Supporting Healthy Futures: Testing care-enhancement strategies to increase annual Health Checks and improve care for Aboriginal and Torres Strait Islander clients in mainstream general practices

A cluster randomised controlled trial with general practices randomly allocated to either the usual care or care enhancement group. Practices allocated to the care enhancement group will receive a 12 month intervention designed to improve the implementation of health assessments and best practice care for Aboriginal and Torres Strait Islander clients. Intervention components will include a suite of care-enhancement strategies developed in consultation with the Aboriginal Reference Group and participating Primary Health Networks to ensure the strategies are feasible and acceptable to the participating practices and Aboriginal and Torres Strait islander communities. The Aboriginal Reference Group and Primary Health Network representatives participated in separate two-hour workshops, where the proposed care-enhancement strategies were presented, including a rationale for their inclusion and details of implementation. Attendees had the opportunity to reflect on and discuss each strategy and make recommendations for further refinement. Perceived potential barriers to implementation were also explored. Following the workshops, strategies were revised and circulated to members via email for further review and feedback. Additional meetings with individual members were held, to discuss recommendations in more detail where necessary. This iterative process occurred over a period of 6 months. All care enhancements strategies will be implemented at each practice allocated to the care enhancement group, with strategies tailored to the individual practices and the Aboriginal and Torres Strait Islander communities they serve as required. For example, practices will be able to select which patient education resources they will display based on suitability for their practice. Care enhancement strategies include: Study Champions: Each practice will identify a Study Champion (e.g. Practice Manager or Practice Nurse) to promote buy-in of strategies within their practice and to help drive positive change. The research team will provide ongoing support to Study Champions throughout the study to help problem solve any challenges or issues that arise. The Study Champions duties will include monitoring of strategy implementation, delegation of responsibilities, meeting with the research team regularly, reviewing and updating policies and facilitating discussion of the project at practice team meetings. Audit and Feedback: Medical record data extraction will be conducted bi-monthly via Pen CS, with the research team providing summarised data-based reports to participating practices every two months. Pen CS is a health analytics software provider for national population health analysis and reporting in primary care. The report will demonstrate change over time in level of care and include agreed goals for level of care to be achieved by the end of the project. The data will include rates of: identification of Aboriginal and Torres Strait Islander status, Aboriginal and Torres Strait Islander Health Checks, and guideline recommended screening. All data reported will be based on recommendations from the latest edition of the National Guide to a preventive health assessment for Aboriginal and Torres Strait Islander people. The Study Champions will use the reports to discuss progress towards goals at practice team meetings. Culturally Safe and Responsive Care: Study Champions will be asked to complete the National Aboriginal Community Controlled Health Organisation (NACCHO) and Royal Australian College of General Practitioners (RACGP) Good Practice Tables (at baseline and 12-months). The five Good Practice Tables provide practical actions the practice can take to support culturally responsive healthcare for Aboriginal and Torres Strait Islander people, and are mapped to practice accreditation standards. For example, "Posters, artwork, flags and map of Aboriginal and Torres Strait Islander Australia are displayed" and "Cultural safety is a standing agenda item in practice team meetings". Completion of the tables requires the participant to indicate whether each activity has been achieved at their practice (Yes/No) and if not, what actions are needed, by whom and by when to complete the activity. It is expected each table will take approximately 1 hour to complete. Practices will be encouraged to seek feedback on their completed Good Practice Tables from the local Primary Health Network Aboriginal Health and Wellbeing Leadership Group representative (or equivalent) to ensure the proposed actions support culturally safe practices. To assist practices to implement the proposed actions, the research team will develop a resource list of publicly available professional education tools, training and guidelines regarding culturally responsive care. Patient Education and Resources: A resource list of existing culturally appropriate patient education resources will be provided to practices by the research team. Information and education will focus on the benefits of identifying as an Aboriginal and/or Torres Strait Islander person to the practice, as well as annual Aboriginal and Torres Strait Islander Health Checks and what to expect, and other preventative health topics. Patient education and resources may include social media templates, brochures, posters, videos to be played in waiting rooms, and fact sheets. Practices will be encouraged to ensure materials are visible and accessible to clients and to actively disseminate information where clinically appropriate. Continuing Professional Education: Practice Managers (or delegate) will be asked to complete a clinical record audit of up to 20 clients per practice who have received an Aboriginal and Torres Strait Islander Health Check between 3-12 months ago (at baseline and 12 months). Where practices opt to complete the audit as a CPE exercise, the clinical record audit will be conducted by clinical staff responsible for the conduct of Health Checks at the practice. The clinical audit will be completed electronically, using a data collection tool provided by the research team. The tool will collect information including: patient age and gender, registration for government-funded programs (e,g. Integrated Team Care), details of Health Check administration, recording of patient goals, priorities and recommended actions, and requested investigations, and referrals provided. The clinical record audit tool will also provide an opportunity to reflect on and rate the quality of the Health Checks, and to identify areas for quality improvement. Relevant staff may also be encouraged to participate in additional training activities related to delivery of high-quality Health Checks, including webinars or training videos delivered by experienced Aboriginal clinicians, training programs offered by local PHNs, or peer-learning activities. Practices will identify relevant staff to complete the training, encourage completion of CPE activities and plan to maximise attendance. A list of additional pre-existing professional education tools and resources to support self-directed learning to conduct high quality health checks will also be provided by the research team. Recall and Reminders: Culturally appropriate reminders will be sent via SMS to eligible patients who are due for an Aboriginal and Torres Strait Islander Health Check. A template for the reminder SMS has been co-designed by the research team and Aboriginal Reference Group. The content of the SMS will be further tailored to the practice and the Community(ies) they serve. For example, greetings in the local Aboriginal language will be incorporated through consultation with Community representatives. Reminders may be automated via the medical record software or sent manually depending on the practice preferences. Practices may also opt to implement a follow-up reminder phone call to overdue patients. Suggested communication strategies for reminder phone calls have also been co-designed by the research team and Aboriginal Reference Group. Adherence to the care enhancement protocol, including progress and barriers to implementation of strategies will be explored during bi-monthly meetings (video-conference) between the Study Champion(s) and the research team at each practice, as well as a semi-structured interview at the end of the implementation period (12 months).