Topics

The available evidence from the past 20 years of government interventions can inform future priorities

Australia is in a critical period of rural workforce policy reform. The Australian government is responding to a surge of domestic and international doctors, while addressing the pervasive problem of geographic and specialty maldistribution.1 There is renewed commitment to strengthen rural health policy and further develop a well skilled, adaptable rural general practitioner workforce. GPs underpin resilient, healthy rural and remote communities and are essential for a coordinated and efficient health system.2 This article seeks to inform future directions and research priorities by reflecting on 20 years of policy activity and outcomes.

1 Flinders University Rural Clinical School, Mt Gambier, SA
2 School of Rural Health, Monash University, Churchill, VIC
3 Northern Institute, Charles Darwin University, Darwin, NT
4 Northern Ontario School of Medicine, Laurentian University and Lakehead University, Sudbury, Canada
5 Mount Isa Centre for Rural and Remote Health, James Cook University, Mt Isa, QLD
6 University of Western Australia, Perth, WA

Correspondence: Lucie.Walters@flinders.edu.au

Competing interests:

No relevant disclosures.

1. Mason J. Review of Australian Government Health Workforce Programs. Canberra: Department of Health and Ageing, 2013. http://www.health.gov.au/internet/main/publishing.nsf/content/review-australian-government-health-workforce-programs (accessed May 2017).
2. Wakerman J, Humphreys JS. Sustainable workforce and sustainable health systems for rural and remote Australia. Med J Aust 2013; 199 (5 Suppl): S14-S17. <MJA full text>
3. Australian Institute of Health and Welfare. Medical workforce 2015 additional material. http://www.aihw.gov.au/workforce/medical/additional (accessed June 2017).
4. Australian Institute of Health and Welfare. Medical workforce 2011 (AIHW Cat. No. HWL 49; National Health Workforce Series No. 3.). Canberra: AIHW, 2013. http://www.aihw.gov.au/publication-detail/?id=60129542627 (accessed June 2017).
5. Australian Government Department of Health. General practice statistics. http://www.health.gov.au/internet/main/publishing.nsf/Content/General+Practice+Statistics-1 (accessed May 2017).
6. McGrail MR, Humphreys JS, Joyce CM, et al. How do rural GPs’ workloads and work activities differ with community size compared with metropolitan practice? Aust J Prim Health 2012; 18: 228-233.
7. McGrail MR, Russell DJ. Australia’s rural medical workforce: Supply from its medical schools against career stage, gender and rural-origin. Aust J Rural Health 2016; doi: 10.1111/ajr.12323 [Epub ahead of print].
8. Kondalsamy-Chennakesavan S, Eley DS, Ranmuthugala G, et al. Determinants of rural practice: positive interaction between rural background and rural undergraduate training. Med J Aust 2015; 202: 41-46. <MJA full text>
9. Sen Gupta T, Woolley T, Murray R, et al. Positive impacts on rural and regional workforce from the first seven cohorts of James Cook University medical graduates. Rural Remote Health 2014; 14: 2657.
10. Wilkinson D, Laven G, Pratt N, et al. Impact of undergraduate and postgraduate rural training, and medical school entry criteria on rural practice among Australian general practitioners: national study of 2414 doctors. Med Educ 2003; 37: 809-814.
11. McGrail MR, Russell DJ, Campbell DG. Vocational training of general practitioners in rural locations is critical for Australian rural medical workforce supply. Med J Aust 2016; 205: 216-221. <MJA full text>
12. Commonwealth of Australia. Australian general practice training program distribution model review: Discussion paper Canberra: Department of Health, 2016.
13. KBC Australia. Evaluation of the Remote Vocational Training Scheme – impact and outcomes: Final report. Orange: KBC, 2016.
14. Russell D, McGrail M. How does the workload and work activities of procedurally-active GPs compare to non-procedural GPs. Aust J Rural Health 2016; doi: 10.1111/ajr.12321 [Epub ahead of print].
15. Russell D, Humphreys JS, McGrail MR, et al. The value of survival analyses for evidence-based rural medical workforce planning. Hum Resour Health 2013; 11: 65.
16. Sen Gupta T, Manahan D, Lennox D, et al. The Queensland Health Rural medical generalist pathway: providing a medical workforce for the bush. Rural Remote Health 2012; 13: 2319.
17. House of Representatives Standing Committee on Health and Ageing. Lost in the labyrinth: report on the inquiry into registration processes and support for overseas trained doctors. Canberra: Parliament of Australia, 2012. http://www.aph.gov.au/Parliamentary_Business/Committees/House_of_Representatives_committees?url=haa/overseasdoctors/report.htm (accessed May 2017).
18. Hawthorne L. International medical migration: what is the future for Australia? Med J Aust 2013; 199 (5 Suppl): S18-S21. <MJA full text>
19. Gibbon P, Hales J. Review of the Rural Retention Program - Final report. Canberra: Australian Government – Department of Health and Ageing, 2006.
20. Li J, Scott A, McGrail M, et al. Retaining rural doctors: Doctors’ preferences for rural medical workforce incentives. Soc Sci Med 2014; 121: 56-64.
21. Scott A, Witt J, Humphreys J, et al. Getting doctors into the bush: general practitioners’ preferences for rural location. Soc Sci Med 2013; 9: 33-44.
22. Humphreys JS, Jones MP, Jones JA, et al. Workforce retention in rural and remote Australia: determining the factors that influence length of practice. Med J Aust 2002; 176: 472-476. <MJA full text>
23. Jackson C. Review of after hours primary health care. Report to the Minister for Health and Minister for Sport. Canberra: Department of Health, 2015. http://www.health.gov.au/internet/main/publishing.nsf/content/primary-ahphc-review (accessed May 2017).
24. Communio. Review of the National Rural Locum Program – Final report – April 2011. Canberra: Department of Health and Ageing, 2011. http://www.health.gov.au/internet/publications/publishing.nsf/Content/work-pubs-rnrlp-toc (accessed May 2017).

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Perspectives

Hepatitis C in Australia — a role for general practitioners?

Mieke L van Driel, David Lim and Paul J Clark

Med J Aust 2017; 207 (2): . || doi: 10.5694/mja17.00323
Published online: 17 July 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Health services administration

Digestive system diseases

General medicine

Infectious diseases

The availability of new antiviral agents opens the way for increasing GP involvement in the management of hepatitis C

The new direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infections became available on the Pharmaceutical Benefits Scheme in March 2016. In September 2016, already over 10% of the estimated 230 500 Australians with chronic HCV infection had been treated.1 While such rapid uptake was unanticipated, it may represent the low-hanging fruit of the HCV epidemic: patients already enlisted in tertiary clinics waiting for treatment. From an epidemiological perspective, the remaining untreated patients may fall under the radar of tertiary-based clinics. If Australia is to capitalise on the opportunities of universal access to DAA therapies, it will require the concerted efforts of general practitioners to improve rates of diagnosis, assessment, treatment and follow-up in the community.

1 University of Queensland, Brisbane, QLD
2 Flinders Rural Health South Australia, Victor Harbor, SA

Correspondence: m.vandriel@uq.edu.au

Competing interests:

No relevant disclosures.

1. The Kirby Institute. Initiations of new treatment for chronic hepatitis C during March to September 2016. Monitoring hepatitis C treatment uptake in Australia 2017; Issue 6, February, 2017. Sydney: The Kirby Institute, University of New South Wales Sydney. https://kirby.unsw.edu.au/sites/default/files/kirby/report/Monitoring-hep-C-treatment-uptake-in-Australia_Iss6-FEB17.pdf (accessed May 2017).
2. The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia. Annual surveillance report 2016. Sydney: Kirby Institute, 2016. https://kirby.unsw.edu.au/sites/default/files/kirby/report/SERP_2016-Annual-Surveillance-Report_UPD170116.pdf (accessed May 2017).
3. Pharmaceutical Benefits Scheme. General statement for drugs for the treatment of hepatitis C. http://www.pbs.gov.au/info/healthpro/explanatory-notes/general-statement-hep-c (accessed May 2017).
4. Thompson AJV. Australian recommendations for the management of hepatitis C virus infection: a consensus statement. Med J Aust 2016; 204: 268-272. <MJA full text>
5. Wade AJ, Veronese V, Hellard ME, Doyle JS. A systematic review of community based hepatitis C treatment. BMC Infect Dis 2016; 16: 202.
6. Mina MM, Clark PJ, Beasley HM, et al. Enhancing hepatitis C treatment in the custodial setting: a national roadmap. Med J Aust 2014; 200: 15-16. <MJA full text>
7. Arora S, Kalishman S, Thornton K, et al. Expanding access to HCV treatment – Extension for Community Healthcare Outcomes (ECHO) Project: disruptive innovation in specialty care. Hepatology 2010; 52: 1124-1133.
8. Keogh K, Clark P, Valery PC, et al. Use of telehealth to treat and manage chronic viral hepatitis in regional Queensland. J Telemed Telecare 2016; 22: 459-464.
9. Lobo R, Mascarenhas L, Worthington D, et al. Evaluation of the regional nurse-supported hepatitis C shared care program in Western Australia: a mixed methods study. BMC Health Serv Res 2015; 15: 399.
10. Queensland Injectors Health Network. Hepatitis C Treatment and Management Program. https://www.quihn.org/hepatitis-c-treatment-and-management-program (accessed May 2017).
11. Jackson C, Askew D. Is there a polyclinic alternative acceptable to general practice? The ‘Beacon’ practice model. Br J Gen Pract 2008; 58: 733.
12. Hepworth J, Bain T, van Driel M. Hepatitis C, mental health and equity of access to antiviral therapy: a systematic narrative review. Int J Equity Health 2013; 12: 92.
13. Hepatitis C Virus Infection Consensus Statement Working Group. Australian recommendations for the management of hepatitis C virus infection: a consensus statement (January 2017). Melbourne: Gastroenterological Society of Australia, 2017. https://www.asid.net.au/documents/item/1208 (accessed May 2017).
14. Hopwood M, Treloar C. Under the watchful eye of ‘a benevolent dictator’. Aust Fam Physician 2013; 42: 900-903.

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Research

Antibiotics for acute respiratory infections in general practice: comparison of prescribing rates with guideline recommendations

Amanda R McCullough, Allan J Pollack, Malene Plejdrup Hansen, Paul P Glasziou, David FM Looke, Helena C Britt and Christopher B Del Mar

Med J Aust 2017; 207 (2): . || doi: 10.5694/mja16.01042
Published online: 17 July 2017

ARTICLE
AUTHORS
REFERENCES

Topics

General medicine

Respiratory tract diseases

Abstract

Objective: To compare the current rate of antibiotic prescribing for acute respiratory infections (ARIs) in Australian general practice with the recommendations in the most widely consulted therapeutic guidelines in Australia (Therapeutic Guidelines).

Design and setting: Comparison of general practice activity data for April 2010 – March 2015 (derived from Bettering the Evaluation and Care of Health [BEACH] study) with estimated rates of prescribing recommended by Therapeutic Guidelines.

Main outcome measures: Antibiotic prescribing rates and estimated guideline-recommended rates per 100 encounters and per full-time equivalent (FTE) GP per year for eight ARIs; number of prescriptions nationally per year.

Results: An estimated mean 5.97 million (95% CI, 5.69–6.24 million) ARI cases per year were managed in Australian general practice with at least one antibiotic, equivalent to an estimated 230 cases per FTE GP/year (95% CI, 219–240 cases/FTE/year). Antibiotics are not recommended by the guidelines for acute bronchitis/bronchiolitis (current prescribing rate, 85%) or influenza (11%); they are always recommended for community-acquired pneumonia (current prescribing rate, 72%) and pertussis (71%); and they are recommended for 0.5–8% of cases of acute rhinosinusitis (current prescribing rate, 41%), 20–31% of cases of acute otitis media (89%), and 19–40% cases of acute pharyngitis or tonsillitis (94%). Had GPs adhered to the guidelines, they would have prescribed antibiotics for 0.65–1.36 million ARIs per year nationally, or at 11–23% of the current prescribing rate. Antibiotics were prescribed more frequently than recommended for acute rhinosinusitis, acute bronchitis/bronchiolitis, acute otitis media, and acute pharyngitis/tonsillitis.

Conclusions: Antibiotics are prescribed for ARIs at rates 4–9 times as high as those recommended by Therapeutic Guidelines. Our data provide the basis for setting absolute targets for reducing antibiotic prescribing in Australian general practice.

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1 Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD
2 Family Medicine Research Centre, University of Sydney, Sydney, NSW
3 Research Unit for General Practice, Aalborg University, Aalborg, Denmark
4 Princess Alexandra Hospital, Brisbane, QLD
5 University of Sydney, Sydney, NSW
6 Bond University, Gold Coast, QLD

Correspondence: CDelMar@bond.edu.au

Acknowledgements:

This investigation was supported by the Centre for Research Excellence in Minimising Antibiotic Resistance from Acute Respiratory Infections, funded by the National Health and Medical Research Council (1044904).

Competing interests:

Between April 2010 and March 2015, the BEACH program was funded by the Australian Government Department of Health and Ageing, the Australian Government Department of Veterans’ Affairs, AstraZeneca (Australia), bioCSL (Australia), Novartis Pharmaceuticals Australia, AbbVie, Merck, Sharp and Dohme (Australia), Pfizer Australia, GlaxoSmithKline Australia, Sanofi-Aventis Australia, Bayer Australia, and the National Prescribing Service. The funding bodies did not influence the concept, design or conduct of the research, nor the preparation of this article; no financial support was provided for preparing the manuscript. Christopher Del Mar has received funding (personal and institutional) from the Australian Commission for Safety and Quality in Health Care (ACSQHC) and British United Provident Association (BUPA) for consulting (regarding shared decision making).

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2. Smith S, Fahey T, Smucny J, Becker L. Antibiotics for acute bronchitis. Cochrane Database Syst Rev 2014; (3): CD000245.
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Narrative review

Cardiac care for Indigenous Australians: practical considerations from a clinical perspective

Warren F Walsh and Nadarajah Kangaharan

Med J Aust 2017; 207 (1): . || doi: 10.5694/mja17.00250
Published online: 3 July 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Cardiovascular diseases

Indigenous health

Summary

Indigenous Australians have a much high burden of cardiovascular disease, which occurs at an earlier age than in the non-Indigenous population. Comorbidities such as diabetes are common.
Early diagnosis of ischaemic heart disease may be difficult because of barriers such as distance to medical centres, communication problems and family and cultural responsibilities.
Disparities in cardiac care between Indigenous and non-Indigenous populations are well documented, with examples including reduced angiography and revascularisation rates in Indigenous patients.
Indigenous patients can have poor health literacy and need careful explanation of procedures, with the assistance of Aboriginal health workers, visual aids and family members.
Acute rheumatic fever and chronic rheumatic heart disease remain ongoing health problems in Indigenous communities, especially in remote areas.
Ambulatory care of Indigenous Australians with chronic cardiovascular disease is challenging. It requires well supported health care systems, including Aboriginal health workers and cardiac nurse coordinators to case-manage patients.
A holistic approach to care, with attention directed towards both cardiac and non-cardiac comorbidities, is crucial for optimal management of cardiovascular disease in Indigenous Australians.
Multidisciplinary care, involving an empowered and supported primary care team working together with specialists through outreach services or telehealth, is important for patients who are at high clinical risk and those living in remote areas.
Indigenous Australians deserve the same level of evidence-based cardiovascular health care and access to care as non-Indigenous Australians.

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1 Prince of Wales Hospital, Sydney, NSW
2 Royal Darwin Hospital, Darwin, NT
3 Alice Springs Hospital, Alice Springs, NT

Correspondence: warren.walsh@ehc.com.au

Competing interests:

No relevant disclosures.

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2. Davidson PM, MacIsaac A, Cameron J, et al. Problems, solutions and actions: addressing barriers in acute hospital care for Indigenous Australians and New Zealanders. Heart Lung Circ 2012; 21: 639-643.
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4. Australian Institute of Health and Welfare. Better cardiac care measures for Aboriginal and Torres Strait Islander people: second national report 2016 (AIHW Cat. No. IHW 169). Canberra: AIHW, 2016. http://www.aihw.gov.au/publication-detail/?id=60129557610 (accessed May 2017).
5. Australian Institute of Health and Welfare. Coronary heart disease and chronic obstructive pulmonary disease in Indigenous Australians (AIHW Cat. No. IHW 126). Canberra: AIHW, 2014. http://www.aihw.gov.au/publication-detail/?id=60129547716 (accessed May 2017).
6. Gruen RL, Bailie RS, Wang Z, et al. Specialist outreach to isolated and disadvantaged communities: a population-based study. Lancet 2006; 368: 130-138.
7. Tideman PA, Tirimacco R, Senior DP, et al. Impact of a regionalised clinical cardiac support network on mortality among rural patients with myocardial infarction. Med J Aust 2014; 200: 157-160. <MJA full text>
8. Hurune PN, O’Shea JM, Maguire GP, Hewagama SS. Utility of exercise electrocardiography testing for the diagnosis of coronary artery disease in a remote Australian setting. Med J Aust 2013; 199: 201-204. <MJA full text>
9. National Heart Foundation of Australia and Australian Healthcare and Hospitals Association. Better hospital care for Aboriginal and Torres Strait Islander people experiencing heart attack. NFHA and AHHA, 2010. https://www.heartfoundation.org.au/images/uploads/publications/A-ATSI-Better-Hospital-Care-20110812.pdf (accessed Apr 2017).
10. Brown A. Acute coronary syndromes in Indigenous Australians: opportunities for improving outcomes across the continuum of care. Heart Lung Circ 2010; 19: 325-336.
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12. Tavella RT, McBride K, Keech W, et al. Disparities in acute in-hospital cardiovascular care for Aboriginal and non-Aboriginal South Australians. Med J Aust 2016; 205: 222-227. <MJA full text>
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28. Wade V, Stocks N. The use of telehealth to reduce inequalities in cardiovascular outcomes in Australia and New Zealand: a critical review. Heart Lung Circ 2017; 26: 331-337.
29. Davidson PM, Abbott P, Davison J, DiGiacomo M. Improving medication uptake in Aboriginal and Torres Strait Islander peoples. Heart Lung Circ 2010; 19: 372-377.
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Short reports

Exclusions from clinical trials in Australia based on proficiency in English

Fiona Stanaway, Robert G Cumming and Fiona Blyth

Med J Aust 2017; 207 (1): . || doi: 10.5694/mja16.01012
Published online: 3 July 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Ethics and law

Health services administration

Global health

Social determinants of health

The exclusion of migrants and members of ethnic minorities from clinical trials is common and can compromise the generalisability of research findings.1 Reasons for these exclusions are complex, but communication difficulties probably contribute.1

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1 University of Sydney, Sydney, NSW
2 Centre for Education and Research on Ageing, Concord Hospital, Sydney, NSW
3 Concord Clinical School, Concord Hospital, Sydney, NSW

Correspondence: fiona.stanaway@sydney.edu.au

Competing interests:

No relevant disclosures.

1. Glickman SW, Ndubuizu A, Weinfurt KP, et al. The case for research justice: inclusion of patients with limited English proficiency in clinical research. Acad Med 2011; 86: 389-393.
2. Australian Bureau of Statistics. 3412.0. Migration Australia, 2014–15 [webpage]. Mar 2016. http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/FA3FC34994687B3BCA2580F2000BF1C7?opendocument (accessed July 2016).
3. Federation of Ethnic Communities’ Councils of Australia. Review of Australian research on older people from culturally and linguistically diverse backgrounds. Canberra: FECCA, 2015. http://fecca.org.au/wp-content/uploads/2015/06/Review-of-Australian-Research-on-Older-People-from-Culturally-and-Linguistically-Diverse-Backgrounds-March-20151.pdf (accessed July 2016).
4. Brady B, Veljanova I, Chipchase L. Are multidisciplinary interventions multicultural? A topical review of the pain literature as it relates to culturally diverse patient groups. Pain 2016; 157: 321-328.
5. Erdal K, Singh N, Tardif A. Attitudes about depression and its treatment among mental health professionals, lay persons and immigrants and refugees in Norway. J Affect Disord 2011; 133: 481-488.

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Perspectives

Embedding cultural safety in Australia’s main health care standards

Martin Laverty, Dennis R McDermott and Tom Calma

Med J Aust 2017; 207 (1): . || doi: 10.5694/mja17.00328
Published online: 3 July 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Indigenous health

Global health

Health services administration

Accreditation with nationally consistent standards for culturally safe clinical care will improve Indigenous health outcomes

In Australia, the existing health safety and quality standards are insufficient to ensure culturally safe care for Indigenous patients in order to achieve optimum care outcomes. Where “business as usual” health care is perceived as demeaning or disempowering — that is, deemed racist or culturally unsafe — it may significantly reduce treatment adherence or result in complete disengagement,1,2 even when this may be life-threatening.3 Peak Indigenous health bodies argue that boosting the likelihood of culturally safe clinical care may substantially contribute to Indigenous health improvement.4 It follows that a more specific embedding of cultural safety within mandatory standards for safe, quality-assured clinical care may strengthen the currently inadequate Closing the Gap mechanisms related to health care delivery.

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1 Royal Flying Doctor Service of Australia, Canberra, ACT
2 Poche Centre for Indigenous Health and Wellbeing, Flinders University, Adelaide, SA
3 Poche Indigenous Health Network, University of Sydney, Sydney, NSW

Correspondence: Martin.Laverty@rfds.org.au

Competing interests:

No relevant disclosures.

1. Henry BR, Houston S, Mooney GH. Institutional racism in Australian healthcare: a plea for decency. Med J Aust 2004; 180: 517-520. <MJA full text>
2. Ziersch AM, Gallaher G, Baum F, Bentley M. Responding to racism: Insights on how racism can damage health from an urban study of Australian Aboriginal people. Soc Sci Med 2011; 73: 1045-1053.
3. Einsiedel LJ, van Iersel E, Macnamara R, et al. Self-discharge by adult Aboriginal patients at Alice Springs Hospital, Central Australia: insights from a prospective cohort study. Aust Health Rev 2013; 37: 239-245.
4. Congress of Aboriginal and Torres Strait Islander Nurses and Midwives. Cultural safety in policy and practice seminar report: summary and implications. Canberra: CATSINaM; 2016. http://catsinam.org.au/static/uploads/files/cultural-safety-in-policy-and-practice-seminar-27-april-2016-report-wfwxsnrkyzyh.pdf (accessed Apr 2017).
5. Australian Government. National Aboriginal and Torres Strait Islander health plan 2013–2023. Canberra: Commonwealth of Australia; 2013. http://www.health.gov.au/internet/main/publishing.nsf/content/B92E980680486C3BCA257BF0001BAF01/$File/health-plan.pdf (accessed May 2017).
6. Amery R. Recognising the communication gap in Indigenous health care. Med J Aust 2017; 207: 13-15
7. Tavella R, McBride K, Keech W, et al. Disparities in acute in-hospital cardiovascular care for Aboriginal and non-Aboriginal South Australians. Med J Aust 2016; 205: 222-227. <MJA full text>
8. Australian Health Ministers’ Advisory Council. Aboriginal and Torres Strait Islander Health Performance Framework 2014 report. Canberra: AHMAC; 2015. http://www.dpmc.gov.au/resource-centre/indigenous-affairs/aboriginal-and-torres-strait-islander-health-performance-framework-2014-report (accessed Apr 2017).
9. Australian Bureau of Statistics. Causes of death, Australia, 2015 (Cat. No. 3303.0). Canberra: Commonwealth of Australia; 2016. http://www.abs.gov.au/ausstats/abs@.nsf/mf/3303.0 (accessed Apr 2017).
10. Newman CE, Gray R, Brener L, et al. One size fits all? The discursive framing of cultural difference in health professional accounts of providing cancer care to Aboriginal people. Ethn Health 2013; 18: 433-447.
11. Taylor K, Guerin P. Health care and Indigenous Australians: cultural safety in practice. 2nd ed. Melbourne: Palgrave Macmillan, 2014.
12. Liaw ST, Hasan I, Wade V, et al. Improving cultural respect to improve Aboriginal health in general practice: a multi-methods and multi-perspective pragmatic study. Aust Fam Physician 2015; 44: 387-392.
13. Freeman T, Edwards T, Baum F, et al. Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners. Aust NZ Public Health 2014; 38: 355-361.
14. Durey A. Reducing racism in Aboriginal health care in Australia: where does cultural education fit? Aust NZ Public Health 2010; 34: 587-592.
15. Ilton MK, Walsh WF, Brown ADH, et al. A framework for overcoming disparities in management of acute coronary syndromes in the Australian Aboriginal and Torres Strait Islander population: a consensus statement from the National Heart Foundation of Australia. Med J Aust 2014; 200: 639-643. <MJA full text>
16. Willis J, Wilson G, Renhard R, et al. Improving the Culture of Hospitals Project — final report. Melbourne. Melbourne: Australian Institute for Primary Care and Ageing, La Trobe University; 2010. http://www.lowitja.org.au/sites/default/files/docs/ICHP_Final_Report_August_2010.pdf (accessed Apr 2017).
17. Sjoberg D, McDermott D. The deconstruction exercise: an assessment tool for enhancing critical thinking in cultural safety education. Int J Critical Indigenous Studies 2016; 9.
18. Delany C, Ewen S, Harms L, et al. Theory and practice: Indigenous health assessment at Australian Qualifications Framework Level 9. Sydney: Office for Learning and Teaching; 2016. http://hdl.handle.net/11343/123564 (accessed Apr 2017).
19. Royal Australian College of General Practitioners. Standards for general practices. 4th ed. Melbourne: RACGP; 2010. http://www.racgp.org.au/your-practice/standards/standards4thedition (accessed May 2017).
20. Australian Commission on Safety and Quality in Health Care. National safety and quality health service standards, September 2012. Sydney: Commonwealth of Australia; 2012. https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf (accessed May 2017).

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Perspectives

Recognising the communication gap in Indigenous health care

Robert Amery

Med J Aust 2017; 207 (1): . || doi: 10.5694/mja17.00042
Published online: 3 July 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Indigenous health

General medicine

Improving shared understandings between health professionals and remote Indigenous people

The communication gap between health professionals and Indigenous Australians has a significant impact on health outcomes.1-4 Limited health literacy is not confined to Indigenous people,5 but it is greatly magnified for speakers of Indigenous languages in comparison, for example, to non-English speaking migrants from countries where a scientific approach to medicine is practised and where these health concepts are already codified. The communication gap is most pronounced in remote areas where cultural and linguistic differences are greatest. The close interdependence of language and culture amplifies the gap, such that communication difficulties in these communities run deeper than language barriers alone.

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University of Adelaide, Adelaide, SA

Correspondence: robert.amery@adelaide.edu.au

Acknowledgements:

I thank Jane Thompson for providing practical examples relating to medical education, Mary-Anne Gale and David Scrimgeour for their comments on an early draft of this article, Steven Guthridge from the Department of Health in Darwin for his assistance, and the reviewers for their valuable comments.

Competing interests:

No relevant disclosures.

1. Lowell A, Maypilama E, Yikaniwuy S, et al. “Hiding the story”: Indigenous consumer concerns about communication related to chronic disease in one remote region of Australia. Int J Speech Lang Pathol 2012; 14: 200-208.
2. Cass A, Lowell A, Christie M, et al. Sharing the true stories: improving communication between Aboriginal patients and healthcare workers. Med J Aust 2002; 176: 466-470. <MJA full text>
3. Mitchell AG, Lowell A, Ralph AP. Report on the Patient Educator service at Royal Darwin Hospital, 2001-2009: insights into inter-cultural communication in healthcare. Darwin: Aboriginal Resource and Development Services, 2016. https://www.researchgate.net/publication/304121921_Report_on_the_Patient_Educator_service_at_Royal_Darwin_Hospital_2001-2009_insights_into_inter-cultural_communication_in_healthcare (accessed Mar 2017).
4. Amery H. They don’t give us the full story: attitudes to hospitalisation amongst Yolŋu people of north-east Arnhem Land, a comparative study. Darwin: Aboriginal Resource and Development Services, 1999. https://www.ards.com.au/resources/downloadable/they-dont-give-us-the-full-story-attitudes-to-hospitalisation-amongst-yolŋu-people-of-north-east-arnhem-land-a-comparative-study (accessed Mar 2017).
5. Phillips C. Improving health outcomes for linguistically diverse patients. Med J Aust 2016; 204: 209-210. <MJA full text>
6. Australian Institute of Health and Welfare. Life expectancy. http://www.aihw.gov.au/deaths/life-expectancy (accessed Dec 2016).
7. Georges N, Guthridge SL, Li SQ, et al. Progress in closing the gap in life expectancy at birth for Aboriginal people in the Northern Territory, 1967–2012. Med J Aust 2017; 207: 25-30.
8. Zhao Y, Wright J, Begg S, Guthridge S. Decomposing Indigenous life expectancy gap by risk factors: a life table analysis. Popul Health Metr 2013; 11: 1.
9. Trudgen R. Why warriors lie down and die. Towards an understanding of why the Aboriginal people of Arnhem Land face the greatest crisis in health and education since European contact. Darwin: Aboriginal Resource and Development Services, 2000.
10. Biddle N. Indigenous Population Project: 2011 Census Papers. Paper 1: Indigenous language usage. Canberra: Centre for Aboriginal Economic Policy Research, Research School of Social Sciences, Australian National University, 2012. http://caepr.anu.edu.au/sites/default/files/cck_indigenous_outcomes/2012/09/2011CensusPaper01_IndLangUsage.pdf (accessed Dec 2016).
11. Aboriginal Resource and Development Services. An absence of mutual respect. Bäyŋu Ŋayaŋu-Dapmaranhamirr Rom ga Ŋorra. Darwin: ARDS, 2008. https://ards.com.au/uploads/Downloads/114/39-114.Absence_of_mutual_respectFINAL.pdf (accessed May 2017).
12. Harris S Culture and learning: tradition and education in Northeast Arnhem Land. Darwin: Northern Territory Education Department, 1980.
13. Queensland Health Aboriginal and Torres Strait Islander Cultural Capability Team. Communicating effectively with Aboriginal and Torres Strait Islander people. Sept 2015. https://www.health.qld.gov.au/__data/assets/pdf_file/0021/151923/communicating.pdf (accessed May 2017).
14. Anderson K, Devitt J, Cunningham J, et al. “All they said was my kidneys were dead”: Indigenous Australian patients’ understanding of their chronic kidney disease. Med J Aust 2008; 189: 499-503. <MJA full text>
15. Strong J, Nielsen M, Williams M, et al. Quiet about pain: experiences of Aboriginal people in two rural communities. Aust J Rural Health 2015; 23: 181-184.
16. Reid J Sorcerers and healing spirits: continuity and change in an Aboriginal medical system. Canberra: Australian National University Press, 1983.
17. Maher P. A review of ‘traditional’ Aboriginal health beliefs. Aust J Rural Health 1999; 7: 229-236.
18. Peile AR. Body and soul: an Aboriginal view. Perth: Hesperian Press, 1997.

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Perspectives

Caring for country and the health of Aboriginal and Torres Strait Islander Australians

Rosalie Schultz and Sheree Cairney

Med J Aust 2017; 207 (1): . || doi: 10.5694/mja16.00687
Published online: 3 July 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Indigenous health

Health services administration

Environment and public health

Social determinants of health

Global health

Investment in caring for country may help close the gaps in education, employment and health

Health services for Aboriginal and Torres Strait Islander people are expensive. The National Aboriginal Community Controlled Health Organisation reported that government Aboriginal and Torres Strait Islander health and hospital service expenditure per person in 2010–11 was $8190 nationally, and as high as $16 110 in the Northern Territory, compared with $4054 per non-Indigenous person.1 Increasing expenditure on health services for Aboriginal and Torres Strait Islander people is not closing the gap in health outcomes at the rate to which governments have committed.2

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1 Centre for Remote Health, Flinders University and Charles Darwin University, Alice Springs, NT
2 Cooperative Research Centre for Remote Economic Participation, Alice Springs, NT

Correspondence: rosalie.schultz@flinders.edu.au

Acknowledgements:

This research is supported by the Cooperative Research Centre for Remote Economic Participation, hosted by Ninti One. We acknowledge the support and involvement of our key organisational stakeholders: Centre for Remote Health (Flinders University and Charles Darwin University), Department of Prime Minister and Cabinet, Northern Star Resources, Yalu Marŋgithinyaraw Indigenous Corporation, Marthakal Homelands Resource Centre, Central Desert Native Title Services, Poche Centre for Indigenous Health, Miwatj Health Aboriginal Corporation, Australian Bureau of Statistics, Muntjiltjarra Wurrgumu Group, Kalano Community Association, Wurli–Wurlinjang Health Service, StrongBala Men’s Health Program, Flinders NT (Katherine), Katherine Stolen Generation Group, Banatjarl Strongbala Wumin Grup, Wiluna Martu Rangers, and Ngangganawili Aboriginal Health Service Community.

Competing interests:

No relevant disclosures.

1. Alford K. Economic value of Aboriginal community controlled health services. Canberra: National Aboriginal Community Controlled Health Organisation, 2014. http://apo.org.au/node/39333? (accessed May 2017).
2. Australian Government Department of Prime Minister and Cabinet. Closing the Gap: Prime Minister’s report 2017. Canberra: Department of Prime Minister and Cabinet, 2017. http://closingthegap.dpmc.gov.au (accessed May 2017).
3. Houston S. We need transformative change in Aboriginal health. Med J Aust 2016; 205: 17-18. <MJA full text>
4. Australian Government Department of Health. National Aboriginal and Torres Strait Islander Health Plan 2013-2023 Canberra: Commonwealth of Australia, 2013. http://www.health.gov.au/natsihp (accessed Aug 2016).
5. Kingsley J, Townsend M, Henderson-Wilson C, et al. Developing an exploratory framework linking Australian Aboriginal peoples’ connection to country and concepts of wellbeing. Int J Environ Res Public Health 2013; 10: 678-698.
6. Nguyen O, Cairney S. Literature review of the interplay between education, employment, health and wellbeing for Aboriginal and Torres Strait Islander people in remote areas: working towards an Aboriginal and Torres Strait Islander wellbeing framework. (CRC-REP Working Paper CW013). Alice Springs: Ninti One, 2013. http://www.crc-rep.com.au/resource/CW013_InterplayLiteratureReview_TowardsWellbeingFramework.pdf (accessed Aug 2016).
7. Hill R, Pert P, Davies J, et al. Indigenous land management in Australia: extent, scope, diversity, barriers and success factors. Cairns: CSIRO: Ecosystem Sciences, 2013. http://www.agriculture.gov.au/SiteCollectionDocuments/natural-resources/landcare/submissions/ilm-report.pdf (accessed Aug 2016).
8. Whitehead PJ, Purdon P, Russell-Smith J, et al. The management of climate change through prescribed savanna burning: emerging contributions of Indigenous people in northern Australia. Public Admin Dev 2008; 28: 374-385.
9. Davies J, Campbell D, Campbell M, et al. Attention to four key principles can promote health outcomes from desert Aboriginal land management. Rangeland J 2011; 33: 417-431.
10. Burgess C, Johnston F, Berry H, et al. Healthy country, healthy people: the relationship between Indigenous health status and “caring for country”. Med J Aust 2009; 109: 567-572. <MJA full text>
11. Gorman J, Vemuri S. Social implications of bridging the gap through ‘caring for country’ in remote Indigenous communities of the Northern Territory, Australia. Rangeland J 2012; 34: 63-73.
12. Campbell D, Burgess C, Garnett S, et al. Potential primary health care savings for chronic disease care associated with Australian Aboriginal involvement in land management. Health Policy 2011; 99: 83-89.
13. Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015. Canberra: AIHW, 2015. http://www.aihw.gov.au/indigenous-observatory/reports/health-and-welfare-2015 (accessed Aug 2016).
14. Australian Government Department of Prime Minister and Cabinet. Indigenous Rangers — Working on Country. https://www.dpmc.gov.au/indigenous-affairs/environment/indigenous-rangers-working-country (accessed Aug 2016).
15. Australian Government Department of Prime Minister and Cabinet. Project funding — Indigenous land and sea management. Indigenous Advancement Strategy funding. https://www.dpmc.gov.au/indigenous-affairs/environment/project-funding-indigenous-land-and-sea-management (accessed May 2017).
16. Social Ventures Australia. Social return on investment — consolidated report on Indigenous protected areas. Sydney: Social Ventures Australia Consulting, 2016. https://www.dpmc.gov.au/resource-centre/indigenous-affairs/social-return-investment-%E2%80%93-consolidated-report-indigenous-protected-areas (accessed May 2017).
17. World Health Organization. Declaration of Alma-Ata. International conference on primary health care, Alma-Ata, USSR, 6–12 September 1978. http://www.who.int/publications/almaata_declaration_en.pdf (accessed May 2017).

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Where to next for rural general practice policy and research in Australia?

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Hepatitis C in Australia — a role for general practitioners?

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Antibiotics for acute respiratory infections in general practice: comparison of prescribing rates with guideline recommendations

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Cardiac care for Indigenous Australians: practical considerations from a clinical perspective

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Exclusions from clinical trials in Australia based on proficiency in English

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Embedding cultural safety in Australia’s main health care standards

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Recognising the communication gap in Indigenous health care

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Caring for country and the health of Aboriginal and Torres Strait Islander Australians

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Improving Indigenous health through education

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The 2016 Royal Australian and New Zealand College of Psychiatrists guidelines for the management of schizophrenia and related disorders

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Where to next for rural general practice policy and research in Australia?

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Hepatitis C in Australia — a role for general practitioners?

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Antibiotics for acute respiratory infections in general practice: comparison of prescribing rates with guideline recommendations

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Cardiac care for Indigenous Australians: practical considerations from a clinical perspective

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Exclusions from clinical trials in Australia based on proficiency in English

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Embedding cultural safety in Australia’s main health care standards

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Recognising the communication gap in Indigenous health care

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Caring for country and the health of Aboriginal and Torres Strait Islander Australians

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Improving Indigenous health through education

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The 2016 Royal Australian and New Zealand College of Psychiatrists guidelines for the management of schizophrenia and related disorders

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