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首页> 外文期刊>BMC Health Services Research >Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment
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Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment

机译：为土著居民和托雷斯海峡岛民建立更好的护理系统：Kanyini卫生系统评估的结果

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Background Australian federal and jurisdictional governments are implementing ambitious policy initiatives intended to improve health care access and outcomes for Aboriginal and Torres Strait Islander people. In this qualitative study we explored Aboriginal Medical Service (AMS) staff views on factors needed to improve chronic care systems and assessed their relevance to the new policy environment. Methods Two theories informed the study: (1) ‘candidacy’, which explores “the ways in which people’s eligibility for care is jointly negotiated between individuals and health services”; and (2) kanyini or ‘holding’, a Central Australian philosophy which describes the principle and obligations of nurturing and protecting others. A structured health systems assessment, locally adapted from Chronic Care Model domains, was administered via group interviews with 37 health staff in six AMSs and one government Indigenous-led health service. Data were thematically analysed. Results Staff emphasised AMS health care was different to private general practices. Consistent with kanyini, community governance and leadership, community representation among staff, and commitment to community development were important organisational features to retain and nurture both staff and patients. This was undermined, however, by constant fear of government funding for AMSs being withheld. Staff resourcing, information systems and high-level leadership were perceived to be key drivers of health care quality. On-site specialist services, managed by AMS staff, were considered an enabling strategy to increase specialist access. Candidacy theory suggests the above factors influence whether a service is ‘tractable’ and ‘navigable’ to its users. Staff also described entrenched patient discrimination in hospitals and the need to expend considerable effort to reinstate care. This suggests that Aboriginal and Torres Strait Islander people are still constructed as ‘non-ideal users’ and are denied from being ‘held’ by hospital staff. Conclusions Some new policy initiatives (workforce capacity strengthening, improving chronic care delivery systems and increasing specialist access) have potential to address barriers highlighted in this study. Few of these initiatives, however, capitalise on the unique mechanisms by which AMSs ‘hold’ their users and enhance their candidacy to health care. Kanyini and candidacy are promising and complementary theories for conceptualising health care access and provide a potential framework for improving systems of care.
机译：背景技术澳大利亚联邦和辖区政府正在实施雄心勃勃的政策计划，旨在改善原住民和托雷斯海峡岛民的医疗服务并提高其结果。在这项定性研究中，我们探讨了原住民医疗服务（AMS）工作人员对改善慢性护理系统所需因素的看法，并评估了其与新政策环境的相关性。方法该研究采用两种理论：（1）“候选人资格”，探讨“个人与卫生服务机构共同协商人们的医疗资格的方式”; （2）kanyini或“控股”，这是澳大利亚中部的一种哲学，描述了培育和保护他人的原则和义务。通过对六个AMS中的37名医护人员和一个政府原住民领导的医疗服务机构进行的小组访谈，进行了一项结构化的医疗系统评估，该评估是根据当地慢性病护理模式领域进行局部调整的。对数据进行专题分析。结果工作人员强调，AMS的医疗保健不同于私人的一般做法。与kanyini一致，社区治理和领导力，员工在社区中的代表权以及对社区发展的承诺是保留和培养员工和患者的重要组织特征。但是，由于一直担心政府会拒绝提供用于AMS的资金，因此削弱了这一点。人员资源，信息系统和高层领导被认为是卫生保健质量的关键驱动力。由AMS工作人员管理的现场专家服务被认为是增加专家访问权限的可行策略。候选资格理论建议上述因素影响服务对用户而言是否“易于处理”和“可导航”。工作人员还描述了医院中根深蒂固的患者歧视，以及需要花费大量精力来恢复护理。这表明原住民和托雷斯海峡岛民仍被视为“非理想用户”，并被医院工作人员“拘留”。结论一些新的政策举措（加强劳动力能力，改善长期护理服务系统和增加专科医生接诊）有可能解决本研究强调的障碍。但是，这些举措中很少有能利用AMS“锁定”用户并增强其对医疗保健资格的独特机制。 Kanyini和候选资格是有前途的补充理论，可用于概念化医疗保健，并为改善医疗体系提供了潜在的框架。

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