Improving access to specialist care for remote Aboriginal communities: evaluation of a specialist outreach service.

OBJECTIVE: To identify barriers faced by Aboriginal people from remote communities in the Northern Territory (NT) when accessing hospital-based specialist medical services, and to evaluate the impact of the Specialist Outreach Service (SOS) on these barriers. DESIGN: Combined quantitative and qualitative study. SETTING: Remote Aboriginal communities in the "Top End" of the NT, 1993-1999 (spanning the introduction of the SOS in 1997). PARTICIPANTS: 25 remote health practitioners, patients and SOS specialists. MAIN OUTCOME MEASURES: Numbers of consultations with specialists; average cost per consultation; perceived barriers to accessing hospital-based outpatient care; and perceived impact of specialist outreach on these barriers. RESULTS: Perceived barriers included geographic remoteness, poor doctor-patient communication, poverty, cultural differences, and the structure of the health service. Between 1993 and 1999, there were 5,184 SOS and non-SOS outreach consultations in surgical specialties. Intensive outreach practice (as in gynaecology and ophthalmology) increased total consultations by up to 441% and significantly reduced the number of transfers to hospital outpatient clinics (P< 0.001). Average cost per consultation was $277 for SOS consultations, compared with $450 at Royal Darwin Hospital and $357 at the closest regional hospital. Outreach has reduced barriers relating to distance, communication and cultural differences, and potentially bolsters existing primary healthcare services. CONCLUSIONS: When compared with hospital-based outpatient services alone, outreach is a more accessible, appropriate and efficient method of providing specialist medical services to remote Aboriginal communities in the NT.

Liquor licensing and community action in regional and remote Australia: a review of recent initiatives.

OBJECTIVE: To review the effectiveness of community-based initiatives involving restrictions on alcohol availability in remote and regional locations in Australia, and to assess their implications for other communities or towns contemplating similar measures. METHODS: Findings from evaluations of community initiatives in Tennant Creek (NT), Derby (WA), Halls Creek (WA), Elliott (NT) and Curtin Springs (NT) are compared with respect to impact on alcohol consumption, and on indicators of alcohol-related harm relating to public order, health and well-being, and economic activities. The extent of community support for these initiatives is also examined. RESULTS: Restrictions were found to have a modest but real impact on alcohol consumption, and a significant impact on indicators of alcohol-related harm, especially violence. Restrictions were also found to have widespread community support, often qualified by a belief that other measures were also required. CONCLUSIONS: Restrictions on availability are an effective means of reducing alcohol-related harm at a local level and, depending upon the processes involved in their introduction, are likely to have strong community support, provided that other measures are also pursued. IMPLICATIONS: Five issues are identified that are likely to arise in other settings where restrictions are contemplated. These are: the issue of representativeness ('who speaks for the community?'); selection of particular kinds of restrictions on availability; selection of most appropriate additional measures; universal vs. selective restrictions; and the role of liquor licensing authorities in imposing or facilitating restrictions.

Out of sight, out of mind? Licensed clubs in remote aboriginal communities.

Most Aboriginal communities in the Northern Territory have used provisions under the NT Liquor Act to impose total or partial bans on alcohol and only eight (as of 30 June 1995) had established licensed clubs. This article examines (a) patterns of alcohol consumption in communities with clubs, and (b) economic, social and political aspects of the place of clubs in these communities. Alcohol consumption was estimated on the basis of 'purchase into store' figures for 1994-95 provided by the NT Liquor Commission. Among male drinkers, consumption of absolute alcohol in 1994-95 was estimated at 42.5 litres a head, 76% higher than the figure for the NT as a whole, which in turn was 42% above the national level. Similar differences were found for female drinkers. Combined retail turnover of the seven clubs that traded throughout the year was estimated at $8.1 million. It is argued that many clubs are able to use their monopolistic control of a valued resource to become powerful political institutions in communities, sometimes leaving non-drinkers effectively disenfranchised. It is also argued that the health consequences of these high consumption levels have received far less attention than the effects of Aboriginal public drunkenness in urban areas. It is concluded that, while the rights of Aboriginal communities to establish community-controlled clubs should be respected, the notion that they are under some sort of obligation to do so should be exposed as a measure likely to add to the health burdens of people already inadequately served by health, education and other services.

Patterns of petrol sniffing and other drug use in young men from an Australian Aboriginal community in Arnhem Land, Northern Territory.

Petrol sniffing and use of other drugs were examined among 48 males aged 13-32 years resident in a remote Aboriginal community in Arnhem Land. The study group consisted of 13 non-sniffers, 13 ex-sniffers and 22 current sniffers. Unemployment was highest among those with a history of petrol sniffing. Employment and family influence emerged as major reported reasons for individuals stopping petrol sniffing. The findings of the study suggest that strategies to reduce petrol sniffing should not only focus on education, employment, skills training and recreation, but should further encourage Aboriginal communities to utilize family relationships to dissuade young people from the practice. Unlike ex-sniffers and current sniffers, non-sniffers tended to be abstainers from tobacco, kava and alcohol. Of the selected study group, 52% smoked >or=25 cigarettes per day. On the basis of the research findings, the local community Council has implemented employment, skills training and recreation strategies to reduce petrol sniffing in this age group. A reduction in tobacco consumption in both adults and young people has also been targeted through health education programmes developed by the community health clinic and the school.

Towards a direct definition of an alcohol-related death: an analysis in Aboriginal adults.

This paper addresses the conceptual and methodological difficulties in obtaining reliable information on alcohol-related mortality in Aboriginal communities. A working definition is proposed; this requires an alcohol-positive history together with a consistent mode of death, and is applied retrospectively to a series of 29 adult deaths in a large Aboriginal community. An informant history of alcohol abuse was found to be the most sensitive indicator of an alcohol-positive history and correlated well with autopsy findings and medical records. Alcohol-positive histories were found for 17 of 29 deaths by informant history, for 9 of 29 by autopsy findings, and for 12 of 29 by medical record review. These indicators were combined with a mode of death categorisation to arrive at an estimate of 5 of 29 definite, 5 of 29 probable, and 1 of 29 possible alcohol-related deaths. We conclude by examining the process by which such a definition might be further developed and the context in which resulting information might then be used.