System enablers and barriers to continuity of care for First Nations people living with chronic conditions: A rapid qualitative review protocol

Maria Alejandra Pinero de Plaza^1,2,3, Shannon Brown⁴, Chiung-Jung (Jo) Wu^5,6, Robyn Clark^1,3, Katharine McBride^7,8,  Lemlem Gebremichael^1,3, Odette Pearson^7,8,9, Sonia Hines³, Kim Morey^7,8

1. Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5000.

2. Centre of Research Excellence in Frailty and Healthy Ageing, The University of Adelaide, Adelaide, SA, 5000.
3. The Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence. Alice Springs, NT, 0871.

4. Library, Flinders University Adelaide, SA, 5000.

5. School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Petrie, QLD, 4502.
6. Royal Brisbane & Women’s Hospital, QLD, 4029. 

7. South Australian Aboriginal Chronic Disease Consortium, Adelaide, SA,5001.

8. Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, 5001.

9. Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5000.

Abstract

Objective: This rapid review aims to evaluate qualitative literature on the health system enablers and barriers to continuity of care for Aboriginal and Torres Strait Islander people in Australia and comparable Indigenous populations and countries (i.e., Māori people of New Zealand and First Nations people of Canada) (collectively referred to as First Nations people). 

Introduction: The First Nations people of Australia, New Zealand, and Canada experience lower life expectancy than their non-Indigenous counterparts, with chronic conditions contributing to approximately 70% of this disparity. Reduced access to health services and poorer care outcomes attributed to chronic diseases account for a significant proportion of this gap. The sub-optimal management of ongoing care when living with chronic conditions contributes to health disparities in these countries. 

The South Australian Aboriginal Chronic Disease Consortium identified a critical need to create a protocol, evidence-informed on continuity of care for Aboriginal and Torres Strait Islander people hospitalised for chronic disease. Reduced access to health services contributes to delayed detection of risk factors and disease, limited ongoing disease management, increased risk of potentially preventable hospitalisation, and complex care needs, often unmet following a hospitalisation. An investigation of qualitative literature on system enablers and barriers to continuity of care for First Nations populations with shared histories of colonisation will help inform evidence-based approaches to continuity of care.

Inclusion criteria: This review will be focused on the qualitative and mixed-method studies that qualify enablers and barriers to continuity of care. It will consider frameworks, protocols, and designs concerning specific chronic conditions, which are the major contributors to health disparities, and the focus of the South Australian Aboriginal Chronic Disease Consortium: cancer, cardiovascular disease, chronic kidney disease, and diabetes and its associated complications. An emphasis will be placed on the health system, healthcare providers, and other professionals related to continuity of care services or integration of care. 

Exclusion criteria: The work will exclude research that does not consider enablers and/or barriers to continuity of care or its integration. Quantitative studies and those considering chronic conditions outside this scope will be excluded.

Methods: This rapid qualitative review will consider relevant primary qualitative and mixed-methods studies published in English between 2010 and June 2022. Key information sources to be searched for publications will be databases Medline, Embase, PsycINFO, and Cochrane Central. Two reviewers will independently review titles and abstracts; relevant sources will be retrieved in full and reviewed. Any disagreements will be resolved through discussion or with one or more additional reviewers. Two independent reviewers will assess papers selected for retrieval for methodological quality using the Aboriginal and Torres Strait Islander quality appraisal tool before inclusion in the review. Relevant articles will be charted to summarise the extracted data. Findings will be explained inductively, in narrative and graphical forms, using the latest frameworks from The World Health Organisation as a lens but allowing themes to emerge from the data. Any deviations from this protocol will be justified and reported in the final review.

Review registration number: PROSPERO ID=CRD42022339990 

Keywords: Continuity of care; integration of care; chronic diseases; Aboriginal; Indigenous; First Nations People