Health service delivery and health outcomes of at-risk populations
Creators: name: Siripol, Samantha
Publisher: name: Canberra, ACT : The Australian National University
Year: 2018
Subjects: Aboriginal and Torres Strait Islander health
social and emotional wellbeing
primary healthcare
health service evaluation
cultural safety
vancomycin-resistant enterococci
infection control
hospital-acquired infection

description: As required by the Master of Philosophy (Applied Epidemiology) program I completed a field placement in the Strategic Investment, Data and Evaluation Section in the Indigenous Health Division, Australian Government Department of Health. Following the introduction chapter (chapter 1), this thesis contains three projects, which aimed to: 1) explore the performance of health organisations providing social and emotional wellbeing (SEWB) services for Aboriginal and Torres Strait Islander peoples (chapter 2); 2) analyse the relationships between health organisations’ cultural safety policies and the uptake of Medicare Benefits Scheme (MBS) health assessments among Aboriginal and Torres Strait Islander clients (chapter 3); and 3) describe and the characteristics of inpatients who acquired vanA vancomycin-resistant enterococci and compare the characteristics of inpatients with vanA versus vanB sterile site infections at the John Hunter and Calvary Mater Newcastle hospitals in Newcastle, New South Wales (chapter 4). My first project was a national survey of SEWB service delivery in 2014-15 using a quantitative questionnaire, administrative data and qualitative case studies. Service delivery strengths included accessibility, capability, continuity, appropriateness, responsiveness and sustainability. Fifteen opportunities to strengthen SEWB service delivery were identified, including in the areas of: client access, perceptions and experiences of service delivery; strengthening the SEWB workforce; and facilities required to support service delivery. These opportunities represent potential approaches that could improve the SEWB of Aboriginal and Torres Strait Islander peoples. For my second project, I used logistic regression to model univariate relationships between seven cultural safety policies and low or high uptake of MBS health assessments in 2014-16 using existing administrative and service performance data. Data from 174 health organisations showed no associations between cultural safety policies and health assessment uptake, however this is likely due to study and data limitations. In my third project, I conducted two case series analyses. The first described numbers and proportions of 168 vanA and vanAB acquisitions in 2013-2015. It also examined potential contributing environmental exposures and other risk factors that might lead to infection or colonisation. The second case series used Wilcoxon rank-sum, Chi-squared or Fisher’s exact tests to compare morbidity and mortality outcomes between vanA and vanB for 42 inpatients with laboratory-confirmed sterile site infections in 2015. No specific environmental exposures or risk factors that likely contributed to acquisition, and no difference in morbidity and mortality outcomes between genotypes, were identified. This may suggest that vanA is endemic to the hospital environment, highlighting the importance of standard, enhanced and tailored infection prevention and control precautions. To meet the teaching requirements, I presented to my peers on logic models and confounding. Additional to the program requirements, I completed an internship in the Ebola Community Engagement Team at the World Health Organization, Geneva, Switzerland. Chapters 5 and 6, respectively, reflect on these experiences. I highly value the opportunities and the skills, experience and knowledge in epidemiology, public health research and practice I developed in the program. I applied my knowledge of logic models, skills in data analysis and interpretation, and knowledge of the importance of understanding and accommodating culture and belief systems when addressing public health issues in my paid employment in my field placement.