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1.
Aust N Z J Public Health ; 45(1): 59-64, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33559961

RESUMEN

OBJECTIVES: To identify and describe chronic disease prevention programs offered by Aboriginal Community Controlled Health Services (ACCHSs) in New South Wales (NSW), Australia. METHODS: ACCHSs were identified through the Aboriginal Health and Medical Research Council of NSW website. Chronic disease programs were identified from the Facebook page and website of each ACCHS. Characteristics, including regions, target population, condition, health behaviour, modality and program frequency were extracted and summarised. RESULTS: We identified 128 chronic disease programs across 32 ACCHSs. Of these, 87 (68%) programs were broad in their scope, 20 (16%) targeted youth, three (2%) targeted Elders, 16 (12%) were for females only and five (4%) were for males only. Interventions included physical activity (77, 60%), diet and nutrition (74, 58%), smoking (70, 55%), and the Aboriginal and Torres Strait Islander Health Check (44, 34%), with 93 programs (73%) of ongoing duration. CONCLUSIONS: Chronic disease prevention programs address chronic conditions by promoting physical activity, diet and nutrition, smoking cessation and health screening. Most target the general Aboriginal community, a few target specific groups based on gender and age, and more than one-quarter are time-limited. Implications for public health: Chronic disease programs that are co-produced with specific groups, based on age and gender, may be needed.


Asunto(s)
Enfermedad Crónica/prevención & control , Conductas Relacionadas con la Salud/etnología , Promoción de la Salud/métodos , Servicios de Salud del Indígena/estadística & datos numéricos , Estilo de Vida Saludable , Grupo de Ascendencia Oceánica/psicología , Cese del Hábito de Fumar/estadística & datos numéricos , Adolescente , Anciano , Australia/epidemiología , Femenino , Humanos , Masculino , Nueva Gales del Sur , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Fumar/epidemiología , Cese del Hábito de Fumar/etnología
2.
PLoS One ; 15(10): e0239384, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33002023

RESUMEN

In recent decades, several studies have emphasized sense of personal control as a prominent aspect of Aboriginal health. However, one limitation is that instruments available to measure personal control were originally developed in western countries and validation for Aboriginal Australians has not been conducted. The aims of the current study were to evaluate whether the Sense of Personal Control Scale (SPCS) can be used to obtain culturally unbiased measurement of personal control across Aboriginal and non-Aboriginal Australians and to assess the psychometric properties of the SPCS for Aboriginal and non-Aboriginal Australian. METHODS: The current study utilized two Australian subsamples retrieved from the Teeth Talk Study (n = 317) and the National Survey of Adult Oral Health 2004-2006 (n = 3,857) in which the SPCS was included. Graphical Loglinear Rasch Models (GLLRM) were used to fulfill the aims of the study. RESULTS: The Perceived Constraints subscale fitted a GLLRM for Aboriginal Australians after the exclusion of three items, while fit to any Rasch model (RM) or GLLRM model could not be found in the non-Aboriginal sample. The Mastery subscale fitted a GLLRM in the non-Aboriginal sample after the exclusion of one item. In the Aboriginal sample, two items of the Mastery subscale fitted the RM, however, two items cannot be considered as a scale. CONCLUSION: In the present study, we showed that the development of new items is crucial before the revised SPCS might constitute a valid and reliable measure of sense of personal control in both Aboriginal and non-Aboriginal Australian populations, and it is possible to assess whether the SPCS can be measured without bias across these two populations.


Asunto(s)
Encuestas Epidemiológicas , Grupo de Ascendencia Oceánica/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia/etnología , Femenino , Servicios de Salud del Indígena/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Adulto Joven
3.
Int J Equity Health ; 19(1): 105, 2020 06 26.
Artículo en Inglés | MEDLINE | ID: mdl-32590981

RESUMEN

BACKGROUND: Inequity in access to healthcare services is a constant concern. While advances in healthcare have progressed in the last several decades, thereby significantly improving the prevention and treatment of disease, these benefits have not been shared equally. Excluded communities such as Indigenous communities typically face a lack of access to healthcare services that others do not. This study seeks to understand why the indigenous communities in Attapadi continue to experience poor access to healthcare in spite of both financial protection and adequate coverage of health services. METHODS: Ethnographic fieldwork was carried out among the various stakeholders living in Attapadi. A total of 47 in-depth interviews and 6 focus group discussions were conducted amongst the indigenous community, the healthcare providers and key informants. The data was coded utilising a reflexive and inductive approach leading to the development of the key categories and themes. RESULTS: The health system provided a comprehensive financial protection package in addition to a host of healthcare facilities for the indigenous communities to avail services. In spite of this, they resisted attempts by the health system to improve their access. The failure to provide culturally respectful care, the discrimination of the community at healthcare facilities, the centralisation of the delivery of services as well as the lack of power on the part of the indigenous community to negotiate with the health system for services that were less disruptive for their lives were identified as the barriers to improving healthcare access. The existing power differentials between the community and the health system stakeholders also ensured that meaningful involvement of the community in the local health system did not occur. CONCLUSION: Improving access to health care for indigenous communities would require UHC interventions to be culturally safe, locally relevant and promote active involvement of the community at all stages of the intervention. Continuing structural power imbalances that affect access to resources and prevent meaningful involvement of indigenous communities also need to be addressed.


Asunto(s)
Prestación de Atención de Salud/economía , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud del Indígena/economía , Servicios de Salud del Indígena/estadística & datos numéricos , Disparidades en Atención de Salud/economía , Pueblos Indígenas/psicología , Adulto , Anciano , Anciano de 80 o más Años , Australia , Prestación de Atención de Salud/estadística & datos numéricos , Femenino , Grupos Focales , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Pueblos Indígenas/estadística & datos numéricos , Masculino , Persona de Mediana Edad
4.
PLoS One ; 15(6): e0234486, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32525909

RESUMEN

This article employs computer-assisted methods to analyse references to Aboriginal and Torres Strait Islander people(s) and issues in a newspaper corpus about diabetes. The objectives are to identify both the frequency and quality of social representation. The dataset consisted of 694 items from 12 Australian newspapers in a five-year period (2013-2017). The quantitative analysis focused on frequency (raw/normalised) and range (number/percentage of texts). The qualitative analysis focused on the identification of semantic prosody (co-occurrence with negative/positive words and phrases) and on selective social actor analysis. The qualitative analysis also compared choices made by the press to language practices recommended in relevant reporting guidelines. Key results include that references to Aboriginal and Torres Strait Islander people(s) or matters appear to be extremely rare. In addition, newspapers' language choices only partially align with guidelines. References that do occur can be classified into four categories: a) references to [groups of] people and other references to identity; b) names of services, institutions, professions, roles etc; c) non-human nouns related to health; d) non-human nouns related to culture. Qualitative analysis of the word COMMUNITY suggests that newspapers for the most part do recognise the existence of different communities at a national level. However, analysis of all references to [groups of] people shows that the vast majority occur in contexts to do with negativity, therefore having a negative semantic prosody. More specifically, there is a strong association with mentions of a higher risk, likelihood, or incidence of having or developing diabetes (or complications/effects). In sum, Aboriginal and Torres Strait Islander people(s) and issues lack in visibility in Australian diabetes coverage, and are associated with deficit framing, which can be disempowering. To change the discourse would require both an increased visibility as well as changing the deficit lens.


Asunto(s)
Análisis de Datos , Diabetes Mellitus/epidemiología , Periódicos como Asunto/ética , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Semántica , Australia/epidemiología , Conjuntos de Datos como Asunto , Diabetes Mellitus/prevención & control , Necesidades y Demandas de Servicios de Salud , Servicios de Salud del Indígena/organización & administración , Servicios de Salud del Indígena/estadística & datos numéricos , Humanos , Incidencia , Periódicos como Asunto/estadística & datos numéricos , Investigación Cualitativa
5.
BMC Public Health ; 20(1): 459, 2020 Apr 06.
Artículo en Inglés | MEDLINE | ID: mdl-32252712

RESUMEN

BACKGROUND: Australian surveillance data document higher rates of sexually transmissible infections (STIs) among young Aboriginal people (15-29 years) in remote settings than non-Aboriginal young people. Epidemiological data indicate a substantial number of young Aboriginal people do not test for STIs. Rigorous qualitative research can enhance understanding of these findings. This paper documents socio-ecological factors influencing young Aboriginal people's engagement with clinic-based STI testing in two remote settings in the Northern Territory, Australia. METHODS: In-depth interviews with 35 young Aboriginal men and women aged 16-21 years; thematic analysis examining their perceptions and personal experiences of access to clinic-based STI testing. RESULTS: Findings reveal individual, social and health service level influences on willingness to undertake clinic-based STI testing. Individual level barriers included limited knowledge about asymptomatic STIs, attitudinal barriers against testing for symptomatic STIs, and lack of skills to communicate about STIs with health service staff. Social influences both promoted and inhibited STI testing. In setting 1, local social networks enabled intergenerational learning about sexual health and facilitated accompanied visits to health clinics for young women. In setting 2, however, social connectedness inhibited access to STI testing services. Being seen at clinics was perceived to lead to stigmatisation among peers and fear of reputational damage due to STI-related rumours. Modalities of health service provision both enhanced and inhibited STI testing. In setting 1, outreach strategies by male health workers provided young Aboriginal men with opportunities to learn about sexual health, initiate trusting relationships with clinic staff, and gain access to clinics. In setting 2, barriers were created by the location and visibility of the clinic, appointment procedures, waiting rooms and waiting times. Where inhibitive factors at the individual, social and health service levels exist, young Aboriginal people reported more limited access to STI testing. CONCLUSIONS: This is the first socio-ecological analysis of factors influencing young Aboriginal people's willingness to undertake testing for STIs within clinics in Australia. Strategies to improve uptake of STI testing must tackle the overlapping social and health service factors that discourage young people from seeking sexual health support. Much can be learned from young people's lived sexual health experiences and family- and community-based health promotion practices.


Asunto(s)
Servicios de Salud del Indígena/estadística & datos numéricos , Grupo de Ascendencia Oceánica/psicología , Aceptación de la Atención de Salud/etnología , Vigilancia de la Población , Enfermedades de Transmisión Sexual/etnología , Adolescente , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Northern Territory/epidemiología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Investigación Cualitativa , Salud Sexual/etnología , Enfermedades de Transmisión Sexual/epidemiología , Adulto Joven
7.
Aust N Z J Public Health ; 44(2): 95-101, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32101360

RESUMEN

OBJECTIVE: To explore caregiver perspectives of their children's journey through the specialist paediatric service, the Aboriginal Ambulatory Care Coordination Program (AACC), and non-AACC services at the Perth Children's Hospital. METHODS: Eighteen semi-structured interviews with families of Aboriginal children were completed. Indigenous research methodology and a phenomenological approach guided data collection and analysis. RESULTS: Four key themes were identified from interviews: hospital admissions, discharge and follow-up outpatient appointments; communication; financial burden; and cultural issues. Our findings suggest Aboriginal children and their caregivers using the AACC program had more positive and culturally secure experiences than those using non-AACC services. However, barriers relating to health providers' understanding of Aboriginal cultural issues and lived experience were commonly discussed, regardless of which service families received. CONCLUSIONS: Australian Aboriginal children have an increased use of tertiary hospital care compared to non-Indigenous children. Healthcare programs specifically designed for Aboriginal children and their families can improve their experience of care in hospital. However, improvements in cultural awareness for other hospital staff is still needed. Implications for public health: Dedicated Aboriginal programs in mainstream services can successfully improve cultural care to their clients, which is fundamental to improving service delivery for families.


Asunto(s)
Competencia Cultural , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud del Indígena/estadística & datos numéricos , Grupo de Ascendencia Oceánica/psicología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Adulto , Australia , Niño , Comunicación , Barreras de Comunicación , Femenino , Necesidades y Demandas de Servicios de Salud , Servicios de Salud del Indígena/organización & administración , Disparidades en Atención de Salud , Humanos , Entrevistas como Asunto , Masculino , Relaciones Profesional-Paciente , Investigación Cualitativa , Australia Occidental
8.
Aust J Rural Health ; 28(1): 51-59, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31957132

RESUMEN

OBJECTIVES: To describe rates of hospitalisation and Coaching on Achieving Cardiovascular Health referral, for Queensland's adults with heart and related disease, and comparisons between Aboriginal and Torres Strait Islander and non-Indigenous peoples in northern Queensland. DESIGN: Descriptive retrospective epidemiological study of Queensland Health Patient Admission Data Collection for adults with heart and related disease, and Coaching on Achieving Cardiovascular Health referral data. Relative risk and age standardisation were calculated for Aboriginal and Torres Strait Islander and non-Indigenous peoples. PARTICIPANTS: Queensland's adults ≥20 years, hospitalised with heart and related disease (1 January 2012-31 December 2016). SETTING: Queensland, Australia. MAIN OUTCOME MEASURES: Queensland Health Hospital and Health Services' hospitalisation and Coaching on Achieving Cardiovascular Health referral rates for heart and related disease. RESULTS: Queensland's Aboriginal and Torres Strait Islander peoples have a higher hospitalisation rate for heart and related disease, with higher rates for northern Queensland. Queensland's overall Coaching on Achieving Cardiovascular Health referral rates were low, but higher for Aboriginal and Torres Strait Islander peoples. Deficiencies in documentation of Aboriginal and Torres Strait Islander people's status affected results in some areas. CONCLUSION: Queensland's Aboriginal and Torres Strait Islander peoples were more likely to be admitted to hospital for heart and related disease and referred to Coaching on Achieving Cardiovascular Health than non-Indigenous peoples. However, hospitalisation and Coaching on Achieving Cardiovascular Health referral rates are unlikely to reflect the needs of Aboriginal and Torres Strait Islander peoples especially in rural and very remote areas given their higher mortality and morbidity rates and fewer services.


Asunto(s)
Rehabilitación Cardiaca/métodos , Rehabilitación Cardiaca/estadística & datos numéricos , Servicios de Salud del Indígena/estadística & datos numéricos , Cardiopatías/prevención & control , Hospitalización/estadística & datos numéricos , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto/métodos , Queensland , Estudios Retrospectivos
9.
Aust J Rural Health ; 28(1): 60-66, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31970843

RESUMEN

PROBLEM: In the Katherine region, Northern Territory, barriers to eye care for Aboriginal and Torres Strait Islander people include unclear eye care referral processes, challenges coordinating patient eye care between various providers, complex socioeconomic determinants and a lengthy outpatient ophthalmology waiting list. DESIGN: Mixed methods participatory approach using a regional needs analysis, clinical file audit and stakeholder survey, to develop, implement and monitor quality improvement strategies. SETTING: Collaboration with Aboriginal Community Controlled Health Services and regional eye care stakeholders in the Katherine region. KEY MEASURES FOR IMPROVEMENT: Clinical audit data captured frequency and rates of primary eye checks, ophthalmology referrals and spectacle prescriptions. A survey was developed and applied to assess stakeholder perspectives of regional eye care systems. STRATEGY FOR CHANGE: Quality improvement strategies informed by regional data (clinical audits and survey) included increasing service delivery to match eye care needs, primary eye care training for Aboriginal Community Controlled Health Services staff, updating Aboriginal Community Controlled Health Services primary care templates and forming a regional eye care coalition group. EFFECTS OF CHANGE: Post-implementation, rates and frequency of recorded optometry examinations, number of spectacles prescribed and rates of annual dilated fundus examinations for patients with diabetes increased. There was a decrease in the number of patients with diabetes who had never had an eye examination. Eye care stakeholders perceived a marked improvement in the effectiveness of the regional eye care system. LESSONS LEARNT: Our findings highlight the importance of engaging services and stakeholders to ensure a systems approach that is evidence-informed, contextually appropriate and reflects commitment to improved eye health outcomes.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Promoción de la Salud/métodos , Servicios de Salud del Indígena/organización & administración , Grupo de Ascendencia Oceánica/educación , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Optometría/educación , Mejoramiento de la Calidad/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Servicios de Salud Comunitaria/estadística & datos numéricos , Femenino , Servicios de Salud del Indígena/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Northern Territory , Mejoramiento de la Calidad/estadística & datos numéricos , Encuestas y Cuestionarios
10.
Aust N Z J Public Health ; 44(2): 102-105, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31914233

RESUMEN

OBJECTIVE: To understand strengths-based practice as articulated by urban Indigenous community workers and to consider its application for public health approaches to Australian Indigenous health advancement. METHODS: Semi-structured interviews with community workers from an urban Indigenous community. Interviews were video and audio recorded and transcribed verbatim. Data were analysed using thematic analysis, using an Indigenist research framework. RESULTS: For our participants (11 Indigenous and one non-Indigenous), a strengths-based approach was fundamental to their practice. This approach reconfigured the usual relationship of client and service provider to fellow community member. They understood the strength of Indigeneity that empowers individuals and communities. They were not blinkered to the challenges in the community but resisted defining themselves, their community or their community practice by these deficits. CONCLUSIONS: Our participants had a sophisticated experiential understanding that a strengths-based practice is not simply a 'culturally acceptable' way for non-Indigenous peoples to work for Indigenous peoples, but rather it is the only way of working with Indigenous people. Implications for public health: Strengths-based practice requires a reconfiguring of relationships of power, of attending to structure over stereotypes, and privileging Indigenous ways of knowing, being and doing. This reconfiguration is an ethical prerequisite for an approach that is genuinely strengths-based.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Agentes Comunitarios de Salud/psicología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud del Indígena/estadística & datos numéricos , Grupo de Ascendencia Oceánica/psicología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Relaciones Profesional-Paciente , Adulto , Australia , Niño , Femenino , Servicios de Salud del Indígena/organización & administración , Humanos , Entrevistas como Asunto , Masculino , Investigación Cualitativa , Población Urbana
11.
Women Birth ; 33(4): 311-322, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31501053

RESUMEN

BACKGROUND: Western models of care to improve the oral health of pregnant women have been successfully implemented in the healthcare setting across various developed countries. Even though Indigenous women experience poorer pregnancy and birth outcomes compared to other women, these models have not been developed with Indigenous communities to address the oral health needs of Indigenous pregnant women. This review aimed to understand the oral health knowledge, practices, attitudes and challenges of Indigenous pregnant women globally. METHODS: A comprehensive search including six electronic databases and grey literature up to September 2018 was undertaken (PROSPERO Registration Number: 111402). Quantitative and qualitative evidence exploring at least one of the four oral health domains relating to Indigenous pregnant women worldwide, including women pregnant with an Indigenous child, were retrieved. RESULTS: Eleven publications related to nine studies were included. Indigenous pregnant women's attitudes, practices and challenges relating to their oral health were influenced by socioeconomic and psychosocial factors, and their healthcare context. Availability of dental services varied depending on the healthcare model, whether services were public or private, and whether services met their needs. Although there was little evidence related to oral health knowledge, the literature suggests some misconceptions within this population. CONCLUSIONS: The availability of culturally appropriate dental services that fulfilled the needs of Indigenous pregnant women varied between developed countries. This review highlighted the need for community-tailored dental services and a care coordinator to provide both education and assistance to those navigating services.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud/etnología , Pueblos Indígenas/psicología , Salud Materna/etnología , Salud Bucal/etnología , Mujeres Embarazadas/psicología , Adulto , Asistencia Sanitaria Culturalmente Competente/estadística & datos numéricos , Servicios de Salud Dental/estadística & datos numéricos , Femenino , Servicios de Salud del Indígena/estadística & datos numéricos , Humanos , Servicios de Salud Materna/estadística & datos numéricos , Embarazo , Mujeres Embarazadas/etnología
12.
Support Care Cancer ; 28(1): 317-327, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31049670

RESUMEN

PURPOSE: The role of general practitioners in cancer care has expanded in recent years. However, little is known about utilization of primary health care (PHC) services by patients with cancer, particularly among socio-economically disadvantaged groups. We describe utilization of PHC services by patients with cancer, and the nature of the care provided. The study focuses on a disadvantaged group in Australia, namely Indigenous Australians. METHODS: A retrospective audit of clinical records in ten PHC services in Queensland, Australia. Demographic and clinical data of Indigenous Australians diagnosed with cancer during 2010-2016 were abstracted from patient's medical records at the PHC services. The rates of cancer-related visits were calculated using person years at risk as a denominator. RESULTS: A total of 138 patients' records were audited. During 12 months following the cancer diagnosis, patients visited the PHC service on average 5.95 times per year. Frequency of visits were relatively high in remote areas and among socioeconomic disadvantaged patients (IRR = 1.87, 95%CI 1.61-2.17; IRR = 1.79, 95%CI 1.45-2.21, respectively). Over 80% of visits were for seeking attention for symptoms, wound care, and emotional or social support. Patients who did not undergo surgery, had greater comorbidity, received chemotherapy and/or radiotherapy, and male gender had significantly greater rate of visits than their counterparts. CONCLUSION: The frequency of utilization of PHC services, especially by patients with comorbidities, and the range of reasons for attendance highlights the important role of PHC services in providing cancer care. The reliance on PHC services, particularly by patients in remote and disadvantaged communities, has important implications for appropriate resourcing and support for services in these locations.


Asunto(s)
Servicios de Salud del Indígena/estadística & datos numéricos , Neoplasias/terapia , Grupo de Ascendencia Oceánica , Médicos de Atención Primaria/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Auditoría Clínica , Femenino , Médicos Generales/normas , Médicos Generales/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/normas , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud del Indígena/normas , Humanos , Pueblos Indígenas/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Neoplasias/etnología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Pautas de la Práctica en Medicina/normas , Atención Primaria de Salud/normas , Queensland/epidemiología , Derivación y Consulta/normas , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Adulto Joven
13.
Intern Med J ; 50(1): 38-47, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31081226

RESUMEN

BACKGROUND: Cancer care involves many different healthcare providers. Delayed or inaccurate communication between specialists and general practitioners (GP) may negatively affect care. AIM: To describe the pattern and variation of communication between primary healthcare (PHC) services and hospitals and specialists in relation to the patient's cancer care. METHODS: A retrospective audit of clinical records of Indigenous Australians diagnosed with cancer during 2010-2016 identified through 10 PHC services in Queensland is described. Poisson regression was used to model the dichotomous outcome availability of hospital discharge summary versus not. RESULTS: A total of 138 patient records was audited; 115 of those patients visited the PHC service for cancer-related care after cancer diagnosis; 40.0% visited the service before a discharge summary was available, and 36.5% of the patients had no discharge summary in their medical notes. While most discharge summaries noted important information about the patient's cancer, 42.4% lacked details regarding the discharge medications regimen. CONCLUSIONS: Deficits in communication and information transfer between specialists and GP may adversely affect patient care. Indigenous Australians are a relatively disadvantaged group that experience poor health outcomes and relatively poor access to care. The low proportion of discharge summaries noting discharge medication regimen is of concern among Indigenous Australians with cancer who have high comorbidity burden and low health literacy. Our findings provide an insight into some of the factors associated with quality of cancer care, and may provide guidance for focus areas for further research and improvement efforts.


Asunto(s)
Servicios de Salud del Indígena/estadística & datos numéricos , Neoplasias/terapia , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Médicos de Atención Primaria/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Médicos Generales/normas , Médicos Generales/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/normas , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud del Indígena/normas , Humanos , Masculino , Auditoría Médica , Persona de Mediana Edad , Neoplasias/etnología , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud/normas , Queensland/epidemiología , Derivación y Consulta/normas , Análisis de Regresión , Estudios Retrospectivos , Adulto Joven
14.
Intern Med J ; 50(1): 48-53, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31659827

RESUMEN

BACKGROUND: Rural and remote patients have reduced access to palliative care, often resulting in inter-hospital transfers and death a long way from home and family. Katherine Hospital (KH), a 50-bed hospital services a population with high Aboriginality who experience this issue. AIMS: To characterise trends in mortality and transfers at a remote hospital in reference to increasing capacity to provide palliative care. METHODS: Retrospective analysis of deaths in patients over 18 years of age, admitted between 2008 and 2018 at KH, Northern Territory. Outcome measures include number of deaths, aeromedical transfers to tertiary facility, palliative care episodes, demographics including Aboriginality, admission data and comorbidity. Statistical analysis included unpaired t-test, chi-square test and regression analysis. RESULTS: The number of deaths in KH increased from 23 (0.88% of inpatient admissions) in 2011 to 52 in 2018 (1.7%). During the same period, the proportion of all deaths classified as palliative increased from 51.4 to 66.0% (P = 0.001), with fewer deaths occurring in the emergency department (17.2-1.4% for the last 3 years, R = 0.75, P = 0.008). The number of aeromedical transfers of patients from KH to tertiary centres decreased from 769 (10.4% of all admissions) in 2011 to 434 (3.4%) in 2018 (P = 0.006). CONCLUSIONS: Increasing the capacity of a remote hospital to provide palliative care allowed more patients to die closer to home and decreased inappropriate aeromedical retrievals. An increased in-hospital mortality rate should not be misinterpreted as reflecting suboptimal care if palliative intent, patients' wishes and non-clinical risk factors have not been ascertained.


Asunto(s)
Accesibilidad a los Servicios de Salud , Servicios de Salud del Indígena/estadística & datos numéricos , Cuidados Paliativos/estadística & datos numéricos , Servicios de Salud Rural/estadística & datos numéricos , Cuidado Terminal , Anciano , Anciano de 80 o más Años , Australia , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Estudios Retrospectivos , Población Rural , Centros de Atención Terciaria
15.
Hum Resour Health ; 17(1): 99, 2019 12 16.
Artículo en Inglés | MEDLINE | ID: mdl-31842946

RESUMEN

BACKGROUND: Residents of remote communities in Australia and other geographically large countries have comparatively poorer access to high-quality primary health care. To inform ongoing policy development and practice in relation to remote area health service delivery, particularly in remote Indigenous communities, this review synthesizes the key findings of (1) a comprehensive study of workforce turnover and retention in remote Northern Territory (NT) of Australia and (2) a narrative review of relevant international literature on remote and rural health workforce retention strategies. This synthesis provides a valuable summary of the current state of international knowledge about improving remote health workforce retention. MAIN TEXT: Annual turnover rates of NT remote area nurses (148%) and Aboriginal health practitioners (80%) are very high and 12-month stability rates low (48% and 76%, respectively). In remote NT, use of agency nurses has increased substantially. Primary care costs are high and proportional to staff turnover and remoteness. Effectiveness of care decreases with higher turnover and use of short-term staff, such that higher staff turnover is always less cost-effective. If staff turnover in remote clinics were halved, the potential savings would be approximately A$32 million per annum. Staff turnover and retention were affected by management style and effectiveness, and employment of Indigenous staff. Review of the international literature reveals three broad themes: Targeted enrolment into training and appropriate education designed to produce a competent, accessible, acceptable and 'fit-for-purpose' workforce; addressing broader health system issues that ensure a safe and supportive work environment; and providing ongoing individual and family support. Key educational initiatives include prioritising remote origin and Indigenous students for university entry; maximising training in remote areas; contextualising curricula; providing financial, pedagogical and pastoral support; and ensuring clear, supported career pathways and continuing professional development. Health system initiatives include ensuring adequate funding; providing adequate infrastructure including fit-for-purpose clinics, housing, transport and information technology; offering flexible employment arrangements whilst ensuring a good 'fit' between individual staff and the community (especially with regard to cultural skills); optimising co-ordination and management of services that empower staff and create positive practice environments; and prioritising community participation and employment of locals. Individual and family supports include offering tailored financial incentives, psychological support and 'time out'. CONCLUSION: Optimal remote health workforce stability and preventing excessive 'avoidable' turnover mandates alignment of government and health authority policies with both health service requirements and individual health professional and community needs. Supportive underpinning policies include: Strong intersectoral collaboration between the health and education sectors to ensure a fit-for-purpose workforce;A funding policy which mandates the development and implementation of an equitable, needs-based formula for funding remote health services;Policies that facilitate transition to community control, prioritise Indigenous training and employment, and mandate a culturally safe work context; andAn employment policy which provides flexibility of employment conditions in order to be able to offer individually customised retention packages There is considerable extant evidence from around the world about effective retention strategies that contribute to slowing excessive remote health workforce turnover, resulting in significant cost savings and improved continuity of care. The immediate problem comprises an 'implementation gap' in translating empirical research evidence into actions designed to resolve existing problems. If we wish to ameliorate the very high turnover of staff in remote areas, in order to provide an equitable service to populations with arguably the highest health needs, we need political and executive commitment to get the policy settings right and ensure the coordinated implementation of multiple strategies, including better linking existing strategies and 'filling the gaps' where necessary.


Asunto(s)
Servicios de Salud del Indígena/estadística & datos numéricos , Fuerza Laboral en Salud/estadística & datos numéricos , Reorganización del Personal/estadística & datos numéricos , Servicios de Salud Rural/estadística & datos numéricos , Australia , Humanos , Población Rural
16.
Public Health Res Pract ; 29(4)2019 Dec 04.
Artículo en Inglés | MEDLINE | ID: mdl-31800644

RESUMEN

The Australian Bureau of Statistics (ABS) Standard Indigenous Question (SIQ) uses a question about 'origin' to collect data on Aboriginal and Torres Strait Islander people. A 2014 review found strong support among Aboriginal and Torres Strait Islander stakeholders for a question focusing on cultural identity, rather than origin. However the ABS retained the origin question to preserve data continuity. In contrast, an Australian influenza-like illness surveillance system, FluTracking, has included the question: "Do you identify as Aboriginal or Torres Strait Islander?" for the past 8 years. Brief consultations found that Aboriginal health professionals and academics preferred the 'identify' question as a more accurate descriptor of social realities of Aboriginal and Torres Strait communities. Statistical collections could adapt to improve the quality of Aboriginal and Torres Strait Islander data, and seek to reflect reality, not define it.


Asunto(s)
Análisis de Datos , Prestación de Atención de Salud/estadística & datos numéricos , Guías como Asunto , Servicios de Salud del Indígena/estadística & datos numéricos , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Australia , Humanos , Reproducibilidad de los Resultados
17.
Rural Remote Health ; 19(4): 5449, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31760754

RESUMEN

Evaluation expertise to assist with identifying improvements, sourcing relevant literature and facilitating learning from project implementation is not routinely available or accessible to not-for-profit organisations. The right information, at the right time and in an appropriate format, is not routinely available to program managers. Program management team members who were implementing The Fred Hollows Foundation's Indigenous Australia Program's Trachoma Elimination Program required information about what was working well and what required improvement. This article describes a way of working where the program management team and an external evaluation consultancy collaboratively designed and implemented an utilisation-focused evaluation, informed by a developmental evaluation approach. Additionally, principles of knowledge translation were embedded in this process, thereby supporting the evaluation to translate knowledge into practice. The lessons learned were that combining external information and practice-based knowledge with local knowledge and experience is invaluable; it is useful to incorporate evaluative information from inception and for the duration of a program; a collaborative working relationship can result in higher quality information being produced and it is important to communicate findings to different audiences in different formats.


Asunto(s)
Promoción de la Salud/organización & administración , Servicios de Salud del Indígena/organización & administración , Hospitales Filantrópicos/organización & administración , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Calidad de la Atención de Salud/organización & administración , Australia , Promoción de la Salud/estadística & datos numéricos , Servicios de Salud del Indígena/estadística & datos numéricos , Hospitales Filantrópicos/estadística & datos numéricos , Humanos , Calidad de la Atención de Salud/estadística & datos numéricos
18.
Sex Health ; 16(6): 566-573, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31623703

RESUMEN

Australian Aboriginal communities experience a high burden of sexually transmissible infections (STIs). Since 2009, a comprehensive sexual health program has been implemented at nine Aboriginal Community Controlled Health Services in South Australia. This study assessed trends in STI testing and positivity using deidentified diagnostic data from this period (2008-16). METHODS: Testing data for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) from one urban, three regional and five remote Aboriginal health services were analysed using logistic regression. RESULTS: From 2008 to 2016, testing increased for CT (twofold), NG (threefold) and TV (sixfold). On average, 30% of testing occurred during an annual 6-week screen. Fewer males were tested (range 27-38% annually). Mean annual STI testing coverage was 28% for 16- to 30-year-old clients attending regional or remote services (2013-16). Positivity at first testing episode for all three infections declined during the study period. From 2013 to 2016, when testing was stable and changes in positivity were more likely to indicate changes in prevalence, there were significant reductions in CT positivity (adjusted odds ratio (aOR) 0.4; 95% confidence interval (CI) 0.2-0.5) and TV positivity (aOR 0.6, 95% CI 0.4-0.9), although declines were statistically significant for females only. There was no significant decrease in NG positivity (aOR 0.9; 95% CI 0.5-1.5). CONCLUSIONS: Since the sexual health program began, STI testing increased and STI positivity declined, but significant reductions observed in CT and TV positivity were confined to females. These findings suggest evidence of benefit from sustained, comprehensive sexual health programs in Aboriginal communities with a high STI prevalence, but highlight the need to increase STI testing among men in these communities.


Asunto(s)
Servicios de Salud del Indígena/estadística & datos numéricos , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Enfermedades de Transmisión Sexual/diagnóstico , Adolescente , Adulto , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis , Femenino , Gonorrea/diagnóstico , Gonorrea/epidemiología , Humanos , Masculino , Neisseria gonorrhoeae , Factores de Riesgo , Enfermedades de Transmisión Sexual/epidemiología , Australia del Sur/epidemiología , Vaginitis por Trichomonas/diagnóstico , Vaginitis por Trichomonas/epidemiología , Trichomonas vaginalis , Adulto Joven
19.
Aust N Z J Public Health ; 43(6): 558-562, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31617660

RESUMEN

OBJECTIVES: To describe and compare vaccination coverage for Aboriginal and Torres Strait Islander (hereafter referred to as Indigenous) adults in 2004-05 and 2012-13, including the impact of national vaccination funding initiatives. METHODS: National Aboriginal and Torres Strait Islander Health cross-sectional surveys - 2004-05 (n=5,757) and 2012-13 (n=5,482) - were compared. Self-reported influenza and pneumococcal vaccination coverage among Indigenous adults was analysed by age, remoteness, gender and risk factor status. RESULTS: Influenza vaccination coverage among Indigenous adults in 2004-05 and 2012-13 remained low. While coverage increased for those aged 18-49 years from 23% to 29%, it declined for those aged ≥65 years from 84% to 74%. For remote areas, influenza coverage among those aged 50-64 years declined from 76% to 66%. Pneumococcal vaccination coverage remained very low and declined across all age groups in 2004-05 and 2012-13 (50-64 years: 30% to 23%). For remote areas, pneumococcal coverage declined among those aged 50-64 years from 52% to 32%. CONCLUSIONS: Indigenous adult vaccination coverage for influenza and pneumococcal disease remains unacceptably low. Between 2004-05 and 2012-13, declines occurred in pneumococcal vaccination coverage across all age groups ≥18 years. Despite national funding of influenza vaccine in 2010, there was no increase in influenza coverage, except for the 18-49-year age group. Implications for public health: Current approaches to promote, deliver and monitor vaccination of Indigenous adults are inadequate.


Asunto(s)
Servicios de Salud del Indígena/estadística & datos numéricos , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Cobertura de Vacunación/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Control de Enfermedades Transmisibles , Estudios Transversales , Femenino , Humanos , Programas de Inmunización/normas , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud , Grupo de Ascendencia Oceánica , Cobertura de Vacunación/tendencias , Adulto Joven
20.
Front Immunol ; 10: 2184, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31572391

RESUMEN

The Pacific region, also referred to as Oceania, is a geographically widespread region populated by people of diverse cultures and ethnicities. Indigenous people in the region (Melanesians, Polynesians, Micronesians, Papuans, and Indigenous Australians) are over-represented on national, regional, and global scales for the burden of infectious and non-communicable diseases. Although social and environmental factors such as poverty, education, and access to health-care are assumed to be major drivers of this disease burden, there is also developing evidence that genetic and microbiotic factors should also be considered. To date, studies investigating genetic and/or microbiotic links with vulnerabilities to infectious and non-communicable diseases have mostly focused on populations in Europe, Asia, and USA, with uncertain associations for other populations such as indigenous communities in Oceania. Recent developments in personalized medicine have shown that identifying ethnicity-linked genetic vulnerabilities can be important for medical management. Although our understanding of the impacts of the gut microbiome on health is still in the early stages, it is likely that equivalent vulnerabilities will also be identified through the interaction between gut microbiome composition and function with pathogens and the host immune system. As rapid economic, dietary, and cultural changes occur throughout Oceania it becomes increasingly important that further research is conducted within indigenous populations to address the double burden of high rates of infectious diseases and rapidly rising non-communicable diseases so that comprehensive development goals can be planned. In this article, we review the current knowledge on the impact of nutrition, genetics, and the gut microbiome on infectious diseases in indigenous people of the Pacific region.


Asunto(s)
Enfermedades Transmisibles/terapia , Microbiota , Enfermedades no Transmisibles/terapia , Salud Pública/estadística & datos numéricos , Determinantes Sociales de la Salud/estadística & datos numéricos , Enfermedades Transmisibles/etnología , Enfermedades Transmisibles/genética , Geografía , Servicios de Salud del Indígena/estadística & datos numéricos , Humanos , Pueblos Indígenas/estadística & datos numéricos , Enfermedades no Transmisibles/economía , Enfermedades no Transmisibles/etnología , Oceanía
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