Understanding the structure and processes of primary health care for young indigenous children
Natalie A. Strobel 1 2 , Kimberley McAuley 1 , Veronica Matthews 3 , Alice Richardson 2 , Jason Agostino 4 , Ross Bailie 3 , Karen M. Edmond 1 , Daniel McAullay 1 51 Medical School, The University of Western Australia, Crawley, Western Australia, Australia
2 National Centre for Epidemiology & Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
3 University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
4 Academic Unit of General Practice, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
5 Kurongkurl Katitjin, Centre for Indigenous Australian Education and Research, Edith Cowan University, Mt Lawley, Western Australia, Australia
Correspondence to: Natalie A. Strobel, School of Biomedical Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia. Email: natalie.strobel@uwa.edu.au
Journal of Primary Health Care 10(3) 267-278 https://doi.org/10.1071/HC18006
Published: 28 August 2018
Journal Compilation © Royal New Zealand College of General Practitioners 2018.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: Primary health care organisations need to continuously reform to more effectively address current health challenges, particularly for vulnerable populations. There is growing evidence that optimal health service structures are essential for producing positive outcomes.
AIM: To determine if there is an association between process of care indicators (PoCIs) for important young indigenous child health and social issues and: (i) primary health-care service and child characteristics; and (ii) organisational health service structures.
METHODS: This was a cross-sectional study of 1554 clinical child health audits and associated system assessments from 74 primary care services from 2012 to 2014. Composite PoCIs were developed for social and emotional wellbeing, child neurodevelopment and anaemia. Crude and adjusted logistic regression models were fitted, clustering for health services. Odds ratios and 95% confidence intervals were derived.
RESULTS: Overall, 32.0% (449) of records had a social and emotional wellbeing PoCI, 56.6% (791) had an anaemia PoCI and 49.3% (430) had a child neurodevelopment PoCI. Children aged 12–23 months were significantly more likely to receive all PoCIs compared to children aged 24–59 months. For every one point increase in assessment scores for team structure and function (aOR 1.14, 95% CI 1.01–1.27) and care planning (aOR 1.14, 95% CI 1.01–1.29) items, there was a 14% greater odds of a child having an anaemia PoCI. Social and emotional wellbeing and child neurodevelopment PoCIs were not associated with system assessment scores.
DISCUSSION: Ensuring young indigenous children aged 24–59 months are receiving quality care for important social and health indicators is a priority. Processes of care and organisational systems in primary care services are important for the optimal management of anaemia in indigenous children.
KEYWORDS: Indigenous health; health services; health systems; paediatrics; epidemiology
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