Factors influencing health care utilisation among Aboriginal cardiac patients in central Australia: a qualitative study.
Factors influencing health care utilisation among Aboriginal cardiac patients in central Australia: a qualitative study.
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DOI：
10.1186/1472-6963-13-83
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发表时间：
2013-03-06
影响因子：
2.8
通讯作者：
Daniel M
中科院分区：
文献类型：
--
作者：
Artuso S;Cargo M;Brown A;Daniel M
与澳大利亚普通人群相比，澳大利亚原住民的整体健康状况较差，特别是在心血管疾病和心脏事件后的预后方面。尽管存在这样的差异，澳大利亚原住民利用医疗保健服务的比率仍远低于一般人群。提高原住民心脏病患者的医疗保健利用率（HCU）需要更好地了解限制或促进使用的因素。该研究旨在确定澳大利亚中部原住民心脏病患者从心脏病发作时到心脏病发作后 6-12 个月内影响医疗保健利用 (HCU) 的生态因素。这项定性描述性研究以生态框架为指导。文化敏感的疾病叙述侧重于原住民心脏病患者的“典型”旅程，引导焦点小组和对原住民心脏病患者、非心脏病社区成员、医疗保健提供者和社区研究人员的半结构化访谈。分析采用主题概念矩阵和混合编码方法。主题分为诱发因素、促成因素、需求因素和强化因素，并在个人、人际、初级保健和医院系统层面进行确定。在初级保健和医院系统层面发现的 HCU 面临的巨大障碍包括沟通、组织和种族主义。与 HCU 相关的个人水平因素包括语言、疾病知识、感知需求和过去的经历。鉴于这些个人和卫生系统的障碍，患者依赖于利用人际层面的替代家庭层面的支持来实现他们的旅程。原住民心脏病患者在接受 HCU 方面面临重大障碍，导致护理质量不佳，使他们面临随后发生心血管事件和负面健康结果的风险。为了促进原住民之间的 HCU，必须实施战略来改善各个层面的沟通并减少卫生系统内运作的系统性障碍。
Aboriginal Australians suffer from poorer overall health compared to the general Australian population, particularly in terms of cardiovascular disease and prognosis following a cardiac event. Despite such disparities, Aboriginal Australians utilise health care services at much lower rates than the general population. Improving health care utilisation (HCU) among Aboriginal cardiac patients requires a better understanding of the factors that constrain or facilitate use. The study aimed to identify ecological factors influencing health care utilisation (HCU) for Aboriginal cardiac patients, from the time of their cardiac event to 6–12 months post-event, in central Australia. This qualitative descriptive study was guided by an ecological framework. A culturally-sensitive illness narrative focusing on Aboriginal cardiac patients’ “typical” journey guided focus groups and semi-structured interviews with Aboriginal cardiac patients, non-cardiac community members, health care providers and community researchers. Analysis utilised a thematic conceptual matrix and mixed coding method. Themes were categorised into Predisposing, Enabling, Need and Reinforcing factors and identified at Individual, Interpersonal, Primary Care and Hospital System levels. Compelling barriers to HCU identified at the Primary Care and Hospital System levels included communication, organisation and racism. Individual level factors related to HCU included language, knowledge of illness, perceived need and past experiences. Given these individual and health system barriers patients were reliant on utilising alternate family-level supports at the Interpersonal level to enable their journey. Aboriginal cardiac patients face significant barriers to HCU, resulting in sub-optimal quality of care, placing them at risk for subsequent cardiovascular events and negative health outcomes. To facilitate HCU amongst Aboriginal people, strategies must be implemented to improve communication on all levels and reduce systemic barriers operating within the health system.
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影响因子：
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