The First Nations experience of accessing rheumatology services in a metropolitan hospital: A qualitative study

• Published in: Health Expectations
• Main Authors: Dr Taylor Cullen, Miki Griffith, Arvin Damodaran, Ebony Lewis, Faye McMillan, Dr Anthony Sammel, Rhiana Honeysette, Brett Biles, Kim Beadman, Sally Nathan
• Format: Article in Journal/Newspaper
• Language: English
• Published: Wiley 2024
• Subjects: caregiver engagement; equity; First Nations Australians; integrated care; participation; patient engagement; Medicine (General); R5-920; Public aspects of medicine; RA1-1270; First Nations
• Online Access: https://doi.org/10.1111/hex.14049; https://doaj.org/article/f03304c611d4478994426f2cd5577d1b

Abstract Objective First Nations Australians experience a higher burden and severity of Rheumatic Disease with poorer outcomes than the general population. Despite a widely acknowledged need to improve health outcomes, there has been minimal research assessing existing models of care from a First Nations perspective in Australia. The objective of this study was to describe First Nations experiences and barriers and enablers to accessing a hospital‐based adult Rheumatology service in Sydney. Methods A qualitative study using semi‐structured interviews was undertaken. Patients who self‐identified as First Nations attending the Prince of Wales Hospital Rheumatology Clinic in 2021 were invited to participate. Interviews were conducted face‐to‐face or by telephone using culturally‐appropriate Yarning methods with an Aboriginal Health Worker (AHW) at the request of participants. Thematic analysis was done in consultation with an Aboriginal Reference Group (ARG). Results Four categories, which encapsulated 11 themes were identified. Participants reported barriers to care such as logistics of the referral process, not feeling culturally safe because of uncomfortable clinic environments and health worker behaviours, inadequate cultural support and community perceptions of the specialty. Enabling factors included family member involvement, AHW support and telehealth consultation. Conclusion The current model of care perpetuates access challenges for First Nations Australians within rheumatology. Barriers to care include the delayed referral process, limited cultural responsivity in the clinic environment and poor cross‐cultural communication. There is a need for models of care that are co‐designed with First Nations Peoples to address these barriers. Patient and Public Contribution Participants were First Nations Australians with lived experience attending the rheumatology clinic. All interviewees were offered the opportunity to review their transcripts to ensure trustworthiness of the data. Preliminary thematic analysis ...