Culturally safe and sustainable solution for Closing the Gap-registered patients discharging from a tertiary public hospital
Scott Mitchell A C , Hayley Michael A C , Stephanie Highden-Smith A , Vivian Bryce A , Sean Grugan A , Hua Bing Yong A , Sonia Renouf A , Tanya Kitchener A and William Y. S. Wang A BA Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. Email: Stephanie.Highden-Smith@health.qld.gov.au; VivianL.Bryce@health.qld.gov.au; Sean.Grugan@health.qld.gov.au; Hua.Yong@health.qld.gov.au; Sonia.Renouf@health.qld.gov.au; Tanya.Kitchener@health.qld.gov.au
B Faculty of Medicine, The University of Queensland, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. Email: William.Wang@uq.edu.au
C Corresponding authors. Emails: Scott.Mitchell@health.qld.gov.au; Hayley.Michael@health.qld.gov.au
Australian Health Review 44(2) 200-204 https://doi.org/10.1071/AH18160
Submitted: 13 September 2018 Accepted: 6 December 2019 Published: 20 March 2020
Journal Compilation © AHHA 2020 Open Access CC BY-NC-ND
Abstract
This case study describes the development, implementation and review of a sustainable and culturally sensitive procedure for a hospital-funded discharge medicine subsidy for Aboriginal and Torres Strait Islander patients registered with the Closing the Gap (CTG) program discharging from a public hospital. A 7-day fully subsidised medication supply was approved to be offered to Aboriginal and Torres Strait Islander patients admitted under cardiac care teams, including cardiology and cardiothoracic surgery patients. Patients were offered the option of a 7-day supply free of cost to them or a full Pharmaceutical Benefits Scheme (PBS) supply if preferred. A general practitioner (GP) appointment was organised within 7 days of discharge to ensure patients received ongoing supply of their medications as well as timely clinical review after discharge. Over a 34-month period from September 2015 to June 2018, 535 Aboriginal and Torres Strait Islander patients were admitted to the hospital under cardiac care teams. Of these patients, 296 received a subsidised discharge medication supply with a total cost of A$6314.56 to the hospital over the trial period, with a mean cost of A$21.26 per discharge. The provision of subsidised medications through the CTG program has improved the continuity of care for Aboriginal and Torres Strait Islander patients. The culturally sensitive approach is well received and has allowed smooth transition back to the community. This site-specific and state-based funding model was found to be financially sustainable at a public hospital.
What is known about the topic? The CTG PBS program is not applicable to discharge prescriptions from public hospitals. As such, patients are required to either leave the hospital with no medicines or leave the hospital with medicines for which they have to pay full PBS price. This creates a huge financial barrier to the care for CTG-registered patients in the acute care setting.
What does this paper add? A sustainable solution to the problem was found via a state-funded model while providing a supportive team to ensure GP follow-up and continuity of care after discharge.
What are the implications for practitioners? If similar approvals are granted and supported at other public hospital sites, practitioners will be afforded one less barrier to provide patient-centred care for Aboriginal and Torres Strait Islander patients.
References
[1] Australian Bureau of Statistics (ABS). Life tables for Aboriginal and Torres Strait Islander Australians 2010–2012. Catalogue no. 3302.0.55.003. Canberra: ABS; 2013.[2] Australian Institute of Health and Welfare (AIHW). Australian burden of disease study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011. Australian Burden of Disease Study Series no. 6. Catalogue no. BOD 7. Canberra: AIHW; 2011.
[3] Zubrick S Sr, Dudgeon P, Gee G, Milroy R, Paradies Y, Scrine C, Walker R. Social determinants of social and emotional wellbeing. In Zubrick S, Dudgeon P, Gee G, Glaskin B, Kelly K, Paradie Y, Scrine C, Walker R, editors. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd edn. Canberra: Department of the Prime Minister and Cabinet; 2014. pp. 75–90.
[4] Australian Indigenous HealthInfoNet. Overview of Aboriginal and Torres Strait Islander health status 2018. 2019. Available at: https://healthinfonet.ecu.edu.au/healthinfonet/getContent.php?linkid=617557&title=Overview+of+Aboriginal+and+Torres+Strait+Islander+health+status+2018 [verified 22 January 2020].
[5] Department of Prime Minister and Cabinet. Closing the Gap: Prime Minister’s report 2017. Canberra: Department of the Prime Minister and Cabinet; 2017.
[6] Australian Government Department of Health. The Closing the Gap – PBS co-payment measure. 2016. Available at: http://www.pbs.gov.au/info/publication/factsheets/closing-the-gap-pbs-co-payment-measure [verified 1 March 2016].
[7] Pharmaceutical Society of Australia (PSA). Guide to providing pharmacy services to Aboriginal and Torres Strait Islander people. Canberra: PSA; 2014.
[8] National Heart Foundation of Australia (NHF) and Australian Healthcare and Hospitals Association (AHHA). Better hospital care for Aboriginal and Torres Strait Islander people experiencing heart attack. Canberra: NHF and AHHA; 2010.
[9] The Society of Hospital Pharmacists of Australia. Submission to: Federal Budget 2017–18. 2017. Available at: https://www.shpa.org.au/sites/default/files/uploaded-content/website-content/Submissions/shpa_federal_budget_submission_2017_final.pdf [verified 5 October 2017].
[10] The Pharmacy Guild of Australia and National Aboriginal Community Controlled Health Organisation. Joint position paper: Closing the Gap Pharmaceutical Benefits Scheme co-payment measure – improving access to Pharmaceutical Benefits Schedule medicines for Aboriginal and Torres Strait Islander people. 2015. Available at: https://www.guild.org.au/__data/assets/pdf_file/0011/6005/20151028-ctg-pbs-copayment-measure-joint-guild-naccho-position-paper.pdf [verified 5 October 2017].
[11] Larkin C, Murray R. Assisting Aboriginal patients with medication management. Aust Prescr 2005; 28 123–5.
| Assisting Aboriginal patients with medication management.Crossref | GoogleScholarGoogle Scholar |
[12] Independent Hospital Pricing Authority (IHPA). National hospital cost data collection cost report: round 19, financial year 2014–15. Sydney: IHPA; 2016.
