How a culturally informed model of care helped First Nations patients with heart disease.

A First Nation child born in Australia today can hope to survive. Eight to nine years less Compared to a non-native child born on the identical day.

During their lifetime, they usually tend to have a heart attack, and this will likely be on average. 20 years younger in comparison with a non-native patient in a hospital bed once they do. Acute rheumatic fever, a disease almost non-existent in non-Indigenous Australians, can damage their heart valves. They are To a great extent To be born and die from cancer, diabetes, kidney failure and lung disease.

First Nations Australians are also more more likely to have lower household incomes, live in overcrowded housing, and 14 times more likely. be imprisoned. We know that such socioeconomic inequalities create health inequalities. There can also be evidence that cultural aspects and Experiences of racism compound the issue.

Close the health gap between First Nations people and non-Indigenous Australians. A national priority. One strategy to reduce health disparities is to enhance the care Aboriginal and Torres Strait Islander people receive once they are admitted to hospital.

Staff at Brisbane's Princess Alexandra Hospital could see first-hand that our health system was not providing the care First Nations patients needed. So they sought to develop a culturally informed model of look after First Nations patients with heart disease.

All of us have worked with this model and were a part of a study to check it. Our results, published recently. Lancet Global Healthindicate that this culturally informed model of care bridged the gap between First Nations patients and non-Indigenous patients after we checked out heart health outcomes after they left hospital.

Designing a culturally informed model of care

This model was developed for First Nations patients with acute coronary syndrome. This includes heart attacks and Anginawhich is chest pain attributable to disease within the arteries that provide blood to the center.

The project was designed in collaboration with First Nations stakeholders. Training was developed and delivered to reinforce cultural competence within the cardiology department and increase staff knowledge of relevant services available to First Nations patients outside the hospital.

Staff established formal partnerships with local Aboriginal and Torres Strait Islander community-controlled health organisations. They enhanced the hospital environment with First Nations artwork and uniforms (displaying First Nations flags and artwork).

They put together a “better cardiac care” team including an Aboriginal and Torres Strait Islander hospital liaison officer, a cardiac nurse and a pharmacist. The team saw First Nations patients at their bedside, providing additional support, advocacy, education and care support.

Patients can confidently ask questions and speak about their diagnosis and treatment in their very own words without embarrassment or shame.

The team was focused on the needs of the patient. For example, they might coordinate accommodations for a relative of a patient who was traveling to the hospital from a distance. They can tell the patient's doctor if the patient needs more time to speak or make a choice, or if a greater explanation is required. Before the patient leaves hospital, the team can liaise with the patient's local chemist to provide their medication and book a follow-up appointment with their GP.

How we tested the model

We investigated the impact of the model of care by outcomes for First Nations and non-Indigenous patients admitted with heart attack and angina before and after implementation of the model.

Specifically, we collected data from 199 First Nations patients and 440 randomly chosen non-Indigenous patients within the 24 months before the project began and compared them with 119 First Nations patients and 467 non-Indigenous patients who Were under treatment for 12 months.

We specifically desired to know whether patients died, had a second heart attack, required unexpected stent or coronary artery bypass surgery, or had a direct return to the hospital inside 90 days of discharge. .

Before the model was introduced, 34% of First Nations patients had certainly one of these antagonistic outcomes, much higher than the 18% rate amongst non-Indigenous patients. Subsequently, these events occurred in 20% of First Nations and non-Indigenous patients. This was a major improvement for First Nations patients and closed the gap between groups.

The most vital improvement was seen in immediate readmissions, but heart attacks were also fewer.

Fewer heart attacks and hospitalizations are good, but we also must be certain that patients feel culturally secure, and that their social and emotional needs are being met.

Oh Related projects Patients and their families were asked about their experience of the model of care. The researchers identified that the connection or rapport between patients and the team, particularly the staff within the Straits Islands and Torres Strait Islands, could be the key to its success.

A promising concept

Our study was not a randomized trial and the control group was historical. It is due to this fact possible that aspects aside from the model of care can have influenced the outcomes. The study was also conducted in just one hospital.

However, we demonstrated that a culturally informed model of care, developed with and for First Nations people, can improve clinical outcomes. Improved cardiac care programs based on this idea have proliferated. Other hospitals in Queensland.

We hope that similar results could be replicated in lots of hospitals and other clinical specialties, as improving hospital outcomes is certainly one of many steps needed to shut health disparities for First Nations people in Australia. One of the essential steps is