Addressing surgical inequity for Aboriginal and Torres Strait Islander people in Australia's universal health care system: a call to action

O’Brien, Penny; Bunzli, Samantha; Lin, Ivan; Bessarab, Dawn; Coffin, Juli; Dowsey, Michelle M.; Choong, Peter

doi:10.1111/ans.16557

Cited by 15 publications

(18 citation statements)

References 49 publications

(75 reference statements)

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“…5 Instead, low rates of TJR are more likely due to disparities in healthcare access. 6 Aboriginal people experience barriers to, and disparities in healthcare along the whole of the pathway to receiving surgical care, including access to appropriate primary and specialist services. 6 In 2014-2015 Aboriginal people reported experiencing difficulty in accessing primary care services at 10 times the rate of the wider population, 20 and Medicare claim rates for specialist services were 43% lower than for non-Aboriginal people.…”

Section: Discussionmentioning

confidence: 99%

Total joint replacement may be a valuable treatment for Aboriginal and Torres Strait Islander people with osteoarthritis, but uptake is low

O’Brien

Thuraisingam

Bunzli

et al. 2022

ANZ Journal of Surgery

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Background: Despite bearing a higher burden of osteoarthritis, little research has examined disparities in the access, utilisation and surgical outcomes associated with total joint replacement (TJR) among Aboriginal and Torres Strait Islander people. Methods: We conducted a retrospective cohort study to compare the sociodemographic and clinical characteristics of all Aboriginal and Torres Strait Islander and non-Aboriginal patients who underwent primary hip and knee replacement at St Vincent's Hospital Melbourne between 1996 and 2019. Results: A total of 10 277 primary total knee or hip replacements were performed in the 1996-2019 study period, of which 49 (0.5%) patients identified as either Aboriginal and/or Torres Strait Islander. Aboriginal and Torres Strait Islander patients were younger (61.7 AE 11.8 vs. 68.3 AE 10.3 years; P < 0.001), recorded higher Body Mass Index scores (median (IQR), 36.0 (29.5-41.4) vs. 30.8 (27.0-35.3); P < 0.001) and were more likely to experience multiple co-morbidities at the time of surgery. Despite these findings, Aboriginal and Torres Strait Islander patients did not experience higher complication rates and experienced comparable, clinically meaningful quality of life improvements 12-months postsurgery.Conclusions: TJR appears to be a valuable treatment option for Aboriginal and Torres Strait Islander people with end-stage osteoarthritis. Our study was limited by the small number of procedures conducted in patients who identify as Aboriginal and Torres Strait Islander. Further research is needed to understand why uptake of TJR by Aboriginal and Torres Strait Islander people is low.

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Section: Discussionmentioning

confidence: 99%

Total joint replacement may be a valuable treatment for Aboriginal and Torres Strait Islander people with osteoarthritis, but uptake is low

O’Brien

Thuraisingam

Bunzli

et al. 2022

ANZ Journal of Surgery

Self Cite

View full text Add to dashboard Cite

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“…A second emerging relationship between Australian healthcare and government based policies and the healthcare quality is on the affordability of the healthcare industry. An analysis of the global healthcare quality literature demonstrates that government policies and regulations impact and dictate the cost of healthcare in a nation [26,27]. The concept of affordability is subjective as it relates to the prevailing social and economic status of a country and a community [28,29].…”

Section: Policies On Healthcare Affordability For the Aboriginal And ...mentioning

confidence: 99%

“…On the one hand, the inclusion of more aboriginal and Torres Strait Islander healthcare workers means that the unique cultural needs and expectations of the minority community are addressed, thus enhancing the quality of healthcare services to the minority community. On the other hand, their inclusion in the workforce and especially in the strategic decision-making levels means that they influence and ensure that there is a stakeholder's diversity representation of the minority groups when formulating and making healthcare decisions [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. This helps in ensuring that formulated healthcare decisions are geared towards ensuring equity for all, both the majority and minority communities in Australia.…”

Section: Minority Population Healthcare Accessmentioning

confidence: 99%

Examining the Role of Government Policies in Improving Healthcare Quality to the Aboriginal and Torres Strait Islander Communities in Australia: Rapid Review

Al-Masaeed¹

2022

Jap J Clin & Med Res

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Aim and Significance: The review examines the impact of Australian government policies on healthcare quality delivery to the minority communities of the aboriginal and Torres Strait Islander community within Australia. The focus is on the value and impacts of the policies, denoting their success and limitation areas. This is informed by the need to ensure equity for all in accessing healthcare services as a global healthcare provision sustainability goal. Methods: This review was based on a search of the existing secondary data that is publicly available. The analysis searched the Australian government website for its official healthcare policy publications and supporting peer reviews from the Google scholar, PubMed, Scopus, and Medline databases, respectively. The findings were analysed through the PRISMA model, and inclusion and exclusion criteria were applied to ensure findings relevance and alignment with the review aim. Findings and Conclusion: The review analysis established that the Australian government has enacted healthcare policies targeting the aboriginal and Torres Strait Islander community within Australia. Key areas of focus in enhancing healthcare quality for this target healthcare population were (i) improving healthcare access and (ii) enhancing healthcare affordability through cost reduction.

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“…Consultation with local indigenous people has led to improvements in health equity [ 37 , 38 ]. However, disparities remain especially among men [ 39 ], and access to surgical care is low [ 40 ]. Health literacy remains low [ 41 ], and levels of chronic and infectious disease remain high [ 41 , 42 ].…”

Section: Introductionmentioning

confidence: 99%

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

Jones¹

2022

IJERPH

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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.

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Addressing surgical inequity for Aboriginal and Torres Strait Islander people in Australia's universal health care system: a call to action

Cited by 15 publications

References 49 publications

Total joint replacement may be a valuable treatment for Aboriginal and Torres Strait Islander people with osteoarthritis, but uptake is low

Total joint replacement may be a valuable treatment for Aboriginal and Torres Strait Islander people with osteoarthritis, but uptake is low

Examining the Role of Government Policies in Improving Healthcare Quality to the Aboriginal and Torres Strait Islander Communities in Australia: Rapid Review

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

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