ABSTRACT
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.
Subject(s)
Community-Institutional Relations , Health Services Accessibility , Medicine , Native Hawaiian or Other Pacific Islander , Specialization , Attitude of Health Personnel , Culture , Female , Humans , Male , Northern Territory , Referral and Consultation , Rural PopulationABSTRACT
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.
