. This RESEARCH ROUNDup highlights evidence for the medication-based CAM used to address chronic conditions considered national priority areas in Australia. Nevertheless, more high quality evidence on prevalence of use, concurrent use of other medications and profiles of CAM users particularly for specific conditions is required for consumers, clinicians (both CAM and non-CAM), regulators, educators, researchers, policy-makers and funders

Primary health care and preventive care

Preventive care refers to interventions which aim to prevent progression of a condition. They may be applied at individual or population levels and at various stages of disease development. For the primary health care (PHC) sector, preventive care is a priority and a challenge. This RESEARCH ROUNDup reviews preventive care in the PHC setting including consideration of time, resources and strategies in an Australian context

Pay for performance: Australian landscape, international efforts, and impact on practice

Fee-for-service (FFS) funding continues to dominate primary health care in Australia despite calls for reform. FFS, where providers bill for each service they provide, rewards increased activity. This may lead to over-servicing, increased costs (with no controls on prices charged), and negative impacts on quality of care. In contrast, pay-for-performance (P4P) approaches refer to payments to general practitioners (GPs) or practices, according to the number of times a certain standard of performance is met, and have been shown to improve quality.1; 2 Blended funding models have been trialled in Australia, with the 2011-14 Diabetes Care Project (DCP) incorporating P4P and flexible funding, while retaining FFS components. This RESEARCH ROUNDup will examine P4P in the Australian primary health care context and provide lessons from both systematic reviews and international experiences of P4P in primary health care

Primary health care funding models

The way primary health care (PHC) services are funded ultimately impacts on the quality, access and coordination of health service delivery. Financial mechanisms have long been used to influence provider behaviour, for example to increase productivity, control costs and improve efficiency.1 Health system administrators are charged with the task of meeting growing demand for services with finite resources, emphasising quality and placing a financial value on it. This RESEARCH ROUNDup examines the funding models that impact on PHC service delivery

Transitions from hospital to primary care

For older Australians, transitions from hospital to primary care (i.e. general practice, community and/or aged care) are frequently accompanied by discontinuities in medication management, delays in follow‐up care, duplication of tests, adverse events and readmissions to hospital. This RESEARCH ROUNDup describes factors affecting smooth transitions and provides examples of best practice

Information sharing & exchange

A presentation given as part of the inaugral Knowledge Exchange Capacity Building Workshop for Higher Degree Students. This workshop took place as a satellite event to the 2014 Primary Health Care Research Conference in Canberra on 22 July, the aim of the event was to encourage a philosophy of knowledge exchange early in researchers’ careers. It included information on resources and tools to help students with planning, conducting and disseminating research. It created opportunities for networking with student colleagues from around Australia, and offered delegates the chance to speak with more experienced researchers, as well as gain an insight into knowledge exchange and how they might apply such a framework in their research

Allied health integration: Collaborative care for arthritis and other musculoskeletal conditions

Musculoskeletal conditions, including rheumatoid arthritis, osteoarthritis and osteoporosis, are prevalent in the Australian population, and they impose a substantial burden on the health care system and the community, reflected by their status as a national health priority area. They are the main cause of impaired physical functioning globally. These conditions have high chronicity rates and often have a long term impact, leading to reduced mobility and dexterity, chronic pain, reduced capacity for employment, and negative impact on family and social life. Much of the care for these conditions is provided in primary health care (PHC) settings