“Access to healthcare”. It makes me think of transport issues, but it’s so much more than that! This month, Vishal Arya, an RVTS ME, speaks about access to health care, particularly for our Aboriginal and Torres Strait Islander patients. Watch the animation or read the transcript below to find out what you can do to improve access to health care in your community.
RVTS registrars provide healthcare to many Indigenous Australians across the continent. Indigenous people of the world have poorer health outcomes than their non-Indigenous counterparts, and this is as true in Australia as it is in other countries. This is why RVTS focusses on providing training to promote high quality care to all patients, including Indigenous Australians, in an effort to improve equitable health care and health outcomes. During webinars, at workshops, during supervisor discussions and on clinical teaching visits, strategies are discussed to provide culturally appropriate care to Aboriginal and Torres Strait Islanders. These discussions include communication strategies, specific treatment guidelines, Medicare items and much more. At the last RVTS workshop we went back to basics and looked at some contributing factors: what are the barriers encountered by Indigenous Australians to access health care and how can we, as GPs, improve universal access.
Why is it important to look at access to health care? Well, we can’t influence the health of individuals or communities if they’re not presenting to our clinics. Being aware of barriers and enablers is helpful in identifying opportunities to improve health access, and thereby improve health outcomes. There are multiple factors that influence access to health care. We will look at only a few.
As a GP registrar, there are many things that are out of your control, but there is a lot you can do right where you are.
To start with, you can ensure that you are aware of factors contributing to the health outcomes of your community, and improve your grasp of the barriers and enablers. For example, understanding Aboriginal culture and history, recognising the importance of Men’s and Women’s Business, as well as shame, confidentiality and privacy factors, and comprehending the kinship systems in caring for an individual patient are all important in delivering culturally appropriate care. Reading this blog is a great start. Let’s look at some practical suggestions.
Providing a welcoming space is possible no matter where you are. You can easily ensure that your practice appears to be a friendly place for all. You may put up posters that would be welcoming to the LGBT community, making patients feel that it’s a safe place to discuss their issues. In the same way, displaying Aboriginal Art or the Aboriginal Flag would make your clinic appear to be a friendly, welcoming place for Aboriginal patients.
You may consider having Aboriginal and Torres Strait Islander Health Workers on staff to promote culturally safe service delivery, or at a minimum, ensure that you have culturally competent non-Indigenous staff. Cultural education of reception staff can go a long way in overcoming some barriers. Remember, your front desk staff are the gatekeepers. You may be able and willing to provide culturally appropriate care, but the staff on the other side of the door may be a barrier that you’re not even aware of, and your effectiveness is limited because the patient doesn’t actually get to see you.
RVTS registrars in Aboriginal Medical Services have regular meetings with Cultural Mentors to improve their understanding of the community’s customs and culture. Cultural Mentors are members of the local community who explain the local culture, traditions and norms, provide advice on effective communication and answer all the registrar’s queries. This has proven to be beneficial in promoting cultural safety. If your practice does not have a Cultural Mentor, you could talk to Aboriginal health workers from other organisations in the town (like the hospital or community health, or even the local police Aboriginal Community Liaison Officer) for tips on local customs.
Having flexibility in setting appointments is another enabler. This can sometimes be tricky, but it’s worth sitting down with your Aboriginal Health Worker and considering the best way to be flexible and available to the community. Longer consultations are also important to consider: these patients often have complex and chronic conditions, coupled with low health literacy. Spending more time with your Aboriginal patients will likely improve their health outcomes. Allowing time to build rapport is essential, and this may not be achieved in a single appointment, but over time.
Good communication is essential. As for all patients, speaking in simple plain English, using active listening skills, and taking time to explain is essential. Use of visual aids when explaining can be very helpful. In the Aboriginal context, having the Aboriginal Health Worker present during the consultation, or another translator is invaluable, if the patient consents. Offering for another family member or a support person to be present may also facilitate care. A patient centred, holistic approach cannot be over-emphasized.
You may consider scheduling various appointments on the same day: a diabetic review with yourself, an education session with the diabetic educator, a foot care appointment with a podiatrist and a teleconference with the renal physician all on the same day! This reduces the logistics of transport and cost to the patient.
Being familiar with MBS items available for providing services and support to Aboriginal and Torres Strait Islander patients can make a significant difference. Finances play a noteworthy role in accessing health care, and utilizing the resources available to your patients will be most beneficial. We will go into more details on MBS items for Aboriginal and Torres Strait Islander patients in a future post, so keep a look-out for that.
Promoting services that are available improves community awareness and therefore promotes access to these services.
You may not be able to start new clinics in areas that have poor health access, or gain the necessary funding for improved transport and services, but you can advocate for your patients and community, making those in power aware of deficits in services, infrastructure and workforce.
Some areas have got great systems in place where transport is provided and patients are collected from their homes in the morning for their clinic review. If you don’t have a system in place and think your community would benefit from that, do some research on how other areas do it; speak to colleagues and advocate for your community.
Finally, nothing can replace the therapeutic relationship based on trust and mutual respect. The relationship that is fostered has a significant impact on how your patients access health care. In fact, relationship with all healthcare staff, including receptionists and nurses, has been identified as an important factor.
Contributing to closing the gap is a privilege and duty for each one of us in general practice. Even the smallest and simplest step to improve access to health care can make a big difference in the health outcomes of individual patients and communities.
If you’d like more information, take a look at the references which go into more depth on the various factors influencing health care.