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Element 4: Wellbeing is supported by best practice care that addresses the particular needs of a community

For Aboriginal and Torres Strait Islander communities, broadening the definition of best practice care to include not only evidence-based medicine, but also Aboriginal and Torres Strait Islander worldviews, will support wellbeing. Best practice care should also address the availability and accessibility of services and should empower communities to actively determine local healthcare priorities. Fostering a sense of empowerment is one strategy for supporting the wellbeing of entire communities. As there are complex interplays between physical, social, emotional, and spiritual aspects to health, it is important to develop multi-disciplinary teams that can adequately address the multiple dimensions of the health and wellbeing needs of people with chronic disease.

PRINCIPLES

Principle 4a: Utilising cultural and scientific evidence to provide best practice healthcare

Best practice care is based on the use of evidence from well-designed and conducted research in healthcare decision-making [references still to be inserted]. This includes ensuring continuous quality improvement through ongoing monitoring and regular evaluation [13, 14, 16, 43]. To adequately support wellbeing, it is important to expand current clinical understandings of ‘best practice’ to incorporate Aboriginal and Torres Strait Islander worldviews [13] and to include different types of evidence and knowledge where appropriate [5, 13].

Principle 4b: Ensuring that primary healthcare services are available, accessible and acceptable

By exploring with communities the factors that impede peoples’ engagement with healthcare services, including financial barriers [16, 20, 33], primary healthcare services can implement strategies to increase the availability, accessibility and acceptability of services in order to adequately meet local needs [13, 44, 45]. This may include facilitating access to specialist services [20], as well as ensuring adequate follow-up care in some cases [13].

Principle 4c: Empowering communities to be involved in determining local healthcare priorities

Encouraging open and continuous dialogue between communities and primary healthcare providers, and ensuring that communities are able to make informed decisions, will assist in ensuring that healthcare priorities are contextually relevant [5].

Principle 4d: Developing multi-disciplinary teams that support holistic care

In Aboriginal and Torres Strait Islander communities, it is important to recognise a broad range of conditions that could be considered chronic, including social, emotional, mental and spiritual health issues [6, 13]. Maintaining integrated teams of healthcare staff who can provide a range of services, including those that support social and emotional health as well as chronic disease management, will better meet the needs of people living with chronic conditions [13, 14, 16, 20, 44, 46].

APPLICATIONS

Applications associated with Principle 4a: Utilising cultural and scientific evidence to provide best practice healthcare

Evidence-based best practice healthcare may be applied by:

  • Including traditional healers, traditional bush medicines, and complementary healthcare within chronic disease care [6, 13, 49]
  • Ensuring staff are trained in evidence-based practice [13]
  • Identifying and implementing evidence-based best practice guidelines [43, 56, 64]
  • Identifying or developing, and then implementing minimum service standards [16, 25]
  • Responding to locally based clinical contexts [5, 13, 14, 28, 33, 49, 59]
  • Ensuring that information management systems support systematic, organised and coordinated evidence-based care [16, 33, 44]
  • Integrating existing information management systems to ensure that timely and accurate information is available to support the care that is provided to individuals [16, 49]
  • Capturing population-based data to identify the healthcare priorities of local setting [16, 44]
  • Ensuring that Aboriginal and Torres Strait Islander ethnicity is identified, where appropriate [16]
  • Developing the capacity of primary healthcare services for in-house research, monitoring and evaluation to reduce reliance on external research capacity [13]
Applications associated with Principle 4b: Ensuring that primary healthcare services are available, accessible and acceptable

Enhancing the availability, accessibility and acceptability of primary healthcare may be achieved by:

  • Establishing accessible primary healthcare services, including after-hours services and telephone support [13, 16, 33, 45]
  • Using technology (e.g. texting people reminders of appointments) and social media to encourage access to services [13]
  • Providing transport to primary healthcare facilities including vehicles that can accommodate people with limited mobility [13, 20, 31, 42, 44, 45, 47, 65]
  • Keeping waiting times to a minimum [13, 20, 45, 47]
  • Providing specialist outreach services where they are not readily accessible [13, 20, 33, 44, 45]
  • Encouraging the use of E-Health especially for transient clients [13]
  • Evaluating the acceptability of care provided to individuals and communities [31, 37, 43, 59]
Applications associated with Principle 4c: Empowering communities to be involved in determining local healthcare priorities

Ensuring that healthcare priorities are determined by empowered communities and primary healthcare services together may be achieved by:

  • Building and maintaining strong relationships between communities and primary healthcare services [6, 14, 16, 18, 20, 32, 36, 44, 66, 67]
  • Facilitating regular dialogue and continuous consultation between primary healthcare providers and communities [6, 14, 16, 44]
  • Providing information regarding consumer rights and formal processes for addressing consumer rights issues [55]
  • Demonstrating how primary healthcare services are addressing the priorities suggested by communities [16, 44]
  • Sharing information between healthcare providers and communities to empower community members to make informed decisions, both about their own healthcare and regarding community priorities for local healthcare services [6, 14, 16, 18, 36, 44]
Applications associated with Principle 4d: Developing multi-disciplinary teams that support holistic care

Holistic, multi-disciplinary chronic disease care may be developed by:

  • Setting goals for chronic disease care [17, 26, 31, 51]
  • Recruiting skilled healthcare staff into chronic disease roles [25, 59]
  • Ensuring that roles and responsibilities for chronic disease staff are transparent [14, 26, 33]
  • Establishing specific chronic disease training which can be easily transferred into practice settings [33]
  • Ensuring that chronic disease staff have the dedicated time required to build relationships and work together with clients [13, 30]
  • Developing teams that may include traditional healers, complementary health practitioners, pharmacists, psychologists, social workers, drug and alcohol workers, allied health staff, and non-clinical support workers [13, 55]
  • Maintaining strong leadership within chronic disease teams to ensure they function to best meet people’s needs [13]
  • Co-locating staff who treat and manage people with chronic disease [13]
  • Utilising people living with chronic diseases as members of chronic care teams, as mentors, or as community educators for health promotion [13]
  • Using care plans as required [13, 26, 54]
  • Ensuring continuity of care, especially when transitioning between healthcare and non-healthcare services [13, 16, 31]
  • Co-ordinating follow-up healthcare [13, 16, 31, 42, 44]
  • Facilitating peer support groups [13]
  • Assisting to coordinate care for people with multiple care providers [17, 26]
  • Brokering tertiary healthcare and non-healthcare services which are not available within the primary healthcare service [14, 46]
  • Establishing formal pathways for referral and interagency follow-up [55]