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Harrop DL, Bryce V, Kitchener T, Grugan S, Renouf S, Mitchell S, Hasking G, Pauza D, Richards G, Ng ACT, Wang WYS. Effects of a culturally informed model of care for Aboriginal and Torres Strait Islander patients with acute coronary syndrome in a tertiary hospital in Australia: a pre-post, quasi-experimental, interventional study. Lancet Glob Health 2024; 12:e623-e630. [PMID: 38485429 DOI: 10.1016/s2214-109x(23)00601-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND Aboriginal and Torres Strait Islander (Indigenous) peoples with cardiac disease in Australia have worse outcomes than non-Indigenous people with cardiac disease. We hypothesised that the implementation of a culturally informed model of care for Indigenous patients hospitalised with acute coronary syndrome (ACS) would improve their clinical outcomes. METHODS For this pre-post, quasi-experimental, interventional study, cohorts of Indigenous patients before and after the implementation of a model of care were compared. The novel, culturally informed, multidisciplinary-team model of care was a local programme of care developed to reduce morbidity and mortality from cardiac conditions among Indigenous Australians. All index admissions in the 24-month pre-implementation period (Jan 1 2013, to Dec 31, 2014) were analysed, as were all index admissions in the 12-month post-implementation period (Oct 1, 2015, to Sept 30, 2016). Comparisons were also made with non-Indigenous cohorts in the same timeframes. Admissions were excluded if the patient did not survive to hospital discharge. The study was conducted at Princess Alexandra Hospital, a tertiary hospital in metropolitan Brisbane (QLD, Australia). Data on presentation, comorbidities, investigations, treatment, and for outcomes were manually collected from a consolidated clinical information application. Mortality data were obtained from the Queensland Registry of Births, Deaths, and Marriages. The primary outcome was a composite of death, acute myocardial infarction, unplanned revascularisation, and cardiac readmission at 90 days after index admission, assessed in all patients. FINDINGS The Indigenous cohorts included 199 patients admitted with ACS before the model of care was implemented (85 [43%] were female and 114 [57%] were male) and 119 admitted post-implementation (62 [52%] were female and 57 [48%] were male). The non-Indigenous cohorts included 440 patients with ACS before the model of care was implemented (140 [32%] were female and 300 [68%] were male) and 467 admitted post-implementation (143 [31%] were female and 324 [69%] were male). Compared with the pre-implementation group, Indigenous patients admitted post-implementation had a significant reduction in the primary outcome (67 [34%] of 199 vs 24 [20%] of 119; hazard ratio 0·60, 95% CI 0·40-0·90; p=0·012), which was driven by a reduction in unplanned cardiac readmissions (64 [32%] of 199 vs 21 [18%] of 119; 0·55, 0·35-0·85; p=0·0060). There was no significant change in non-Indigenous patients between the pre-implementation and post-implementation timeframes in the composite endpoint at 90 days (81 [18%] of 440 vs 93 [20%] of 467; 1·08, 0·83-1·41; p=0·54). Pre-implementation, there was significantly more incidence of the primary outcome in Indigenous patients than non-Indigenous patients (p<0·0001), with no significant difference in the post-implementation period (p=0·92). INTERPRETATION Clinical outcomes for Indigenous patients admitted to a tertiary hospital in Australia improved after implementation of a culturally informed model of care, with a reduction in the disparity in incidence of primary endpoints that existed between Indigenous and non-Indigenous patients before implementation. FUNDING Queensland Department of Health Aboriginal and Torres Strait Islander Health Division (now First Nations Health Office).
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Affiliation(s)
- Danielle L Harrop
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Vivian Bryce
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Tanya Kitchener
- Aboriginal and Torres Strait Islander Liaison Service, Mater Hospital, Brisbane, QLD, Australia
| | - Sean Grugan
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Sonia Renouf
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Scott Mitchell
- Department of Pharmacy, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | | - Debra Pauza
- First Nations Health Office, Queensland Health, Brisbane, QLD, Australia
| | - Gregory Richards
- Queensland Aboriginal and Islander Health Council, Brisbane, QLD, Australia
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - William Y S Wang
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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Jennings W, Egert S, Fisher C, Renouf S, Bryce V, Grugan S, Wang W, Askew D. Better cardiac care - the patient experience - a qualitative study. Int J Equity Health 2023; 22:122. [PMID: 37380998 DOI: 10.1186/s12939-023-01931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND In 2015, a Brisbane tertiary hospital's cardiac unit implemented a new model of multidisciplinary care (Better Cardiac Care (BCC)) for Aboriginal and Torres Strait Islander patients. Since then, clinical indicators for Aboriginal and Torres Strait Islander cardiac patients have improved, but the recipients' voices have not been heard. This research aimed to determine the acceptability and appropriateness, features of value, and opportunities for improvements in this model of care, from the perspective of patients and their family members. METHODS This descriptive qualitative study employed a narrative methodology. BCC Health Workers contacted prospective participants; with consent, interested individuals were then contacted by the Aboriginal Research Officer (RO) who arranged yarning sessions and consent. Family members were also invited to share their stories of their loved ones' hospitalisation. Two researchers conducted the interviews, using a yarning approach. Inductive narrative analysis, informed by Aboriginal and Torres Strait Islander ways of Being, Knowing, and Doing, focused on enabling participants' stories to be heard and understood from their perspectives. RESULTS Relationality was at the heart of the BCC model of care, particularly between patients and Aboriginal and Torres Strait Islander staff. The relationality included a responsibility for holistic care, extending beyond hospital discharge, although support and handover for family members required improvement. The Aboriginal and Torres Strait Islander staff understood the contextual and structural challenges faced by participants, including the disempowerment and racism experienced in healthcare. This understanding was shared with the BCC team who, in turn, protected, advocated for, and holistically supported participants through their cardiac health journeys. CONCLUSIONS Empowering (and employing) Aboriginal and Torres Strait Islander staff, and relating to patients as people, enabled BCC to meet Aboriginal and Torres Strait Islander patient's needs and improve outcomes. The wider health system and health academia could benefit from exploring and valuing Aboriginal and Torres Strait Islander discourses of relationality.
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Affiliation(s)
- Warren Jennings
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, 37 Wirraway Parade, Inala, Qld, 4077, Australia.
- General Practice Clinical Unit, The University of Queensland, Women's Hospital, Level 8, Health Sciences Building, Royal Brisbane, Brisbane, Qld, 4029, Australia.
| | - Sonya Egert
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, 37 Wirraway Parade, Inala, Qld, 4077, Australia
| | - Celestine Fisher
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld, 4102, Australia
| | - Sonia Renouf
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld, 4102, Australia
| | - Vivian Bryce
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld, 4102, Australia
| | - Sean Grugan
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld, 4102, Australia
| | - William Wang
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld, 4102, Australia
- Faculty of Medicine, The University of Queensland, 199 Ipswich Road, Woolloongabba, Qld, 4102, Australia
| | - Deborah Askew
- General Practice Clinical Unit, The University of Queensland, Women's Hospital, Level 8, Health Sciences Building, Royal Brisbane, Brisbane, Qld, 4029, Australia
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Welch S, Patel B, Williams A, Moles R. Connecting the dots of care: survey of Australian hospital pharmacy departments regarding current initiatives in place to care for Aboriginal and/or Torres Strait Islander inpatients. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Susan Welch
- Pharmacy Department St Vincent's Hospital, Sydney Darlinghurst Australia
- PhD Candidate University of Sydney Camperdown Australia
| | - Bhavini Patel
- Northern Territory Department of Health Charles Darwin University Darwin Australia
- Medicines Management Top End Health Service Darwin Australia
| | - Aleena Williams
- Public Health Directorate Department of Health Northern Territory Government Darwin Australia
| | - Rebekah Moles
- Faculty Medicine and Health School of Pharmacy University of Sydney Camperdown Australia
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Blignault I, Norsa L, Blackburn R, Bloomfield G, Beetson K, Jalaludin B, Jones N. "You Can't Work with My People If You Don't Know How to": Enhancing Transfer of Care from Hospital to Primary Care for Aboriginal Australians with Chronic Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7233. [PMID: 34299688 PMCID: PMC8306914 DOI: 10.3390/ijerph18147233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
Abstract
Indigenous Australians experience significantly poorer health compared to other Australians, with chronic disease contributing to two-thirds of the health gap. We report on an evaluation of an innovative model that leverages mainstream and Aboriginal health resources to enable safe, supported transfer of care for Aboriginal adults with chronic conditions leaving hospital. The multisite evaluation was Aboriginal-led and underpinned by the principles of self-determination and equity and Indigenous research protocols. The qualitative study documented processes and captured service user and provider experiences. We found benefits for patients and their families, the hospital and the health system. The new model enhanced the patient journey and trust in the health service and was a source of staff satisfaction. Challenges included staff availability, patient identification and complexity and the broader issue of cultural safety. Critical success factors included strong governance with joint cultural and clinical leadership and enduring relationships and partnerships at the service delivery, organisation and system levels. A holistic model of care, bringing together cultural and clinical expertise and partnering with Indigenous community organisations, can enhance care coordination and safety across the hospital-community interface. It is important to consider context as well as specific program elements in design, implementation and evaluation.
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Affiliation(s)
- Ilse Blignault
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia;
| | - Liz Norsa
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia;
| | - Raylene Blackburn
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
| | - George Bloomfield
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
| | - Karen Beetson
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
| | - Bin Jalaludin
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
- Ingham Institute for Applied Medical Research, UNSW Sydney, Liverpool, NSW 2170, Australia
| | - Nathan Jones
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
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