Posts tagged as:

PATS

Renal Appoinment – The Convoluted Journey

by Robbo on December 3, 2009

in Equity of Access,Indigenous,Remote health

The incidence of chronic kidney disease is increasing in Australia, most significantly amongst Indigenous Australians, with rates in remote areas being 35 times higher than amongst non-Indigenous Australians. When the kidneys fail, a person must receive a transplant or their blood must be cleansed of waste artificially (dialysis).

There is strong evidence that effectively managing high blood pressure can delay the need for dialysis, a treatment which in remote areas, can require long distance travel to access services and result in separation from family, social and cultural support. There is also strong evidence that an arteriovenous (AV) fistula is the most effective means of providing permanent access to veins in people starting dialysis.

When best practice is not applied, there is a significant psychological and financial cost to the individuals and their community

The above comes from the profile of Bhavini Patel, Director of Pharmacy, Department of Health and Community Services, NT and a NICS-HCF Foundation Fellow in 2007.

As part of her project “Improving management of chronic kidney disease in remote indigenous communities” she charted the steps taken and the patient contact with various parts of the health service from when the renal clinic in “town” (in this case Darwin) contacted a remote clinic wishing to see a patient. And remember the patient may be in town for up to several weeks depending on the transport options to get home.

It views best in full screen.

Patient Journey through the Health System

View more presentations from BiteTheDust.

The term “PAT form” you see in one of the slides is the transport assistance provided to remote Australians going for health appointments.

Look at the slide show (only 4 slides) again and picture yourself not knowing the language, being away form country and family with all these people you don’t know wanting to interact with you and pass on all sorts of information in a way that is foreign to you.

I wouldn’t go.

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many thanks to Bhavini for the copy of the slides (previously seen in the NT Chronicle).

Tagged as: aboriginal, appointment, Chronic Kidney Disease, CKD, Indigenous, PATS, renal

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Hospital Readmission Rates

by Robbo on April 23, 2009

in Indigenous,Professional Services,Remote health

I wrote a little while ago about the high rates of chronic disease in indigenous Australians compared to the rest of the population. Near the end of the post I quoted from the Expenditures on health for Aboriginal and Torres Strait Islander peoples 2004-05 which stated that hospital separations for Indigenous Australians living in remote and very remote areas are 820 and 606 per 1000 people respectively.

I don’t for a minute believe that 820 out of every 1000 Indigenous people in remote Australia have gone to hospital. Some are bound to be frequent visitors. But how many re-present at a hospital due to being booted out too soon.

I haven’t found any data for Australia but the blog Notes from Dr. RW looks at an interesting study from the NEJM on Medicare Readmission Rates in America.

Let me steal some of the quotes from the blog.

Almost one fifth (19.6%) of the 11,855,702 Medicare beneficiaries who had been discharged from a hospital were rehospitalized within 30 days, and 34.0% were rehospitalized within 90 days; 67.1% of patients who had been discharged with medical conditions and 51.5% of those who had been discharged after surgical procedures were rehospitalized or died within the first year after discharge. In the case of 50.2% of the patients who were rehospitalized within 30 days after a medical discharge to the community, there was no bill for a visit to a physician’s office between the time of discharge and rehospitalization.

Twenty per cent re-hospitalised within thirty days. Half of those had not been seen by a doctor before being readmitted. Put this into the remote Australia context where doctors are very thin on the ground. Discharges are often difficult to obtain from a hospital in a timely manner. We usually know when the patient is coming back home due to bookings via the patient Assisted Transport Service and our own Patient Liasion staff, but they are not always seen at the clinic on return. As well as perhaps being discharged too soon the continuity of care lapses due to many other reasons, lack of communication in particular. I am not surprised that some re-present.

Being discharged early may save the hospital money on weekends and public holidays as they cut back on staffing but costs are borne by other parts of the health service. From overworked Remote Area Nurses trying to see these patients and chase up discharge notes and obtain prescriptions to the Royal Flying Doctor Service flying the patient back to hospital and the costs borne by the Patient Assisted Travel Scheme (PATS)

The article goes on to state:

Even a small decrease in the readmission rate could result in substantial savings for the Medicare program. The recently enacted prospective-payment legislation, however, creates economic incentives that could increase readmission rates

I am sure a study done in Australia would show early discharges leading to representations costs the hospital system heaps rather than saving money.

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Tagged as: aboriginal, hospital, Indigenous, Medicare, PATS, readmission, RFDS

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Language and Health

by Robbo on December 17, 2008

in Indigenous,Pharmaceutical Society of Australia,Remote health

Over 20 years ago in what seems another world I used to make use of a government translating service with many immigrant patients. And then they started to charge. I can’t remember what the rate was, but it wasn’t cheap. I had to stop using the service and it led to some unsatisfactory exchanges with patients with a poor understanding of English.

The fees now charged by the Translating and Interpreting Service (TIS) vary. Telephone interpreting comes in at a mere $23.10. Each fifteen minutes.

So I was delighted to read in my Auspharm e-news that a pilot program had resulted in all pharmacies across Australia obtaining access to free telephone interpreting services through TIS 24hours a day, seven days a week.

These free services are now available for:

* private medical practitioners providing Medicare-rebateable services and their reception staff to arrange appointments and provide results of medical tests
* non-profit, non-government, community-based organisations for case work and emergency services where the organisation does not receive funding to provide these services
* Members of Parliament for constituency purposes
* local government authorities to communicate with non-English speaking residents on issues such as rates, garbage collection and urban services
* trade unions to respond to members’ enquiries or requests
* Emergency Management Australia
* pharmacies for the purpose of dispensing Pharmaceutical Benefits Scheme (PBS) medications.

Warwick Plunkett, President of the Pharmaceutical Society of Australia (PSA) is quoted as saying: “Such information is a critical aspect to good health care and the Pharmaceutical Society of Australia sees this service as an innovative tool which will not only educate non-English speaking Australians about their medicines but give them confidence about the medicines they are taking.”

So Warwick has released a statement, the information is updated on the TIS website, but PSA is still yet to put out an official press release advising members of a valuable service. I wonder whose idea it was for the pilot project. Did PSA see it as a need for its pharmacist members to assist those with poor English skills? I only ask as I consider my professional body to be inward looking and not proactive.

I assume the impetus came from TIS as the Pharmacy Guild has not been trumpeting another success for community (retail) pharmacy

If PSA had been involved perhaps it could have extended the availability of this service to accredited pharmacists doing medication reviews in peoples homes. Not all these pharmacists are employed by a pharmacy.

However TIS does not include any indigenous languages. This sort of support is very unstructured in Australia for indigenous languages. Royal Darwin Hospital runs an innovative program while other hospitals rely on a third party providers such as a remote aboriginal health service.

The Royal Perth Hospital GP Handbook states:

To overcome the communication barrier and provide equal access to all its patients Royal Perth Hospital has established a Language Services Unit which provides professional interpreting services in over 75 languages including Auslan (Australian Sign language for the Deaf) and some major Aboriginal dialects spoken in WA. Services are provided by on-site attendance or over the telephone.

Unfortunately, in my one encounter with them wishing to use their services I found that they go north to the Kimberley for indigenous language translation. Unfortunately the languages of the Kimberley are not spoken all over the state of WA! It ended with me passing basic words and phrases to the ward pharmacist who placed them up around the elderly gentleman’s bed so his basic requests could be understood.

The Patient Assistance Travel Scheme (PATS) is an essential service in helping to pay the costs of remote Australians seeking medical attention in the cities. However the costs in getting people there and back, particularly by road are not covered adequately as a recent Senate Committee discovered. This little vignette about travelling in from a remote community sums up some of the problems.

One large problem with the PATS scheme is that while it allows for an escort for children, it does not allow an escort for the frail elderly, confused or non-English speaker. Consider an elderly Aboriginal person with very limited English who is very ill and being evacuated by the RFDS. he may be asked to sign for procedures that he does not understand. He may need to talk to someone within his kinship system almost for authority to have the procedure done. Surely the benefits an escort with a better understanding of English could provide far outweigh the cost of a fare and accommodation.

I have not even touched on the belief systems and how we need to work within them with our biomedical health model in a spiritual and visual world. I don’t think I am qualified to make comments and my aboriginal friends might think my thoughts are hilarious! I do recommend a book by Father Anthony Rex Peile titled “Body and Soul – An Aborigiinal View” by Hesperian Press where he writes of the concepts of health of the Kukatja people from the Balgo region of Western Australia