The broad approach for 2015 will be to build and maintain the network of key stakeholders. Resources to support the network and implementation of models of service development and evaluation for a further period will capitalise on the, now well-established, collaboration and build on a set of solid foundations and a momentum for the work. Extensive discussions will be undertaken to ensure the sustainability of the networks.

Projects

1.The Home-based Outreach Chronic Disease Management Exploratory Study (HOME Study) The home-based outreach model of care developed at the Inala Indigenous Health Service in partnership with the Kanyini Vascular Collaboration (KVC) has achieved ongoing funding from Queensland Health for a case manager, and there is agreement to expand this model across the Metro South health district to include three Aboriginal controlled health services.

This program of extension work will support the final elements of the evaluation of the HOMES Study at Inala to collate critical mixed-methods data, health economic analysis data and detailed descriptive qualitative findings of the way in which this model has improved care and outcomes for Aboriginal people with complex chronic disease.

2.The study, Towards the Development of a Wellbeing Model for Aboriginal and Torres Strait Islander Peoples Living with Chronic Disease (Wellbeing Study), successfully developed a Wellbeing Framework for local adaptation into primary healthcare services by the end of 2014. In 2015, extension funding will support translation of the Wellbeing Study in a number of ways. First, several of the Wellbeing Study Research Fellows will be supported to attend and present at the KVC Annual Meeting as well as at several conferences around the country, including: the National Rural Health Conference, Darwin, May 2015; Primary Health Care Research Conference in Adelaide, July 2015; National Primary Health Care Conference, Canberra, November 2015; and National Complex Needs Conference, Canberra 2015.  In February 2016, the Wellbeing Study Research Fellows will attend a Translation Workshop in Adelaide to progress translation of the Wellbeing Framework into quality standards, evaluation tools.

3.The Validation of a Culturally-specific Measure to Identify Depression in Aboriginal and Torres Strait Islander Peoples with or without Chronic Disease (“Getting it right”: The Validation Study), a NHMRC project which was awarded as a result of the KVC work, is currently recruiting 500 Aboriginal and Torres Strait Islander people attending ten primary healthcare services around Australia.

Publications

Peer Reviewed Publications

• Tuttle C, Carrington M, Stewart S, Brown A. Overcoming the tyranny of distance: An analysis of outreach visits to optimise secondary prevention of cardiovascular disease in high risk individuals living in Central Australia. The Australian Journal of Rural Health. 2015.
• Truelove M, Patel A, Bompoint S, Brown A, Cass A, Hillis GS, et al. The Effect of a Cardiovascular Polypill Strategy on Pill Burden. Cardiovasc Ther. 2015:n/a-n/a.
• Togni S, Askew D, Brown A, Rogers L, Potter N, Egert S, et al. Creating Safety to Explore Strengthening Innovation in an Australian Indigenous Primary Health Care Setting through Developmental Evaluation. In: McKegg K, editor.2015.
• Petrak F, Baumeister H, Skinner TC, Brown A, Holt RIG. Depression and diabetes: treatment and health-care delivery. Lancet Diabetes Endocrinology [Internet]. 2015.
• Keenihan S. Closing the gap in indigenous health - a new way forward. The Lead. 2015 16 March 2015.
• Roberts K, Brown, A, Atkinson D, Remenyi B, et al. Rheumatic heart disease in Indigenous children in northern Australia: differences in prevalence and the challenges of screening. Med J Aust. 2015.
• Jamieson L, Skilton M, Maple-Brown L, Kapellas K, Askie L, Hughes J, et al. Periodontal disease and chronic kidney disease among Aboriginal adults; an RCT. BMC Nephrol. 2015;16(1):181.
• Gomersall JS, Canuto K, Aromataris E, Braunack-Mayer A, Brown A. Systematic review to inform prevention and management of chronic disease for Indigenous Australians: overview and priorities. Aust N Z J Public Health. 2015:n/a-n/a.
• Gibson O, Lisy K, Davy C, Aromataris E, Kite E, Lockwood C, et al. Enablers and barriers to the implementation of primary health care interventions for Indigenous people with chronic diseases: a systematic review. Implementation Science [Internet]. 2015; 10:[71 p.]. Available from:
• Davy C, Bleasel J, Liu H, Tchan M, Ponniah S, Brown A. Factors influencing the implementation of chronic care models: A systematic literature review. BMC Fam Pract. 2015;16(102):102.
• Brown A, O'Shea RL, Mott K, McBride KF, Lawson T, Jennings GL, et al. A strategy for translating evidence into policy and practice to close the gap - developing essential service standards for Aboriginal and Torres Strait Islander cardiovascular care. Heart Lung Circ. 2015;24(2):119-25.
• Brown A, O'Shea RL, Mott K, McBride KF, Lawson T, Jennings GL, et al. Essential service standards for equitable national cardiovascular care for Aboriginal and Torres Strait Islander people. Heart Lung Circ. 2015;24(2):126-41.
• Brown A, Mentha R, Howard M, Rowley K, Reilly R, Paquet C, et al. Men, hearts and minds: developing and piloting culturally specific psychometric tools assessing psychosocial stress and depression in central Australian Aboriginal men. Soc Psychiatry Psychiatr Epidemiol. 2015:1-13.
• Stewart M, O’Brien M, Sivak L, Davy C, Ahmat T, Brahim G, Brown A, Dowling A, Jacobson S, Kelly T, Kemp K, Kite E, Mitchell F, Newman T, Pitt J, Rickards B, Roesch K, Saddler C, Thomas T. A ‘Wellbeing Framework’ for Aboriginal and Torres Strait Islander peoples living with chronic disease: methods and examples of both-way learning. Conference proceedings of the National Rural Health Conference, Darwin 24-27 May 2015.

Presentations

• Co presented by Togni S “Principles of Developmental Evaluation Practice - deepening the evidence” American Evaluation Association Evaluation 2015 Conference, Chicago, 13 Nov 2015.
• Askew D, Togni S, Schluter P et al. HOMES “Count Me In: Partnerships in Chronic Care” Australian Disease Management Association (ADMA) 11th National Conference Thursday 10 September 2015, Brisbane Convention Centre
• Askew D, Togni S, Schluter P et al “Unpacking a successful model of outreach case management for Aboriginal and Torres Strait Islander peoples with complex chronic disease – why is it making the difference it is?” Presented at Primary Health Care Research Conference, July 2015, South Australia
• Burgin A, Darlington E. et al. “HOME alone no more! Home based outreach chronic disease management exploratory study (HOMES) multidisciplinary case management for Aboriginal and Torres Strait Islander people with chronic disease – why is it making the difference?” Presented to the Metro South Nursing Symposium, Brisbane 7 September 2015
• Darlington E. et al “The model of outreach case management for Aboriginal and Torres Strait Islander peoples with complex chronic disease – why is it making the difference it is?” Presented at a Networking Morning Tea with non-Government organisations August 2015
• Stewart M, O’Brien M, Sivak L, Davy C, Ahmat T, Brahim G, Brown A, Dowling A, Jacobson S, Kelly T, Kemp K, Kite E, Mitchell F, Newman T, Pitt J, Rickards B, Roesch K, Saddler C, Thomas T. A ‘Wellbeing Framework’ for Aboriginal and Torres Strait Islander peoples living with chronic disease: methods and examples of both-way learning. National Rural Health Conference, Darwin 24-27 May 2015.
• Kerse N, Kite E, Mules R, Brahim G, Stewart M. Research the right way: engaging Indigenous communities – plenary panel. Primary Health Care Research Conference, Adelaide, 29-31 July 2015.
• Brahim G, Kelly T, Kite E, Pitt J, Roesch K, Stewart M, Ahmat T, Brown A, Davy C, Dowling A, Jacobson S, Kemp K, Mitchell F, Newman T, O’Brien M, Rickards B, Saddler C, Sivak L, Thomas T. Towards the development of a Wellbeing Framework for Aboriginal and Torres Strait Islander peoples living with chronic disease – symposium. Primary Health Care Research Conference, Adelaide, 29-31 July 2015.
• Stewart M, Ahmat T, Brahim G, Brown A, Davy C, Dowling A, Jacobson S, Kelly T, Kemp K, Kite E, Mitchell F, Newman T, O’Brien M, Pitt J, Rickards B, Roesch K, Saddler C, Sivak L, Thomas T. Evaluating how well a healthcare service works for Our Mob. National Primary Health Care Conference, Canberra 2-4 November 2015.
• Saddler C, Davy C, Ahmat T, Brahim G, Brown A, Dowling A, Jacobson S, Kelly T, Kemp K, Kite E, Mitchell F, Newman T, O’Brien M, Pitt J, Rickards B, Roesch K, Sivak L, Stewart M, Thomas T. Wellbeing Framework supporting Aboriginal and Torres Strait Islander peoples with chronic disease. Second National Complex Needs Conference, Canberra 17-18 November 2015.