1
|
Liddle Z, Fitts MS, Bourke L, Murakami-Gold L, Campbell N, Russell DJ, Mathew S, Bonson J, Mulholland E, Humphreys JS, Zhao Y, Boffa J, Ramjan M, Tangey A, Schultz R, Wakerman J. Attitudes to Short-Term Staffing and Workforce Priorities of Community Users of Remote Aboriginal Community-Controlled Health Services: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:482. [PMID: 38673393 PMCID: PMC11050694 DOI: 10.3390/ijerph21040482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/07/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024]
Abstract
In recent years, there has been an increasing trend of short-term staffing in remote health services, including Aboriginal Community-Controlled Health Services (ACCHSs). This paper explores the perceptions of clinic users' experiences at their local clinic and how short-term staffing impacts the quality of service, acceptability, cultural safety, and continuity of care in ACCHSs in remote communities. Using purposeful and convenience sampling, community users (aged 18+) of the eleven partnering ACCHSs were invited to provide feedback about their experiences through an interview or focus group. Between February 2020 and October 2021, 331 participants from the Northern Territory and Western Australia were recruited to participate in the study. Audio recordings were transcribed verbatim, and written notes and transcriptions were analysed deductively. Overall, community users felt that their ACCHS provided comprehensive healthcare that was responsive to their health needs and was delivered by well-trained staff. In general, community users expressed concern over the high turnover of staff. Recognising the challenges of attracting and retaining staff in remote Australia, community users were accepting of rotation and job-sharing arrangements, whereby staff return periodically to the same community, as this facilitated trusting relationships. Increased support for local employment pathways, the use of interpreters to enhance communication with healthcare services, and services for men delivered by men were priorities for clinic users.
Collapse
Affiliation(s)
- Zania Liddle
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT 0870, Australia; (Z.L.); (D.J.R.); (S.M.); (J.B.); (J.W.)
| | - Michelle S. Fitts
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT 0870, Australia; (Z.L.); (D.J.R.); (S.M.); (J.B.); (J.W.)
| | - Lisa Bourke
- Department of Rural Health, The University of Melbourne, Shepparton, VIC 3630, Australia;
| | - Lorna Murakami-Gold
- Poche SA and NT, College of Medicine and Public Health, Flinders University, Alice Springs, NT 0870, Australia;
| | - Narelle Campbell
- College of Medicine and Public Health, Flinders University, Darwin, NT 0800, Australia;
| | - Deborah J. Russell
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT 0870, Australia; (Z.L.); (D.J.R.); (S.M.); (J.B.); (J.W.)
| | - Supriya Mathew
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT 0870, Australia; (Z.L.); (D.J.R.); (S.M.); (J.B.); (J.W.)
| | - Jason Bonson
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT 0870, Australia; (Z.L.); (D.J.R.); (S.M.); (J.B.); (J.W.)
| | - Edward Mulholland
- Miwatj Health Aboriginal Corporation, Nhulunbuy, NT 0880, Australia;
| | - John S. Humphreys
- School of Rural Health, Monash University, Bendigo, VIC 3550, Australia;
| | - Yuejen Zhao
- Northern Territory Department of Health, Northern Territory Government, Darwin, NT 0800, Australia;
| | - John Boffa
- Central Australian Aboriginal Congress, Alice Springs, NT 0870, Australia;
| | - Mark Ramjan
- Top End Health Service, Northern Territory Government, Casuarina, NT 0810, Australia;
| | - Annie Tangey
- Ngaanyatjarra Health Service, Alice Springs, NT 0870, Australia; (A.T.); (R.S.)
| | - Rosalie Schultz
- Ngaanyatjarra Health Service, Alice Springs, NT 0870, Australia; (A.T.); (R.S.)
| | - John Wakerman
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT 0870, Australia; (Z.L.); (D.J.R.); (S.M.); (J.B.); (J.W.)
| |
Collapse
|
2
|
Khanal V, Shaw T, Wills E, Wakerman J, Russell DJ. Co-design of digital health technologies in Australian First Nations communities. Lancet Digit Health 2024; 6:e90. [PMID: 38278618 DOI: 10.1016/s2589-7500(23)00251-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/25/2023] [Accepted: 12/01/2023] [Indexed: 01/28/2024]
Affiliation(s)
- Vishnu Khanal
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT 0871, Australia.
| | - Timothy Shaw
- Charles Perkins Centre, School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Elaine Wills
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT 0871, Australia
| | - John Wakerman
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT 0871, Australia
| | - Deborah J Russell
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT 0871, Australia
| |
Collapse
|
3
|
Taylor EV, Dugdale S, Connors CM, Garvey G, Thompson SC. "A Huge Gap": Health Care Provider Perspectives on Cancer Screening for Aboriginal and Torres Strait Islander People in the Northern Territory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:141. [PMID: 38397632 PMCID: PMC10887611 DOI: 10.3390/ijerph21020141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
Cancer is one of the leading causes of death for Aboriginal and Torres Strait Islander people in the Northern Territory (NT). Accessible and culturally appropriate cancer screening programs are a vital component in reducing the burden of cancer. Primary health care plays a pivotal role in facilitating the uptake of cancer screening in the NT, due to the significant challenges caused by large distances, limited resources, and cultural differences. This paper analyses health care provider perspectives and approaches to the provision of cancer screening to Aboriginal people in the NT that were collected as part of a larger study. Semi-structured interviews were conducted with 50 staff from 15 health services, including 8 regional, remote, and very remote primary health care (PHC) clinics, 3 hospitals, a cancer centre, and 3 cancer support services. Transcripts were thematically analysed. Cancer screening by remote and very remote PHC clinics in the NT is variable, with some staff seeing cancer screening as a "huge gap", while others see it as lower priority compared to other conditions due to a lack of resourcing and the overwhelming burden of acute and chronic disease. Conversely, some clinics see screening as an area where they are performing well, with systematic screening, targeted programs, and high screening rates. There was a large variation in perceptions of the breast screening and cervical screening programs. However, participants universally reported that the bowel screening kit was complicated and not culturally appropriate for their Aboriginal patients, which led to low uptake. System-level improvements are required, including increased funding and resourcing for screening programs, and for PHC clinics in the NT. Being appropriately resourced would assist PHC clinics to incorporate a greater emphasis on cancer screening into adult health checks and would support PHCs to work with local communities to co-design targeted cancer screening programs and culturally relevant education activities. Addressing these issues are vital for NT PHC clinics to address the existing cancer screening gaps and achieving the Australian Government pledge to be the first nation in the world to eliminate cervical cancer as a public health problem by 2035. The implementation of the National Lung Cancer Screening Program in 2025 also presents an opportunity to deliver greater benefits to Aboriginal communities and reduce the cancer burden.
Collapse
Affiliation(s)
- Emma V Taylor
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA 6530, Australia
| | - Sarah Dugdale
- Health Statistics and Informatics, NT Health, Darwin, NT 0800, Australia
| | | | - Gail Garvey
- The School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA 6530, Australia
| |
Collapse
|
4
|
Doran J, Canty D, Dempsey K, Cass A, Kangaharan N, Remenyi B, Brunsdon G, McDonald M, Heal C, Wang Z, Royse C, Royse A, Mein J, Gray N, Bennetts J, Baker RA, Stewart M, Sutcliffe S, Reeves B, Doran U, Rankine P, Fejo R, Heenan E, Jalota R, Ilton M, Roberts-Thomson R, King J, Wyber R, Doran J, Webster A, Hanson J. Surgery for rheumatic heart disease in the Northern Territory, Australia, 1997-2016: what have we gained? BMJ Glob Health 2023; 8:bmjgh-2023-011763. [PMID: 36963786 PMCID: PMC10040039 DOI: 10.1136/bmjgh-2023-011763] [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: 01/14/2023] [Accepted: 03/06/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Between 1964 and 1996, the 10-year survival of patients having valve replacement surgery for rheumatic heart disease (RHD) in the Northern Territory, Australia, was 68%. As medical care has evolved since then, this study aimed to determine whether there has been a corresponding improvement in survival. METHODS A retrospective study of Aboriginal patients with RHD in the Northern Territory, Australia, having their first valve surgery between 1997 and 2016. Survival was examined using Kaplan-Meier and Cox regression analysis. FINDINGS The cohort included 281 adults and 61 children. The median (IQR) age at first surgery was 31 (18-42) years; 173/342 (51%) had a valve replacement, 113/342 (33%) had a valve repair and 56/342 (16%) had a commissurotomy. There were 93/342 (27%) deaths during a median (IQR) follow-up of 8 (4-12) years. The overall 10-year survival was 70% (95% CI: 64% to 76%). It was 62% (95% CI: 53% to 70%) in those having valve replacement. There were 204/281 (73%) adults with at least 1 preoperative comorbidity. Preoperative comorbidity was associated with earlier death, the risk of death increasing with each comorbidity (HR: 1.3 (95% CI: 1.2 to 1.5), p<0.001). Preoperative chronic kidney disease (HR 6.5 (95% CI: 3.0 to 14.0) p≤0.001)), coronary artery disease (HR 3.3 (95% CI: 1.3 to 8.4) p=0.012) and pulmonary artery systolic pressure>50 mm Hg before surgery (HR 1.9 (95% CI: 1.2 to 3.1) p=0.007) were independently associated with death. INTERPRETATION Survival after valve replacement for RHD in this region of Australia has not improved. Although the patients were young, many had multiple comorbidities, which influenced long-term outcomes. The increasing prevalence of complex comorbidity in the region is a barrier to achieving optimal health outcomes.
Collapse
Affiliation(s)
- James Doran
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- Aboriginal Community Controlled Health Organisation, Gurriny Yealamucka Health Service Aboriginal Corporation, Yarrabah, Queensland, Australia
- School of Medicine, James Cook University, Cairns, Queensland, Australia
| | - David Canty
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Karen Dempsey
- Menzies School of Health Research, Royal Darwin Hospital Campus, Rocklands Drive Casuarina, Northern Territory, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | | | - Bo Remenyi
- Menzies School of Health Research, Royal Darwin Hospital Campus, Rocklands Drive Casuarina, Northern Territory, Australia
| | | | - Malcolm McDonald
- School of Medicine, James Cook University, Cairns, Queensland, Australia
| | - Clare Heal
- School of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia
| | - Zhiqiang Wang
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Colin Royse
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Alistair Royse
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Jacqueline Mein
- School of Medicine, James Cook University, Cairns, Queensland, Australia
| | - Nigel Gray
- Medical Education, NTGPE, Casuarina, Northern Territory, Australia
| | - Jayme Bennetts
- Department of Cardiothoracic Surgery, Adelaide SA, Adelaide, South Australia, Australia
- Department of Surgery, Flinders University SA, Adelaide, South Australia, Australia
| | - Robert A Baker
- Department of Cardiothoracic Surgery, Adelaide SA, Adelaide, South Australia, Australia
- Department of Surgery, Flinders University SA, Adelaide, South Australia, Australia
| | - Maida Stewart
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- Aboriginal Community Controlled Health Organisation, Danila Dilba Health Service, Darwin, Northern Territory, Australia
| | - Steven Sutcliffe
- Department of Cardiology, Cairns Hospital, Cairns, Queensland, Australia
| | - Benjamin Reeves
- Department of Paediatrics, Cairns Hospital, Cairns, Queensland, Australia
| | - Upasna Doran
- Department of Paediatrics, Cairns Hospital, Cairns, Queensland, Australia
| | - Patricia Rankine
- Medical Education, Northern Territory General Practice Education, Darwin, Northern Territory, Australia
| | - Richard Fejo
- Medical Education, Northern Territory General Practice Education, Darwin, Northern Territory, Australia
| | - Elisabeth Heenan
- Medical Education, Northern Territory General Practice Education, Darwin, Northern Territory, Australia
| | - Ripudaman Jalota
- School of Medicine, James Cook University, Cairns, Queensland, Australia
| | - Marcus Ilton
- Cardiology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | | | - Jason King
- Aboriginal Community Controlled Health Organisation, Gurriny Yealamucka Health Service Aboriginal Corporation, Yarrabah, Queensland, Australia
| | - Rosemary Wyber
- The George Institute for Global Health, Newtown, New South Wales, Australia
- Telethon Kids Institute, Nedlands, Perth, Australia
| | - Jonathan Doran
- Department of Anaesthesia, University Hospital Galway, Galway, Ireland
| | - Andrew Webster
- Aboriginal Community Controlled Health Organisation, Danila Dilba Health Service, Darwin, Northern Territory, Australia
| | - Joshua Hanson
- The Kirby Institute, Kensington, New South Wales, Australia
- Department of General Medicine, Cairns Hospital, Cairns, North Queensland, Australia
| |
Collapse
|
5
|
Fitts MS, Cullen J, Kingston G, Wills E, Soldatic K. "I Don't Think It's on Anyone's Radar": The Workforce and System Barriers to Healthcare for Indigenous Women Following a Traumatic Brain Injury Acquired through Violence in Remote Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14744. [PMID: 36429463 PMCID: PMC9691172 DOI: 10.3390/ijerph192214744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
Aboriginal and Torres Strait Islander women experience high rates of traumatic brain injury (TBI) as a result of violence. While healthcare access is critical for women who have experienced a TBI as it can support pre-screening, comprehensive diagnostic assessment, and referral pathways, little is known about the barriers for Aboriginal and Torres Strait Islander women in remote areas to access healthcare. To address this gap, this study focuses on the workforce barriers in one remote region in Australia. Semi-structured interviews and focus groups were conducted with 38 professionals from various sectors including health, crisis accommodation and support, disability, family violence, and legal services. Interviews and focus groups were audiotaped and transcribed verbatim and were analysed using thematic analysis. The results highlighted various workforce barriers that affected pre-screening and diagnostic assessment including limited access to specialist neuropsychology services and stable remote primary healthcare professionals with remote expertise. There were also low levels of TBI training and knowledge among community-based professionals. The addition of pre-screening questions together with professional training on TBI may improve how remote service systems respond to women with potential TBI. Further research to understand the perspectives of Aboriginal and Torres Strait Islander women living with TBI is needed.
Collapse
Affiliation(s)
- Michelle S. Fitts
- Institute for Culture and Society, Western Sydney University, Parramatta, NSW 2751, Australia
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT 0871, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD 4878, Australia
| | - Jennifer Cullen
- Synapse Australia, Brisbane, QLD 3356, Australia
- College of Healthcare Sciences, James Cook University, Cairns, QLD 4878, Australia
| | - Gail Kingston
- Townsville Hospital and Health Service, Townsville, QLD 4814, Australia
| | - Elaine Wills
- Institute for Culture and Society, Western Sydney University, Parramatta, NSW 2751, Australia
| | - Karen Soldatic
- Institute for Culture and Society, Western Sydney University, Parramatta, NSW 2751, Australia
- School of Social Sciences, Western Sydney University, Parramatta, NSW 2751, Australia
| |
Collapse
|
7
|
Jones RP. A Model to Compare International Hospital Bed Numbers, including a Case Study on the Role of Indigenous People on Acute 'Occupied' Bed Demand in Australian States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11239. [PMID: 36141510 PMCID: PMC9517562 DOI: 10.3390/ijerph191811239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/01/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
Comparing international or regional hospital bed numbers is not an easy matter, and a pragmatic method has been proposed that plots the number of beds per 1000 deaths versus the log of deaths per 1000 population. This method relies on the fact that 55% of a person's lifetime hospital bed utilization occurs in the last year of life-irrespective of the age at death. This is called the nearness to death effect. The slope and intercept of the logarithmic relationship between the two are highly correlated. This study demonstrates how lines of equivalent bed provision can be constructed based on the value of the intercept. Sweden looks to be the most bed-efficient country due to long-term investment in integrated care. The potential limitations of the method are illustrated using data from English Clinical Commissioning Groups. The main limitation is that maternity, paediatric, and mental health care do not conform to the nearness to death effect, and hence, the method mainly applies to adult acute care, especially medical and critical care bed numbers. It is also suggested that sensible comparison can only be made by comparing levels of occupied beds rather than available beds. Occupied beds measure the expressed bed demand (although often constrained by access to care issues), while available beds measure supply. The issue of bed supply is made complex by the role of hospital size on the average occupancy margin. Smaller hospitals are forced to operate at a lower average occupancy; hence, countries with many smaller hospitals such as Germany and the USA appear to have very high numbers of available beds. The so-called 85% occupancy rule is an "urban myth" and has no fundamental basis whatsoever. The very high number of "hospital" beds in Japan is simply an artefact arising from "nursing home" beds being counted as a "hospital" bed in this country. Finally, the new method is applied to the expressed demand for occupied acute beds in Australian states. Using data specific to acute care, i.e., excluding mental health and maternity, a long-standing deficit of beds was identified in Tasmania, while an unusually high level of occupied beds in the Northern Territory (NT) was revealed. The high level of demand for beds in the NT appears due to an exceptionally large population of indigenous people in this state, who are recognized to have elevated health care needs relative to non-indigenous Australians. In this respect, indigenous Australians use 3.5 times more occupied bed days per 1000 deaths (1509 versus 429 beds per 1000 deaths) and 6 times more occupied bed days per 1000 population (90 versus 15 beds per 1000 population) than their non-indigenous counterparts. The figure of 1509 beds per 1000 deaths (or 4.13 occupied beds per 1000 deaths) for indigenous Australians is indicative of a high level of "acute" nursing care in the last months of life, probably because nursing home care is not readily available due to remoteness. A lack of acute beds in the NT then results in an extremely high average bed occupancy rate with contingent efficiency and delayed access implications.
Collapse
Affiliation(s)
- Rodney P Jones
- Healthcare Analysis and Forecasting, Wantage OX12 0NE, UK
| |
Collapse
|