In the article (“Two-speed Indigenous health continues”) it is apparent that one of the greatest challenges to improving the gap in life expectancy between Indigenous and non-Indigenous Australians would be to find better ways of managing chronic disease. Despite the current effort and resources put into this, progress is painfully slow and in some areas of health, such as diabetes management, it is just not working for the majority of sufferers.
It is all very well, and appropriate in terms of duty of care, for practitioners to be advising Indigenous (and non-Indigenous) people to quit smoking, avoid junk food and soft drinks, consume less alcohol and exercise more. Unfortunately, and not surprisingly, this often falls on deaf ears.
This is often seen as just another patronising approach into how people with often limited financial resources and unsupportive environments should live their lives.
A better approach may be for Indigenous people to self-determine what they want to discuss during consultations, to hear about practical and affordable ideas for lifestyle change, and to address their health problems.
Whatever the lukewarm response at the federal level, health literacy is all-important and GPs in Aboriginal health services and mainstream practices are well placed to actively listen and tune in to what is achievable.
One-to-one consultations certainly have their place but there may be other ways as well. In the last GPSpeak, and again in this one, there was an article about Shared Medical Appointments (SMAs), where doctors see patients in groups of 6-12 over a one-hour period.
SMAs were said ‘to become the next big thing in chronic disease management, with the first Australian trials now being completed on the NSW North Coast.’
SMA trials have now been done in Indigenous communities in Walgett, Bourke and Lismore. The Lismore SMA was conducted under the auspice of Rekindling the Spirit (RKS), an Indigenous support organisation that has been running regular support groups over many years.
To bring a GP into a group of 10-12 men was trialed in the garage under the RKS building. It could just as well have been held under the shade of a tree - all is needed is a basic meeting place for a ‘yarn’ lasting 90 minutes with a facilitator to organise and run the group session and a GP coming into the circle for 60 minutes.
Each person has a chance to be heard and asks the GP for advice on a health topic of their choosing. There is plenty of opportunity for health education and for all to hear and engage in the group conversations. The group dynamics work very well in this environment, as evidenced by the positive feedback received.
If matters come up that require further one-toone consultation, arrangements are made for this. The facilitator’s role is crucial to get the group engaged and focused on the health agenda of each participant and the GPs role is quite straightforward and enjoyable. A wide range of topics can be covered. The return SMA visit rate was very high over three sessions.
More SMAs are being planned for an Indigenous women’s group. There is increasing interest from GPs to become involved. I have personally found the groups work well, with great patient feedback, and they are fun to do. Research is needed in the future to see if the proven patient satisfaction leads to better health outcomes through lifestyle changes and better treatment compliance. I am highly optimistic.