Word of Mouth - School of Public Health and Community Medicine ...

APPENDIXThe Queensland study found that the emergencyrate for Indigenous people was especially highin ‘rural other’ and ‘remote major’ areas, withdental staff reporting that Indigenous peopletended to present to the clinic when a problemexisted and that they wanted the problem fixedimmediately. If, for example, a sedative dressingwas applied for further treatment at a later date,the person was not likely to attend the secondappointment. If placed on the waiting list, theywere likely not to attend and not be contactable.Clinicians reported trying to complete as muchtreatment as possible at each presentation.Related to this is the higher number ofIndigenous people receiving extractions for bothemergency and general services [54].The size of waiting lists for public dentaltreatment precludes optimal dental care forthose reliant on the public system [46], as wellas ATSIHSs [19]; and Aboriginal people tendnot to join lengthy waiting lists [32, 54]. TheQueensland study found a smaller mean waitingtime for general services for Indigenous peoplein all rurality areas, although higher waitingtimes occur in areas of dense population orwould vary according to the availability of clinicpersonnel [54].It has been suggested that, for Aboriginaland Torres Strait Islander peoples, financialand cost barriers are relatively less importantthan cultural barriers in accessing health careservices. It is suggested that people are oftenprepared to travel some distance to receivemore culturally appropriate services and thatculturally appropriate services often involvecommunity control [64] in [65].Related to this is that the cumulative effects ofAboriginal and Torres Strait Islander peoples’contact with the health system have createdsignificant mistrust, particularly of governmentservices. This mistrust is regarded as a keydeterminant of the under-utilisation of all healthservices [65]. Aboriginal and Torres StraitIslander people tend to prefer dental servicesprovided by ATSIHSs over mainstream services,subject to a number of factors [19]:hospital that most Indigenous Australians use• Indigenous Australians may not feelcomfortable coming to a mainstream practice• Cost – may be unable to afford the charges[or find the billing system culturallyappropriate [65]]• Location/transport difficulties• No Indigenous Australians on staff• Language barriers• Practice does not bulk bill [50].ATSIHSs are able to accommodate family andcultural obligations and associated mobility thatis known to affect attendance patterns [21, 46],and which traditional modes of delivery orientedaround set appointments finds difficult. ‘Failureto show’ can seriously affect clinic productivity,impede the timely delivery of treatment plans,and impact on clinical service time availableto other patients [21]. Many ACCHSs haveovercome these barriers by providing transportand childcare facilities and structuring theirprograms to be flexible, and, where possible,take into account family and communityresponsibilities [65].Aboriginal and Torres Strait IslanderCommunity Controlled ServicesAboriginal and Torres Strait Islander CommunityControlled Health Services (ACCHSs) havefeatured in the delivery of primary health care inAustralia since 1971. ACCHSs are,“culturally appropriate and autonomousprimary health care services initiated, plannedand governed by local Aboriginal [and TorresIslander] communities through their electedAboriginal [and Torres Strait Islander] boardof directors” [44].Within the Ottawa Charter, providing culturallyappropriate services falls within the action areaof creating supportive environments [66]. Thisprinciple is encapsulated in the vision of theNational Aboriginal and Torres Strait IslanderOral Health Action Plan: To improve the oralhealth status of Aboriginal and Torres StraitIslander people in culturally supportive ways thatinduce overall health benefits [19].68• Availability of an ATSIHS nearby• Availability of another local practice orWord of MouthAs well as being culturally appropriate,advantages typically attributed to ATSIHSs