Major deficits in stroke care for Indigenous people are being addressed in WA programs that include cultural safety training and the use of Aboriginal Brain Injury Coordinators, neurologists say.
With a recent study showing substantial ongoing inequities in the diagnosis, management and follow up of stroke in Indigenous Australians, WA is trialling a “Healing Right Way” approach according to Dr David Blacker, consultant neurologist and stroke physician at Sir Charles Gairdner Hospital, Perth.
The new approach is needed in light of a study showing that Aboriginal Australians with ischaemic stroke are less likely to have basic investigations such as carotid and cardiac ultrasounds compared to non-Indigenous Australians, said Dr Blacker in an editorial co-authored with Professor Beth Armstrong PhD, a speech pathologist at Edith Cowan University, WA.
An investigation into stroke management for Indigenous Australians in a rural NSW setting also found that they were less likely to receive follow up (74.4% vs 87.4%) compared to non-Indigenous stroke patients.
The findings are of concern given that Indigenous people have a three fold higher risk of stroke and are on average 16 years younger than non‐indigenous subjects (56.8 vs 72.6 years old), notes Dr Blacker.
The high rates of stroke risk factors in Indigenous patients, including smoking (diabetes mellitus and past history of cerebrovascular accident or transient ischaemic attack “may indicate a failure of both primary and secondary prevention of stroke, with a particular focus on individuals with communication disorders,” according to Dr Blacker and Professor Armstrong
They say the Healing Right Way trial would provide Indigenous stroke survivors with a holistic health model that would require cultural security training for hospital staff involved in the care of patients following stroke and traumatic brain injuries.
“The cultural security training is aimed at improving the acute hospital experience of patients by providing more accessible support and information at the beginning of their recovery journey so that follow up and two-way engagement are more likely.”
The Indigenous stroke plan will also deploy Indigenous nurses and health workers as Aboriginal Brain Injury Coordinators based in the community, who will visit the hospital to meet the person and his or her family immediately after the stroke and then support them for the following months.
“Based on a chronic care model and informed by local neurological nursing care programmes, the Aboriginal Brain Injury Coordinators provide educational information regarding stroke and subsequent rehabilitation/recovery, psychological support and advocacy services, keeping patients and their families in touch with local and remote services, telehealth facilities and the latest information regarding stroke rehabilitation treatment, the commentary states.
But there will also need to be system change in the services providing early stroke management for indigenous people, to address problems with communication, transport and racism, they add.
“Numerous solutions have been proposed, including the wider implementation of indigenous hospital liaison officers and indigenous community health professionals acting as cultural brokers in vital health interactions, as well as increased use of interpreters,” they note.
“Further investigations demonstrating the inequities but also exploring ways of better aligning western models of care with indigenous views of health and wellness will be crucial in yielding useful ways forward,” they conclude.