title: Determinants of access to chronic illness care: a mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians.
abstract: OBJECTIVE
  Indigenous Australians have a disproportionately high burden of chronic illness, and relatively poor access to healthcare. This paper examines how a national multicomponent programme aimed at improving prevention and management of chronic disease among Australian Indigenous people addressed various dimensions of access.
  
  
  METHODS
  Data from a place-based, mixed-methods formative evaluation were analysed against a framework that defines supply and demand-side dimensions to access. The evaluation included 24 geographically bounded 'sentinel sites' that included a range of primary care service organisations. It drew on administrative data on service utilisation, focus group and interview data on community members' and service providers' perceptions of chronic illness care between 2010 and 2013.
  
  
  METHODS
  Urban, regional and remote areas of Australia that have relatively large Indigenous populations.
  
  
  METHODS
  670 community members participated in focus groups; 374 practitioners and representatives of regional primary care support organisations participated in in-depth interviews.
  
  
  RESULTS
  The programme largely addressed supply-side dimensions of access with less focus or impact on demand-side dimensions. Application of the access framework highlighted the complex inter-relationships between dimensions of access. Key ongoing challenges are achieving population coverage through a national programme, reaching high-need groups and ensuring provision of ongoing care.
  
  
  CONCLUSIONS
  Strategies to improve access to chronic illness care for this population need to be tailored to local circumstances and address the range of dimensions of access on both the demand and supply sides. These findings highlight the importance of flexibility in national programme guidelines to support locally determined strategies.
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
authors.forename: Jodie
authors.initials: J
authors.lastname: Bailie
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
authors.forename: Gill
authors.initials: G
authors.lastname: Schierhout
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Laycock
authors.affiliation: Centre for Health Policy, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Kelaher
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
authors.forename: Nikki
authors.initials: N
authors.lastname: Percival
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
authors.forename: Lynette
authors.initials: L
authors.lastname: O'Donoghue
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
authors.forename: Tracy
authors.initials: T
authors.lastname: McNeair
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
authors.forename: Ross
authors.initials: R
authors.lastname: Bailie
mesh_terms: D001315:Australia; D002908:Chronic Disease / Q000517:prevention & control / Q000628:therapy*; D005251:Fees, Medical; D005380:Financing, Government; D017144:Focus Groups; D006297:Health Services Accessibility; D006303:Health Services, Indigenous / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D015397:Program Evaluation / Q000379:methods; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords: PRIMARY CARE; PUBLIC HEALTH