Improving transitions of care for Aboriginal and Torres Strait Islander patients

Aboriginal and Torres Strait Islander people have centuries of wisdom in the health and wellbeing space, but have long experienced challenges when interacting with the Australian healthcare system.

Based on Western values, and comprised mainly of English speaking professionals, our nation’s health service is largely geared towards metro-dwelling, non-Indigenous populations.

While this could be behind the poorer general health outcomes seen in First Nations people, Mike Stephens of NACCHO (The National Aboriginal Community Controlled Health Organisation) believes they also play a profound role in medication safety.

When transitioning care from hospital to the home or allied health, information exchanges with First Nations people may break down, leaving them disproportionally exposed to medication errors, he says.

“We are still seeing a fair bit of structural bias in Australian healthcare. Historically, Indigenous peoples around the world have not had the best experiences with the health system generally. But when we look at the intersections between the various healthcare environments, these barriers are particularly stark.

“For instance, when it comes to medication, we know that information exchange is very important, and we also know that these exchanges must be done in a way that is appropriate and culturally responsive. Without this we may see incomplete medication history being disseminated between care providers, or patients becoming disengaged with their follow on care plan.”

Language and health literacy

With medical advice largely disseminated in English, First Nations people – some of whom speak English as their second or third language – may require specific considerations by care providers, relevant to the communities’ needs.

While Aboriginal Liaison Offices are there to help, they are not necessarily language translators.

“We need to see a broader investment in supporting Aboriginal and Torres Strait Islander people beyond the existing resources,” Mr Stephens said.

“Translation of healthcare information, in the broadest sense, is not a routine fixture of the healthcare system, and I believe this needs to change – particularly in the context of medication safety, where a firm understanding of communities’ health literacy and language is crucial.

“Managing complex medicines regimes can be challenging for anyone without a medical background. Add to that English and health literacy considerations, and there are clear disadvantages and risks at play.”

Cultural safety

Aside from health literacy and language, cultural safety can affect the quality of health information exchanges.

“When there is minimal cultural safety, people may not feel supported, and may even feel threatened. At the very least, they would not feel welcome. None of these feelings are conducive to effective communication,” Mr Stephens said.

A lack of cultural safety could even determine whether advice is received at all. Data shows that the rate at which Aboriginal and Torres Strait Islander people leave hospital without direct medical advice is disproportionately high.

“It’s understandable to me that people who feel unsafe would want to discharge themselves early, potentially before receiving any advice. If you don’t feel safe somewhere, it is understandable you would want to leave.”

Technology use

Where technology is used to bridge the gaps between different healthcare providers, biases within the technology could be perpetuating cultural disadvantage.

Mr Stephens said apps are particularly vulnerable, given their lack of regulation.

“Certain apps are mainly used by – and geared towards – the general Australian population. And so, if these apps are driving any value in the care transition process, they will often be disproportionately improving care for non-Indigenous people. At a system level, that translates to a foregone opportunity to Close the Gap,” he said.

What is the solution?

Mr Stephens applauds a recent decision by the government to fund CTG PBS medicines for Aboriginal and Torres Strait Islander people being discharged from hospital – a move that will come into effect in January 2025.

“This has the potential to take the burden off rapid medication information dissemination from hospitals to community-based primary care health service providers. The client can essentially have a full month’s worth of medication when they’re discharged, and can avoid the awkward situation of having to get back to a prescriber very quickly from when they are discharged.”

Formulary alignment – where similar drugs are prescribed across the healthcare system – could also be an effective approach.

“It ensures a more seamless experience and improves the continuity of a person’s treatment regime, without the need for them to change drugs, and therefore encounter transition challenges.”

Advocacy and support is already underway

Mr Stephens organisation, NACCHO, is already committed to overcoming structural disadvantages, with its network of 146 country-wide members, called Aboriginal Community Controlled Health Organisations (ACCHOs).

“ACCHOs are invested in the health of the respective Aboriginal and Torres Strait Islander communities that they serve. ACCHOs have very comprehensive, longitudinal programmes that support Aboriginal and Torres Strait Islander peoples’ health across their whole life lifespan, and likely know many clients better than a hospital would.”

ACCHOs run a range of community-focused services, from justice services, to education, childcare and much more. Hospitals and other care service providers linking with them can help build trust and community relationships, in addition to supporting policies and processes, Mr Stephens said.

“All in all, we are committed to ensuring that the workflow between different service providers work really well and is culturally safe.”

Join the debate

Sharing more of his views on culturally safe care transitions, Mike Stephens will join a panel at the upcoming Medication Safety & Efficiency Conference, as part of Connect Virtual Care.

Joining him on the panel are Michael Bakker, Chief Pharmacy Information Officer, SA Pharmacy, SA Health; Kendra Hagedorn, Chief Nursing Information Officer, Ramsay Health Care; and Daniel Trajkov, Chief Pharmacy Information Officer, South Eastern Sydney LHD, Senior Program Manager, UnitingCare Queensland.

One ticket to Connect Virtual Care gives you access to three conferences: Medication Safety & Efficiency, National Telehealth and Virtual Care, and Hospital in the Home.

This year’s event will be held 2-3 April 2025 at the Hilton Sydney.

Learn more and register your tickets here.

About Mike Stephens

Mike Stephens is Director of Medicines Policy and Program at the National Aboriginal Community Controlled Health Organisation (NACCHO) and a Consultant Pharmacist.

Through his work with NACCHO, Mike has provided policy advice to all levels of government and has worked with a range of national agencies, national advisory groups, boards and peak bodies to influence medicines policy to benefit Aboriginal and Torres Strait Islander people.