Sandra Wilson

BACKGROUND: Working effectively with Aboriginal and Torres Strait Islander people is important for maximising the effectiveness of a health care interaction between and Aboriginal and Torres Strait Islander patients and a health professional. This paper presents a framework to guide health professional practice in Aboriginal and Torres Strait Islander health. METHODS: This qualitative study was based in a social constructionist epistemology and was guided by a critical social research methodology. Two methods were employed: interviews with Aboriginal health workers and allied health professionals about their experiences of working together in Aboriginal health, and an auto-ethnography conducted by the researcher, a non-Aboriginal dietitian and researcher who worked closely with two Aboriginal communities while undertaking this research. RESULTS: Interviews were conducted with 44 allied health professionals and Aboriginal health workers in 2010. Critical Social research, which involves the deconstruction and reconstruction of data, was used to analyse data and guided the evolution of themes. Strategies that were identified as important to guide practice when working respectfully in Aboriginal health included: Aboriginal and non-Aboriginal people working with Aboriginal health workers, using appropriate processes, demonstrating commitment to building relationships, relinquishing control, having an awareness of Aboriginal history, communication, commitment, flexibility, humility, honesty, and persistence. Reciprocity and reflection/reflexivity were found to be cornerstone strategies from which many other strategies naturally followed. Strategies were grouped into three categories: approach, skills and personal attributes which led to development of the Framework. CONCLUSIONS: The approach, skills and personal attributes of health professionals are important when working in Aboriginal health. The strategies identified in each category provide a Framework for all health professionals to use when working with Aboriginal and Torres Strait Islander people.

We conducted a qualitative study of the attitudes of teens and parents toward the use of a patient portal. We conducted two teen and two parent focus groups, one teen electronic bulletin board, and one parent electronic bulletin board. Videotapes and transcripts from the groups were independently analyzed by two reviewers for significant themes, which were then validated by two other members of the research team. Twenty-eight teens and 23 parents participated in the groups. Significant themes included issues about teens' control of their own healthcare; enthusiasm about the use of a patient portal to access their providers, seek health information, and make appointments; and concerns about confidentiality. In summary, there was considerable support among teens and parents for a patient portal as well as concerns about confidentiality. The teen portal affords an opportunity to negotiate issues of confidentiality.

Background: A strong primary care (PC) system provides accessible, comprehensive care in an ambulatory setting on a continuous basis and by coordinated care processes. These features give PC the opportunity to play a key role in providing public health (PH) services to their practice population. There is however a lack of up to date comparable information to evaluate the overall state of PC systems, and thus the degree in which PH is integrated in the structure and process level of PC systems. Methods: A comprehensive set of indicators has been developed to evaluate the functioning of PC systems based on a literature review and expert consultations. The integration of PH tasks in PC is a key focus point of the instrument. PH activities are featuring at both structure (e.g. governance), process (e.g. comprehensiveness of care) and outcome level (e.g. quality) of PC systems. In 2009–10, an international consortium implemented the Monitoring system by collecting PC data in 31 European countries by reviewing (inter)national literature, statistical databases and consulting national expert panels. Results: The current variation in the integration of PH in European PC systems will be shown. This will be illustrated by indicators such as type of preventive care and health promotion tasks performed by PC providers and utilization rates of these services. Furthermore, the efforts of European countries to improve the performance of PH services by appropriately structuring their PC system through policies and regulation, financial measures and workforce development will be presented. Conclusions: This study shows a variation in the degree in which PH activities are part of PC systems in Europe.