[Extract] Advocacy can extend across all interactions. However, in healthcare it can form an integral part of the care we give to patients or the community. For most healthcare professionals, professional regulations and societal laws bind the scope of practice concerning advocacy. In this chapter, advocacy is defined and applied to individuals and community situations. The role of the health professional regarding advocacy is delineated and challenges to this role are highlighted and discussed. The position of social justice regarding ethical decision-making and policy development is debated. Real-life scenarios allow the reader to examine the various ways in which effective advocacy has been achieved. Finally, the chapter poses questions, encouraging the reader to pause and think about how they would manage various challenges related to healthcare advocacy.
The National guide to a preventive health assessment in Aboriginal and Torres Strait Islander peoples (National guide) is an initiative of the National Aboriginal Community Controlled Health Organisation (NACCHO), lead agency of the Chronic Disease Alliance of Non- Government Organisations. The Royal Australian College of General Practitioners (RACGP) supported the development of the guide.
The National guide is intended for all health professionals delivering primary health care to the Aboriginal and Torres Strait Islander population. This includes general practitioners (GPs), Aboriginal health workers, nurses and those specialists with a role in deliveringprimary health care.
The National guide package consists of:
The National guide
• Recommendations compiled from the review of the Evidence base
• Child and adult preventive health life cycle summaries.
The Chronic Disease Alliance determined that recommendations in the National
guide should be based on a review of the evidence, seeking where possible existing systematic reviews addressing questions related to preventive health care, expert opinion and consensus statements of relevance to the Aboriginal and Torres Strait Islander population.
The Evidence base documents the research literature used to form the National
guide and can be accessed on the RACGP website at: www.racgp.org.au and on the NACCHO website at: www.naccho.org.au. Users of this guide are encouraged to access this Evidence base for more information.
Health care providers (particularly in regional and remote areas) are also encouraged to refer to local guidelines (where they are appropriate and available) in order to optimise preventive health assessments. Many of the recommendations in the National guide describe health problems that may be of concern only in certain regional areas. For example, trichiasis screening is not appropriate in Victoria except when an elderly Aboriginal person from northern Australia is assessed. Consequently, many recommendations highlight the importance of clinical discretion in decision making.
The National guide makes specific recommendations regarding the elements of a
preventive health assessment in the non-pregnant adult Aboriginal and Torres Strait Islander population as well as children. The aim is to provide a national evidence based resource that can inform health care providers and policy makers on a defined set of activities that are of particular relevance to this population, or that are different from those for the non-Indigenous population.
These activities may prevent disease, detect early and unrecognised disease, and promote health in the Aboriginal and Torres Strait Islander population while allowing for variations based on regional and local circumstances.
General practitioners should use the recommendations to enhance the clinical care that they provide to their Aboriginal and Torres Strait Islander clients.
The National guide aims to complement the RACGP Guidelines for preventive activities in general practice (known as the ‘red book’) by dealing with health issues that are specific to the Aboriginal and TorresStrait Islander population. The chosen subject areas represent key health issues that are
amenable to primary health care intervention and contribute to morbidity and mortality in the Aboriginal and Torres Strait Islander population. Where issues common in the general Australian population have not been dealt with in this guide (eg. osteoporosis), GPs are encouraged to cross reference with the ‘red book’ which is available on the RACGP website at: www.racgp.org.au/document.asp?id=4169.
To assist health care providers, the Evidence base used to form the National guide provides a summary of recommendations from the ‘red book’ and from other groups, such as the Central Australian Rural Practitioners Association and the Northern Zone Management Unit of Queensland Health in north Queensland.
The authors have presented the information in this guide so that it can apply to both Aboriginal and Torres Strait Islander peoples. It is recognised that, while the health of Torres Strait Islanders is very similar to the Aboriginal population, they represent a distinct Indigenous Australian population.
Health care providers should use the National guide to systematically appraise current preventive practice, especially where recommendations for the general population have previously been applied to Aboriginal and Torres Strait Islander clients. Providers may also benefit by appraising certain screening activities for which there is little evidence. These activities may draw resources away from other activities to improve the health of the Aboriginal
and Torres Strait Islander population, eg. risk factor modification and immunisation programs.
General practitioners may undertake preventive health assessment activities as part of their normal consultations. Medicare benefits are payable for a medical examination or test on a symptomless patient by that patient’s own medical practitioner in the course of normal medical practice, to ensure the patient receives any medical advice or treatment necessary to maintain his or her state of health.
To describe tobacco control policies and activities at a nationally representative sample of Aboriginal community-controlled health services (ACCHSs).The Talking About The Smokes (TATS) project used a quota sampling design to recruit 34 ACCHSs around Australia. Between April 2012 and October 2013, a representative at each ACCHS completed a survey about the service's tobacco control policies and activities. Questions about support for smoke-free policies were also included in the TATS project survey of 2435 Aboriginal and Torres Strait Islander members of the communities served by the ACCHSs.ACCHS tobacco control policies and activities.Thirty-two surveys were completed, covering 34 sites. Most ACCHSs (24/32) prioritised tobacco control "a great deal" or "a fair amount", and all services had smoke-free workplace policies. Most had staff working on tobacco control and had provided tobacco control training within the past year. A range of quit-smoking information and activities had been provided for clients and the community, as well as extra smoking cessation support for staff. There was strong support for smoke-free ACCHSs from within the Aboriginal communities, with 87% of non-smokers, 85% of ex-smokers and 77% of daily smokers supporting a complete ban on smoking inside and around ACCHS buildings.The high level of commitment and experience within ACCHSs provides a strong base to sustain further tobacco control measures to reduce the very high smoking prevalence in Aboriginal and Torres Strait Islander populations.
To describe the research methods and baseline sample of the Talking About The Smokes (TATS) project.The TATS project is a collaboration between research institutions and Aboriginal community-controlled health services (ACCHSs) and their state and national representative bodies. It is one of the studies within the International Tobacco Control Policy Evaluation Project, enabling national and international comparisons. It includes a prospective longitudinal study of Aboriginal and Torres Strait Islander smokers and recent ex-smokers; a survey of non-smokers; repeated cross-sectional surveys of ACCHS staff; and descriptions of the tobacco policies and practices at the ACCHSs. Community members completed face-to-face surveys; staff completed surveys on paper or online. We compared potential biases and the distribution of variables common to the main community baseline sample and unweighted and weighted results of the 2008 National Aboriginal and Torres Strait Islander Social Survey (NATSISS). The baseline survey (Wave 1) was conducted between April 2012 and October 2013.2522 Aboriginal and Torres Strait Islander people in 35 locations (the communities served by 34 ACCHSs and one community in the Torres Strait), and 645 staff in the ACCHSs.Sociodemographic and general health indicators, smoking status, number of cigarettes smoked per day and quit attempts.The main community baseline sample closely matched the distribution of the Aboriginal and Torres Strait Islander population in the weighted NATSISS by age, sex, jurisdiction and remoteness. There were inconsistent differences in some sociodemographic factors between our sample and the NATSISS: our sample had higher proportions of unemployed people, but also higher proportions who had completed Year 12 and who lived in more advantaged areas. In both surveys, similar percentages of smokers reported having attempted to quit in the past year, and daily smokers reported similar numbers of cigarettes smoked per day.The TATS project provides a detailed and nationally representative description of Aboriginal and Torres Strait Islander smoking behaviour, attitudes, knowledge and exposure to tobacco control activities and policies, and their association with quitting.
This submission is made to the Senate Inquiry in order to inform on issues that are relevant with regard to the provision of hearing support services to Aboriginal peoples. Accompanying this submission is research which has recently examined access to hearing services, which was endorsed by the National Aboriginal Community Controlled Health Organisation.
The Broome Regional Aboriginal Medical Service (BRAMS) in Broome, Western Australia, conducted a 4 month program to augment the Pap smear screening of Aboriginal women. The emphasis was on those with a past history of abnormal smears, aged greater than 40 years, living in remote communities and very (more than 5 years) overdue.Continuation of existing opportunistic recall processes supplemented by three components: the development of an Aboriginal Health Worker (AHW) run Pap smear clinic; the provision of Aboriginal outstation screening; and active recruitment of targeted women (by AHW staff) using worklists. All components used Healthplanner, a computerised process tool to facilitate targeting and recall.The number of Pap smears taken from the target groups before and after intervention and the proportion screened from the women eligible in each target group at the start of the program.There was statistically significant increase in the coverage of Aboriginal women overall, those over the age of 40 years, and those from remote communities when compared with the same period the previous years. In 4 months, 21-30% of Aboriginal women eligible for Pap smears in these high risk categories including those with past abnormal smears were screened. Over-screening of women did not occur as only 4% of smears taken were from women screened less than 12 months previously. Smears taken by AHW staff were of high quality.Use of a computerised process tool in a remote setting can facilitate selective recruitment of high risk women overdue for Pap smears.
Aboriginal Community Controlled Health Services (ACCHSs) are culturally appropriate, autonomous primary health services initiated, planned and governed by local Aboriginal communities through their elected Aboriginal board of directors. ACCHSs are the practical expression of Aboriginal self-determination in Aboriginal health. By definition, they are not government run. Aboriginal communities around Australia have been establishing community controlled services since 1971. There are now over 100 ACCHSs operating across Australia in all States and Territories. All Aboriginal communities have unmet primary health care needs and in many ACCHSs primary health care is not available. At the national level all ACCHSs are members of their umbrella body, the National Aboriginal Community Controlled Health Organisation. There are similar umbrella structures at the State/ Territory level. This chapter summarises the structure and function of ACCHSs in their delivery of comprehensive primary health care to Aboriginal people. It contextualises many of the current developments in Australian general practice within the preferred model of care to Aboriginal people. The ACCHS model of care pre-dates and exemplifies the application of the Alma Ata Declaration on primary health care endorsed by the World Health Organization (WHO 1978).
[Extract] The review and updating of the first (2005) edition of the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people (‘National Guide’) is a joint initiative of the National Aboriginal Community Controlled Health Organisation (NACCHO) and The Royal Australian College of General Practitioners (RACGP) National Faculty of Aboriginal and Torres Strait Islander Health. The National Guide is a practical resource intended for all health professionals delivering primary healthcare to Aboriginal and/or Torres Strait Islander people. Its purpose is to provide GPs and other health professionals with an accessible, user-friendly guide to best practice in preventive healthcare for Aboriginal and Torres Strait Islander patients. This second edition of the National Guide comprises:
• the National Guide, which contains evidence statements, recommendations, risk calculation tables and an outline of the development of the guide
• the evidence base: the collection of evidence underpinning the guide and recommendations (electronic only) (see the Methodology section ‘Searching the evidence base and drafting recommendations’)
• a child and adult lifecycle summary chart listing activities recommended at each age group.
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