Academic journal article Australian Health Review

Exploring Aboriginal Patients' Experiences of Cardiac Care at a Major Metropolitan Hospital in Melbourne

Academic journal article Australian Health Review

Exploring Aboriginal Patients' Experiences of Cardiac Care at a Major Metropolitan Hospital in Melbourne

Article excerpt

Introduction

The life expectancy gap between Aboriginal and Torres Strait Islander (respectfully referred to here as 'Aboriginal') people and other Australians remains one of Australia's most enduring health divides.1,2 Despite improved diagnosis and treatment (and declining rates of cardiovascular disease (CVD) deaths), CVD remains Australia's biggest killer and has a significant impact on Aboriginal communities.3 Aboriginal Australians have a threefold higher rate of major coronary events, such as heart attack, 1.4-fold the out-of-hospital death rate from coronary heart disease (CHD), lower rates of coronary intervention and a more than double in-hospital CHD death rate than other Australians.4,5 There is strong evidence showing that Aboriginal people experiencing acute coronary syndrome (ACS) tend to be younger, less likely to have private health insurance, have more risk factors and greater comorbidity and are more likely to present to hospital >12 h after the onset of symptoms.6-9 Rates of participation in cardiac rehabilitation, an evidence-based strategy to improve function, quality of life and survival rates following a cardiac event, are also lower among Aboriginal people.10 Corresponding with these disparities, Aboriginal people have been described as facing significant barriers to use the healthcare system, with different patterns of access and experiences of hospital compared with other Australians, including a higher number of admissions and longer hospital stays.11,12

The well being of Aboriginal people is strongly connected to country and community, and disconnection from these because of hospitalisation can affect their access to healthcare system in several ways.13,14 Hospitalisation can be a frightening experience for some Aboriginal people because of the fear of leaving home, especially for people who have never been far away from their home lands, the fear of disempowerment associated with leaving the support of family networks, fears about hospital environments and 'high-tech' treatments, fear of cultural alienation from familiar foods and ways of being, fear of travel, fear of loneliness, fear of language and communication barriers, financial fears and fear of dying away from the home lands.15

Access to quality care is important to help tackle the health disadvantage experienced by many Aboriginal people and the issue is not only the provision of services, but also the effectiveness of care provided.16 There is considerable activity underway across Australia to improve the cardiovascular health of Aboriginal people.17-19 In 2008, the Federal Government signed a National Partnership Agreement on Closing the Gap on inequities facing Aboriginal people and communities across a range of domains.20 The Heart Foundation and the Australian Healthcare and Hospitals Association are committed to helping close the life expectancy gap and, among a range of other recommendations, have identified the need for more research with the goal of improving hospital care for Aboriginal people.12,21 With this in mind, the objective of the present study was to engage Aboriginal people who had been admitted to a major metropolitan hospital in the assessment of their care in order to develop a better understanding of their experiences of cardiac services.

Methods

Study design and study site

Data were collected through a qualitative approach that involved open-ended in-depth interviews, audiorecording, and verbatim transcription of the recordings as well as a thematic analyses using descriptive phenomenology. The study site was a large tertiary public hospital with 848 beds that has more Aboriginal patient admissions than any other hospital in Melbourne.17 The hospital has an emergency department that provides in-patient and out-patient services, as well as research and training for health staff. The hospital also employs Aboriginal Hospital Liaison Officers (AHLO) and they are key and central to the care of the Aboriginal patients. …

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