Volume 211 Issue 1

A new taskforce of Aboriginal and Torres Strait Islander clinicians will address the needs of an Indigenous-led kidney health workforce in Northern Australia

Jaquelyne T Hughes · Gwendoline Lowah · Janet Kelly

Without improved practices and policy to guide the engagement and inclusion of Indigenous Australians in biobanks, the full health benefits provided by the genomic era will not be shared equitably

Imogen Elsum · Callum McEwan · Emma E Kowal · Yvonne Cadet‐James · Margaret Kelaher · Lynn Woodward

Infectious disease burden, antimicrobial use and resistance highlight the need for antimicrobial stewardship in Indigenous communities

Asha C Bowen · Kathryn Daveson · Lorraine Anderson · Steven YC Tong

The intended audience has not arrived; there are no men

Kootsy Canuto

Social determinants of infectious disease and awareness of the risks of acute kidney disease must be improved

Alan Cass · Jaquelyne T Hughes

Refining our diagnostic concepts and understanding their phenomenological basis will allow culturally meaningful, person-focused care

Sivasankaran Balaratnasingam · Aleksandar Janca

Reducing vaccine-preventable disease is a major achievement in equitable health service delivery

Frank H Beard · Katrina K Clark

Infectious conditions were common among patients, underscoring the significance of environmental determinants of health

Joseph V Mohan · David N Atkinson · Johan B Rosman · Emma K Griffiths

We have an evidence-based tool for screening for depression in Indigenous Australians

The Getting it Right Collaborative Group

Improving completion rates for Indigenous Australian women are needed to end their higher burden of cervical cancer

Julia ML Brotherton · Karen L Winch · Genevieve Chappell · Carolyn Banks · Dennis Meijer · Sonya Ennis · Karen Peterson · Rosalind Webby · Lisa J Whop

Lactic acidosis associated with metformin use is a complex issue and the causal relationship remains open to debate

Cara Tanner · Gayathiri Wang · Nancy Liu · Sofianos Andrikopoulos · Jeffrey D Zajac · Elif I Ekinci

To the Editor: We refer to Liaw and colleagues’1 recently published study in the Journal. We acknowledge the positive intentions and rigour of this trial, and empathically concur with Thompson and Thackrah’s2 comment that the results of this research “[do] not mean that efforts to improve cultural competence in health care settings should be abandoned”. To the contrary, this study demonstrates the urgent need for more research to improve cultural competence in the health care setting; in particular, the use of culturally safe research methods that truly benefit Aboriginal and Torres Strait Islander peoples and communities.3 Like Thompson and Thackrah,2 we question the authors’ choice of the cultural quotient questionnaire.4 This generic tool is not designed for assessing cultural competence of health professionals when working with Aboriginal and Torres Strait Islander peoples in Australia. Importantly, it lacks recognition of the unique colonial experiences of Aboriginal and Torres Strait Islander peoples and, therefore, it cannot measure health professionals’ understandings or attitudes about such a key part of any cultural training, where we would hope to see change. We suggest the use of a scale that has been designed and validated by Aboriginal and Torres Strait Islander peoples, such as the Cultural Capability Measurement Tool.5 We fear that, if not carefully interpreted, the study findings have the potential to further complicate and undermine the substantial work — endorsed by the National Aboriginal Community Controlled Health Organisation and the Department of Health — being undertaken to develop the cultural safety of Australia’s health system.6 It is crucial that in all areas of Australia’s health system, including Aboriginal and Torres Strait Islander health, we present a reliable, strategically aligned approach consistent with the vision of an Australian health system free of racism and inequality.6 It is important that we continue to work together to harness the energy and commitment of the workforce towards our shared goals. We look forward to the qualitative findings of the research study.

Sophie Hickey · Roianne West

In reply

Siaw‐Teng Liaw · Vicki Wade

To the Editor: We strongly agree with St Clair and colleagues1 that telehealth is a “game changer” for the provision of health services to Aboriginal and Torres Strait Islander communities in Australia. For more than 15 years, we have been engaging with Indigenous communities throughout Queensland, to plan and establish telehealth services for a range of clinical disciplines, including diabetes, ear, nose and throat, and aged care. Telehealth is contributing to positive changes in our health system and this is evidenced in our recent studies highlighting the value of telehealth for Aboriginal and Torres Strait Islander people. A systematic review of the outcomes of using telehealth for the provision of care to Aboriginal and Torres Strait Islander people reported improved social and emotional wellbeing, clinical outcomes and access to health services.2 Other benefits included improved screening rates and reduced need for travel.3 This review reinforced the importance of partnerships between Aboriginal community controlled health services (ACCHSs) and public hospitals. Telehealth also helps with the delivery of culturally appropriate care. In a qualitative investigative study,4 we found that telehealth allowed specialist care to be delivered from Aboriginal medical services which were familiar to the patient and local care providers. According to this study, a telehealth consultation with a specialist held in the ACCHS resulted in less stress and greater convenience; and also meant that an Indigenous health worker could be present during the telehealth appointment to provide advocacy and support for the patient.4 Telehealth also reduced out‐of‐pocket expense for the patient. These factors contributed to the interpretation of culturally appropriate services. Telehealth is already benefiting Indigenous people throughout Australia. All studies recognise the pivotal role of ACCHSs as advocates for telehealth. While telehealth applications are predominantly reported in rural and remote areas, we believe that telehealth is just as important for the delivery of specialist health care services to metropolitan ACCHSs, in lieu of community members attending mainstream health services. Telehealth is one mechanism to help close the gap. Telehealth empowers community health services and can improve equity of access to health services in rural and remote — and urban — settings.

Anthony C Smith · Nigel R Armfield · Liam J Caffery

To the Editor: In the recently published article by Morgan and colleagues1 and associated podcast, the authors raised the issue of future research into the outcomes of identification of Aboriginal and Torres Strait Islander peoples in hospital. The implementation of a visual identification methodology has previously been described2 and was put in place in partnership with the hospital department of Aboriginal health. The purpose of this identification initiative was to encourage all medical professionals who care for Aboriginal and Torres Strait Islander patients to question what they can do to assist them while they are in hospital. We describe here the positive outcomes of this process. In addition to hospital pharmacists,2 the visual alert system is also used by other departments and professionals within the hospital, such as cardiothoracic care, the emergency department (ED), Aboriginal health, and speech pathology, as well as ward‐based nursing and medical staff. The Aboriginal and Torres Strait Islander patients’ identification system is used by health care providers within the hospital to easily identify the patients they need to visit, to provide culturally appropriate resources and services and links to other services, and to enhance the care patients receive and enable them to remain in a caring hospital environment. At ward level, nursing and medical staff use the identification system to highlight the referral process needed to link with Aboriginal health workers — connecting the right resources to the right people. Because of the visual alert,2 staff feel more aware of the cultural needs of the patient before they meet them. Specifically in the ED, there is a system‐wide approach that firstly identifies Aboriginal and Torres Strait Islander patients presenting to the ED using the visual alert at triage, and then implementing initiatives that aim to reduce the level of “did not wait for treatment” episodes. The Heart and Lung Stream at St Vincent's Hospital uses the system to identify Aboriginal and Torres Strait Islander patients early during their admission in order to provide culturally specific education, resources and follow‐up after hospital discharge. We encourage others to explore this initiative in their hospital, together with cultural responsiveness training, to enhance the care of Aboriginal and Torres Strait Islander peoples during and after their hospital visit.

Susan A Welch · Sonia Robinson · Tamra Langley · Pauline Deweerd

In reply

David JR Morgan · Martin Whitely · Tania Harris

The Queen’s Birthday Honours list includes a host of accomplished medical professionals

Cate Swannell