Culture must be at the heart of hospital care for Aboriginal and Torres Strait Islander patients

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Hospitals need to change the way they deliver care to Aboriginal and Torres Strait Islander cardiac patients to help improve their health outcomes, the Heart Foundation’s Group CEO, Adjunct Professor John Kelly, said today.

“More hospitals need to consider how they can provide care for Aboriginal and Torres Strait Islander patients that is culturally safe, responsive to their needs and accessible to ensure these patients get the care they need in hospital and as outpatients,” Professor Kelly said.

Professor Kelly said Aboriginal and Torres Strait Islander people die from heart disease at twice the rate of non-Indigenous Australians and were seven times more likely to leave hospital against the advice of their doctors, potentially compromising their treatment and recovery.

“The high rate of discharge against medical advice (DAMA) can be traced to cultural and socio-economic reasons, as well as practical concerns such as accessibility for people who live in remote locations,” he said.

Professor Kelly will speak at the national forum of the Heart Foundation’s Lighthouse Hospital Project, which is being held over two days at the Richmond Football Club in Melbourne during national Heart Week (28 April - 4 May).

The Lighthouse Hospital project was set up seven years ago to improve the hospital experience for Aboriginal and Torres Strait Islander patients with acute coronary syndrome (ACS). It is a joint initiative of the Heart Foundation and the Australian Healthcare and Hospitals Association and is funded by the Commonwealth Department of Health through the Indigenous Australians Health program.

An independent evaluation of the project is under way to assess the full impact of the project nationally, but Professor Kelly said initial reports indicate Lighthouse is making a difference.

“We have seen a decline in DAMA rates among Aboriginal and Torres Strait Islander patients at Lighthouse hospitals since 2017,” he said.

Project officers have been employed at 18 hospitals in the Northern Territory, Queensland, NSW, Victoria, South Australia and Western Australia. The hospitals account for almost half of all heart-related admissions for Aboriginal and Torres Strait Islander peoples.

Nurse Darsha Beetson, an Aboriginal woman who is the Lighthouse project officer at the Prince Charles Hospital in Brisbane, said it was important that culture and beliefs were respected across the health care journey.

Her team will begin collecting culturally relevant information that could indicate if patients are at risk of discharging themselves against medical advice.

Staff will ask patients if they are taking bush medicines, which could affect the impact of medications that are prescribed by their doctor, and if they have traditional women’s or sorry business to attend to, which could lead them to discharge themselves before they are well enough to leave.

A map depicting 15 local tribal languages and boundaries is on display, and a community garden with a mural featuring images from the local landscape and traditional black, yellow and ochre colors is “a culturally safe space for visitors and patients”, Ms Beetson said.

A hospital dietician is including some bush tucker on the hospital menu – bush tomato relish and wattleseed.

“It’s such a good feeling to see an Indigenous patient’s face light up when they realise they have an Indigenous nurse looking after them, it’s an unspoken thing,” Ms Beetson said.

For Joe Bryant, the project officer at the Coffs Harbour Health Campus, one simple, effective step has been to introduce name tags that identify staff who are Indigenous Australians.

“When they see the tags, they feel culturally safe, there is a sense of belonging,” he said.

Lighthouse hospitals have made changes to administration and discharge procedures, formalised how they identify Aboriginal and Torres Strait Islander patients and all hospitals have held cultural competency training for non-Indigenous staff. Accommodation units have been set aside for Indigenous patients from regional and remote areas and clinical resources and signs have been co-written in local community languages.

Hospitals are also improving their communication and follow-up arrangements and are helping patients to navigate the health system. Outpatient appointments and follow-up phone calls to Indigenous patients after discharge are a regular service.

The project has also led to more Aboriginal health and Torres Strait health workers being included in cardiac rehabilitation programs and other cardiac care teams.

The Lighthouse Hospital National Forum will be held at the Richmond Football Club on 1-2 May.