Centre for Quality and Patient Safety Research in the Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety Research - Western Health Partnership, St Albans, Vic. 3021, Australia.
Centre for Quality and Patient Safety Research in the Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong, Vic. 3220, Australia; and Australian Catholic University, 1100 Nudgee Road, Banyo, Qld 4014, Australia.
Aust Health Rev. 2023 Feb;47(1):16-25. doi: 10.1071/AH21363.
Objectives To compare outpatient attendance rates for Aboriginal and Torres Strait Islander ('Aboriginal') and non-Aboriginal patients at a large metropolitan health service in Melbourne, Australia, and to describe the barriers and enablers experienced by urban-dwelling Aboriginal patients in attending hospital outpatient appointments. Methods This study used a mixed-method approach. Proportions of referred patients who booked and attended outpatient appointments were extracted from a health service database. Aboriginal versus non-Aboriginal cohorts were compared using chi-squared tests. Eleven patients, one parent of a patient and two community nurses were interviewed by telephone to investigate perceived barriers and enablers to attending outpatient appointments among Aboriginal patients. Results Outpatient referrals were greater among Aboriginal than non-Aboriginal people; however, referrals were significantly less likely to result in an outpatient clinic booking and attendance for Aboriginal compared to non-Aboriginal people. Interview participants reported several barriers to attending appointments, related to logistical, quality of care and cultural factors. Suggested facilitators to make appointment attendance easier included: provision of transport support, improving clinic scheduling, utilising a variety of appointment reminder formats, providing food in waiting rooms, flexible appointment timing options, outreach services, access to Aboriginal support workers, improving communication and relationships with Aboriginal people, cultural awareness training for staff and the provision of culturally appropriate spaces. Conclusion Some barriers faced by Aboriginal patients in attending hospital outpatient appointments in urban areas can be addressed through implementation of enablers suggested by participants. Data have informed the development of a tailored, inclusive, culturally and consumer-focused appropriate hospital outpatient service model of care.
比较澳大利亚墨尔本一家大型都市卫生服务机构的原住民和托雷斯海峡岛民（“原住民”）和非原住民患者的门诊就诊率，并描述城市居住的原住民患者在参加医院门诊预约时所经历的障碍和促进因素。
本研究采用混合方法。从卫生服务数据库中提取转诊患者预约和就诊门诊的比例。使用卡方检验比较原住民和非原住民队列。通过电话采访了 11 名患者、1 名患者的家长和 2 名社区护士，以调查原住民患者参加门诊预约的感知障碍和促进因素。
原住民的门诊转诊比例高于非原住民；然而，与非原住民相比，转诊患者预约门诊就诊的可能性显著降低。受访者报告了一些参加预约的障碍，涉及后勤、护理质量和文化因素。建议的促进因素包括：提供交通支持、改善诊所预约安排、使用多种预约提醒格式、在等候室提供食物、灵活的预约时间选择、外展服务、提供原住民支持工作人员、改善与原住民的沟通和关系、为员工提供文化意识培训以及提供适合文化的空间。
通过实施参与者提出的促进因素，可以解决原住民患者在城市地区参加医院门诊预约时面临的一些障碍。数据为制定量身定制的、包容的、注重文化和消费者的医院门诊服务模式提供了信息。
