Utility and outcomes among Indigenous and non-Indigenous patients requiring domiciliary oxygen therapy in the regional and rural Australian population.

OBJECTIVE: To evaluate the utility and outcomes for Indigenous and non-Indigenous patients requiring domiciliary oxygen therapy. DESIGN: Retrospective study. SETTING: Patients residing in the regional and rural Top End Health Service region of the Northern Territory of Australia. PARTICIPANTS: Indigenous and non-Indigenous patients prescribed domiciliary oxygen therapy between 2018 and 2020. INTERVENTIONS: Demographics and clinical indication for domiciliary oxygen therapy and mortality were analysed. MAIN OUTCOME MEASURES: Differences between Indigenous patients requiring domiciliary oxygen therapy in comparison with their non-Indigenous counterparts. RESULTS: Of the 199 study participants, the majority were male (51%), non-Indigenous (77%) and urban residents (72%). Overall chronic obstructive pulmonary disease was the most common indication for domiciliary oxygen therapy (51%) followed by palliative intent (22%). Indigenous patients were significantly younger (61 vs 73 years), with a higher proportion of males (62% vs 45%, P = .039) and remote residents (62% vs 8%, P < .001). Among Indigenous patients, a significantly greater proportion of domiciliary oxygen therapy was indicated for chronic obstructive pulmonary disease and bronchiectasis (16% vs 1%, P < .001). Among non-Indigenous patients, malignancies were a more common indication for domiciliary oxygen therapy. A similar proportion of Indigenous and non-Indigenous patients were prescribed domiciliary oxygen therapy for palliative intent (31% and 20%, P = .108); however, the underlying diagnosis differed significantly, with a greater proportion of chronic obstructive pulmonary disease among Indigenous patients (43% vs 13%, P = .030) and malignancy among the non-Indigenous patients (73% vs 43%, P = .050). Mortality and length of survival were not significantly different by Indigenous status. Linear regression showed longer survival with domiciliary oxygen therapy for chronic obstructive pulmonary disease. CONCLUSION: Indigenous Australian patients living in remote communities will likely derive the same benefits and outcomes of domiciliary oxygen therapy as non-Indigenous peers.

Exploring the appropriateness of prescribing practice of inhaled pharmacotherapy among Aboriginal Australians in the Top End Northern Territory of Australia: a retrospective cohort study.

BACKGROUND: Aboriginal Australians are reported to have a high burden of chronic airway diseases. However, prescribing patterns and related outcomes of airway directed inhaled pharmacotherapy, (short-acting beta agonists (SABA), short-acting muscarinic antagonists (SAMA), long-acting ß-agonists (LABA), long-acting muscarinic antagonists (LAMA) and inhaled corticosteroids (ICS)) among Aboriginal Australian patients with chronic airway disease have been sparsely reported in the past. METHODS: A retrospective cohort study was conducted, using clinical, spirometry data, chest radiology, primary healthcare (PHC) presentations and hospital admission rates among Aboriginal patients identified to have been prescribed inhaled pharmacotherapy in remote and rural communities referred to the respiratory specialist service in the Top End, Northern Territory of Australia. RESULTS: Of the 372 identified active patients, 346 (93%) had inhaled pharmacotherapy prescribed (64% female, median age 57.7 years). ICS was the most common prescription (72% of the total cohort) and was recorded to be prescribed in 76% of patients with bronchiectasis, and 80% of patients with asthma or chronic obstructive pulmonary disease (COPD). Fifty-eight percent of patients had a respiratory hospital admission and 57% had a recorded PHC presentation for a respiratory issue during the study period, with a higher rate of hospital admissions among patients prescribed ICS compared with those on SAMA/SABA or LAMA/LABA without ICS (median rate (per person per year) 0.42 vs 0.21 and 0.21 (p=0.004). Regression models demonstrated that presence of COPD or bronchiectasis alongside ICS was associated with significantly increased hospitalisation rates (1.01 admissions/person/year (95% CI 0.15 to 1.87) and 0.71 admissions/person/year (95% CI 0.23 to 1.18) against patients without COPD/bronchiectasis, respectively). CONCLUSIONS: This study demonstrates that among Aboriginal patients with chronic airway diseases, ICS is the most common inhaled pharmacotherapy prescribed. Although LAMA/LABA and concurrent ICS use may be appropriate among patients with asthma and COPD, the use of ICS may have detrimental effects among those with underlying bronchiectasis either in isolation or concurrent COPD and bronchiectasis, potentially leading to higher hospital admission rates.

COPD disease knowledge, self-awareness and reasons for hospital presentations among a predominately Indigenous Australian cohort: a study to explore preventable hospitalisation.

BACKGROUND: The prevalence of chronic obstructive pulmonary disease (COPD) is higher among Indigenous Australians than that of non-Indigenous Australians. However, no studies have investigated COPD disease awareness and knowledge among Indigenous Australians. In this study, we assessed the COPD disease awareness among Indigenous and non-Indigenous patients in the Top End Health Service region of the Northern Territory of Australia. METHODS: Of a total convenience sample of 100 adults, 86 patients consented to participate in this study over a 15-month period. A structured interview was conducted to identify participant's level of knowledge about COPD, medications, self-management, healthcare interaction and utilisations. RESULTS: Most (69%) participants were Indigenous and men (52%). Indigenous patients were significantly younger (mean 56 vs 68 years p<0.001), with a higher proportion of remote residence and current smoking. COPD knowledge across the cohort was low, with 68% of Indigenous and 19% of non-Indigenous participants reporting they 'know nothing/had never heard of COPD'. Most patients self-reported use of puffers/inhalers and were able to identify medication used; however, adherence to therapy was observed in only 18%. Shortness of breath was the most common symptom for hospital presentation (83%) and 69% of Indigenous patients reported seeking medical attention during an exacerbation. Self-management and COPD action plans were poorly implemented. A significant proportion (49%) reported ≥2 hospital admissions in the preceding 12 months. During exacerbation, although the majority of Indigenous patients were transferred to a tertiary centre from remote communities, patient's preference was to be managed in their respective local communities. CONCLUSIONS: Awareness and understanding of COPD are low in this cohort on several domains. Tailored and culturally appropriate initiatives for both patients and health professionals alike are required to improve COPD disease management among Indigenous population. This will not only improve quality of life but also reduce recurrent hospitalisation, healthcare cost and utilisation.