Exploring Aboriginal patients' experiences of cardiac care at a major metropolitan hospital in Melbourne.

Objectives The aim of the present study was to explore Aboriginal patients' lived experiences of cardiac care at a major metropolitan hospital in Melbourne. Methods The study was a qualitative study involving in-depth interviews with a purposive sample of 10 Aboriginal patients who had been treated in the cardiology unit at the study hospital during 2012-13. A phenomenological approach was used to analyse the data. Results Eight themes emerged from the data, each concerning various aspects of participants' experiences: 'dislike of hospitals', 'system failures', 'engagement with hospital staff', 'experiences of racism', 'health literacy and information needs', 'self-identifying as Aboriginal', 'family involvement in care' and 'going home and difficulties adapting'. Most participants had positive experiences of the cardiac care, but hospitalisation was often challenging because of a sense of dislocation and disorientation. The stress of hospitalisation was greatly mediated by positive engagements with staff, but at times exacerbated by system failures or negative experiences. Conclusion Cardiac crises are stressful and hospital stays were particularly disorienting for Aboriginal people dislocated from their home land and community. What is known about the topic? Aboriginal people have higher mortality rates due to cardiovascular diseases compared with other Australians. Along with different factors contributing to the life expectancy gap, Aboriginal people also face significant barriers in the use of the healthcare system. What does this paper add? Aboriginal patients' lived experience of cardiac care at a major metropolitan hospital in Melbourne is explored in this paper. Different issues were revealed during their interaction with the hospital staff and the hospital system in conjunction with their cultural aspect of patient care. What are the implications for practitioners? Positive interactions with staff, ongoing support from family and community, culturally appropriate cardiac rehabilitation programs can improve the cardiac care experiences of Aboriginal patients.

Making the connection: a qualitative study of brokerage in Aboriginal health in a metropolitan area of Victoria and a regional area of New South Wales.

OBJECTIVE: Health brokerage is one method being employed by government health agencies in an attempt to improve Aboriginal and Torres Strait Islander people's access to primary healthcare. This qualitative study explores key stakeholders' understanding and acceptance of the health brokerage model, prior to the implementation of brokerage services. METHODS: Semistructured interviews and focus groups were conducted with key stakeholders. The resulting data was analysed using a grounded theory approach. RESULTS: Qualitative analysis of the interviews and focus groups revealed five major themes. These were: (1) the perceived limitations of brokerage as a service delivery model; (2) the benefits of health brokerage such as increased flexibility; (3) issues relating to patient independence; (4) the necessity for broker independence; and (5) a mistrust of health brokerage and the authority handling the brokerage funds. CONCLUSIONS: Since this study was conducted in 2008, ongoing funding for urban brokerage services has been suspended. Although the reasons for this are unclear, our study suggests that barriers to the acceptance of brokerage services by the community may have existed even before such services were implemented, thus highlighting the need for transparency when launching new health initiatives that hope to engage the Aboriginal community.

Reattendance and chlamydia retesting rates at 12 months among young people attending Australian general practice clinics 2007-10: a longitudinal study.

UNLABELLED: Background Clinical guidelines commonly recommend annual chlamydia (Chlamydia trachomatis) testing in young people. General practice (GP) clinics can play an important role in annual testing, as a high proportion of young people attend these clinics annually; however, little is known about the timing of attendance and testing in this setting. METHODS: The Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmitted Infections and Blood-Borne Viruses system extracted consultation and pathology data on 16-29-year-olds attending 25 GP clinics in 2007-10. We calculated the proportion of individuals with an initial negative test that reattended at 12 months (±3 months) and retested at 12 months (±3 months). Individuals with an initial positive test were excluded, as guidelines recommend retesting at 3 months. RESULTS: Among 3852 individuals who had an initial negative test, 2201 (57.1%) reattended at ~12 months; reattendance was higher among females (60.8%) than males (44.1%; P<0.001) and higher among 16-19-year-olds (64.2%) than 25-29-year-olds (50.8%; P<0.001). Of 2201 individuals who reattended at 12 months, 377 had a chlamydia test (retesting rate of 9.8%); retesting was higher among females (10.8%) than males (6.1%; P<0.01) and higher among 16-19-year-olds (13.3%) than 25-29-year-olds (7.5%; P<0.001). CONCLUSION: Although over half of young people reattended their GP clinic ~1 year after a negative chlamydia baseline test, only 9.8% were retested at this visit. Strategies are needed to promote regular attendance and testing to both patients and clinicians.

The ten most common adverse drug reactions (ADRs) in oncology patients: do they matter to you?

AIMS: To assess incidence, predictability, preventability and severity of adverse drug reactions (ADRs) in hospitalised oncology patients. PATIENTS AND METHODS: Patients hospitalised at Peter MacCallum Cancer Centre from 28 February to 2 June 2000 were selected for interviews about symptoms related to their drug therapy. Medical records were also reviewed. Causality, predictability, preventability and severity were assessed for each ADR. RESULTS: One hundred and sixty-seven patients associated with 171 admissions were interviewed. Four hundred and fifty-four ADRs were identified in 127 (74.3%) separate admissions (mean ADRs per admission 2.7; range 0-18). Eighty-eight percent of ADRs were predictable. Of these, 1.6% was classified as definitely preventable and 46.1% probably preventable. The ten most common ADRs were constipation, nausea +/- vomiting, fatigue, alopecia, drowsiness, myelosuppression, skin reactions, anorexia, mucositis and diarrhoea. These ADRs have high-documented incidence rates and were also the ten most predictable ADRs in this study. Common reasons for ADRs to be assessed as definitely or probably preventable were omission or inadequate/inappropriate use of preventative measures. The results also showed a discrepancy between clinical severity and patients' perception of the impact of ADRs on well being. CONCLUSIONS: ADRs are common in hospitalised oncology patients and are predictable and at least probably preventable in many instances. Improved use of preventative measures has the potential to contribute to reducing the incidence and severity of ADRs. Recognition and understanding of the discrepancy that exists between clinical severity and patient-perceived severity of ADRs will enable specific areas to be identified and targeted for vigourous intervention.