Langham Erika, McCalman Janya, Matthews Veronica, Bainbridge Roxanne Gwendalyn, Nattabi Barbara, Kinchin Irina, Bailie Ross
Centre for Indigenous Health Equity Research, Central Queensland University, Cairns, QLD, Australia.
The Cairns Institute, James Cook University, Cairns, QLD, Australia.
Front Public Health. 2017 Jul 7;5:159. doi: 10.3389/fpubh.2017.00159. eCollection 2017.
Social and emotional wellbeing (SEWB) is a critical determinant of health outcomes for Indigenous Australians. This study examined the extent to which primary healthcare services (PHSs) undertake SEWB screening and management of Aboriginal and Torres Strait Islander clients, and the variation in SEWB screening and management across Indigenous PHS.
Cross-sectional analysis between 2012 and 2014 of 3,407 Indigenous client records from a non-representative sample of 100 PHSs in 4 Australian states/territory was undertaken to examine variation in the documentation of: (1) SEWB screening using identified measurement instruments, (2) concern regarding SEWB, (3) actions in response to concern, and (4) follow up actions. Binary logistic regression was used to determine the factors associated with screening.
The largest variation in SEWB screening occurred at the state/territory level. The mean rate of screening across the sample was 26.6%, ranging from 13.7 to 37.1%. Variation was also related to PHS characteristics. A mean prevalence of identified SEWB concern was 13% across the sample, ranging from 9 to 45.1%. For the clients where SEWB concern was noted, 25.4% had no referral or PHS action recorded. Subsequent internal PHS follow up after 1 month occurred in 54.7% of cases; and six-monthly follow up of referrals to external services occurred in 50.9% of cases.
Our findings suggest that the lack of a clear model or set of guidelines on best practice for screening for SEWB in Indigenous health may contribute to the wide variation in SEWB service provision. The results tell a story of missed opportunities: 73.4% of clients were not screened and no further action was taken for 25.4% for whom an SEWB concern was identified. There was no follow up for just under half of those for whom action was taken. There is a need for the development of national best practice guidelines for SEWB screening and management, accompanied by dedicated SEWB funding, and training for health service providers as well as ongoing monitoring of adherence with the guidelines. Further research on barriers to screening and follow up actions is also warranted.
社会和情感幸福（SEWB）是澳大利亚原住民健康结果的关键决定因素。本研究调查了初级医疗服务（PHS）对原住民和托雷斯海峡岛民客户进行SEWB筛查和管理的程度，以及不同原住民PHS在SEWB筛查和管理方面的差异。
对2012年至2014年间来自澳大利亚4个州/领地的100个PHS的非代表性样本中的3407份原住民客户记录进行横断面分析，以检查以下方面记录的差异：（1）使用确定的测量工具进行SEWB筛查；（2）对SEWB的关注；（3）针对关注采取的行动；（4）后续行动。采用二元逻辑回归确定与筛查相关的因素。
SEWB筛查的最大差异出现在州/领地层面。整个样本的平均筛查率为 .6%，范围从 7%到 1%。差异也与PHS的特征有关。整个样本中确定的SEWB关注的平均患病率为 3%，范围从 9%到 1%。对于记录有SEWB关注的客户，25.4%没有转诊记录或PHS行动记录。1个月后内部PHS的后续跟进在54.7%的病例中进行；转介到外部服务机构的六个月随访在50.9%的病例中进行。
我们的研究结果表明，在原住民健康中缺乏关于SEWB筛查最佳实践的明确模式或一套指南可能导致SEWB服务提供的广泛差异。结果表明存在错失机会的情况：73.4%的客户未接受筛查，对于确定有SEWB关注的客户，25.4%没有采取进一步行动。对于采取行动的客户，近一半没有进行随访。需要制定关于SEWB筛查和管理的国家最佳实践指南，同时提供专门的SEWB资金，对医疗服务提供者进行培训，并持续监测对指南的遵守情况。还需要对筛查和后续行动的障碍进行进一步研究。
