Exploring the outcomes of Indigenous patients from critical care environments

Abstract

Objective: The objective of this thesis is to investigate the factors contributing to poorer long-term outcomes for Indigenous patients following Intensive Care Unit (ICU) admission
Introduction: In Australia, despite Government policy priorities, barriers to health and healthcare remain a pressing issue for Indigenous populations. Research has indicated that this leads to a greater burden of disease, and more acute presentations to hospital and ICUs. This scoping review aims to identify the contributing factors on poorer long-term outcomes for Indigenous patients post an ICU admission.
Inclusion criteria: This scoping review has considered studies that include Australian Indigenous and non-Indigenous patients – all sexes, and their family members over the age of 18 presenting to a hospital for care, as well as healthcare workers.
Methods: A scoping review method was selected for this work, as defined by The Johanna Briggs Institute. The databases MEDLINE, Informit and CINAHL were searched for primary and secondary articles. Data was then extracted and tabulated for presentation purposes along with a narrative synthesis as per the JBI Methodology for JBI Scoping Reviews. Search limiters included English, and dates of publication between 2000 and 2021.
Findings: The studies found in this scoping review present a range of factors having an impact on Indigenous patients presenting to hospital for care. The barriers to care can be identified and categorised into three main themes: social, cultural, and organisational. These themes along with an identified lack of health literacy, later presentation to hospital, and greater severity of illness, provide an explanation for the poorer outcomes of longer length of stay, higher long term mortality rates, and higher rates of subsequent ICU admissions seen in Indigenous patients following an ICU admission.
Conclusions: there are well documented health disparities between Indigenous and non-Indigenous Australians that are reinforced by complex cultural and historical factors. Indigenous patients are less likely to access healthcare services or significantly delay accessing health services, due to several access barriers that fall under social, cultural, and organisational factors. These factors include ingrained personal and cultural beliefs, communication, racism, and low health literacy. When Indigenous patients do present to services, they are usually sicker, further along in the disease process, with higher acuity scores, higher rates of admission to ICU, and have poorer outcomes. They are also more likely to DAMA, or not survive. Further research needs to be conducted into why this disparity remains for Indigenous patients seeking healthcare and outcomes post ICU admissions, despite health service delivery policies and attention from governments and policymakers over several decades. Qualitative research would be appropriate for this. As Pope and Mays (2020) identify, healthcare services interact with people who are complex. Qualitative research methods can be used to classify a phenomenon or why something is occurring. So, in this case – why this disparity remains.

Date of Award	2022
Original language	English
Supervisor	Maree Duddle (Supervisor)