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Targeted Call for Research - public call for research priorities in Aboriginal and Torres Strait Islander health

ID: 
39
Personal Details
First Name: 
Raymond
Last Name: 
Lovett
Specific Questions
1. What is the research priority (a significant research knowledge gap or unmet need) you are nominating? How would a TCR in this area greatly advance our understanding of this issue? (200 word maximum): 
Chronic disease and related risk factors account for around 70% of the difference in health outcomes for Aboriginal and Torres Strait Islander Australians. Optimising chronic disease screening and management among Aboriginal and Torres Strait Islander Australians is therefore a priority. Cardiovascular disease is the single leading cause of disease burden in the Indigenous Australian population and the largest contributor to the health gap between Indigenous and non-Indigenous Australians. Accurately and efficiently identifying those at high risk of chronic disease, combined with effective preventative management, has great potential to reduce the burden of chronic disease among Aboriginal and Torres Strait Islander Australians. There are several mechanisms available to improve our efforts at prevention of chronic disease including the Aboriginal Health Check (MBS item 715). There exists a gap between the provision of the MBS supported systems approach and national guideline recommendations for screening and management of chronic disease. This gap highlights an opportunity to optimise the impact of the Aboriginal Health Check on chronic disease outcomes by evaluating the effectiveness of evidence-based approaches.
2. What are the relevant Australian Government Priorities, and/or Ministerially-agreed State and Territory health research priorities linked to your nominated priority? (200 word maximum): 
Chronic disease prevention is a key priority for national and state governments, as noted by the Australian Government National Health Priority Areas and the National Chronic Disease Strategy. Improving the systems approach to chronic disease prevention has been the focus of government initiatives including the Indigenous Chronic Disease Package and the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023. The process of evaluating the effectiveness of evidence-based Aboriginal Health Checks to improve chronic disease outcomes would include collaboration between researchers, Aboriginal communities and health services. These partnerships would promote the uptake of Aboriginal Health Checks, build capacity at health services through training and support, and ultimately reduce the burden of chronic disease. Therefore, there is alignment with the NHMRC action areas in Indigenous health: 1) improving Indigenous participation in programs; 2) capacity exchange; 3) NHMRC role in Indigenous health; 4) closing the gap; 5) evaluation research; 6) intervention research; and 7) priority-driven research. A targeted call for research in this area would be timely given the anticipated completion of the Australian Government National Strategic Framework for Chronic Conditions in late 2016 and the current Medicare Benefits Scheme review.
3. How would a TCR in this area contribute to Aboriginal and Torres Strait Islander health and improve health outcomes for the individual and/or community? (200 word maximum): 
Evidence-based screening is effective in the prevention of chronic disease; however the effectiveness of Aboriginal Health Checks to improve chronic disease outcomes is unknown. An evidence-based approach to Aboriginal Health Checks has the potential to more accurately identify Aboriginal and Torres Strait Islander Australians at risk of chronic disease, provide preventative management accordingly, and ultimately reduce the burden of chronic disease. The process of implementing and evaluating an evidence-based approach to Aboriginal Health Checks would provide the opportunity for partnerships between researchers, Aboriginal communities and health services to maximise the likelihood of acceptable and feasible evidence-based approaches. Evidence-based approaches to Aboriginal Health Checks found to be culturally appropriate, acceptable, feasible and effective could be implemented more widely to reduce the burden of chronic disease among Aboriginal and Torres Strait Islander Australians.
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
Although some chronic disease management approaches have been evaluated, it is unclear what works on a systems level to reduce chronic disease among Aboriginal and Torres Strait Islander Australians. Identifying effective approaches to evidence-based Aboriginal Health Checks provides an opportunity to align systems level chronic disease screening and management with national guidelines for Aboriginal and Torres Strait Islander people. For example, national guidelines recommend absolute cardiovascular disease risk assessment/screening for Aboriginal and Torres Strait Islander Australians aged 35 years or more; however, screening for cardiovascular disease in health checks does not recommend this approach, or any other. Absolute cardiovascular disease risk assessment and management is a cost-effective approach, so therefore it has great potential for inclusion in the Aboriginal Health Check. Evidence-based Aboriginal Health Checks will likely reduce harms, costs and burden associated with chronic disease among Aboriginal and Torres Strait Islander Australians. Evaluating the effectiveness and cost-effectiveness of evidence-based Aboriginal Health Checks to improve chronic disease outcomes is essential to identify approaches with potential to be implemented widely.
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
Health risk screening guideline development and implementation alone has limited impact on improvements in screening and treatment alone. However International evidence shows that for risk factors such as smoking use of valid screening instruments and treatment, preventive and longer visits, and an established primary care physician improves smoking counselling. The absence of screening tools and guidelines in MBS items such as the Aboriginal Health Check are currently justified as allowing the clinician to express autonomy in clinical decision making. However there are a number of reports that describe limited knowledge in selecting and using appropriate screening tools. In addition, most guidelines are focused on specific diseases or conditions and primary care providers often attend to multiple conditions. We especially have a lack of Information about implementation of screening guidelines in Aboriginal and Torres Strait Islander primary health care and their association with changes in health outcomes. Heike Sch├╝tze, Lisa Jackson Pulver, Mark Harris (2016). The uptake of Aboriginal and Torres Strait Islander health assessments fails to improve in some areas. Australian Family Physician. Volume 45, No.6, June 2016 Pages 415-420.

Page reviewed: 30 August, 2018