Aust Fam Physician
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Aboriginal men experience unacceptably high morbidity and mortality rates for almost all medical conditions. Heart disease and depression in particular are common, inter-linked, and potentially amendable to interventions delivered through primary care. ⋯ It would be simplistic to think that these problems can be adequately addressed merely through improved general practice services, but improved recognition of illness by GPs, improved accessibility and acceptability of health services, active follow up and management of depression and heart disease, and ongoing engagement with communities is likely to improve the current situation.
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The prevalence of asthma is higher in Aboriginal and Torres Strait Islander adults than in non-Indigenous Australian adults in all age groups, and hospitalisation rates for acute asthma episodes are much higher, indicating suboptimal prevention. A 2001-2002 Australian Federal Budget initiative, the Asthma 3+ Plan, encouraged doctors to talk to their patients about asthma management over at least three visits and provide an asthma action plan. ⋯ Significant barriers prevent ACCHSs accessing the Asthma 3+ Visit Plan limiting Aboriginal people's capacity to benefit. In addition, Aboriginal and Torres Strait Islander patient access to both spacer devices and asthma medication is often poor. A targeted asthma information strategy is needed, and spacer devices must be made accessible to the Aboriginal and Torres Strait Islander population. Chronic disease management Medicare items offer a preferable and alternative funding mechanism for asthma care, if supplemented by pharmaceutical access reforms.
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'Compliance' is an important issue for the health of the Aboriginal people. The word implies that patients are not following the doctor's 'rules'. Concordance may be a better concept to describe both doctor and patient working together in 'harmony and agreement'. ⋯ The broader socio-political issues, the 'ethnocentrism' of the doctor, the health literacy of the patient, a more 'patient centred' model of the doctor-patient interaction, and the support of organisations are some of the variables that can be improved. It is important for general practitioners not to have a pessimistic attitude toward these issues, to identify ways in which the best possible results can be achieved, and to work hard to accomplish them.