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

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 (henceforth, First Nations people) and comparable Indigenous populations and countries (i.e., Māori people of New Zealand and First Nations people of Canada).

Introduction: The First Nations and Indigenous people of Australia, New Zealand, and Canada experience lower life expectancy than their non-Indigenous counterparts. 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 latest Australian data indicate that chronic conditions were responsible for more than two-thirds (70%) of the gap in disease burden between Aboriginal and Torres Strait Islander people and non-Indigenous Australians.
The South Australian Aboriginal Chronic Disease Consortium has identified a critical need to create a unified, evidence-informed, continuity of care protocol for Aboriginal and Torres Strait Islander people hospitalised for chronic disease. The Consortium’s previous work has highlighted that reduced access to health services contributes to delayed detection of risk factors and disease, increased risk of potentially preventable hospitalisation, and complex care needs, often unmet following a hospitalisation. A investigation of qualitative literature on enablers and barriers of healthcare service and system for First Nations populations with shared histories of colonisation and health system organisation was an identified priority to 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. The work will exclude research that does not consider enablers and/or barriers to continuity of care or integration. Quantitative studies and those considering chronic conditions outside the scope will also 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 (Ovid), Embases (Ovid), PsycINFO (OVID) Cochrane Central (Wiley). 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 an or more additional reviewers. Two independent reviewers will assess papers selected for retrieval for methodological quality methodological quality using the Aboriginal and Torres Strait Islander quality appraisal tool and JBI tool before inclusion in the review. Relevant articles will be charted with a descriptive review 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 registration under evaluation: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022339990

Maria Alejandra Pinero de Plaza, Shannon Brown, Jo Wu, Robyn Clark, Katharine McBride, Kim Morey.