Understanding and responding to the cost and health impact of short-term health staffing in remote and rural Aboriginal and Torres Strait Islander community-controlled health services: a mixed methods study protocol
Yuejen Zhao,
Steven Guthridge,
Mark Ramjan,
Michael P Jones,
John Wakerman,
John Humphreys,
Annie Tangey,
Terry Dunbar,
John Boffa,
Rosalie Schultz,
Michelle S Fitts,
Lisa Bourke,
Edward Mulholland,
Lorna Murakami-Gold,
Clarissa Comerford,
Narelle Campbell,
Supriya Mathew,
Zania Liddle,
Deborah Russell
Affiliations
Yuejen Zhao
Population and Digital Health, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
Steven Guthridge
Menzies School of Health Research, Casuarina, Northern Territory, Australia
Mark Ramjan
Clinical Governance, Darwin Region & Strategic Primary Health Care, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
Michael P Jones
School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
John Wakerman
Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
John Humphreys
School of Rural Health, Monash University, Strathdale, Victoria, Australia
Annie Tangey
Ngaanyatjarra Health Service, Alice Springs, Northern Territory, Australia
Terry Dunbar
Indigenous Social and Wellbeing Centre, School of Population Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
John Boffa
Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia
Rosalie Schultz
Ngaanyatjarra Health Service, Alice Springs, Northern Territory, Australia
Michelle S Fitts
Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
Lisa Bourke
Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
Edward Mulholland
Miwatj Health Aboriginal Corporation, Nhulunbuy, Northern Territory, Australia
Lorna Murakami-Gold
Poche SA + NT, Flinders University, Alice Springs, Northern Territory, Australia
Clarissa Comerford
Ngaanyatjarra Health Service, Alice Springs, Northern Territory, Australia
Narelle Campbell
Flinders Northern Territory, College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia
Supriya Mathew
Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
Zania Liddle
Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
Deborah Russell
Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
Introduction Access to high-quality primary healthcare is limited for remote residents in Australia. Increasingly, remote health services are reliant on short-term or ‘fly-in, fly-out/drive-in, drive-out’ health workforce to deliver primary healthcare. A key strategy to achieving health service access equity, particularly evident in remote Australia, has been the development of Aboriginal Community Controlled Health Services (ACCHSs). This study aims to generate new knowledge about (1) the impact of short-term staffing in remote and rural ACCHSs on Aboriginal and Torres Strait Islander communities; (2) the potential mitigating effect of community control; and (3) effective, context-specific evidence-based retention strategies.Methods and analysis This paper describes a 3-year, mixed methods study involving 12 ACCHSs across three states. The methods are situated within an evidence-based programme logic framework for rural and remote primary healthcare services. Quantitative data will be used to describe staffing stability and turnover, with multiple regression analyses to determine associations between independent variables (population size, geographical remoteness, resident staff turnover and socioeconomic status) and dependent variables related to patient care, service cost, quality and effectiveness. Qualitative assessment will include interviews and focus groups with clinical staff, clinic users, regionally-based retrieval staff and representatives of jurisdictional peak bodies for the ACCHS sector, to understand the impact of short-term staff on quality and continuity of patient care, as well as satisfaction and acceptability of services.Ethics and dissemination The study has ethics approval from the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (project number DR03171), Central Australian Human Research Ethics Committee (CA-19-3493), Western Australian Aboriginal Health Ethics Committee (WAAHEC-938) and Far North Queensland Human Research Ethics Committee (HREC/2019/QCH/56393). Results will be disseminated through peer-reviewed journals, the project steering committee and community/stakeholder engagement activities to be determined by each ACCHS.
