Closing the health gap in Central Australia: reduction in Indigenous Australian inpatient self-discharge rates following routine collaboration with Aboriginal Health Workers

BMC Health Services Research

Research Article

Kanishka Williams¹  Richard Delaney-Bindahneem¹  Linda Bray²  Pradeep Mathew Poonnoose³  Ruurd Jaarsma⁴  Morgan Berman⁵  Tim Cheok⁶  Narlaka Jayasekera⁷  Matthew Phillip Jennings⁸ 

[1] Department of Trauma and Orthopaedics, Alice Springs Hospital, 6, Gap Road, The Gap, 0870, Northern Territory, Australia;Department of Trauma and Orthopaedics, Alice Springs Hospital, 6, Gap Road, The Gap, 0870, Northern Territory, Australia;Aboriginal Liaison Services, Alice Springs Hospital, 6, Gap Road, The Gap, 0870, Northern Territory, Australia;Department of Trauma and Orthopaedics, Alice Springs Hospital, 6, Gap Road, The Gap, 0870, Northern Territory, Australia;Department of Orthopaedic Surgery, Christian Medical College Hospital, IDA Scudder Road, 632004, Vellore, Tamil Nadu, India;Department of Trauma and Orthopaedics, Alice Springs Hospital, 6, Gap Road, The Gap, 0870, Northern Territory, Australia;Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders Drive, 5042, Bedford Park, South Australia, Australia;Department of Trauma and Orthopaedics, Alice Springs Hospital, 6, Gap Road, The Gap, 0870, Northern Territory, Australia;Department of Orthopaedic Surgery, Monash Medical Centre, 246, Clayton Road, 3168, Clayton, Victoria, Australia;Department of Trauma and Orthopaedics, Alice Springs Hospital, 6, Gap Road, The Gap, 0870, Northern Territory, Australia;Department of Orthopaedic Surgery, Palmerston North Hospital, 50, Ruahine Street, 4414, Roslyn, Palmerston North, New Zealand;Department of Trauma and Orthopaedics, Alice Springs Hospital, 6, Gap Road, The Gap, 0870, Northern Territory, Australia;Department of Orthopaedic Surgery, Wairau Hospital, Hospital Road, 7201, Blenheim, New Zealand;Department of Trauma and Orthopaedics, Alice Springs Hospital, 6, Gap Road, The Gap, 0870, Northern Territory, Australia;Department of Plastics and Reconstructive Surgery, Bendigo Base Hospital, 100 Barnard Street, 3350, Bendigo, VIC, Australia;

关键词: Indigenous health;    Self-discharge;    Surgery;    Orthopaedics;   

DOI  :  10.1186/s12913-023-09921-7

 received in 2022-11-13, accepted in 2023-08-14,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundIndigenous Australians experience significant socioeconomic disadvantage and healthcare disparity compared to non-Indigenous Australians. A retrospective cohort study to describe the association between rates of self-discharge in Indigenous orthopaedic patients and the introduction of routine Aboriginal Liaison Officers (ALO) within the Orthopaedic multi-disciplinary team (MDT) was performed.MethodsALO were introduced within our routine Orthopaedic MDT on the 22nd of February 2021. Two patient cohorts were analysed, Group 1; patients admitted in the 9-months prior to inclusion of ALO, and Group 2; patients admitted within 9-months thereafter. The primary outcome of interest was the rate of self-discharge among Indigenous patients. Secondary outcomes of interest were the stage of treatment when patients self-discharged, recurrent self-discharge, risk factors for self-discharge and association between self-discharge and length of hospital stay.ResultsIntroduction of ALO within routine Orthopaedic MDT was associated with a significant 37% reduced risk of self-discharge among Indigenous patients (p = 0·009), and significantly fewer self-discharges before their definitive surgical and medical treatment (p = 0·0024), or before completion of postoperative intravenous antibiotic treatment (p = 0·030). There was no significant change in the risk of recurrent self-discharge (p = 0·557). Risk factors for self-discharge were younger age; pensioners or unemployed; residents of Alice Springs Town-Camps or of communities within 51 to 100 km of Alice Springs; and those diagnosed with lacerations of the upper limb, but without tendon injury, wound and soft tissue infections or osteomyelitis. In Group 2, the odds of self-discharge decreased with increased length of hospital stay (p = 0·040).ConclusionsRoutine inclusion of ALO within the Orthopaedic MDT reduced the risk of self-discharge in Indigenous patients. Those who self-discharged did so only after critical aspects of their care were met.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023