Health is not only the absence of diseases but is the state in which an individual feels physical, mental, and social well-being (World Health Organ
Introduction
Health is not only the absence of diseases but is the state in which an individual feels physical, mental, and social well-being (World Health Organization, 2023). This case presents how primary health care (PHC) intersects with social determinants of health (SDH) and can influence health outcomes. It studies access to healthcare for Gemma; an Indigenous Australian female diagnosed with colorectal cancer based in Karuah, Hunter Region of New South Wales, and its surroundings.
Overview of the healthcare system at different levels.
Primary healthcare services are basic healthcare services from general practitioners, nurses, and health workers which include preventive care, health promotion, health education, chronic disease management, and basic medical treatment (World Health Organization, 2022). Primary care is the medical services provided by health care professionals. Primary health incorporates both primary care and public health initiatives. Some of the primary healthcare services are at Karuah and nearby.
Karuah Medical Centre.
Offersgeneral practiceservices, pathology, and chronicdisease management (Karuah Medical Centre, n.d.). It is essential for managing Gemmas chronic conditions like T2DM, hypertension, and COPD. Additionally, it provides wound care and general health check-ups.
Triple C Health KaruahFamily medical center provides holistic care, general consultation and chronic disease management (Triple c Health, n.d.). Gemma can meet her immediate health needs including chronic disease management, mental health support, and wound care.
Aboriginal Medical Service, Redfern.
Culturally appropriate healthcare for Aboriginal and Torres Strait Islander people offering comprehensive primary care and chronic disease management (Aboriginal Medical Service Cooperative, n.d.).
Secondary healthcare services involve specialist consultations and diagnostic services, with local facilities (Glover & Woods, 2020). These healthcare services provide oncology and chemotherapy.
Maitland Hospital
Shoalhaven District Memorial Hospital, NowraDubbo Base Hospital, Dubbo
In addition, Maitland Hospital has a 24-hour emergency department (Yump, 2024).
Tertiary healthcare are large hospitals with more specialized facilities for advanced medical investigations such as:
Royal Prince Alfred Hospital, Sydney.
Prince of Wales Hospital, Randwick.
John Hunter Hospital, Newcastle
Rural and Remote healthcare services provide all primary, secondary, and tertiary care in less accessible areas (Department of Health and Aged Care, 2020). They rely on telehealth and visit specialists occasionally to meet the healthcare needs of the community. Karuah falls under Hunter New England and Central Coast primary healthcare network (Health, 2021). The Healthone program facilitates smooth transitions between primary, secondary, and tertiary health services (HealthOne NSW, n.d.). The Rural Health Outreach Fund (RHOF) supports the delivery of medical specialists, GPs, nurses, and other health services in rural and remote areas (Health, 2021).
SDH in Gemmas Case
Financial stability:
The economic uncertainty makes it difficult to afford healthcare services, nutritious food, and essentials (Australian Institute of Health and Welfare, 2024). Along with employment, she lost her sense of purpose and routine, increasing mental health issues.
Education and Health Illiteracy:
Health literacy helps to understand treatment plans and self-management. Gemma lacks health awareness and knowledge to manage her chronic conditions such as T2DM and COPD. Additionally, she could find the diagnosis and treatment plan complex.
Living situation and support:
Gemma lives in a household that is overcrowded and complex which makes it harder for her to meet ongoing care needs. The lack of a strong support system impacts her mental health and improper sanitization makes it difficult to cope with her treatments (Mazel, 2018).
Healthcare Access:
The distance to tertiary healthcare facilities may result in missed appointments, and delayed treatments, potentially compromising her cancer care, planned chemotherapy and radiotherapy as well as post-operative recovery.
Housing:
Good living situation are vital as unstable and crowded homes increase stress and slow recovery (Australian Institute of Health and Welfare, 2024). Given Gemma's housing instability, she may be eligible for rental assistance to help cover the cost of her accommodation. Social services have assisted Gemma in applying for emergency housing and Centrelink benefits, but the lengthy waiting time adds stress and uncertainty.
Cultural factor:
As an IndigenousAustralian, Historical trauma and racism can disrupt her willingness to seek care or follow treatment recommendations (Australian Institute of Health and Welfare, 2024). Gemma needs culturally appropriate care within the healthcare system where she can feel comfortable and understood.
Primary Healthcare Strategies and the Role of Nurses
Enhanced coordination of care:
A patient-centered approach with dedicated case managers can close the gap between healthcare providers and services (Health, 2023). We can facilitate communication and advocate for Gemma's needs, helping her navigate the healthcare system and access resources.
Culturally appropriate services:
Adequate funding and support for Aboriginal Community Controlled Health Services (ACCHSs) is necessary to provide culturally safe care to Gemma (National Aboriginal Community Controlled Health Organisation, 2024). ACCHSs support chronic disease management. Healthcare providers should deliver culturally competent care to address the unique needs of diverse Indigenous patients like Gemma.
Addressing Social Determinants of Health:
Housing solutions and financial assistance may reduce Gemmas stress and support her recovery (Health, 2023). The application has been submitted for emergency housing and Centrelink benefits. Meanwhile, we can offer education on health promotion and disease prevention.
Leveraging Technology
Getting remote consultations and follow-up care through telehealth services can reduce the need and hassle of travel ensuring timely access to specialists (Health, 2023). This is particularly important for Gemma as she is from a rural area.
Empowerment through Community engagement
Involvement in decision-making processes can help the patient recognize their strengths (Mazel, 2018). This strength-based model can empower Gemma to take an active role in her health.
Education on Medicare and other subsidies
She can rebate through the Medicare Benefits Schedule for medical services and GP appointments. If out-of-pocket costs reach the MBS Safety Net threshold, Medicare pays a higher rebate to reduce her costs for rest of the calendar year (Australian Institute of Health and Welfare, 2023). Through Pharmaceutical Benefits Scheme (PBS) she can subsidize medicines with co-payment options (Services Australia, 2022).
Conclusion
This case highlights the importance of addressing SDH and ensuring access to holistic and culturally appropriate healthcare services in communities. Better coordination of care, overcoming social economic barriers, technology, and utilizing medicare along with other financial assistance can help us achieve better outcomes and equity in health. The National Primary Health Care Strategic Framework provides a solid foundation for these strategies, emphasizing the importance of a holistic and inclusive approach to healthcare (Department of Health and Aged Care, 2020). By establishing follow-up plan, including her regular checkup with patient centered approach we can be responsive to both her medical and social needs.
Reference
Australian Government Department of Health and Aged Care. (2022).Chronic disease support for Aboriginal and Torres Strait Islander people. Australian Government Department of Health and Aged Care; Australian Government. https://www.health.gov.au/topics/aboriginal-and-torres-strait-islander-health/chronic-disease-support
Australian Institute of Health and Welfare. (2023, October 25).Health Expenditure. Australian Institute of Health and Welfare; Australian Government. https://www.aihw.gov.au/reports/health-welfare-expenditure/health-expenditureDepartment of Health and Aged Care. (2020).National strategic framework for rural and remote health. https://www.health.gov.au/sites/default/files/documents/2020/10/national-strategic-framework-for-rural-and-remote-health.pdf
Glover, L., & Woods, M. (2020, June 5).Australia | Commonwealth Fund. The Commonwealth Fund. https://www.commonwealthfund.org/international-health-policy-center/countries/australiaHealth. (2021, April 15).New South Wales Primary Health Networks. Australian Government Department of Health and Aged Care. https://www.health.gov.au/our-work/phn/your-local-PHN/NSW-PHNsHealth. (2021, November 12).Rural Health Outreach Fund. Australian Government Department of Health and Aged Care. https://www.health.gov.au/our-work/rural-health-outreach-fundHealth. (2023, June).Rural health workforce. Australian Government Department of Health and Aged Care. https://www.health.gov.au/topics/rural-health-workforce
HealthOne NSW. (n.d.). Www.health.nsw.gov.au. https://www.health.nsw.gov.au/healthone/Pages/default.aspxKaruah Medical Centre. (n.d.). Www.healthdirect.gov.au. Retrieved July 28, 2024, from https://www.healthdirect.gov.au/australian-health-services/healthcare-service/karuah-2324-nsw/karuah-medical-centre/gp-general-practice/4bccd9a9-5dd7-8601-f244-c25fb18cf2a1Mazel, O. (2018). Indigenous Health and Human Rights: A Reflection on Law and Culture.International Journal of Environmental Research and Public Health,15(4), 789. https://doi.org/10.3390/ijerph15040789
National Aboriginal Community Controlled Health Organisation. (2024).NACCHO National Aboriginal Community Controlled Health Organisation. NACCHO. https://www.naccho.org.auServices Australia. (2022, March 3).Pharmaceutical Benefits Scheme - Services Australia. Www.servicesaustralia.gov.au. https://www.servicesaustralia.gov.au/pharmaceutical-benefits-scheme
Triple C Health Karuah | Triple C Health. (n.d.). Retrieved July 28, 2024, from https://triplechealth.com.au/karuah/
World Health Organization. (2022).Primary Health Care. https://www.who.int/health-topics/primary-health-care#tab=tab_1World Health Organization. (2023).Constitution of the world health organization. World Health Organization. https://www.who.int/about/governance/constitution
Yump. (2024, July 29).https://maitlandprivatehospital.com.au. Maitland Private Hospital. https://maitlandprivatehospital.com.au
Appendix
ISBAR Handover
I have used ISBAR to standardize clinical handover. It stands for identify, situation, background, assessment and recommendations.
Identify
I AM -
Rojina Shrestha | Student Nurse
Charles Darwin University
First Year | Second Placement
Supervisor: RN Angela Patient Name Gemma
Gender Female
Background Recently diagnosed with colorectal Cancer
Situation
Recent Hospitalization:Admitted for bowel resection (laparotomy) and formation of a temporary colostomy.
Post-Op Recovery:Uneventful recovery, but with a dehisced laparotomy wound and post-op infection requiring daily saline-soaked gauze packing.
Background
Past Medical History:
Obesity (recent significant weight loss >20kg)
Type 2 Diabetes Mellitus (T2DM)
Hypertension
Chronic Obstructive Pulmonary Disease (COPD)
Smoker (20 cigarettes/day for 25 years)
Symptoms Prior Diagnosis:Rectal bleeding, bloating, intermittent constipation, diarrhea, nausea, anorexia.
Previous Surgeries:Right hemicolectomy and formation of colostomy in June 2024
Assessment and Action
Current Needs
Stomal care
Wound care for the dehisced laparotomy wound
Follow-up appointments with GP, colorectal surgeon, and medical oncologist
Planned adjuvant chemotherapy and radiotherapy in 6 weeks
Recommendation Immediate Care:Community nurse to assess and dress the wound appropriately.
Follow-up:Ensure Gemma attends all scheduled follow-up appointments.
Support Services:Coordinate with social services to address housing and family support needs.
Priorities for Gemmas Care
Wound and Stomal Care:
Daily assessment and dressing of the dehisced laparotomy wound.
Education and support for managing the colostomy.
Chronic Disease Management:
Monitoring and management of T2DM, hypertension, and COPD.
Smoking cessation support.
Cancer Treatment Follow-up:
Coordination of follow-up appointments with GP, colorectal surgeon, and oncologist.
Preparation for upcoming chemotherapy and radiotherapy.
Social Support:
Address housing instability and support applications for emergency housing and Centrelink benefits.
Provide mental health support for Gemma and her husband, Jack.
