NACCHO Aboriginal healthy debate: Mandatory cultural training in Aboriginal Health. Do GPs need it?

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“GPs are in a key position to make a difference. We are the first point of contact in the health care system, gate keepers to other health services, and advocates for our patients. However, the Australian Bureau of Statistics reports that 15% of Aboriginal and Torres Strait Islander people had wanted to go to a doctor in the previous 12 months but had not gone.”

From The Australian Doctor Professor Jennifer Reath

The RACGP is again leading the way in addressing health needs of Aboriginal and Torres Strait Islander Australians.

SEE BELOW RACGP

Government must not become complacent if Close the Gap progress to continue

At the RACGP Convocation last year a proposal that the RACGP should look at moving towards compulsory cultural awareness education as part of the QI & CPD requirements was passed.

It will now go to the RACGP Council for consideration.

The statistics about the health disparities between Aboriginal and Torres Strait Islander Australians and non-Indigenous Australians don’t need to be reiterated here.

Close the gap

Close the gap

We all know that Aboriginal people die 10-12 years younger than their non-Indigenous counterparts. In spite of their poorer health status Aboriginal and Torres Strait Islander people receive lower standards of care when they present to health services.

Aboriginal people presenting to hospital with cardiac chest pain are 40% less likely to receive revascularisation procedures in stroke care, Indigenous patients were less likely to receive timely allied health assessment and were three times more likely to die or to be dependent at discharge.

Though there are many reasons for these disparities in care, it is clear that health services have an important role in improving the health of Aboriginal and Torres Strait Islander people.

GPs are in a key position to make a difference. We are the first point of contact in the health care system, gate keepers to other health services, and advocates for our patients. However, the Australian Bureau of Statistics reports that 15% of Aboriginal and Torres Strait Islander people had wanted to go to a doctor in the previous 12 months but had not gone.

The majority of these were in non-remote areas.

Watch: http://www.youtube.com/watch?feature=player_embedded&v=auCk9kn6ENE

It is clear from both the published evidence and from what Aboriginal and Torres Strait Islander people are telling us that one of the reasons they don’t present to doctors is that too often non-Indigenous health practitioners don’t understand what is important to their Aboriginal and Torres Strait Islander patients – their history, cultural world-view and lived experience of being Aboriginal and Torres Strait Islander.

Often we are not recognising that our patients are Aboriginal or Torres Strait Islander, despite the fact that the immunisation requirements, screening and preventive health recommendations and management strategies, including access to medications, are all clinical decisions which depend on this.

The evidence shows that education in cultural awareness, which encompasses an awareness of how history and culture impact on health and on trust in health services, are essential for providing high quality care.

Many Australian trained GPs will have developed an awareness of an Indigenous Australian history during this their schooling and their medical school training. Some however, will have studied medicine in other countries or studied at a time when Indigenous health was not part of the medical school teaching.

Though GP vocational training now includes some teaching about Aboriginal and Torres Strait Islander health, there are many GPs in practice today who will not have undertaken this learning.

In any case, like most areas of learning, cultural competency is not something that can be learned in one workshop. Cultural competence requires life-long learning and reflection. The best way of providing the opportunity for all GPs to gain and maintain these skills, is through QI & CPD.

Cardiopulmonary Resuscitation training has been compulsory in the RACGP program for two triennia now without much controversy.

Statistics from Europe indicate an incidence of cardiac arrest in the community to be 37.72 per 100,000 person years (the figure for the US being 54.99). On this basis, a quick back of the envelope calculation would indicate that a GP with 2000 patients on their books would have two to three patients each triennium who have a cardiac arrest. In most circumstances the GP would not be in attendance at the time.

In contrast, you are far more likely as a GP to treat an Aboriginal or Torres Strait Islander patient and to make a difference to their health outcomes.

We know that Aboriginal and Torres Strait Islander people comprise 2.5% of the population, and BEACH data shows us that if we ask each of our patients we increase the number of patients we identify from 1.0% to 2.1%.

Evidence from the Kanyini vascular collaboration shows that when Aboriginal people engage with culturally appropriate services they trust, there is good opportunity for high quality cardiovascular prevention.

Inala at Queensland Health and the Majellan General Practice in Brisbane are just two examples of how primary health care services and general practices can make changes that improve their accessibility to Aboriginal and Torres Strait Islander people.

GPs have a proud history of doing what is necessary to improve the health of the communities in which they work. Providing access for our Aboriginal and Torres Strait Islander patients to culturally safe, effective medical care is just another example of this.

The RACGP is embarking on a conversation with its members and with Aboriginal and Torres Strait Islander people to determine best ways forward, for we all know that GPs are at the forefront of improving the health of Australia’s first peoples.

RACGP PRESS RELEASE CLOSE THE GAP

Government must not become complacent if Close the Gap progress to continue

       12 February 2014       

The Royal Australian College of General Practitioners (RACGP) welcomes the release of the Prime Minister’s sixth Closing the Gap report highlighting positive progress made towards meeting the Close the Gap targets but urges the Government to not become complacent.

The report, launched at today’s Close the Gap Parliamentary event aims to provide insight into the key determinants of health, education, employment and community safety in meeting the Close the Gap objectives.

RACGP Chair of the National Faculty of Aboriginal and Torres Strait Islander Health, Associate Professor Brad Murphy, said figures released in the report suggest positive progress has been made in some Close the Gap objectives including child mortality, however there is still considerable progress to be made in other areas such as improving life expectancy.

“The Federal Government’s leadership in the delivery of measures to meet the Close the Gap targets is essential if real progress is to be made.

“The empowerment of Aboriginal and Torres Strait Islander peoples and communities must occur alongside a coordinated strategic, policy driven response,” said A/Prof Murphy.

The RACGP believes general practice and primary healthcare is in the optimum position to improve life expectancy, identified within the report as a key objective in need of urgent progression.

“No outcome acts in isolation.

“We know the benefit general practice holds in the provision of preventive healthcare for Aboriginal and Torres Strait Islander peoples; however life expectancy is affected by a range of factors beyond addressing health risks including education and employment status.

“The health and social care sector employs 15% of the total Aboriginal and Torres Strait Islander workforce1, the highest rate of any sector.

“An investment in Aboriginal and Torres Strait Islander health, including to the Community Controlled sector, not only works towards curbing health disparities, but is also an investment in Aboriginal and Torres Strait Islander employment,” said A/Prof Murphy.

The RACGP is a member of the Close the Gap Steering Committee which today released its 2014 progress and priorities report providing both the Close the Gap campaign and Australian Governments with a blueprint for closing the health equality gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians by 2030.

“Achieving Aboriginal and Torres Strait Islander health equality is an ambitious yet achievable task and these two reports reflect a shared commitment to the improvement of Aboriginal and Torres Strait Islander peoples’ lives,” said A/Prof Murphy.

In its 2014–15 pre-budget submission, the RACGP called on the Government to commit to the funding and implementation of the National Aboriginal and Torres Strait Islander Health Plan 2013–2023, developed by the Department of Health, as a vital step to improving Aboriginal and Torres Strait Islander health and wellbeing.

The RACGP is committed to supporting all Close the Gap efforts and is proud of the daily work of many of its members to improve health outcomes for their Aboriginal and Torres Strait Islander patients.

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NACCHO needs to improve how we  connect, inform and engage into the Ifuture.

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One comment on “NACCHO Aboriginal healthy debate: Mandatory cultural training in Aboriginal Health. Do GPs need it?

  1. Life Expectancy is based on primary services in early childhood development phase and begins in the mothers womb. Primary Services require that additional programs include injection of make works projects that is focused on getting parents working and feeding there children which will help to create a sense of self identity. Preserving Cultural Identity in every aspect of personal and interpersonal development is central towards closing the gap.