Discharge Against Medical Advice And Its Effects On Aboriginal And Torres Strait Islander People

Factors contributing to high rates of DAMA in Australian aboriginals and Torres Strait islanders

Discharge Against Medical Advice (DAMA) – Aboriginal and Torres Strait Islander peoples’ rates of DAMA is significantly higher than that of other Australians. Briefly discuss common health system factors that contribute to Aboriginal and Torres Strait Islander peoples’ rates of DAMA. Then discuss one (1) health system improvement strategy that could reduce the incidence of Aboriginal and Torres Strait Islander peoples’ rates of DAMA.

The current study focuses upon the aspect of the Discharge against medical advice (DAMA) of the aboriginal and Torres Strait islander people. The aboriginal and the Torres Strait islander people were the native Australians, who normally inhabited the outskirts of the city and had been for long the victims of social exclusion. Their native language is different from those of the Australians residing in the city. The social exclusion has often resulted in them suffering from unequal health, education and employment distribution. The assignment discusses the high rates of Discharge against medical advice (DAMA) found in the aboriginal and Torres Strait islander people. The DAMA has resulted in adverse health outcomes and is an indicator of the responsiveness of the hospitals to the healthcare needs of the aboriginal and Torres Strait islander people (Katzenellenbogen et al., 2013, p.330). The assignment discusses in details the various factors triggering the same as well as the improvements in health system strategy which could help in reducing the incidence of DAMA in the aboriginal and Torres Strait islander people.

Health system factors that contribute to Aboriginal Torres strait Islander people DAMA

There are a number of health system factors which contributes to the high rates of DAMA in the Australian aboriginal and Torres Strait islander people. Between July 2011 and June 2013, there had been 17,494 hospitalizations, where the aboriginal or Torres Strait islander people have left the hospital against the medical advice of the physician (Discharge against medical advice Aboriginal and Torres Strait Islander Health Performance Framework 2014 Report, 2018). As reported by Davies et al. (2016, p.313), the rate of DAMA is 5% in the indigenous Australians compared to 0.5% in the non-indigenous Australians. These are most common for the indigenous Australians living in the interior or the rural areas. However, difference in rates of DAMA has been found across the Australian territory. The highest rates found in the north Australian territory, whereas the lowest rate observed in Tasmania, Victoria etc. The discharge rates were highest for injury and poisoning and were recorded at 7.4% whereas endocrine, metabolic and nutritional disorders lead to 7.3% of the DAMA (Marmot, 2011, p.512). As mentioned by Katzenellenbogen et al. (2013, p.330), the injury and poisoning were caused as an effect of deep seated psychosocial factors. The high rates of unemployment and social exclusion led to high rates of frustrations in the population, which often forced them uptake lethal coping strategies such as drugs. Some of these triggered violent behaviour within the population such as self harm or harm to others. Additionally, the high unemployment rates and social exclusion also triggered suicidal behaviour within the indigenous population. As mentioned by Chapman, Smith & Martin (2014, p.50), the language barriers also resulted in insufficient health services being let out to the Aboriginal and Torres Strait islander people. The language and cultural barriers often resulted in difference of opinion of the indigenous Australians and the health service providers, leading to high rates of discharge against medical advice.

Health system factors leading to high rates of DAMA in indigenous Australians

As mentioned by Katzenellenbogen  et al.(2015, p.435), some of the other factors which contributed to the high rates of DAMA in the indigenous Australians are – distance of the hospital from usual residence, sex, age, treatment mode etc. One of the reasons which have been recently highlighted due to the high rates of DAMA within the indigenous population is lack of trust in the healthcare system. Additionally, factors such as attitude of the hospital staffs, health policies and the environment of the hospital are other important factors.

Racism has been found to be one of the major factors which had been found to affect the health and DAMA rates of the indigenous Australians. Studies have focused upon self reported racism and poor outcomes of adult health. The self reported racism had been linked with high rates of depression, anxiety and psychological distress within the population. The inequalities in health have been further seen to impact the equal distribution of health. As mentioned by Priest, Paradies, Gunthorpe, Cairney & Sayers (2011, p.549), environment in early childhood is key to health status. The lack of cultural awareness also contributes to the unequal health pattern distribution. As mentioned by Davies  et al. (2016, p.314), implementation of nursing care that takes into consideration the culture of  others before certain care activities are met out to the indigenous people, can  help in reducing the rates of DAMA in the indigenous people. Poverty is another concern which prevents the indigenous Australians from prolonging their care on hospitalisation (Priest et al., 2011, p.547). The poverty and social exclusion leads to added level of mistrust in the healthcare structure. It has been found that the rate of discharge of the indigenous Australians from the intensive care wards have been double the rate of discharge from the non-critical wards. This could be attributed to the high amount of vigilance associated with the critical care wards which interferes with the privacy concerns of the indigenous group of people.

A number of improvements could be brought about within the health system to reduce the incidence of DAMA within the indigenous group of Australians. One of the most effective manners in which the same could be implemented was by being culturally sensitive of the need of the indigenous group of population. As suggested by Durey & Thompson (2012, 151), implementation of cultural competency training in hospitals as per the Aboriginal and Torres Strait islander people health performance framework helps  in developing an understanding of the patient experiences in hospitals. The aim of the cultural competency framework is to deliver quality care. As commented by van der Meer  et al. (2016, p.1252), institutional change in the responsiveness towards the needs of the indigenous population can bring about positive results. Greater awareness to family obligations such as providing extra time for family members to visit can be a huge step forward (Marmot, 2011, p.512). The implementation of a departmental cultural safety policy at the institutional and the interpersonal level can facilitate the provision of culturally appropriate care. Increased visibility of aboriginal health workers can also help in making the patient more comfortable within the hospital environment and reduce the rates of DAMA. They serve as interpreter channels which help the indigenous patients communicate with the hospital set up (Chapman, Smith & Martin, 2014, p.56).

Impact of racism on the health and DAMA rates of indigenous Australians

There is a need for widespread systematic and organizational review to reduce the rates of DAMA within the indigenous population group. As mentioned by Keech, Kelly, Dowling, McBride & Brown (2016, p.316), increased recruitment and retention of aboriginal health workers can also help in the improvement of the care quality. The formal arrangements between hospitals and local aboriginal medical services can help in better managing patients with chronic illness requiring long hospital stays.

Conclusion

The high rates of DAMA of the aboriginal and Torres islander people point towards less responsiveness on the part of the medical care community. Some of these could be attributed to lack of cultural awareness within the healthcare workers towards the needs and requirements of the aboriginal and tortes islander people. Additionally, the lack of an effective community care structure also resulted in poor care support delivery to the indigenous Australians. The support from the multilevel channels of the national and the federal level government has also found to be effective. One of the main reasons for the health disparity found in the indigenous population could be attributed to the high amounts of social exclusion. Hence, implementation of more social inclusion policies can help in removing the gap in the heath and support care services.

References

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