Increasing health assessments in Aboriginal Community Controlled Health Services

A multiple baseline study design will be undertaken which utilises a continuous quality improvement (CQI) approach. Three Aboriginal Community Controlled Health Services (ACCHSs) located in New South Wales will be invited to participate. An Aboriginal Advisory Group will be established to provide guidance regarding all aspects of the research including ACCHS selection and engagement, the development of the research protocol and its implementation, and evaluation and reporting of results. Baseline prevalence data will be undertaken immediately prior to intervention implementation. The 9-month intervention will be implemented in all ACCHSs and follow-up data collected upon completion. Repeated, cross-sectional measurement of the primary outcomes will occur for each ACCHS on a monthly basis during the intervention period using automated electronic medical record reports to facilitate feedback to sites. The proportion of active patients aged 18 and over years with an up-to-date Health Assessment in their medical record, and the proportion of smokers who have received best practice smoking cessation care, will be compared between baseline and 9-month follow-up. Prior to intervention implementation, The intervention will be tailored to the needs of each ACCHS and are designed to address barriers to care at system, healthcare provider and client level. Project record will be kept to monitor the implementation of all intervention strategies. A base set of strategies will be provided to ACCHSs. The base strategies will include: 1) Establishing targets/successive approximations. It is expected that each ACCHS will be performing at levels in delivering MBS Item 715. Consequently, there will be negotiation each ACCHS regarding changes that might be expected in the initial three month period following the initiation of the intervention phases. This negotiation will follow the principles for behavioural change and therefore attempt to make the targets achievable. This will allow for successive approximations, and provide an opportunity for the clinic to have success. 2) Training regarding Health Assessments and smoking cessation care. The training module will be developed by the researchers in collaboration with the ACCHSs and the Aboriginal Advisory Group. To support the training, training manuals and power point presentations will be developed. A General Practitioner (GP) at each ACCHS will provide the training to other GPs, practice nurses and Aboriginal Health Workers at group training session where practicable or one on one sessions. Training will occur on ACCHS premises. Training will be provided once, however booster training will be provided where ACCHSs conclude where it will be helpful. Training will be provided to all new staff who join an ACCHS during the study period. 3) Electronic medical record template for recording Health Assessments. A template will developed in consultation with the ACCHSs and the Aboriginal Advisory Group that is in line with the National Guide to a Preventive Health Assessment for Aboriginal and Torres Strait Islander People. Although a number of the electronic templates exist, none completely align with these guidelines in terms of the health items to be included and how the health items should be assessed. 4) Monthly feedback on performance regarding the implementation of 715 Health Assessments and smoking cessation care. Feedback to the ACCHS about their baseline performance will be provided by a member of the research teamand will continue to be provided every fortnight. Performance feedback will be provided to ACCHSs every month in a variety of formats tailored for CEOs, Board, ACCHS managers, GPs, nurses and health workers. Graphical and text feedback will indicate the proportion of eligible patients with an up-to-date Health Assessment, highlighting the benefits to patients. 5) Culturally appropriate patient resources. A readily available resource will be used that has been developed by the Australian Governments Health Department (Your Health is in Your Hands). Dependent upon agreed performance levels (see strategy 1), 3 months after intervention commencement additional strategies will be provided to ACCHSs to address barriers to care delivery. Potential additional strategies will be developed in consultation with ACCHSs staff and will be dependent on ACCHSs existing process and the local context. These strategies may include: 6) Electronic patient recall/follow-up and reminder systems; 7) Prompts in the electronic medical record to opportunistically undertake Health Assessments and provide smoking cessation care; 8) Electronic referral to the NSW Health Aboriginal Quitline: 9) Dedicated Health Assessment clinic days; and 10) Patient incentives to attend for Health Assessments.