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54. Can a continuous quality improvement program create culturally safe emergency departments for Aboriginal people in Australia? A multiple baseline study

Author

Michelle Winters, Angela Clarke, Louise Maher, Thomas Gadsden, Erin Passmore, James Totterdell, Kym Donahue, Gai Wilson, Andrew Milat, Aaron W. Cashmore, Sonia Posenelli, Helen Gardiner, Ashima Gupta, John Willis, Alwin Chong, Jessica Stewart, Gadsden, Thomas, Wilson, Gai, Totterdell, James, Willis, John, Gupta, Ashima, Chong, Alwin, Clarke, Angela, Winters, Michelle, Donahue, Kym, Posenelli, Sonia, Maher, Louise, Stewart, Jessica, Gardiner, Helen, Passmore, Erin, Cashmore, Aaron, and Milat, Andrew

Subjects
Adult, Male, medicine.medical_specialty, Native Hawaiian or Other Pacific Islander, emergency department, Cultural safety, Psychological intervention, Rural Health, Aboriginal health, incomplete emergency department visit, Health administration, 03 medical and health sciences, 0302 clinical medicine, Health care, medicine, Medical Staff, Hospital, cultural safety, Health Services, Indigenous, Humans, 030212 general & internal medicine, Cultural Competency, Indigenous health, business.industry, Emergency department, lcsh:Public aspects of medicine, 030503 health policy & services, Health Policy, Public health, Nursing research, Urban Health, lcsh:RA1-1270, Quality Improvement, Hospitals, Multiple baseline design, Incomplete emergency department visit, Family medicine, Female, New South Wales, 0305 other medical science, business, Emergency Service, Hospital, Research Article
Abstract

Background Providing culturally safe health care can contribute to improved health among Aboriginal people. However, little is known about how to make hospitals culturally safe for Aboriginal people. This study assessed the impact of an emergency department (ED)-based continuous quality improvement program on: the accuracy of recording of Aboriginal status in ED information systems; incomplete ED visits among Aboriginal patients; and the cultural appropriateness of ED systems and environments. Methods Between 2012 and 2014, the Aboriginal Identification in Hospitals Quality Improvement Program (AIHQIP) was implemented in eight EDs in NSW, Australia. A multiple baseline design and analysis of linked administrative data were used to assess program impact on the proportion of Aboriginal patients correctly identified as Aboriginal in ED information systems and incomplete ED visits in Aboriginal patients. Key informant interviews and document review were used to explore organisational changes. Results In all EDs combined, the AIHQIP was not associated with a reduction in incomplete ED visits in Aboriginal people, nor did it influence the proportion of ED visits made by Aboriginal people that had an accurate recording of Aboriginal status. However, in two EDs it was associated with an increase in the trend of accurate recording of Aboriginality from baseline to the intervention period (odds ratio (OR) 1.31, p

Published
2018

55. Body mass index among Melanesian and Indian Fijians aged ≥ 40 years living in Fiji.

Author

Brian G, Ramke J, Maher L, Page A, Fischer-Harder K, and Sikivou B

Subjects
Adult, Age Distribution, Aged, Cross-Sectional Studies, Educational Status, Female, Fiji epidemiology, Humans, India ethnology, Male, Melanesia ethnology, Middle Aged, Obesity ethnology, Sex Factors, Body Mass Index, Overweight ethnology
Abstract

To determine the distribution and sociodemographic associations of body mass index (BMI; kg/m(2)) among Melanesian and Indian Fijians aged ≥40 years living in Fiji, a population-based cross-sectional survey with multistage random sampling was conducted in 2009. Melanesians were more likely to have BMI ≥25 (odds ratio [OR] = 4.73; 95% confidence interval [CI] = 3.57-6.28; P < .001) and BMI ≥30 (OR = 3.84; 95% CI = 2.94-5.03; P < .001). Among Melanesians, gender and educational attainment were predictive of BMI ≥25 on multivariate analysis. Women were more likely to be overweight (OR = 2.03; 95% CI = 1.34-3.06) or obese (OR = 1.92; 95% CI = 1.43-2.59). Among Indians, gender and age were predictive of BMI ≥25. Again, women were more likely to be overweight (OR = 2.51; 95% CI = 1.69-3.73) or obese (OR = 3.71; 95% CI = 2.19-6.29). Gender-age-domicile-adjusted, and extrapolating across Fiji, 0.3%, 84.5%, and 51.7% of Melanesians aged ≥40 years had BMI <18.5, ≥25, and ≥30, respectively. Among Indians, these values were 5.8%, 54.2%, and 21.2%, respectively.

Published
2011
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56. The prevalence of diabetes among adults aged 40 years and over in Fiji.

Author

Brian G, Ramke J, Maher L, Page A, and Szetu J

Subjects
Adult, Age Distribution, Age Factors, Aged, Cluster Analysis, Diabetes Mellitus diagnosis, Diabetes Mellitus therapy, Ethnicity statistics & numerical data, Female, Fiji epidemiology, Glycated Hemoglobin metabolism, Health Surveys, Humans, Logistic Models, Male, Middle Aged, Prevalence, Sex Distribution, Diabetes Mellitus epidemiology
Abstract

Aim: To estimate the prevalence of diabetes among adults aged ≥40 years in Fiji, and determine the demographic characteristics associated with this diagnosis., Method: During a population-based survey, participant glycosylated haemoglobin (HbA1c) was determined and physician diagnosis of diabetes self-reported. HbA1c ≥6.5% or claimed previous diagnosis, independent of HbA1c, defined presence of diabetes. Results were extrapolated to the whole population. Predictors of risk for diabetes were investigated using logistic regression models., Results: Of those enumerated, 1381 participated (73.0%). For 1353 with either a history of diabetes or valid HbA1c, prevalence of diabetes was 44.8% (95%CI 42.2-47.5). Adjusting for age and domicile, Indians had significantly higher risk of diabetes than Melanesians among males (OR 2.02, 95%CI 1.37-2.97, p<0.001) and females (OR 1.99, 95%CI 1.44-2.73, p<0.001). Females were at greater risk than males among Melanesians (OR 1.75, 95%CI 1.30-2.36, p<0.001) and Indians (OR 1.94, 95%CI 1.33-2.84, p<0.001). Risk increased with age for both genders and ethnicities, adjusting for ethnicity and domicile, then gender and domicile. The ethnicity-gender-age-domicile adjusted prevalence of diabetes among adults aged ≥40 years in Fiji was 41.0% (95%CI 38.4-43.6): 99,000 people., Conclusion: As identified in 1970, diabetes continues to be a substantial population health problem in Fiji.

Published
2010

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