Community care, Item 715 and CTG medicines

Aboriginal Community Controlled Health Organisations (ACCHOs)

Aboriginal Community Controlled Health Organisations (ACCHOs) represent the gold standard of primary healthcare delivery for First Nations Australians. The first ACCHO was established in Redfern, Sydney, in 1971 in response to widespread discrimination and lack of accessible primary healthcare.

• Governance Model: An ACCHO is an incorporated organisation initiated, governed, and operated by the local Aboriginal community through an elected Board of Directors.
• Comprehensive Primary Health Care (CPHC): ACCHOs deliver holistic care that encompasses clinical general practice, chronic disease management, dental care, maternal-child health, mental health and social-emotional wellbeing, substance rehabilitation, aged care, and transport services.
• ACCHOs: Community governance and culturally safe care can improve access and continuity. Partner with the service chosen by the patient, and recognise local strengths and needs rather than assuming one service model fits every community.

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Australian Primary Care Initiatives: MBS Item 715 & PBS Co-Payment

The Commonwealth Government has established targeted Medicare and Pharmaceutical Benefits Scheme (PBS) mechanisms to enhance primary prevention and treatment adherence for First Nations Australians.

Medicare MBS Item 715: Health Assessment for Aboriginal and Torres Strait Islander People

• Item 715: Available to eligible Aboriginal and Torres Strait Islander people of all ages, once every nine months under the descriptor. Tailor the assessment to age, risks and preferences; it is not a compulsory identical pathology panel for every child and adult.
  • Child assessment: Infants and children aged 0 to 14 years.
  • Adult assessment: Adults aged 15 to 54 years.
  • Older person assessment: Adults aged $\ge 55\text{ years}$.
• Clinical Components: A structured, comprehensive annual review encompassing:
  • Medical history, family history, and lifestyle factors (nutrition, physical activity, smoking, alcohol, substance use).
  • Physical examination: Blood pressure, BMI, waist circumference, oral health, vision, and ear examination with otoscopy.
  • Pathology screening: Cardiovascular lipid profile, blood glucose / HbA1c, and renal function (serum eGFR and urine albumin-to-creatinine ratio [ACR]).
  • Immunisation status review and routine update.
  • Assessment of social, emotional, and cultural wellbeing.
• Secondary Benefits Unlocked by Item 715:
  • Unlocks access to MBS Items 81300 to 81360, which provide up to 5 Medicare-subsidized individual allied health consultations per calendar year (e.g., podiatry, physiotherapy, exercise physiology, dietetics, diabetes education, psychology).
  • Unlocks follow-up services provided by Aboriginal Health Workers and practice nurses under MBS Item 10987.

The PBS Co-Payment Measure (Closing the Gap)

• Purpose: Alleviates financial barriers to medication adherence for First Nations patients managing chronic medical conditions.
• CTG eligibility: The person self-identifies as Aboriginal/Torres Strait Islander, is enrolled in Medicare, would have setbacks without the medicine and is unlikely to continue treatment without cost help. Obtain consent and register through HPOS using an eligible PBS prescriber/health practitioner or delegate. Item 715 is not a prerequisite, and registration need not be repeated after moving clinics.
• Financial Entitlement:
  • General patients (non-concession cardholders) pay only the concessional co-payment rate for PBS-listed medicines.
  • Concession cardholders receive their PBS-listed medicines completely free of charge ($0 co-payment).

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Culturally Safe Communication & Consultation Practice

Effective communication with Aboriginal and Torres Strait Islander patients requires adapting conventional Western consultation styles to foster trust, rapport, and mutual respect.

1. Clinical Yarning

Clinical yarning is an evidence-based communication framework that combines traditional First Nations storytelling with biomedical clinical consultation: Respect the person’s pace and preferences. Allow time to reflect, use an interpreter where needed, and ask whom they want involved. Family/community strengths can support care, but the patient remains central to consent and confidentiality.

• Diagnostic Yarn: The clinician invites the patient to tell their health story in their own words, exploring the patient's illness perspective, social context, and physical symptoms through open-ended, non-judgmental discussion.
• Management Yarn: The clinician and patient collaboratively interpret clinical findings and negotiate a shared management plan that aligns with the patient's cultural responsibilities, family priorities, and living circumstances.

2. Respecting Silence

In First Nations communication, silence is an active, positive, and purposeful component of dialogue. Pauses allow thoughtful reflection, emotional processing, and respect for the conversation. Clinicians must:

• Remain comfortable with extended pauses (10 to 30 seconds).
• Resist the urge to interrupt, fill the silence, or rephrase the question prematurely.
• Avoid interpreting silence as incomprehension, disinterest, or passivity.

3. Non-Verbal Communication & Eye Contact

• Direct, continuous, or piercing eye contact can be perceived as confrontational, invasive, or disrespectful, particularly when interacting with Elders or members of the opposite sex.
• Communication preferences: Ask what helps the person feel comfortable and follow their cues. Eye contact, silence, language, kinship involvement and decision-making preferences vary between people and communities; cultural safety must not become a fixed stereotype.

4. Involving Kinship Networks, Family & Elders

• Family members (aunties, grandmothers, partners, siblings) frequently accompany patients and play a central role in health decision-making.
• Clinicians should actively welcome family members into consultations and obtain the patient's consent to involve trusted family in treatment discussions and discharge planning.

5. Partnering with Aboriginal Health Workers & Liaison Officers

• Aboriginal Health Workers (AHWs) & Aboriginal Health Practitioners (AHPs): AHPs are registered healthcare professionals under AHPRA with specialized clinical training. They provide direct clinical care, perform health assessments, administer medications, and serve as invaluable cultural brokers.
• Aboriginal Hospital Liaison Officers (AHLOs): Hospital-based professionals who provide emotional support, assist with communication between medical teams and families, facilitate discharge planning, and help reduce rates of discharge against medical advice.

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Clinical comparison: High-Burden Conditions & Management Protocols

• ARF/RHD: Etiology & Risk Context: GAS-associated immune disease; Key Clinical Screening / Diagnostic Feature: Assess with the current Australian diagnostic criteria and echocardiography; Evidence-Based Prevention & Management: Benzathine benzylpenicillin usually four-weekly; duration depends on ARF history and RHD severity, not one universal ten-year rule
• Rheumatic Heart Disease (RHD): Etiology & Risk Context: Cumulative permanent valve scarring from recurrent ARF attacks; Key Clinical Screening / Diagnostic Feature: Echocardiography screening (mitral regurgitation/stenosis, aortic regurgitation); Evidence-Based Prevention & Management: Register on State/Territory RHD register; regular echocardiography; secondary penicillin prophylaxis
• Trachoma: Etiology & Risk Context: Recurrent ocular Chlamydia trachomatis infection in remote communities; Key Clinical Screening / Diagnostic Feature: Follicular conjunctivitis in children; trichiasis and corneal opacification in adults; Evidence-Based Prevention & Management: WHO SAFE strategy; single-dose oral azithromycin ($20\text{ mg/kg}$ up to $1\text{ g}$) for cases and community contacts
• Otitis in high-risk children: Australian First Nations guidance uses persistent ear discharge with a perforation for at least two weeks to define CSOM. Arrange ear toilet, appropriate topical treatment, hearing assessment and follow-up rather than waiting six weeks.
• Chronic Kidney Disease (CKD): Etiology & Risk Context: Diabetic nephropathy, hypertensive nephrosclerosis, glomerulonephritis; Key Clinical Screening / Diagnostic Feature: Annual urine albumin-to-creatinine ratio (ACR) and eGFR screening via MBS Item 715; Evidence-Based Prevention & Management: SGLT2 inhibitors; ACE inhibitors or ARBs; aggressive BP control ($< 130/80\text{ mmHg}$); pre-dialysis pathway
• Type 2 Diabetes Mellitus: Etiology & Risk Context: Insulin resistance, metabolic syndrome, social determinants; Key Clinical Screening / Diagnostic Feature: Annual HbA1c screening; early onset in youth and young adults; Evidence-Based Prevention & Management: Lifestyle support; metformin; SGLT2 inhibitors and GLP-1 receptor agonists; PBS Co-payment access

Primary references (checked 7 October 2026): 2025 Australian ARF/RHD guideline; CTG eligibility.