Attendance at, and experiences of, urban hospital outpatient appointments: informing a new model of care for urban-dwelling Aboriginal and Torres Strait Islander patients.

Objectives: To compare outpatient attendance rates for Aboriginal and Torres Strait Islander ('Aboriginal') and non-Aboriginal patients at a large metropolitan health service in Melbourne, Australia, and to describe the barriers and enablers experienced by urban-dwelling Aboriginal patients in attending hospital outpatient appointments. Methods: This study used a mixed-method approach. Proportions of referred patients who booked and attended outpatient appointments were extracted from a health service database. Aboriginal versus non-Aboriginal cohorts were compared using chi-squared tests. Eleven patients, one parent of a patient and two community nurses were interviewed by telephone to investigate perceived barriers and enablers to attending outpatient appointments among Aboriginal patients. Results: Outpatient referrals were greater among Aboriginal than non-Aboriginal people; however, referrals were significantly less likely to result in an outpatient clinic booking and attendance for Aboriginal compared to non-Aboriginal people. Interview participants reported several barriers to attending appointments, related to logistical, quality of care and cultural factors. Suggested facilitators to make appointment attendance easier included: provision of transport support, improving clinic scheduling, utilising a variety of appointment reminder formats, providing food in waiting rooms, flexible appointment timing options, outreach services, access to Aboriginal support workers, improving communication and relationships with Aboriginal people, cultural awareness training for staff and the provision of culturally appropriate spaces. Conclusion: Some barriers faced by Aboriginal patients in attending hospital outpatient appointments in urban areas can be addressed through implementation of enablers suggested by participants. Data have informed the development of a tailored, inclusive, culturally and consumer-focused appropriate hospital outpatient service model of care. What is known about the topic? Health outcomes are poorer and burden of disease greater among Aboriginal and Torres Strait Islander people than non-Aboriginal and Torres Strait Islander people. What does this paper add? Compared to non-Aboriginal and Torres Strait Islander people, among Aboriginal and Torres Strait Islander people in urban settings, more outpatient referrals are made, but these referrals are significantly less likely to result in an outpatient clinic booking and attendance. Barriers and enablers to urban-dwelling Aboriginal and Torres Strait Islander people attending outpatient hospital appointments relate to logistical, quality of care and cultural factors. What are the implications for practitioners? Identifying and understanding the barriers and enablers to healthcare access for urban-dwelling Aboriginal and Torres Strait Islander people provides a foundation on which practitioners and organisations can facilitate urban hospital outpatient service development, with the aim to better support healthcare engagement and appointment attendance. [ABSTRACT FROM AUTHOR]