Attendance at, and experiences of, urban hospital outpatient appointments: informing a new model of care for urban-dwelling Aboriginal and Torres Strait Islander patients
Karen Wynter A B * , Leanne Mullan
A C , Tanya Druce D , Gilbert Freeman D , Graeme Maguire E F , Lauren Davidson E , Harin Karunajeewa G , Shane Crowe A H and Bodil Rasmussen A B I J
A Centre for Quality and Patient Safety Research in the Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong, Vic. 3220, Australia.
B Centre for Quality and Patient Safety Research - Western Health Partnership, St Albans, Vic. 3021, Australia.
C Australian Catholic University, 1100 Nudgee Road, Banyo, Qld 4014, Australia.
D Aboriginal Health, Policy and Planning, Wilim Berrbang, Western Health, 176 Furlong Road, St Albans, Vic. 3021, Australia.
E General Internal Medicine, Western Health, 176 Furlong Road, St Albans, Vic. 3021, Australia.
F Curtin Medical School, 410 Koorliny Way, Bentley, WA 6102, Australia.
G Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Vic. 3021, Australia.
H Nursing and Midwifery Division, Western Health, St Albans, Vic. 3021, Australia.
I Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 1165, Denmark.
J Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Odense 5230, Denmark.
Australian Health Review 47(1) 16-25 https://doi.org/10.1071/AH21363
Submitted: 24 November 2021 Accepted: 6 January 2023 Published: 27 January 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
Abstract
Objectives To compare outpatient attendance rates for Aboriginal and Torres Strait Islander (‘Aboriginal’) and non-Aboriginal patients at a large metropolitan health service in Melbourne, Australia, and to describe the barriers and enablers experienced by urban-dwelling Aboriginal patients in attending hospital outpatient appointments.
Methods This study used a mixed-method approach. Proportions of referred patients who booked and attended outpatient appointments were extracted from a health service database. Aboriginal versus non-Aboriginal cohorts were compared using chi-squared tests. Eleven patients, one parent of a patient and two community nurses were interviewed by telephone to investigate perceived barriers and enablers to attending outpatient appointments among Aboriginal patients.
Results Outpatient referrals were greater among Aboriginal than non-Aboriginal people; however, referrals were significantly less likely to result in an outpatient clinic booking and attendance for Aboriginal compared to non-Aboriginal people. Interview participants reported several barriers to attending appointments, related to logistical, quality of care and cultural factors. Suggested facilitators to make appointment attendance easier included: provision of transport support, improving clinic scheduling, utilising a variety of appointment reminder formats, providing food in waiting rooms, flexible appointment timing options, outreach services, access to Aboriginal support workers, improving communication and relationships with Aboriginal people, cultural awareness training for staff and the provision of culturally appropriate spaces.
Conclusion Some barriers faced by Aboriginal patients in attending hospital outpatient appointments in urban areas can be addressed through implementation of enablers suggested by participants. Data have informed the development of a tailored, inclusive, culturally and consumer-focused appropriate hospital outpatient service model of care.
Keywords: Aboriginal, appointment, attendence, clinic, health, health service, hospital, Indigenous, outpatient, referral, Torres Strait Islander, urban.
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