Background:

Closing the Gap addresses the underutilisation of primary health care services and the higher burden of chronic disease experienced by Indigenous people. The Chronic Disease Care Coordination Program (CC) aims to improve chronic disease management through improved access to coordinated multidisciplinary care. This presentation reports on program staff reflections in engaging clients.

Methods:

The CC Program in Tennant Creek was staffed by one member until an AHW joined to provide additional support and facilitate cultural connections within the community. The program started by educating clinicians to generate referrals. Once the referral was received, clients were visited to discuss what they needed to address their chronic condition.  

Results/Discussions:

Significant barriers emerged in relation to service coordination and service access. It was apparent that Indigenous people need to have their basic needs met first in order to engage in health services to improve their chronic disease conditions. If they did not have shelter or food then a visit to the clinic was a low priority. As a consequence, service coordination began with addressing some of the basics like, Meals on Wheels and taking steps to provide shelter by liaising with Housing. Cultural and language barriers existed and often other family and cultural priorities took precedence over health.  At the primary health care system level other barriers were evident. High staff turnover made it very difficult to coordinate services and for clients to establish rapport and trust. When successful engagement occurs, the health impacts are enormous.  Case examples will be outlined in this presentation.

Conclusions/implications:

Progress has been made with the formation of partnerships, and community confidence is growing.  People have started to re-engage in their health care.  Trust is being built with the community as they see a change in themselves with some of their survival needs being met and healthcare.