Close the Gap (CTG) Policy and Diabetes Management

The assignment is based on the case study of a 57 years old aboriginal women, Judy. She has been suffering from type 2 diabetes and she has been discharged from the hospital with leg ulcer for dressing in a daily basis. She has been referred by the Aboriginal Medical Service (AMS). The Aboriginal Liaison Officer has requested to the community nurse for providing home visits in order to dressing the leg ulcer of Judy in a daily basis. The hospital has provided an accompanying discharge letter which states that Judy is eligible for registering under Close the Gap policy (CTG). The purpose of the assignment is to gather information regarding the health condition, policies and benefits that has been provided to the patient. In this regard the paper will provide brief description of the CTG policy, impact of diabetes on Judy and the way of addressing them with CTG, benefits of CTG and impact on social determinants and the role of AMS and ALO.

1. The increasing health inequality between the Australian indigenous and non-indigenous population became the concern of the health department of Australia and the Australian government. It has been found that the gap between the literacy, infant mortality, maternal mortality, severe disease status, mental health status and other health issues is high. The social disadvantages of the aboriginal people have been identified as one of the main reason behind such gap. Thus, the Australian government as introduced an effective strategy known as Closing the Gap in order to decrease the disadvantages of the indigenous people (Closingthegap.pmc.gov.au. 2018). The idea of introducing the strategy of CTG has been influenced by the Social Justice Report, 2005. The report has been identified two major issues such as less progress in achieving positive health outcomes for the Aboriginal and Torres Strait Islander peoples in the country. The report has identified that the existing policies and commitments are not adequate in order to reduce the inequality in the health status. Another major concern is less progress in the introduction and implementation of new arrangements in order to mitigate the issue of health inequality in the population (humanrights.gov.au 2018). It has been found that the gap of cardiovascular disease is 20%, diabetes is 16%, cancer is 6%, respiratory disorder is 9%, mental health issue is 16%, injuries is 7% and the total gap in the burden of disease is 37% (Australian Institute of Health and Welfare. 2018). Such situation has influenced the Australian government to work together with the Aboriginal and Torres Strait Islander people in order to mitigate the gap in the health status.

Benefits of CTG Policy

The government has decided to propose more holistic approaches in order to achieve successful outcomes. However, one of the main barrier in the progress of the plan is the cultural barriers that restricts the aboriginal people in participating in the program. The government has been trying to introduce more effective policies, resources and services in order to provide equitable health care service to the indigenous population, but the obstacle of cultural barriers is remain unresolved that could affect the effectiveness of the CTG plan (Freeman et al. 2014, p 355-361, ).

2. Type 2 diabetes or diabetes mellitus caused due to the metabolic disorder such as insulin resistance, high blood sugar and lack of insulin as well. Lifestyle such as poor diet, lack of physical activities, poor nutritional condition leads to the consequence of type 2 diabetes. In this case the patient has been suffering from type 2 diabetes. It can be said that the illness could impact on the health of the patient to an extent. For example, the patient may suffer from increased thirst and hunger, weight loss, blurred vision, skin infection and frequent urination. In addition, the illness may lead to oral yeast infection, urinary infection, itching and burning sensation (American Diabetes Association 2014, p S81-S90). In case of long term complication the patient may suffer from disease of kidney, coronary heart disease and stroke (Chatterjee, Khunti & Davies 2017, p 2239-2251). It has been found that the patient has been suffering from leg ulcer. Due to diabetes the patient may take more time to recover the ulcer as diabetes leads to the slower recovery of wound or infection (American Diabetes Association 2014, p S81-S92). There are many social determinants that lead to the rising in the illness, such as low socio economic status that is responsible for the disadvantage of aboriginals in accessing adequate health service (de Andrade et al. 2015, p 1343-1351). In this regards the CTG could help to identify the risk of diabetes by proper risk assessment, could introduce program to educate people about diabetes management and introduce program for promoting healthy lifestyle. The CTG Pharmaceutical Benefits Schedule Co-payment is another effective scheme and the case study has indicated that the patient is eligible for the registering in the scheme. The scheme would help the patient to access medicines at a concessional rate (Rosenstock et al. 2013, p 356-364). Cost of medicines is one of the major issue that restrict a person to avail adequate medicines. The CTG scheme would help to access medicines at a lower rate thus, helps to reduce the effect of social determinants of health such as poverty (Braveman & Gottlieb 2014, p 19-31).

Social Determinants of Health and CTG Policy

3. The CTG could provide adequate benefits to the patient in order to access health service to remain healthy by managing diabetes in an effective manner. The CTG policy would help to access adequate health service for the aboriginal people in an affordable expenditure. It provides adequate home support for the aboriginal people. In this case, Judy has been discharged to home with leg ulcer and need home based care for daily dressing. As the patient is eligible for registering in CTG, it would help her to access home based care from community nurse (Cohen 2017, p 31-33). On the other hand, CTG could help her to learn about diabetes management and reduce the effect of lack of education to restrict her in maintain her well-being (de Andrade et al. 2015, p 1343-1351). On the other hand, the CTG Pharmaceutical Benefits Schedule Co-payment would help to access required medicines with less price so that the patient could avail adequate medications to recover faster (Rosenstock et al. 2013, p 356-364) In this way the CTG could help to reduce the effect of income and poverty on the health outcomes of the patient and help to manage such social determinants of health in an effective manner (Braveman & Gottlieb 2014, p 19-31).

4. In Australia an Aboriginal Liaison Officer or ALA play an important role in providing social, emotional and cultural support to the aboriginal and Torres strait Islander patient and their families during the period of hospitalization at a government health care organization. An ALO helps to contact and communicate with a health professional, understand the treatment process, medical routine and help to take proper decision regarding the health. They provide adequate information to access support from a government health staff. Furthermore, they help to make arrangements for admission in the hospital and during discharge and also help to link with community health services, programs and agencies (Health.act.gov.au. 2018). On the other hand the Aboriginal Medical Service or AMS is the first health service controlled by the aboriginal community in Australia. The AMS has been established in the year 1971 in order to improve the health status of the aboriginal population across Australia. AMS provides aged care, medical care and alcohol and drug services. There are many organizations and agencies that are the part of the AMS (Amsant.org.au. 2018). The AMS referred the patients to the adequate health service and ALO support the patients by help them in admission, discharge and other community health services. In this way the health system coordinate in order to improve the health status of the aboriginal community (Levesque, Harris & Russell 2013, p 18). In this case Judy has been referred to the community nurse for visiting her at home and daily dressing of her leg ulcer by the ALO, as it is the responsibility of the ALO to help the aboriginal patients to contact community health service and ensure that the aboriginals are accessing adequate health service. The referral from AMS has been come as the AMS functions for providing health care support to the aboriginal community. As the patient has been living alone at home thus, she need such support from the government in order to access adequate health service and cope up with health issues (Rosenstock et al. 2013, p 356-364).

Role of Aboriginal Liaison Officer (ALO)

From the above discussion it can be said that, Australian government has introduced a plan to work with the Aboriginal and Torres Strait Islander people in order to reduce their social disadvantages that restrict them to access adequate health service. The Government has introduced Closing the Gap plan in 2008 to mitigate the health inequality in the country. The plan helps to access health service, home based care and medicines at a lower cost for the aboriginal people to help them to avail effective health service to maintain the well-being and reduce the gap in the health status. The ALO and AMS also play an important role in supporting aboriginal people regarding health related matter. In this case study, adequate help has been provided by the ALO and AMS to manage the diabetes and leg ulcer. The patient has been registered in CTG that could help her to gather information about diabetes management at home and avail adequate medicines at a lower price. In this way the CTG could help the patient to reduce the effect of the social determinants of health such as education and income on the health outcomes of the patient.

References:

American Diabetes Association, 2014. ‘Diagnosis and classification of diabetes mellitus.’ Diabetes care, vol. 37, Supplement 1), pp.S81-S90.

Amsant.org.au. 2018. AMSANT | Aboriginal Medical Services Alliance Northern Territory. [online] Available at: https://www.amsant.org.au/ [Accessed 17 Aug. 2018].

Australian Institute of Health and Welfare. 2018. Reports & statistics – Australian Institute of Health and Welfare. [online] Available at: https://www.aihw.gov.au/reports-statistics [Accessed 17 Aug. 2018].

Braveman, P. & Gottlieb, L. 2014. ‘The social determinants of health: it’s time to consider the causes of the causes.’ Public health reports, vol. 129, no. 1, pp.19-31.

Chatterjee, S., Khunti, K. & Davies, M.J. 2017. ‘Type 2 diabetes.’ The Lancet, vol. 389, no. 10085, pp.2239-2251.

Closingthegap.pmc.gov.au. 2018. Home | Closing the Gap. [online] Available at: https://closingthegap.pmc.gov.au/ [Accessed 17 Aug. 2018].

Cohen, N. 2017. Closing the gap in diabetes: how is it going to be achieved?.’ Endocrinology today. Vol. 6, no. 2, pp. 31-33.

de Andrade, L.O.M., Pellegrini Filho, A., Solar, O., Rígoli, F., de Salazar, L.M., Serrate, P.C.F., Ribeiro, K.G., Koller, T.S., Cruz, F.N.B. & Atun, R. 2015. ‘Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries.’ The Lancet, vol. 385, no. 9975, pp.1343-1351.

Freeman, T., Edwards, T., Baum, F., Lawless, A., Jolley, G., Javanparast, S. & Francis, T. 2014. ‘Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners.’ Australian and New Zealand Journal of Public Health, vol. 38, no. 4, pp.355-361.

Health.act.gov.au. 2018. Aboriginal liaison officer | ACT Health. [online] Available at: https://health.act.gov.au/our-services/canberra-hospital-campus/patient-liaison/aboriginal-liaison-officer [Accessed 17 Aug. 2018].

humanrights.gov.au. 2018. [online] Available at: https://www.humanrights.gov.au/our-work/…social-justice/…/social-justice-report-6 [Accessed 17 Aug. 2018].

Levesque, J.F., Harris, M.F. & Russell, G. 2013. ‘Patient-centred access to health care: conceptualising access at the interface of health systems and populations.’ International journal for equity in health, vol. 12, no. 1, p.18.

Rosenstock, A., Mukandi, B., Zwi, A.B. & Hill, P.S. 2013. ‘Closing the Gaps: competing estimates of Indigenous Australian life expectancy in the scientific literature.’ Australian and New Zealand journal of public health, vol. 37, no. 4, pp.356-364.