Barriers to accounting: Australian Indigenous students’ experience

Background: Indigenous Australians are slightly morethan 2% of the total Australian population however, in recent years they havecomprised between 6 and 10% of new patients beginning treatment for end-stagekidney disease (ESKD). Although transplant is considered the optimal form oftreatment for many ESKD patients there is a pronounced disparity between therates at which Indigenous ESKD patients receive transplants compared with theirnon-Indigenous counterparts. The IMPAKT (Improving Access to KidneyTransplants) Interview study investigated reasons for this disparity through alarge scale, in-depth interview study involving patients, nephrologists and keydecision-making staff at selected Australian transplant and dialysis sites.

Methods: The design and conduct of the study reflected the multi-disciplinarymembership of the core IMPAKT team. Promoting a participatory ethos, IMPAKTestablished partnerships with a network of hospital transplant units andhospital dialysis treatment centres that provide treatment to the vast majorityof Indigenous patients across Australia. Under their auspices, the IMPAKT teamconducted in-depth interviews in 26 treatment/service centres located inmetropolitan, regional and remote Australia. Peer interviewing supported theengagement of Indigenous patients (146), and nephrologists (19). In totalIMPAKT spoke with Indigenous and non-Indigenous patients (241), key renalnursing and other (non-specialist) staff (95) and a small number of relevantothers (28). Data analysis was supported by QSR software. At each site, IMPAKTalso documented educational programs and resources, mapped an hypothetical‘patient journey’ to transplant through the local system and observed patientcare and treatment routines.

Discussion: The national scope, inter-disciplinaryapproach and use of qualitative methods in an investigation of a significanthealth inequality affecting Indigenous people is, we believe, an Australianfirst. An exceptionally large cohort of Indigenous participants providedevaluative comment on their health services in relation to dialysis andtransplant. Additionally, the data includes extensive parallel commentary froma cohort of specialists, nurses and other staff. The study considers a ‘patientjourney’ to transplant within a diverse range of Australian treatmentcentre/workplace settings. The IMPAKT Interview study protocol may contributeto improvements in multi-disciplinary, flexible design health services researchwith hard to reach or vulnerable populations in Australia and elsewhere.