Addressing Profound Disadvantages to Improve Indigenous Health and Reduce Hospitalisation: A Collaborative Community Program in Remote Northern Territory

Simon Quilty, Lisa Wood, Sophie Scrimgeour, Geordan Shannon, Elisha Sherman, Bruce Lake, Richard Budd, Paul Lawton and Mary Moloney
Additional contact information
Simon Quilty: Department of Medicine, Alice Springs Hospital, Alice Springs 0870, Australia
Lisa Wood: School of Population and Global Health, University of Western Australia, Perth 6009, Australia
Sophie Scrimgeour: Royal Darwin Hospital, Darwin 0810, Australia
Geordan Shannon: Institute of Global Health, University College London, London WC1N 1EH, UK
Elisha Sherman: Wurli-Wurlinjang Aboriginal Health Service, Katherine 0850, Australia
Bruce Lake: Wurli-Wurlinjang Aboriginal Health Service, Katherine 0850, Australia
Richard Budd: Katherine Hospital, Katherine 0850, Australia
Paul Lawton: Menzies School of Health Research, Darwin 0810, Australia
Mary Moloney: Katherine Hospital, Katherine 0850, Australia

IJERPH, 2019, vol. 16, issue 22, 1-12

Abstract: Background: Aboriginal people in rural and remote areas of the Northern Territory of Australia have suffered longstanding issues of homelessness and profound health and social inequities. The town and region of Katherine are particularly impacted by such inequities and have the highest rates of homelessness in Australia, composed almost entirely of Aboriginal people who represent 51% of the total population of 24,000 people. The region is serviced by a 60-bed hospital, and a small cohort of frequent attenders (FAs) represent 11% of the Emergency Department (ED) case load. The vast majority of FAs are Aboriginal and have very high burdens of social inequity and homelessness. FAs are a challenge to efficient and effective use of resources for most hospitals around the world, and investment in programs to address underlying social and chronic health issues contributing to frequent attendance have been demonstrated to be effective. Methods: These are the interim findings of a prospective cohort study using five sources of linked health and related data to evaluate a community-based case management pilot in a culturally competent framework to support frequent attenders to the Katherine Hospital ED. FAs were defined as people with six or more presentations in 12 preceding months. The intervention composed of a community-based case management program with a multi-agency service delivery addressing underlying vulnerabilities contributing to ED presentations. Results: Among this predominantly Aboriginal cohort (91%), there were high rates of homelessness (64%), food insecurity (60%) and alcohol misuse (64%), limited access to transport, and complex comorbidities (average of 2.8 chronic conditions per client). Following intervention, there was a statistically significant reduction in ED presentations (IRR 0.77, 95% CI 0.69–0.85), increased engagement with primary health care (IRR 1.90, 95% CI 1.78–2.03), and ambulance utilisation (IRR 1.21, 95% CI 1.07–1.38). Reductions in hospital admissions (IRR 0.93, 95% CI 0.77–1.10) and aeromedical retrievals (IRR 0.67, 95% CI 0.35–1.20) were not statistically significant. Conclusions: This study demonstrates the short-term impacts of community-led case management extending beyond the hospital setting, to address causes of recurrent ED presentations among people with complex social and medical backgrounds. Improving engagement with primary care is a particularly important outcome given the national impetus to reduce preventable hospital admissions.

Keywords: indigenous health; frequent attender; emergency department; homelessness; tropical environment (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
References: View complete reference list from CitEc
Citations: View citations in EconPapers (5)

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