Abstract
Introduction: Allied health services in rural and remote hospitals often work in siloed and solo discipline-specific positions. They are often part of general multi-disciplinary teams without a clearly articulated service model that integrates care for individuals and addresses broader community health needs. Integrated care service models for clients with complex disabilities or chronic health needs have demonstrated improved outcomes, but feasible service models are rarely described in the context of rural, remote and First Nations communities. Integration can support primary care in remote communities where resources are thin, and the breadth of multidisciplinary service providers is not available. To respond to the context, a co-designed student-assisted, community rehabilitation and lifestyle service was developed to support three very remote communities.
Context: This study was based in three very remote (modified monash model 7) communities in Cape York, Far North Queensland. Two of these communities are discrete Aboriginal communities, with many services based in the third community which acts as a ‘hub’ community for the surrounding region.
Engagement: Over a 4-year period, this service was co-created (co-designed and co-implemented) with local community members and organisations, the local public health service, local Aboriginal Community Controlled Health Service, and an on-site University Department of Rural Health. The purpose of this service was to deliver a holistic healthy aging service that supports individuals to age well in community, provides support to carers and families, and increases community capacity improve health and wellbeing for the whole community.
Aim: This study aims to explore the perspectives of health professionals, community organisations and allied health university students on the integration of care provided by the service.
Methods: Structured interviews were conducted with 18 participants who were involved in either the delivery, participation or support of the service. Deductive thematic analysis utilised theory-based codes derived from an integrated care theory. Each of the nine pillars of integrated care represented a theme that was further sorted into micro, meso, and macro system-level enablers and barriers to service delivery.
Results: Macro themes broadly identified a lack of a shared vision and values between organisations. The lack of integration, including fragmented data systems, at the macro level impacted on meso and micro level integration of care. The culture of siloed, discipline focused service models was a meso barrier impacting on micro level interprofessional working. The most frequently discussed micro level enabler to the success of the service was the collaborative relationships between Indigenous and non-Indigenous staff and students.
Lessons learned:
- Culturally responsive practice principles are an enabler to integrated care in First Nation communities.
- An integrated care approach can help define rural and remote allied health, primary care service models that address health outcomes from individual to population level needs.
Conclusions: These results reinforce that services striving to provide integrated care require organisational scaffolding to embed process that reflect integration of care.