What Respiratory Services Are Available in Aboriginal Community Controlled Health Services in NSW, Australia?

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Abstract Rationale: Aboriginal Community Controlled Health Services (ACCHSs) are primary care services, providing healthcare in culturally safe environments for Aboriginal and Torres Strait Islander Peoples, the Indigenous peoples of Australia. New South Wales (NSW) is the most populated state in Australia with a population of 8.3 million, approximately 3% (246,000) of whom are Aboriginal or Torres Strait Islander Peoples. There is little information about respiratory services provided by ACCHSs to ensure that Aboriginal people with chronic respiratory diseases have access to best-practice care. Aim: To describe current provision of respiratory services by NSW-based ACCHSs, especially identifying barriers and facilitators to providing pulmonary rehabilitation. Methods: The study used a Zoom-assisted survey with ACCHSs that were members of the NSW Aboriginal Health and Medical Research Council. Exclusions were ACCHSs that only delivered drug and alcohol rehabilitation, housing or employment services. The survey questions related to client population, demographics, workforce, respiratory services, and pulmonary rehabilitation. Results: Of the 41 eligible ACCHSs, 18 (44%) completed the survey and represented ACCHSs in metropolitan, regional, rural and remote regions. Eleven of the participating ACCHSs provided client numbers which totalled 27,932 Aboriginal people. The ACCHS workforce was mostly general medical practitioners (family doctors), (median, IQR) (3.7 fulltime equivalent (FTE) per ACCHS, IQR 2.1 to 5.4), nurses (3.0 FTE, 2.4 to 5.0), and Aboriginal Health Workers (3.0 FTE, 3.0 to 6.0), with negligible allied health professionals employed. 78% of ACCHSs reported some access to respiratory physicians, either face-to-face or tele-health, mostly at regional hospitals via established referral pathways. Aboriginal clients with a COPD diagnosis as a percent of those with a smoking history ranged from 7%-24%. The main respiratory services provided were smoking cessation (100% of ACCHSs), spirometry (89%), respiratory clinics (33%). At the time of completing the survey, no ACCHSs provided pulmonary rehabilitation, with the main reasons being financial constraints, staff shortages, lack of staff training, and inadequate space. Ten ACCHSs (56%) reported that Aboriginal clients would not access hospital-based pulmonary rehabilitation mainly due to experiences of racism, transportation issues and geographical location. Conclusions: ACCHSs mainly support respiratory services that have been government funded e.g smoking cessation and spirometry. Additional funding is required to enable equitable access to best-practice, evidenced-based care for Aboriginal people living with COPD, such as establishing culturally safe and accessible pulmonary rehabilitation programs.

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