ATSI Flashcards
(10 cards)
Why is it useful to know if a patient is ATSI
- the Aboriginal and Torres Strait Islander Health Check Medicare Benefits Schedule (MBS) item 715, which assists early detection and preventive care of common conditions27
- specific immunisations, particularly for influenza and pneumococcal disease
- the Indigenous Chronic Disease Package, designed to enhance the focus of the primary healthcare system on preventive health and effective chronic disease management for Aboriginal and Torres Strait Islander Australians, later incorporated into the Indigenous Australians Health Programme.29
All patients registered at the practice should be asked the standard question: ‘Are you of Aboriginal or Torres Strait Islander origin?’30
Barriers to effective health care of ATSI?
cultural resistance,
dependence on social security and poverty.
Many doctors are from cultural backgrounds of individualism and personal responsibility, which can contribute to their having different priorities to those of Aboriginal and Torres Strait Islander patients.
Aboriginal and Torres Strait Islander people are more likely to have lower levels of formal education and health literacy levels than non-Indigenous Australians, compounded by the complexity of their health and social conditions.31
Enablers of effective health care in ATSI?
providers can leverage their patients’ strengths:
These may include pride in their
- First Nations status;
- connections to their Country,
- family and community;
- and mental, emotional, social and spiritual resilience.32
Improving medication adherence in ATSI
- The PBS subsidises some medications specifically for Aboriginal and Torres Strait Islander people, reflecting their greater burden of disease, including iron deficiency, musculoskeletal pain and chronic suppurative otitis media
- Under the CTG PBS Co-payment Measure, Aboriginal and Torres Strait Islander people can access the concessional rate for PBS medications, and those with concession cards can access PBS medications at no out-of-pocket cost.
- developing therapeutic relationships,
- reducing stigma
- recognising people’s own needs and priorities, the complexities of their daily lives and the limitations of biomedicine in improving health outcomes.3
- At the consultation, doctors can prescribe simple treatment regimens
- promote dosette medication organisers.40
What are the benefits of My health record in preventive med?
Benefits to patients
My Health Record can empower people by providing current health information for themselves and their healthcare providers. It supports continuity of care and can reduce unnecessary repeating of pathology. Inappropriate immunisations or the time required to access the Australian Immunisation Register may be avoided.41 In Rhonda’s case, when she returns home, information from her current appointment with you will be available to her community clinic. However, information in My Health Record may still not be ideal for patients, especially when it does not meet their health literacy needs.42
Benefits to health professionals
When My Health Record is up to date, health professionals can save time by using it to obtain information about patients’ medical history, current medications, pathology results and immunisations. Patient safety is improved through information on adverse medication reactions.41
Benefits to health systems
Time and cost savings could provide widespread benefits.The usefulness and value of My Health Record will increase as more information is added, and more professionals and community members use it.43
There are concerns about breaches of privacy, sales of sensitive health information and difficulties in using My Health Record. Feedback including concerns and instances of breaches can be provided by telephone or online to the Australian Digital Health Agency.44
What extra vaccines are recommended for ATSI
Hepatitis B
Non-vaccinated and non-immune adults*
Influenza
All Aboriginal and Torres Strait Islander people
Pneumococcal disease
23vPPV at ages 50 and 55 years
Recommendations re: Kidney disease in ATSI?
Aboriginal and Torres Strait Islander Australians are twice as likely as non-Indigenous Australians to have CKD and four times as likely to have stage 4 or 5 CKD. Regular assessment by measuring blood pressure, urine albumin-to-creatinine ratio and estimated glomerular filtration rate is recommended from the age of 18 years as part of an annual health assessment
Specific interventions for ATSI with CKD?
- LOWER CVD risk
CKD is associated with absolute cardiovascular risk. Interventions aimed at improving diet, increasing physical activity, quitting smoking and drinking no more than two standard drinks per day can reduce absolute cardiovascular and CKD risk.47,48
- The National Aboriginal and Torres Strait Islander Health Plan highlights the benefits of community-based programs and health services that address determinants of health to support clinical care.49
- Rhonda has stage 2 CKD and diabetes so, for her, medication in addition to lifestyle interventions may slow CKD progression. Ramipril, an angiotensin-converting enzyme (ACE) inhibitor, is a first-line medication to slow progression of CKD in people with diabetes.47
However, Rhonda may be at risk of planned or unplanned pregnancy, and ACE inhibitors are listed as Category D for pregnancy.50 Asking all women of reproductive age if they are planning to become pregnant provides opportunities for preconception planning and prevention of unexpected and at-risk pregnancy.51 Pregnancy can accelerate the progression of CKD.52
- MBS CDM items -General practitioners (GPs) can use MBS Chronic Disease Management items to support efforts to integrate complex chronic disease prevention issues.53
- Community based - However, effective chronic disease care for Aboriginal and Torres Strait Islander people extends beyond the clinical encounter and includes community engagement, Aboriginal and Torres Strait Islander leadership and knowledge, sharing of responsibilities and sustainable resourcing.54
What MBS items are useful in chronic disease management
GP Management Plans (GPMPs; MBS item 721) provide support for GPs and patients to agree on management goals and identify what each will do to achieve these, including referral to specialists and allied health services. Team Care Arrangements (TCAs; MBS item 723) support GPs to coordinate care with a multidisciplinary team of service providers. Management plans should be done by the patient’s usual GP because of the importance of ongoing relationships between patients and GPs for chronic disease care.55 The MBS provides further benefits for regular review and updating of GPMPs and TCAs.53
What can an Aboriginal Community controlled Health service do?
ACCH services aim to provide quality clinical care for Aboriginal and Torres Strait Islander people in culturally determined paradigms that address complex health and social needs.56 Some community-controlled services can help clients with transport, housing and legal issues, which may underlie the medical conditions that GPs are trained to manage.57 Employment of Aboriginal and Torres Strait Islander staff embeds the service in the community and supports economic development.
Aboriginal and Torres Strait Islander community-controlled health services are developed to meet the specific cultural, social and healthcare needs of Aboriginal and Torres Strait Islander people. However person-centred care recognises people’s rights to choose where to access healthcare.
