Transforming access, relational care, and primary health care in an urban Aboriginal and Torres Strait Islander population through patient-centered medical homes.

Evaluating the implementation and effectiveness of the evidence-based ISoC2 model utilising PCMHs. 

Despite recent gains in health disparity across many domains of health, there remains significant work to achieve health equity for Indigenous Australians, particularly in the domains of improved access to care, and in the prevention and management of infectious and chronic diseases. The aim of this study is to evaluate the implementation and effectiveness of a model of care appropriate for primary health care (PHC) titled the “Patient-Centred Medical Homes” (PCMH) to improve access, quality of care, and health outcomes whilst reducing costs in a rapidly growing urban Aboriginal and Torres Strait Islander population.

The PCMH model of care is used internationally to improve health outcomes particularly for populations with complex health needs. Defining features of PCMH models include multidisciplinary team-based care, voluntary enrolment (of patients) with their choice of providers, patient education and self-management, in addition to the exchange of health information particularly using technology, service planning, redesign and coordination. Our study addresses three of the specified priorities of this funding initiative: (1) lessons from Aboriginal and Torres Strait Islander PHC services for application within the broader primary health care system; (2) incorporates voluntary patient enrolment to a PCMH and blended payments; and (3) workforce issues including scope of practice. Our proposed research aims to transform patient access, coverage, quality of care and health outcomes for the Indigenous population of South East Queensland. We anticipate positive outcomes that will provide evidence to inform policy and practice not only for Indigenous health, but also for the broader Australian PHC system. Our research team brings together expertise from Indigenous and broader PHC research disciplines, the Aboriginal and Torres Strait Islander community sector, and workforce development to undertake this important study.