A systematic review of approaches to improve practice, detection and treatment of unhealthy alcohol use in primary health care: a role for continuous quality improvement

Background: Primary health care (PHC) services are complex systems, shaped by an interplay of factors at individual, organisational and broader system levels. For Aboriginal and Torres Strait Islander PHC services, closer relationships with the people they serve, local knowledge of community, and cultural awareness are critical. Continuous quality improvement (CQI) has proven to be an effective process for identification of priority issues in health care delivery and for instigating the design, implementation and evaluation of improvement interventions in these settings. However, wide-scale variation in care quality persists partly due to the mismatch between CQI interventions and context.Methods: This critical review of implementation frameworks for CQI in Aboriginal and Torres Strait Islander primary health care was conducted in two phases: (1) a review of primary published implementation frameworks used in PHC contexts, and (2) a comparison of key features of these frameworks with quality concepts identified by high-improving Aboriginal and Torres Strait Islander PHC services in remote Australia.Results: We found nine primary implementation frameworks previously used in PHC contexts guiding interventions within and between macro (broader contextual) level; meso (health service) level; and micro (community and inter-personal) level systems. There was commonality between these frameworks and key quality concepts in Aboriginal and Torres Strait Islander PHC. However, none of the frameworks covered all concepts with rare consideration of communities driving health improvement, two-way learning (integrating cultural knowledge into healthcare provision), and caring staff—engendering trusting relationships with community enacted through respect.Conclusion: Respect, as a secret essence, privileges the importance of culture, and is an essential element of CQI implementation frameworks for positive change in Aboriginal and Torres Strait Islander PHC services. It is essential to work with communities to design workforce models that grow a caring stable workforce to ensure improvements in quality of care that are effective for their context.

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Screening and brief interventions to reduce unhealthy alcohol use in primary health care: results of the RCT study in Prague

10.26226/morressier.5d1a035857558b317a13f6ae ◽

2019 ◽

Author(s):

Ladislav Csemy ◽

Zuzana Dvořáková

Keyword(s):

Health Care ◽

Primary Health Care ◽

Alcohol Use ◽

Brief Interventions ◽

Unhealthy Alcohol Use ◽

Unhealthy Alcohol ◽

Primary Health

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

Journal of Primary Health Care ◽

10.1071/hc17014 ◽

2017 ◽

Vol 9 (3) ◽

pp. 208 ◽

Cited By ~ 2

Author(s):

Sandeep Reddy

Keyword(s):

Primary Care ◽

Health Care ◽

Quality Improvement ◽

Primary Health Care ◽

Continuous Quality Improvement ◽

Continuous Quality ◽

Funding Model ◽

Primary Health ◽

Set Up

ABSTRACT 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.

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‘There’s only one enabler; come up, help us’: staff perspectives of barriers and enablers to continuous quality improvement in Aboriginal primary health-care settings in South Australia

Australian Journal of Primary Health ◽

10.1071/py14098 ◽

2016 ◽

Vol 22 (3) ◽

pp. 244 ◽

Cited By ~ 5

Author(s):

Jo Newham ◽

Gill Schierhout ◽

Ross Bailie ◽

Paul R. Ward

Keyword(s):

Health Care ◽

Quality Improvement ◽

Primary Health Care ◽

Continuous Quality Improvement ◽

South Australia ◽

Regional Level ◽

Primary Health Care System ◽

Barriers And Enablers ◽

Continuous Quality ◽

Primary Health

This paper presents the findings from a qualitative study, which sought to investigate the barriers and enablers to implementation of a continuous quality improvement (CQI) program by health-care professionals in Aboriginal primary health-care services in South Australia. Eighteen semi-structured interviews across 11 participating services were conducted alongside CQI implementation activities. Multiple barriers exist, from staff perspectives, which can be categorised according to different levels of the primary health-care system. At the macro level, barriers related to resource constraints (workforce issues) and access to project support (CQI coordinator). At the meso level, barriers related to senior level management and leadership for quality improvement and the level of organisational readiness. At the micro level, knowledge and attitudes of staff (such as resistance to change; lack of awareness of CQI) and lack of team tenure were cited as the main barriers to implementation. Staff identified that successful and sustained implementation of CQI requires both organisational systems and individual behaviour change. Improvements through continuing regional level collaborations and using a systems approach to develop an integrated regional level CQI framework, which includes building organisational and clinic team CQI capacity at the health centre level, are recommended. Ideally, this should be supported at the broader national level with dedicated funding.

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