Collaborating to Improve Access to Primary Health Care for Vulnerable Populations

Primary health care (PHC) services in Australia are well placed to provide a range of health services. While most Australians have ready access to these services, more vulnerable groups may experience barriers. This thesis explores barriers and enablers to accessing PHC services for some vulnerable groups including children, Aboriginal people and the elderly and explores strategies to improve access. These five studies, undertaken as part of the NSW Public Health Officer Training Program, provide information useful to public health policy makers, service planners, managers and health workers. The first study develops an evaluation framework for community child health services. The second study demonstrates application of the framework and focuses on how paediatric outreach services in an Aboriginal community in Sydney work in partnership with families, the community and other services. Recommendations were made to formalise collaboration in the planning of care for Aboriginal children. Early intervention for more children with resulting better outcomes is an anticipated benefit of this evaluation. The third study was undertaken in Broken Hill, NSW and investigates the decline in participation at blood lead screening services, particularly by Aboriginal children. Strategies to improve screening rates include better communication between services, better use of public health data and more support for families whose children have elevated blood lead levels. The fourth study examines public health partnerships between government health services and Aboriginal Community Controlled Health Services at the state and local level, with a focus on communicable disease control. Collaborations between services could be strengthened by the creation of organisational opportunities, strengthening the workforce and further developing cultural awareness. The final study looks at fall-related injuries requiring an ambulance in Sydney in 2008. Falls are the second most common reason for the dispatch of an ambulance and paramedics are well placed to expand their role in assessing fall risk, treating injuries on the scene and referring patients to community based PHC services. Improvements in the collection and linking of ambulance data would allow further analysis of characteristics and outcomes of fall-related injury. This thesis demonstrates how collaboration between services can strengthen access to PHC for some vulnerable populations