To describe general knowledge and perceived risk of the health consequences of smoking among Aboriginal and Torres Strait Islander people; and to assess whether knowledge varies among smokers and whether higher knowledge and perceived risk are associated with quitting.The Talking About The Smokes project used quota sampling to recruit participants from communities served by 34 Aboriginal community-controlled health services and one community in the Torres Strait. Baseline survey data were collected from 2522 Aboriginal and Torres Strait Islander adults from April 2012 to October 2013.Knowledge of direct effects of smoking and harms of second-hand smoke (SHS), risk minimisation, health worry, and wanting and attempting to quit.Most Aboriginal and Torres Strait Islander participants who were daily smokers demonstrated knowledge that smoking causes lung cancer (94%), heart disease (89%) and low birthweight (82%), but fewer were aware that it makes diabetes worse (68%). Similarly, almost all daily smokers knew of the harms of SHS: that it is dangerous to non-smokers (90%) and children (95%) and that it causes asthma in children (91%). Levels of knowledge among daily smokers were lower than among non-daily smokers, ex-smokers and never-smokers. Among smokers, greater knowledge of SHS harms was associated with health worry, wanting to quit and having attempted to quit in the past year, but knowledge of direct harms of smoking was not.Lack of basic knowledge about the health consequences of smoking is not an important barrier to trying to quit for Aboriginal and Torres Strait Islander smokers. Framing new messages about the negative health effects of smoking in ways that encompass the health of others is likely to contribute to goal setting and prioritising quitting among Aboriginal and Torres Strait Islander people.
[Extract] EXECUTIVE SUMMARY
In this paper, the National Aboriginal Community Controlled Health Organisation(NACCHO), the peak Aboriginal health body in Australia, has described the importance of primary health care activity incorporating all types of preventive interventions, not just tertiary prevention for Aboriginal populations.
Efforts by the Federal Government to enhance the effectiveness of Medicare to reward preventive health activity have been welcomed by NACCHO. The new Enhanced Primary Care (EPC) items offer service providers more appropriately structured remuneration for several aspects of work commonly undertaken in Aboriginal primary health care services.
However, only a limited number of Aboriginal people can benefit from these Medicare rebates, as they are currently structured. Firstly, these new Medicare items reward health assessments or health checks for the elderly. The elderly were defined as people over the age of 75 years or over the age of 55 years if Aboriginal or Torres Strait Islander. Secondly, the Care Plan items are valid for all regardless of age, but are an investment in tertiary prevention only. They aim to reward practice that will prevent worsening of chronic disease and hospitalisation for those who are already known to have chronic disease. There is no financial incentive of any kind, which rewards primary and secondary prevention of chronic disease.
There is a need for an incentive to encourage and reward broad GP involvement in best practice pertaining to Aboriginal health. This is especially urgent given that there is a high burden of unidentified chronic illness in the Aboriginal population, and this illness is preventable based on good evidence, and interventions to high-risk populations is costeffective.
NACCHO, with the support of the Australian Medical Association, Divisions of General Practice, the General Practice Partnership Advisory Council and the EPC Taskforce recommends a Medicare Rebate for a health check in an Aboriginal adult (regardless of age) which should be available for any doctor to claim. This is otherwise known as a 'well persons health check'. Any Aboriginal person should have a right to expect and receive such a comprehensive service.
Such a Rebate has the potential to generate savings over and above the foregone fee-for-service activity. It would provide for streamlined, cost-effective administration of investments in prevention for Aboriginal health, compared with current or alternative mechanisms. Early identification and intervention for chronic disease in the primary care setting will reduce the need for care in the acute hospital sector, with a concomitant reduction in downstream costs. As a result of increased primary and secondary prevention of disease in Aboriginal populations, investments in tertiary prevention (Care Plans) would yield better returns.
In 1995-7 there were over 51,000 years of potential Aboriginal life lost before age 65 years due to premature deaths. The excess burden of chronic disease and the high rate of premature deaths in the Aboriginal population require urgent investments in preventive activity at the primary health care level.
There are a number of levers the Federal Government could introduce to foster improvements in clinical practice, discourage inappropriate practice and enhance health outcomes for the Aboriginal community. This paper compares and contrasts current Federal Government initiatives aimed at fostering improvements in immunisation activity with the relative lack of initiatives fostering primary and secondary prevention of chronic disease in Aboriginal populations.
Aboriginal people carry the excess burden of disease and consequent financial and health costs fall on those that are least able to afford it. A health system that perpetuates the free market provision of preventive health care ('laissez faire' approach) perpetuates inequity. The health profession needs to enable preventive health interventions to those who are least able to ask for it. This underlies the need for interventionist options
A number of options are presented to assist the Commonwealth Department of Health and Aged Care in planning for future activity to foster improvements in Aboriginal health. Underpinning all these options is the development of a Medicare Rebate for the health assessment for Aboriginal adults (of any age) as an investment in primary and secondary prevention at the practice level.
Hepatitis B virus (HBV) infection remains an important cause of morbidity and mortality in Aboriginal and Torres Strait Islander people, who have high rates of infection compared with non-Indigenous Australians. We aimed to increase the evidence base around HBV in Aboriginal and Torres Strait Islander people through an analysis of routine clinical encounter data.
The National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people was conceived and started by NACCHO in 2001 and went on to be supported by the RACGP from 2002. The first edition was published in 2005 and has proven to be widely used by health services and health policy makers to inform best practice in preventing disease in Aboriginal and Torres Strait Islander populations. This second edition has been significantly updated and improved, with appraisal and endorsement from peak bodies across Australia.
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.
The National Guide is available on the NACCHO and the RACGP websites at www. naccho.org.au and at www.racgp.org.au/aboriginalhealth/nationalguide.
The National Guide is being integrated into clinical software over time to support primary healthcare professionals to implement best practice by providing them with accessible, accurate and up-to-date preventive health information relevant to Aboriginal and Torres Strait Islander people. For further information contact the RACGP National Faculty of Aboriginal and Torres Strait Islander Health on 03 8699 0499 or email aboriginalhealth@racgp.org.au.
Purpose:
The National Guide is intended for all health professionals delivering primary healthcare to the Aboriginal and Torres Strait Islander population. This includes general practitioners (GPs), Aboriginal and Torres Strait Islander health workers, nurses and those specialists with a role in delivering primary healthcare. The National Guide makes specific recommendations regarding the elements of a preventive health assessment across the lifecycle of the Aboriginal and Torres Strait Islander population.
The aim of the National Guide is to provide an up-to-date, evidence-based national resource that can help inform health providers and policy makers on a defined set of activities that are of particular relevance to Aboriginal and Torres Strait Islander people.
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. The health status of Torres Strait Islander people is very similar to that of the Aboriginal population, and the information in the National Guide can be applied to both population groups.
Many Aboriginal conmmunities in rural and remote western Australia have rates of chronic suppurative otitis media (CSOM) 10 times the rate that the World Health Organization deemed as a massive public health problem in the child population. The recognition by Aboriginal leaders that the treatment of CSOM is a priority area has led to this issue being highlighted in Australia's National Aboriginal Health Strategy. In Aboriginal children, the disease usually commences in infancy within a few weeks of birth, causes hearing loss, is recurrent, can persist into adulthood, and may impact adversely on child development. Our trial aimed to compare the effectiveness of topical ciprofloxacin (0.3%) and framycetin (0.5%), gramicidin, dexamethasone (FGD, Sofradex) as treatments for CSOM in Aboriginal children. The trial was the first conmmunity controlled, multicenter, double-blind, randomized, controlled trial in Aboriginal children across the north of Australia.
Background Gonorrhoea occurs at high levels in young Aboriginal and Torres Strait Islander people living in remote communities, but there are limited data on urban and regional settings. An analysis was undertaken of gonorrhoea testing and positivity at four non-remote Aboriginal Community Controlled Health Services participating in a collaborative research network. Methods: This was a retrospective analysis of clinical encounter data derived from electronic medical records at participating services. Data were extracted using the GRHANITE program for all patients aged 15–54 years from 2009 to 2013. Demographic characteristics and testing and positivity for gonorrhoea were calculated for each year. Results: A total of 2971 patients (2571 Aboriginal and/or Torres Strait Islander) were tested for gonorrhoea during the study period. Among Aboriginal and/or Torres Strait Islander patients, 40 (1.6%) tested positive. Gonorrhoea positivity was associated with clinic location (higher in the regional clinic) and having had a positive chlamydia test. By year, the proportion of patients aged 15–29 years tested for gonorrhoea increased in both men (7.4% in 2009 to 15.9% in 2013) and women (14.8% in 2009 to 25.3% in 2013). Concurrent testing for chlamydia was performed on 86.3% of testing occasions, increasing from 75% in 2009 to 92% in 2013. Factors related to concurrent testing were sex and year of test. Conclusions: The prevalence of gonorrhoea among young Aboriginal and/or Torres Strait Islander people in non-remote settings suggests that the current approach of duplex testing for chlamydia and gonorrhoea simultaneously is justified, particularly for women.
To describe recall among a national sample of Aboriginal and Torres Strait Islander smokers and recent ex-smokers of having received advice to quit smoking and referral to non-pharmacological cessation support from health professionals, and their association with quit attempts.
Chlamydia infections are notified at much higher rates in Aboriginal and/or Torres Strait Islander people compared to non-Indigenous people. The Australian Collaboration Chlamydia Enhanced Sentinel Surveillance System (ACCESS) was established to complement population-based surveillance.We describe patient demographics, completeness of recording of Aboriginal and/or Torres Strait Islander ('Aboriginal') status, chlamydia testing rates and positivity rates from the Aboriginal Community Controlled Health Service (ACCHSs), General Practice (GP) clinics and Sexual Health Services (SHSs) networks in ACCESS during 2009. Data were extracted from electronic medical records of each participating health service for consultations with patients aged 16-29 years and for chlamydia testing and positivity.Data were included from 16-29 year olds attending six ACCHSs (n = 4,950); 22 SHSs (n = 20,691) and 25 GP clinics (n = 34,462). Aboriginal status was unknown for 79.3% of patients attending GP clinics, 4.5% attending SHSs and 3.8% of patients attending ACCHSs. Chlamydia testing rates among Aboriginal patients were 19.8% (95%CI:18.6%-21.0%) at ACCHSs, 75.5% (95% CI:72.5%-78.4%) at SHSs and 4.3% (95% CI: 2.6%-6.6%) at GP clinics. Positivity rates were highest in Aboriginal patients tested at SHSs at 22.7% (95% CI:19.5%-26.2%), followed by 15.8% (95% CI:3.8%-43.4%) at GP clinics and 8.6% at ACCHSs (95% CI:7.9%-12.4%). This compared with non-Indigenous patients positivity rates at SHSs of 12.7% (95% CI:12.2-13.2%); 8.6% (7.2%-11.3%) at GP clinics and 11.3% at ACCHSs (95% CI:15.4%-24.9%).Higher chlamydia positivity in Aboriginal people across a range of clinical services is reflected in national notification data. Targeted efforts are required to improve testing rates in primary care services; to improve identification of Aboriginal patients in mainstream services such as GP clinics; and to better engage with young Aboriginal Australians.
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