The latest Issues Brief from the Australian Healthcare and Hospitals Association (AHHA) Deeble Institute for Health Policy Research Summer Scholarship Program has outlined the need for institutional change in hospitals to reduce rates of Aboriginal and Torres Strait Islander patients discharging against medical advice (DAMA).
The Deeble Institute for Health Policy Research Issues Brief, An evidence-based approach to reducing discharge against medical advice amongst Aboriginal and Torres Strait Islander patients by Summer Scholar Caitlin Shaw from James Cook University, explored the causes of higher rates of DAMA among Aboriginal and Torres Strait Islander peoples, particularly in rural and remote areas.
The Issues Brief found the current high levels of DAMA suggested acute care settings such as hospitals are not effectively addressing the concerns of Aboriginal and Torres Strait Islander patients in order to keep them engaged in care for the duration of their treatment.
The literature review found a number of contributory factors associated with DAMA among Aboriginal and Torres Strait Islander peoples. Significant factors included a lack of cultural safety, a distrust of the health system, institutionalised racism, miscommunication, family and social obligations, and isolation and loneliness.
Ms Shaw wrote that the available evidence showed enhancing cultural safety in hospitals would be instrumental in addressing self-discharge rates. Aboriginal Health Workers (AHWs) and Aboriginal Liaison Officers (ALOs) have a crucial role in providing culturally appropriate care, and the brief proposed greater employment and utilisation of such health workers. However, it cautioned against the cultivation of a mentality that would see AHWs and ALOs assume sole responsibility for Aboriginal and Torres Strait Islander patients.
“Coordination between acute and community-based care providers can aid in offering healthcare services that are more accessible and culturally acceptable,” Ms Shaw wrote.
“Improved community care and health education may encourage Aboriginal and Torres Strait Islander patients to remain in care for the duration of their treatment.”
AHHA Acting Chief Executive Dr Linc Thurecht said the Issues Brief showed the importance of working with Aboriginal and Torres Strait Islander peoples and representatives to improve health outcomes.
“On Close the Gap Day this is a timely reminder that cultural awareness is a powerful tool in helping the health sector to reduce health inequality between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians,” he said.
Communications Officer, The Australian Healthcare and Hospitals Association
0487 783 775
This issues brief was developed with the support of HESTA.