Abstract

Chronic disease is the leading cause of premature death among Aboriginal and Torres Strait Islander (First Nations) communities. In these communities, there can be:

• inherent cultural safety considerations that are not addressed adequately in mainstream health-care services; and
• limited access to affordable and accessible ongoing chronic disease medical treatment.

The Integrated Team Care (ITC) Program provides care coordination and supports for First Nations people with chronic health conditions.

Hunter New England Central Coast Primary Health Network (HNECC PHN) is one of many PHNs that commission appropriate service providers to facilitate the ITC Program. This paper outlines findings and learnings from an evaluation undertaken by the HNECC PHN – with a focus on how well the program has provided an integrated service that supports both the social and emotional wellbeing of clients, as well as their chronic health conditions. The evaluation identifies examples of the ITC program as best practice and highlights future opportunities to improve integrated service delivery that supports holistic wellbeing for First Nations people.