In this 42-month, HRC-funded study, we are examining how the primary and secondary prevention of chronic conditions is being modelled, practiced and measured in three case study sites. Read on for the latest update on this project.
Extensive work is underway in the health sector to manage chronic conditions including service and workforce redesign, and clinical guideline development. Key health service approaches include quality management, primary and secondary care integration, care coordination and multidisciplinary teamwork. For those with chronic conditions, emphasis is often placed on self-management as an outcome of interventions, education and support. These approaches however contribute little to the prevention of chronic conditions and commonly inadequately address the needs of Māori, under-utilise broader whānau engagement in prevention and struggle to achieve and maintain cross sector collaboration.
Our research aims to:
Under the umbrella of a Māori-centred approach a collective case study design, utilising qualitative and evaluation-based research methods, is being used to examine a chronic condition prevention case study in each of the health provider sites. Data is being interrogated across three levels, policy (government), practice (provider) and whānau (community). Multilevel, comparative exploration will produce results that demonstrate the diversity in perspectives, priority setting, and intervention practices and experiences between key actors.
Phase One of the study was completed at the close of 2015. That Phase included identifying and defining each chronic condition prevention case along with addressing research questions about how prevention is modelled and priorities are defined.
Our three research sites are each implementing models of care to improve Māori health outcomes for chronic conditions. All have similar principles: cross sector collaboration; integrated health services; improved health service access; emphasis on health outcomes; increased responsiveness to Māori; and whānau-centred services.
Data collected from the three sites and analysed in Phase One highlights the following:
Providers know their communities in-depth and have some degree of flexibility to be able to re-orient themselves to better meet those needs. That provider responsiveness however, demands a mix of staff and skills that may not necessarily be readily available. Negotiating constant flux, exacerbated by ongoing changes in organisational funding and contracting, contributes to some lack of clarity with regard to organisational vision, roles and responsibilities. Ongoing organisational change therefore has impacts that can undermine the momentum to keep moving forward.
Commitment to working at whānau level is being articulated, but is not readily facilitated by the wider national policy environment which conditions funding and contracting. For example, whilst key players may identify multi-sector collaboration as being integral to delivery of services which promote wellness much of the existing wider policy environment remains tuned to delivery ‘in silos’. Such delivery is directed towards separately addressing each of an individual’s specific medical conditions in isolation.
There are a range of impediments to achieving wellbeing through health service delivery. The dominant individualistic, medical conditions focused discourse noted above is a driver of service delivery norms. There are examples of shifts in organisational structure, skill mix focus and delivery configurations that demonstrate that these norms are being challenged and reframed, in some form, by the providers. Early indications are that promising whānau focussed, integrated models of care are being developed and implemented by providers though significant hurdles exist.
Phase Two (15 months) of the study is exploring how the chronic condition prevention cases identified in Phase One are being implemented in each site. In this Phase, we will also determine the outcome frameworks being utilised. Phase Three (late 2017 to January 2018) will then identify short term outcomes achieved, with respect to the implementation of each of the case study interventions, over the period of the research. Using the results and knowledge gained from each phase, Phase Three will inform broader health service development.
In the long-term this research has the potential to reduce chronic conditions for Māori through a number of interlinked pathways including the modelling of effective prevention along with using a combination of evidence and Māori models of practice. It will also contribute to Indigenous models of chronic condition prevention globally.
