Feature

---

Recording Aboriginal and Torres Strait Islander status vital to meeting health needs

---

GPs should ask every patient if they identity as Aboriginal and Torres Strait Islander people irrespective of their appearance to help deliver better care, experts have said.
 
A 2013 Australian Institute of Health and Welfare (AIHW) report showed that only a minority of mainstream general practices had routine identification processes in place for all patients.
 
Earlier newsGP reported the suicide rate among Aboriginal and Torres Strait Islander people may be underestimated due to missing data on Australian and Torres Strait Islander status.
 
Dr Fadwa Al-Yaman, who heads the AIHW’s Indigenous and Maternal Health Group, told newsGP there is always more to be done when it comes to identification.
 
She said hospital use by Australian and Torres Strait Islander people, as well as mortality data, is under-identified by 10%.
 
‘We know that identification is a lot better in remote and very remote areas and a bit lower in urbanised areas,’ Dr Al-Yaman said.
 
Dr Al-Yaman said correct identification will lead to improved service delivery and outcomes.
 
‘You have to ask the question because the minute you find out the person is Indigenous you have to give them Indigenous-specific [Medicare Benefits Schedule] items,’ she said.
 
‘If the GP doesn’t know the client is Indigenous, how can they help them by offering them … many of the items that are mandated for Indigenous people?
 
‘Likewise, in the hospitals if you don’t know they are Indigenous you can’t actually offer them an Indigenous liaison officer, which helps them coordinate their care within the hospital and navigate their way in the health system.’
 
Dr Lisa Whop, a post-doctoral research fellow at the Menzies School of Health Research, is a descendent of the Gumulgal people of Mabuiag Island in the Torres Strait.
 
She told newsGP that while a majority of those who access Aboriginal Medical Services are Aboriginal and Torres Strait Islander people, 50% of Aboriginal Torres Strait Islander people access mainstream GP clinics.
 
‘There’s been a huge effort to increase the recording of Aboriginal and Torres Strait Islander status in health data sets,’ Dr Whop said.
 
‘The under-identification of Indigenous status has really serious implications for Aboriginal and Torres Strait Islander people.
 
‘By not asking the question, [it is] actually an act of silencing us because it means we can’t be counted in a way that it is meaningful for how resources are allocated.’
 
Specific Medicare Benefits Schedule (MBS) items and other benefits for Aboriginal and Torres Strait Islander people include:

• item 715 for an annual health check
• item 10987 for follow up health services
• items 81300–81360 for allied health services follow up
• Closing the Gap for PBS – prescriptions at a lower price or free on a Health Care Card
• free pneumococcal and influenza vaccines.

According to AIHW data, the number of MBS 715 items billed across Australia in 2016 was 27.9%, an increase from 9% in 2010.
 
Dr Tim Senior, a GP with a special interest in Aboriginal and Torres Strait Islander health, said some of the barriers stopping health practitioners from asking the question of identity include not knowing the reason for asking.
 
‘I think there’s a myth that GPs feel that [asking the question] is irrelevant to their care and they often say they treat everyone the same,’ he told newsGP.
 
‘But, actually, we should be treating people according to their individual needs … and knowing whether a patient is an Aboriginal and Torres Strait Islander affects clinical decisions: the immunisations recommended are different for Aboriginal patients than for non-Indigenous patients, the preventive health care recommendations are different.
 
‘Sometimes people feel uncomfortable talking about race and culture in the context of medicine.’

GP Dr Tim Senior said it is also important to be able to explain to patients why the question of Aboriginal and Torres Strait Islander identification is being asked.
 
Dr Whop said most of her work around Aboriginal and Torres Strait identification has been on cervical cancer and prevention.
 
‘Australia has a national cervical cancer prevention program since 1991, but they have never been able to record Indigenous status,’ she said.
 
‘The actual pathology form doesn’t record Indigenous status.
 
‘So our recent work has looked at providing statistics around that to show that Indigenous women continue to experience much worse outcomes of a completely preventable cancer.’
 
But Dr Whop said the data has to be recorded in a ‘meaningful way’.
 
‘[The data] should be complete, recorded according to the way the Australian Bureau of Statistics recommends the question be recorded and that way you can use it for health statistics,’ she said.
 
‘Because if it is done in an ad-hoc way, it just means that the quality of the data … is not very representative, and it might not be portraying the GP clinic’s cliental in a way that is useful for them as a clinic for service delivery, but also for broader statistical use.’
 
According to the Australian Bureau of Statistics (ABS), the method for collecting information about Aboriginal and Torres Strait Islander people in Australia is through self-identification questions.
 
A person’s Aboriginal and Torres Strait Islander status is determined by their response to the ABS Standard Indigenous Question: ‘Are you of Aboriginal or Torres Strait Islander origin?’ for which the categories are:

• No
• Yes, Aboriginal
• Yes, Torres Strait Islander.

This question also allows respondents to report that they are both ‘Aboriginal’ and ‘Torres Strait Islander’ if that is how they identify.
 
Dr Senior said it is also important to be able to explain to patients why the question is being asked.
 
‘Asking the question is important … the explanation is crucial is well,’ Dr Senior said. ‘Being able to say, “The reason I am asking is to allow us to make better clinical decisions so that your immunisations are correct, the preventive healthcare we do is correct, and we can actually tailor it towards you better than we might otherwise”.’
 
Dr Whop said people should be asked the question routinely and repeatedly, regardless of their appearance or ethnicity.
 
‘The idea of Aboriginality or Indigeneity is often decided by someone else, based on something superficial; so by looking at person’s facial features or general appearance, and I think colour is often measured or what has historically been measured as truth of Aboriginality,’ she said.
 
‘What we know is that’s not right. Really, it is about culture and past oppression.
 
‘That’s definitely why asking the question about our Aboriginality or Indigeneity is so important, because the health of our people isn’t as great as mainstream people and therefore we have other specific health interventions that we might need.’
 
Dr Whop said that some people might be reluctant to answer due to the history of persecution, but the AIHW has guidelines on how best to explain the reasons for asking.
 
‘That fear of why people are asking is real,’ she said.
 
‘Our history has been that, and is probably still, that treatment of Aboriginal and Torres Strait Islander people based on their Indigeneity has often been terrible … so just re-clarifying why you are asking can be really important for that relationship building.’

---

---

Aboriginal and Torres Strait Islander health AIHW indigenous status

---