Objective This study aimed to investigate associations between patient activation, healthcare use and clinical outcomes for Aboriginal peoples living with a chronic condition in remote Northern Territory (NT) communities. Methods A retrospective cohort study was undertaken between 2 April 2020 and 1 April 2022 to measure activation and its associations with chronic conditions secondary prevention treatment targets and healthcare usage: hospitalisations, potentially preventable hospitalisations and patient travel. All Aboriginal peoples enrolled at NT Government health services, who had one or more preventable chronic conditions and were prescribed one or more oral chronic condition medications identified in the Primary Care Information System, were included in the study. Patient activation was defined as a 90-day medicine possession ratio ≥80%. An activated patient has the belief, knowledge, skills and behaviours to manage their chronic conditions. Results A total of 5356 patients met the inclusion criteria; 9% of these patients were activated. Activated patients were older and sicker but were significantly more likely to achieve treatment targets for glycosylated haemoglobin, blood pressure and total and low-density lipoprotein cholesterol. Activated patients used more primary healthcare and outpatient resources and had a non-significant trend for less acute care use. Conclusions The remote NT Government primary healthcare system is providing low-value chronic conditions care for patients. As identified by Aboriginal peoples, strengthening culturally appropriate self-management support could lead to more patients becoming activated, better health outcomes and decreased acute care demand.