Research on Why Patients Should Be Asked

QUESTION 1:

Q1: Why are you asking me this question when I don’t look Aboriginal or Torres Strait Islander? A1: South Australia is a multicultural place and there are many differences in appearance between Aboriginal and Torres Strait Islander communities as well as the broad range of other ethnic communities we provide services to – it’s not possible to tell from appearance and the only way to know is to ask.

QUESTION 2:

Q2: Why do you need that information? Will I get treated differently? A2: The statistics are important for improving Aboriginal and Torres Strait Islander health

QUESTION 3:

Q3: Why should they (Aboriginal and Torres Strait Islander people) get special treatment? A3: The information we collect allows health planners to find out why the health of Aboriginal and Torres Strait Islander people is not as good as the health of the general population.

QUESTION 4:

Q4: Does answering this question change the way I will be treated? A4: No, it won’t change the way you are treated by health staff. However, complete and accurate records will ensure timely access to your clinical information and improve the quality of your care.

QUESTION 5:

Q5: Who is going to use this information? A5: Only healthcare workers and those involved in the management of the health system will have authorised access to the information. Individuals will not be identified if the data is used outside of the health service.

Research on Why Patients Should Be Asked

The Australian Institute of Health and Welfare has reported chronic diseases such as cardiovascular disease, diabetes, mental disorders and chronic lung disease occur more often and at a much younger age amongst Aboriginal Australians compared with non-Aboriginal Australians. National data taken from years of research and studies show that there is a clear 20-year health gap between aboriginal and non-Aboriginal Australians.

This graph shows around four years of clinical risk mapping data relating to SAAS events per age range.

The Y axis represents patient age ranges in four-year groups. The higher we travel up the Y axis, the younger the age range of the patient event. The X-axis represents the percentage or volume of cases attended within each age range.

The orange section on the left-hand side of the graph represents non-Aboriginal patient data and the blue section on the right-hand side represents Aboriginal patient data there are a few key points we’re about to highlight about this graph. It should be recognized that whilst these key points are lined with known national data, there are assumptions or extrapolations made about SAAS data and correlating national information. The first key point is the accuracy of the SAAS-specific information collected is relying on us asking the question, are you of Aboriginal or Torres Strait Islander origin?

The second key point is the peak age range for ambulance attendance for non-Aboriginal patients is around 65 to 89 years.

In comparison, the peak age range for ambulance attendance for Aboriginal patients is around 25 to 59 years. While several reasons could account for the significant difference in peak age range is one of the considerations must be the well-defined 20-year health gap between aboriginal and non-Aboriginal Australians.

The final key point is the significant decline in ambulance attendance for Aboriginal patients, most noticeable after the age of 75. This points to a shorter lifespan of Aboriginal and Torres Strait Islander people and needs to be considered.

So what can we do with this information?

As a clinician, there are specific circumstances where consideration of a 20-year health gap is very relevant. These may include age-related comorbidities in the clinical picture or risk of any assessed patient or when referring to the RDR chart for consideration of patient risk. Knowing if a patient is of Aboriginal or Torres Strait Islander origin is important for referrals to another health stream. For example, non-Aboriginal patients over 65 years are eligible for My Aged Care, whereas Aboriginal or Torres Strait Islander patients are eligible if over the age of 50. Always keep the 20-year age gap in mind as certain clinical assessments or standards may also apply at an earlier age for Aboriginal or Torres Strait Islander patients. An example of this is the 4AT assessment for delirium, which is routinely applied at 65 years but is applied at 45 years for Aboriginal or Torres Strait Islander patients.

INEQUITY IN HEALTH

Research suggests there is an inequity between the health of Aboriginal and non-Aboriginal patients. “20-year health age gap”

UNDER IDENTIFICATION

Under identification creates difficulties in measuring the gap in health outcomes and understanding Aboriginal people’s preferences in the health services they access, and need, to achieve the best healthcare outcomes.

WE CARE

Evidence shows many Aboriginal people are at greater risk of some health problems and we want to reduce these risks. Therefore, we want to encourage Aboriginal patients to access specific services that will help reduce the health risk for the patient.

COMPLEX NEEDS

Some Aboriginal and Torres Strait Islander patients have complex needs, or certain health conditions, and may need different choices of information.

THE DATA IS IMPORTANT

The collection of data helps us to better understand and assess the health issues of Aboriginal patients so we can improve services and the well-being of all our patients

IT’S THE RIGHT THING TO DO

We cannot guess or make assumptions about a patient’s origin. Therefore, providing the patient with an opportunity to identify themselves and their origin is the right thing to do.