Local community reporting models for regional primary health care organisations

Community reporting models used by primary health care organisations (PHCOs) in New Zealand, Canada (Ontario), England and Scotland were reviewed. The roles, functions and mandated community engagement requirements for these PHCOs varied, shaping the scope of their reporting. All countries included in this report recognised the importance of engaging the community in healthcare and the value of communication between service providers, service commissioners and the public. All countries were involved in receiving information from the community to inform decisions relating to the planning, design and implementation of health care services. It was, however, difficult to ascertain the extent of this involvement, and how well disadvantaged groups were included in this process

National key performance indicators for Aboriginal and Torres Strait Islander primary health care: results from December 2013

Captures data from over 200 primary health care organisations that receive funding from the Australian Government Department of Health to provide services primarily to Aboriginal and Torres Strait Islander people. Summary This is the second national report on the Indigenous primary health care national Key Performance Indicators (nKPIs) data collection. Data for this collection are provided to the AIHW by primary health care organisations who receive funding from the Department of Health to provide services to Aboriginal and Torres Strait Islander people. The purpose of the nKPIs is to improve the delivery of primary health care services by supporting continuous quality improvement (CQI) activity among service providers. The nKPIs also support policy and planning at the national and state and territory level by monitoring progress and highlighting areas for improvement.   The report presents data on 19 indicators (and 24 indicator measures) collected for 4 reporting periods over 2 years: June 2012, December 2012, June 2013 and December 2013. The number of organisations reporting increased substantially over the 4 reporting periods, from 90 in June 2012 to 207 in December 2013.   The indicators focus on chronic disease prevention and management, and on maternal and child health. There are 19 ‘process of care’ measures and 5 ‘health outcomes’ measures. The former are largely under the control of organisations and are therefore used to assess practices in primary health care. Health outcomes, on the other hand, are influenced by a wide range  of factors beyond the immediate control of primary health care organisations

A framework for regional primary health care to organise actions to address health inequities

“This is a post-peer-review, pre-copyedit version of an article published in International Journal of Public Health. The final authenticated version is available online at: http://dx.doi.org/10.1007/s00038-018-1083-9”. © Swiss School of Public Health (SSPH+) 2018Objectives Regional primary health-care organisations plan, co-ordinate, and fund some primary health-care services in a designated region. This article presents a framework for examining the equity performance of regional primary health-care organisations, and applies it to Australian Medicare Locals (funded from 2011 to 2015). Methods The framework was developed based on theory, literature, and researcher deliberation. Data were drawn from Medicare Local documents, an online survey of 210 senior Medicare Local staff, and interviews with 50 survey respondents. Results The framework encompassed equity in planning, collection of equity data, community engagement, and strategies to address equity in access, health outcomes, and social determinants of health. When the framework was applied to Medicare Locals, their inclusion of equity as a goal, collection of equity data, community engagement, and actions improving equity of access were strong, but there were gaps in broader advocacy, and strategies to address social determinants of health, and equity in quality of care. Conclusions The equity framework allows a platform for advancing knowledge and international comparison of the health equity efforts of regional primary health-care organisations

Exploration of funding models to support hybridisation of Australian primary health care organisations

Primary Health Care (PHC) funding in Australia is complex and fragmented. The focus of PHC funding in Australia has been on volume rather than comprehensive primary care and continuous quality improvement. As PHC in Australia is increasingly delivered by hybrid style organisations, an appropriate funding model that matches this set-up while addressing current issues with PHC funding is required. This article discusses and proposes an appropriate funding model for hybrid PHC organisations

Collaborative population health planning between Australian primary health care organisations and local government: lost opportunity

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Objective: To examine the strength and extent of collaborations between primary health care organisations and local government in population health planning. Methods: Methods included: a) online surveys with Medicare Locals (n=210) and Primary Health Networks (n=66), comparing the two using two‐level mixed models; b) interviews with Medicare Local (n=50) and Primary Health Network (n=55) executives; c) interviews with members of local government associations and Primary Health Network board members with local government experience (n=7); and d) review of 54 Medicare Local and 31 Primary Health Network publicly available annual reports. Results: Despite partnership being a policy objective for Medicare Locals/ Primary Health Networks, they reported limited time and financial support for collaboration with local government. Organisational capacity and resources, supportive governance and public health legislation mandating a role for local governments were critical to collaborative planning. Conclusions: Local government has the potential to tackle social factors affecting health; therefore, their inclusion in population health planning is valuable. Legislative mandates would help to achieve this, and PHNs require a stronger Federal Government mandate backed by sufficient resources and a governance structure that supports collaboration. Implications for public health: Improving primary health care and local government collaboration has great potential to improve the quality of health planning and action on social determinants, thus advancing population health and health equity

Improving the reporting efficiency for Aboriginal Community Controlled Health Organisations: progress over a decade

This issues brief examines the evolution of the reporting requirements of Aboriginal Community Controlled Health Organisations (ACCHOs) over the last ten years, with a particular focus on programs funded by the Australian Government Department of Health (the Department). With one exception, the issues brief examines key initiatives implemented by the Department, up to the end of 2013, in an attempt to improve reporting arrangements for ACCHOs. It also examines the impacts of these changes on reporting efficiency. The exception is the Healthy for Life Program. The program is included here because it pioneered Continuous Quality Improvement and outcomes based reporting and as such influenced subsequent reporting developments. The key initiatives are: the Service Development and Reporting Framework (SDRF) (2005 to 2011); the Healthy for Life program (2005 and continuing); the Indigenous and Rural Health Division (formerly Office for Aboriginal and Torres Strait Islander Health) Risk Assessment Process (2008 to 2013); developments in Information Technology and Information Management, with a particular focus on the OCHREStreams web-based reporting tool (2011 and continuing); and a multi-year funding agreement (2011 and continuing). These initiatives have brought about some significant improvements in reporting efficiency, including: standardisation of reporting requirements across several programs under the SDRF, with a consequent reduction in reporting complexity and effort and adoption of a more strategic cross-program approach to planning and reporting; a shift to outcomes based planning and reporting as part of a continuous quality improvement cycle, and an increase in the data management skills and systems needed to support continuous quality improvement; progressive move to independent risk assessment that focused primarily on governance and financial management, which has driven improvements in the quality of financial reporting; the development and roll-out of a web-based reporting tool that allows ACCHOs to submit organisational and service activity data, as well as data for national Key Performance Indicators; and further standardisation of reporting requirements under the Department’s multi-year funding agreement. Despite these improvements, ACCHOs still face a complex and resource intensive reporting load. Current reporting requirements are discussed in some detail, along with a range of possible improvements that could be made with the aim of avoiding unnecessary reporting yet maintaining information flows for policy and programme design implementation and review supporting the accountability requirements of public funds and supports continuous quality improvement in the sector. These include: working with other funders, particularly the states, to coordinate and standardise reporting requirements, with a possible extension of OCHREStreams to enable it to be used by states for some aspects of reporting; reviewing the extensive data reporting-related requirements with a view to removing those that are of least value to the Commonwealth and the sector; and where formal accountability requirements permit, moving progressively away from reporting on inputs and throughputs in favour of outcomes-based reporting, with possible use of targets and benchmarks to enable organisations to track performance. The identified improvements provide a framework for continuing to work towards maximising reporting efficiency which will help to address a range of strategic outcomes including the Aboriginal and Torres Strait Islander Health Plan (2013–2023) priorities. It should be noted that whilst this issues brief references only arrangements until the end of 2013, there have been considerable reporting changes and initiatives since that time

Healthy communities: immunisation rates for children in 2011-12

Immunisation helps protect individuals and the community generally against potentially serious diseases such as measles, polio, tetanus and whooping cough (pertussis). Although the great majority of children in Australia are immunised, it is important to maintain high immunisation rates to reduce the risk of outbreaks of these and other diseases recurring. Australian governments and experts endorse achieving high immunisation rates to protect individuals and those not immunised or too young to be immunised. States and territories are expected to maintain or improve their existing respective immunisation rates under the terms of the National Partnership Agreement on Essential Vaccines agreed in 2009. This report allows the public, clinicians and health managers to see for all children, and for Aboriginal and Torres Strait Islander children, the percentages fully immunised and how those percentages differ across the country. It reports these immunisation rates for each of the 61 geographic areas covered by the new network of Medicare Locals, which have been established to improve the responsiveness, coordination and integration of local health services. These data were sourced from the Australian Childhood Immunisation Register (ACIR). It is important to note that these data cover the period from July 2011 to June 2012. As Medicare Locals were still being set up during this time, this report establishes a baseline for comparisons that in future will help clinicians, health managers and others to assess whether improvements are occurring. Where possible, the results are broken down into geographic areas that are smaller than Medicare Local catchments – more than 300 statistical areas and more than 1500 postcodes. The report shows the percentages of children who were fully immunised at 1 year, 2 years and 5 years in each Medicare Local catchment, and in the smaller units of geography where applicable. Also reported are the numbers of children in each area who are not fully immunised. Key findings: The report’s findings can be considered in the context of three broad themes: The percentages of children fully immunised and variation between Medicare Local catchments, and between age groups The numbers of children who are not fully immunised in each Medicare Local catchment Lower immunisation rates among Aboriginal and Torres Strait Islander children

How institutional forces, ideas and actors shaped population health planning in Australian regional primary health care organisations

BACKGROUND: Worldwide, there are competing norms driving health system changes and reorganisation. One such norm is that of health systems’ responsibilities for population health as distinct from a focus on clinical services. In this paper we report on a case study of population health planning in Australian primary health care (PHC) organisations (Medicare Locals, 2011–2015). Drawing on institutional theory, we describe how institutional forces, ideas and actors shaped such planning. METHODS: We reviewed the planning documents of the 61 Medicare Locals and rated population health activities in each Medicare Local. We also conducted an online survey and 50 interviews with Medicare Local senior staff, and an interview and focus group with Federal Department of Health staff. RESULTS: Despite policy emphasis on population health, Medicare Locals reported higher levels of effort and capacity in providing clinical services. Health promotion and social determinants of health activities were undertaken on an ad hoc basis. Regulatory conditions imposed by the federal government including funding priorities and time schedules, were the predominant forces constraining population health planning. In some Medicare Locals, this was in conflict with the normative values and what Medicare Locals felt ought to be done. The alignment between the governmental and the cultural-cognitive forces of a narrow biomedical approach privileged clinical practice and ascribed less legitimacy to action on social determinants of health. Our study also shed light on the range of PHC actors and how their agency influenced Medicare Locals’ performance in population health. The presence of senior staff or community boards with a strong commitment to population health were important in directing action towards population health and equity. CONCLUSIONS: There are numerous institutional, normative and cultural factors influencing population health planning. The experience of Australian Medicare Locals highlights the difficulties of planning in such a way that the impact of the social determinants on health and health equity are taken into account. The policy environment favours a focus on clinical services to the detriment of health promotion informed by a social determinants focus

Informing implementation of quality improvement in Australian primary care

Background: Quality Improvement (QI) initiatives in primary care are effective at improving uptake of evidence based guidelines, but are difficult to implement and sustain. In Australia meso-level health organisations such as Primary health care Organisations (PHCO) offer new opportunities to implement area-wide QI programs. This study sought to identify enablers and barriers to implementation of an existing Australian QI program and to identify strategic directions that PHCOs can use in the ongoing development of QI in this environment. Methods: Semi-structured telephone interviews were conducted with 15 purposively selected program staff and participants from the Australian Primary Care Collaborative (APCC) QI program. Interviewees included seven people involved in design, administration and implementation of the APCC program and eight primary care providers (seven General Practitioners (GPs) and one practice nurse) who had participated in the program from 2004 to 2014. Interviewees were asked to describe their experience of the program and reflect on what enabled or impeded its implementation. Interviews were recorded, transcribed and iteratively analysed, with early analysis informing subsequent interviews. Identified themes and their implications were reviewed by a GP expert reference group. Results: Implementation enablers and barriers were grouped into five thematic areas: (1) leadership, particularly the identification and utilisation of change champions; (2) organisational culture that supports quality improvement; (3) funding incentives that support a culture of quality and innovation; (4) access to and use of accurate data; and 5) design and utilisation of clinical systems that enable and support these issues. In all of these areas, the active involvement of an overarching external support organisation was considered a key ingredient to successful implementation. Conclusion: There are substantial opportunities for PHCOs to play a pivotal role in QI implementation in Australia and internationally. In developing QI programs and policies, such organisations ought to invest their efforts in: (1) identifying and mentoring local leaders; (2) fostering QI culture via development of local peer networks; (3) developing and advocating for alternative funding models to support and incentivise these activities; (4) investing in data and audit tool infrastructure; and (5) facilitation of systems implementation within primary care practices

Aboriginal and Torres Strait Islander health organisations: online services report - key results 2012-13

Summary: This fifth national report provides an overview of 260 Australian Government-funded organisations that aim to improve health outcomes for Aboriginal and Torres Strait Islander people. It presents findings from the 2012-13 data collection on health services and activities provided, clients seen, staffing levels and challenges faced by these organisations. In 2012-13, most (83%) organisations delivered health services through one site, while 17% reported two or more delivery sites. Two-thirds of organisations (67%) were Aboriginal Community Controlled Health Organisations (ACCHOs), 15% were other non-government organisations and 18% were government-run. Most organisations (70%) were accredited against either the Royal Australian College of General Practitioners (RACGP) or organisational standards. This was higher compared with 2011-12 (64%). Staffing increased in primary health-care services In 2012-13, 205 (79%) organisations provided primary health-care services to Aboriginal and Torres Strait Islander people, and there were 21 fewer primary health-care organisations in the data collection than in 2011-12 due to rationalisation of reporting requirements. Nevertheless, the number of full-time equivalent (FTE) staff employed increased by over 20%, from about 5,500 as at 30 June 2012 to around 6,700 FTE staff as at 30 June 2013. This increase may be due to additional Australian Government funding for new positions. These organisations were also assisted by 330 FTE visiting health professionals, paid for by other organisations. The primary health-care organisations served around 417,000 clients in around 4.1 million contacts. The number of clients decreased by 6% compared with 2011-12 (445,000), partly due to the lower number of organisations in the data collection. Combined with increasing staff numbers, this led to an increased staff to client ratio in every remoteness area. Most counsellors in social and emotional wellbeing or Link Up counselling services were Indigenous In 2012-13, 98 (38%) organisations provided social and emotional wellbeing or Link Up counselling services. These organisations employed 186 counsellors and nearly two-thirds of these (64%) were Indigenous. Around 17,700 clients had around 89,100 contacts in total. New substance-use organisations increased client numbers and episodes of care In 2012-13, 63 (24%) organisations provided substance-use services. These included new organisations with large client bases. As a result, both episodes of care (around 305,000) and client numbers (around 50,000) were much higher compared with 2011-12 (74,000 and 32,600 respectively). Most episodes of care (91%) were for non-residential, follow-up or after care services. Key gaps and challenges Sixty-two percent of all organisations reported mental health and social and emotional health and wellbeing as a service delivery gap in their communities. Recruitment, training and support of Aboriginal and Torres Strait Islander staff (70%) and staffing levels (58%) were reported as key challenges to providing quality services