Care Coordination in Aboriginal primary health care

Trials of care coordination have been underway in Australia since at least the late 1990s.Many services for Aboriginal and Torres Strait Islander people have included care coordination in an effort to improve health outcomes for people with chronic disease. Still, many health professionals and community members struggle to understand the concept of care coordination and why it may be useful for them. This module provides an overview of what is care coordination? who does it? and how can it help improve access to coordinated, multidisciplinary care for Aboriginal and Torres Strait Islander people?

This module is suitable for all those providing care to clients in an Aboriginal Medical Service (AMS). It will provide useful information to Aboriginal health workers and practitioners, nurses, allied health care professionals, and doctors. It will be very informative for managers and will assist managers’ understanding of the elements required in planning for coordinated care service.

At the end of this module participants will be able to:

• Define care coordination
• Identify individuals who would be benefit from care coordination
• Highlight general strategies included as part of care coordination, such as team work, case management and medication reviews
• Describe individualised interventions that are part of care coordination, including actions plans, goal setting and health coaching
• Determine the role of health professionals including nurses and Aboriginal Health Workers in providing care coordination
• Understand how care coordination can help improve access to coordinated, multidisciplinary care for Aboriginal and Torres Strait Islander people