By Dr Jeannie Knapp, GP and Primary Health Care Improvement GP Adviser, North Western Melbourne Primary Health Network.
The Royal Australian College of General Practitioners (RACGP) has developed the Standards for general practices (5th edition) to protect patients from harm by improving the quality and safety of health services.
Aboriginal and Torres Strait Islander people are likely to experience significantly poorer health and life outcomes across all ages and stages, from pregnancy to premature mortality. As outlined in the North Western Melbourne Primary Health Network Health Needs Assessment, Aboriginal and Torres Strait Islander people in our region generally have higher rates of mental illness, self-harm and suicide, mental illness-related hospitalisations and drug and alcohol comorbidities.
There is strong evidence that the delivery of clinical preventive health services, especially within a primary health care context, improves health outcomes.
Core Standard 1
Communication and patient participation
Communication must be patient centred. This means that the practice team considers the patient’s values, needs and preferences, and gives the patient time to provide input and participate actively in decisions regarding their health care.
Although Aboriginal and Torres Strait Islander people may appear comfortable with English, they may still benefit from being offered an appropriate interpreting service.
Criterion C1.4 – Interpreter and other communication services
- Patients have a right to understand the information and recommendations they receive from their practitioners.
- Practitioners have a professional obligation to communicate effectively and to understand their patients’ health concerns.
C1.4 A Our practice endeavours to use an interpreter with patients who do not speak the primary language of our practice team.
To meet this criterion, you must:
- Provide evidence that interpreters are used with patients who do not speak the primary language of your practice team.
- Document in the patient’s health record details of any translation services used for that patient.
To meet this criterion, you could:
- Have a policy addressing the use of interpreter and communication services.
- Register all your practitioners with TIS National.
- Use appropriately qualified interpreters.
- Make sure all team members can access a list of contact details for interpreter and other communication services.
C1.4 B Our patients can access resources that are culturally appropriate, translated, and/or in plain English.
To meet this criterion, you could:
- Maintain a list of websites and services from which patients can access translated resources.
- Keep information sheets in the common languages of the patient population in the consultation spaces.
Core Standard 2
Rights and needs of patients
Criterion C2.1 – Respectful and culturally appropriate care
Understanding what constitutes respectful and culturally appropriate care based on cultural awareness and sensitivity begins with learning about other cultures and cultural beliefs.
Patients have the right to respectful care that considers their religion and cultural beliefs, displays an acceptance of diversity, and promotes their dignity, privacy, and safety. Respect for a patient extends to recording, storing, using, and disclosing health and other information about them.
C2.1 A Our practice, in providing patient healthcare, considers patients’ rights, beliefs, and their religious and cultural backgrounds.
To meet this criterion, you must:
- Demonstrate that you have considered patients’ rights, beliefs, and religious and cultural backgrounds when providing health care.
To meet this criterion, you could:
- Maintain a policy about patients’ rights and responsibilities.
- Maintain a policy about the ceasing of a patient’s care.
- Maintain policies and processes about patient health records.
- Maintain an anti-discrimination policy.
- Provide access to cultural awareness and cultural safety training for the practice team and keep records of the training in the practice’s training register.
- Meet a patient’s request for a practitioner of a specific gender, if possible.
- Use a clinical audit tool to identify cultural groups in your population.
- Display signs acknowledging the traditional custodians of the land.
- Display Aboriginal or Torres Strait Islander art and flags.
- Display organisational cultural protocols within the office, waiting areas and consultation rooms.
- Provide resources appropriate to the health literacy and cultural needs of your patients.
Core Standard 7
Criterion C7.1 – Content of patient health records
Why this is important?
Complete patient health records improve patient safety and wellbeing as they support clinical decision making.
Identifying patients of Aboriginal or Torres Strait Island origin, or another cultural background:
The RACGP encourages you to identify and record the Aboriginal or Torres Strait Islander status and cultural background of all patients. This information can be an important indicator of clinical risk factors and therefore help practitioners to provide relevant care.
Before asking a patient any questions about their cultural background, explain that knowing such information helps the practice provide appropriate health care.
Routinely ask all patients the following question regardless of the patient’s appearance, country of birth, or whether the practice team know of the patient or their family background: “Are you of Aboriginal or Torres Strait Islander origin?”
All patients have the right to respond to this question as they see fit. If a patient indicates that they do not wish to answer the question, record ‘Not stated/inadequately described’.
The patient’s response must be received without question or comment, and the response must be recorded without any amendments or annotations. However, if the patient does not answer this question when it is on a form, you need to follow up immediately in case they missed it by mistake, rather than assume that the patient has refused to answer.
Collecting information about a patient’s cultural heritage before a consultation (for example: by using a new patient form) will help you to provide the most appropriate care.
The place where patients were born, where they grew up, or where their parents are from may indicate that they are at higher risk of developing certain health conditions. Similarly, this and other information such as the language spoken at home, can help to identify patients who require specific care or targeted interventions. It is good practice to record this information in the patient health record if it is relevant to their patient care.
C7.1 E Our practice routinely records the Aboriginal and/or Torres Strait Islander status of our patients in their patient health record.
To meet this criterion, you must:
- Document the patient’s Aboriginal and/or Torres Strait Islander status in patient health records.
To meet this criterion, you could:
- Maintain a policy addressing the management of patient health information.
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