Early screening essential to help close health gap

Associate Professor, General Practice and Rural Medicine, Sophia Couzos, said general recommendations for preventative health assessments did not address the higher incidence and earlier onset of a range of diseases in the Aboriginal and Torres Strait Islander community.

“For these reasons, a different set of recommendations and guidance is needed to assist primary health care providers caring for these patients,” she said.

Today marks the launch of the third edition of the National guide to a preventative health assessment for Aboriginal and Torres Strait Islander people (National Guide), produced by the National Aboriginal Community Controlled Health Organisation (NACCHO) and the Royal Australian College of General Practitioners (RACGP).

Dr Couzos, the project leader for the publication, said the National Guide provided crucial clinical guidelines for assessing health risks in Aboriginal and Torres Strait Islander patients.

“There are conditions that can be prevented and should be prevented, like rheumatic heart disease, rheumatic fever, eye infections such as trachoma, pneumonia and chronic lung disease in children,” she said. “There is also much earlier age of onset of chronic health problems like diabetes and kidney disease.

“The earlier onset is really important in making decisions about when to initiate preventive interventions. So whilst general Australian recommendations might say to start screening for heart disease from the age of 45, in the Aboriginal population the evidence suggests starting much earlier.

“There’s a lot of evidence, with regard to Aboriginal health, that many of these chronic health conditions are often not diagnosed until they’re very advanced. A lot could have been done had those conditions been picked up earlier. It’s heart-breaking for patients and their families. People with advanced conditions also require more hospital care, which impacts on government health budgets,” she said.

Dr Couzos played an instrumental role in compiling the first edition of the National Guide, published in 2005, while working as the public health medical officer for NACCHO – a position she held for 14 years.

“We were acutely aware there was a considerable variation in preventative health care delivery across Australia,” she said. “And in view of the fact that there is a high staff turnover, particularly in remote areas, there was often a period of re-learning how best to deliver preventative health interventions. A guide was required to alleviate uncertainty.”

The NACCHO initiative soon attracted the support and involvement of the Royal Australian College of General Practitioners, which had pre-existing guidelines for preventative health activities in general practice, but these strategies did not address different health patterns in the Aboriginal and Torres Strait Islander community.

Apart from the latest recommendations of preventative health organisations such as the Cancer Council, National Heart Foundation and Diabetes Australia, the National Guide began – and continues – to draw upon the experiences of grassroots general practitioners and others involved in the frontline delivery of primary health care to Aboriginal and Torres Strait Islander people around Australia.

“Many of the recommendations in the National Guide are based on the best research evidence and on good practice points,” Dr Couzos said. “This means that where there is no research evidence to guide clinical decision-making, clinical experience and what we call ‘good practice’, as well as the needs and values of the patient, should guide decision making.”

Dr Couzos began working with the Aboriginal community controlled health sector in the East Kimberly region of Western Australia in 1991. Her highly-regarded work, “Aboriginal Primary Health Care: An evidence-based Approach”, was a foundation stone for the first National Guide.

She believes health issues in the Aboriginal and Torres Strait Islander community are improving over time.

“There are some good news stories, such as reductions in trachoma,” she said. “Rheumatic heart disease is still a problem, but it’s hopeful that with good interventions that’s going to reduce over time, with improvements in the social circumstances that actually predispose to the condition; over-crowding, poor access to health care services, and inadequate treatment of throat infections.

“The issue of chronic disease is still a big one, really for all Australians, but particularly for the Aboriginal and Torres Strait Islander community, where the rates are much higher. We need to do a lot of work there.”

Access to health care services, particularly quality primary health care, remains a major issue for many Aboriginal and Torres Strait Islander people, according to Dr Couzos.

“In many parts of Australia it can be difficult to access the right types of care,” she said. “We know that good access to quality primary health care – including preventative health care – is lower for Aboriginal and Torres Strait Islanders than for other Australians.

“Quality care means culturally appropriate care. It’s about being holistic, addressing social determinants, understanding the patient context and being able to include prevention in the health care interaction.”

Dr Couzos believes the Aboriginal community controlled health sector (ACCHS) offers the best model of care to manage primary health issues within the community.

“It’s a model that was way ahead of its time. It exemplifies holistic care,” she said.

“This sector had devised outreach programs, recall and reminder systems, ways to enhance continuity of care, better integrated care, community engagement and empowerment, and patient-centred care – before these concepts ever became mainstream.

“One of the best ways we can improve access to preventive health care for Aboriginal peoples and Torres Strait Islanders is through this model of care,” she said.

James Cook University is spearheading moves to improve access to quality primary health care through the recent introduction of a Generalist Medical Training program which encourages and supports General Practice registrars willing to work in regional and remote areas, including Aboriginal and Torres Strait Islander communities.

All GMT registrars are assisted to develop high levels of cultural and clinical competence in Aboriginal and Torres Strait Islander health issues. A number of training posts are offered within the ACCHS.

“I think there are tremendous opportunities to advance health care delivery through working with Aboriginal people, for Aboriginal people,” Dr Couzos said.

Note: The third edition of the National guide to a preventative health assessment for Aboriginal and Torres Strait Islander people will be launched by the Minister for Aged Care and Minister for Indigenous Health, Ken Wyatt, at 11 am on 28 March 2018, in Parliament House.