Discharge against medical advice

The study focuses on Discharge against medical advice (DAMA) of the aboriginal and Torres Strait islander people. The assignment discusses in details the various factors triggering the same as well as the improvements in health system strategy which could help in reducing the incidence of DAMA in the aboriginal and Torres Strait islander people.

Running head: DISCHARGE AGAINST MEDICAL ADVICE
Discharge against medical advice
Name of the student
University name
Author’s note

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DISCHARGE AGAINST MEDICAL ADVICE
Table of Contents
Introduction............................................................................................................................2
Discussion:.............................................................................................................................2
Health system factors that contribute to Aboriginal Torres strait Islander people DAMA.......2
Contemporary relevance of health system improvement strategy to reduce incidence of
DAMA in the indigenous group of people.................................................................................4
Conclusion..................................................................................................................................6
References..............................................................................................................................7

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Introduction
The current study focuses upon the aspect of the Discharge against medical advice
(DAMA) of the aboriginal and Torres Strait islander people. The aboriginal and the Torres
Strait islander people were the native Australians, who normally inhabited the outskirts of the
city and had been for long the victims of social exclusion. Their native language is different
from those of the Australians residing in the city. The social exclusion has often resulted in
them suffering from unequal health, education and employment distribution. The assignment
discusses the high rates of Discharge against medical advice (DAMA) found in the aboriginal
and Torres Strait islander people. The DAMA has resulted in adverse health outcomes and is
an indicator of the responsiveness of the hospitals to the healthcare needs of the aboriginal
and Torres Strait islander people (Katzenellenbogen et al., 2013, p.330). The assignment
discusses in details the various factors triggering the same as well as the improvements in
health system strategy which could help in reducing the incidence of DAMA in the aboriginal
and Torres Strait islander people.
Discussion:
Health system factors that contribute to Aboriginal Torres strait Islander people
DAMA
There are a number of health system factors which contributes to the high rates of
DAMA in the Australian aboriginal and Torres Strait islander people. Between July 2011 and
June 2013, there had been 17,494 hospitalizations, where the aboriginal or Torres Strait
islander people have left the hospital against the medical advice of the physician (Discharge
against medical advice Aboriginal and Torres Strait Islander Health Performance Framework
2014 Report, 2018). As reported by Davies et al. (2016, p.313), the rate of DAMA is 5% in

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the indigenous Australians compared to 0.5% in the non-indigenous Australians. These are
most common for the indigenous Australians living in the interior or the rural areas.
However, difference in rates of DAMA has been found across the Australian territory. The
highest rates found in the north Australian territory, whereas the lowest rate observed in
Tasmania, Victoria etc. The discharge rates were highest for injury and poisoning and were
recorded at 7.4% whereas endocrine, metabolic and nutritional disorders lead to 7.3% of the
DAMA (Marmot, 2011, p.512). As mentioned by Katzenellenbogen et al. (2013, p.330), the
injury and poisoning were caused as an effect of deep seated psychosocial factors. The high
rates of unemployment and social exclusion led to high rates of frustrations in the population,
which often forced them uptake lethal coping strategies such as drugs. Some of these
triggered violent behaviour within the population such as self harm or harm to others.
Additionally, the high unemployment rates and social exclusion also triggered suicidal
behaviour within the indigenous population. As mentioned by Chapman, Smith & Martin
(2014, p.50), the language barriers also resulted in insufficient health services being let out to
the Aboriginal and Torres Strait islander people. The language and cultural barriers often
resulted in difference of opinion of the indigenous Australians and the health service
providers, leading to high rates of discharge against medical advice.
As mentioned by Katzenellenbogen et al.(2015, p.435), some of the other factors
which contributed to the high rates of DAMA in the indigenous Australians are – distance of
the hospital from usual residence, sex, age, treatment mode etc. One of the reasons which
have been recently highlighted due to the high rates of DAMA within the indigenous
population is lack of trust in the healthcare system. Additionally, factors such as attitude of
the hospital staffs, health policies and the environment of the hospital are other important
factors.

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Racism has been found to be one of the major factors which had been found to affect
the health and DAMA rates of the indigenous Australians. Studies have focused upon self
reported racism and poor outcomes of adult health. The self reported racism had been linked
with high rates of depression, anxiety and psychological distress within the population. The
inequalities in health have been further seen to impact the equal distribution of health. As
mentioned by Priest, Paradies, Gunthorpe, Cairney & Sayers (2011, p.549), environment in
early childhood is key to health status. The lack of cultural awareness also contributes to the
unequal health pattern distribution. As mentioned by Davies et al. (2016, p.314),
implementation of nursing care that takes into consideration the culture of others before
certain care activities are met out to the indigenous people, can help in reducing the rates of
DAMA in the indigenous people. Poverty is another concern which prevents the indigenous
Australians from prolonging their care on hospitalisation (Priest et al., 2011, p.547). The
poverty and social exclusion leads to added level of mistrust in the healthcare structure. It has
been found that the rate of discharge of the indigenous Australians from the intensive care
wards have been double the rate of discharge from the non-critical wards. This could be
attributed to the high amount of vigilance associated with the critical care wards which
interferes with the privacy concerns of the indigenous group of people.
Contemporary relevance of health system improvement strategy to reduce incidence of
DAMA in the indigenous group of people
A number of improvements could be brought about within the health system to reduce
the incidence of DAMA within the indigenous group of Australians. One of the most
effective manners in which the same could be implemented was by being culturally sensitive
of the need of the indigenous group of population. As suggested by Durey & Thompson
(2012, 151), implementation of cultural competency training in hospitals as per the

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Aboriginal and Torres Strait islander people health performance framework helps in
developing an understanding of the patient experiences in hospitals. The aim of the cultural
competency framework is to deliver quality care. As commented by van der Meer et al.
(2016, p.1252), institutional change in the responsiveness towards the needs of the
indigenous population can bring about positive results. Greater awareness to family
obligations such as providing extra time for family members to visit can be a huge step
forward (Marmot, 2011, p.512). The implementation of a departmental cultural safety policy
at the institutional and the interpersonal level can facilitate the provision of culturally
appropriate care. Increased visibility of aboriginal health workers can also help in making the
patient more comfortable within the hospital environment and reduce the rates of DAMA.
They serve as interpreter channels which help the indigenous patients communicate with the
hospital set up (Chapman, Smith & Martin, 2014, p.56).
There is a need for widespread systematic and organizational review to reduce the
rates of DAMA within the indigenous population group. As mentioned by Keech, Kelly,
Dowling, McBride & Brown (2016, p.316), increased recruitment and retention of
aboriginal health workers can also help in the improvement of the care quality. The formal
arrangements between hospitals and local aboriginal medical services can help in better
managing patients with chronic illness requiring long hospital stays.

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Conclusion
The high rates of DAMA of the aboriginal and Torres islander people point towards
less responsiveness on the part of the medical care community. Some of these could be
attributed to lack of cultural awareness within the healthcare workers towards the needs and
requirements of the aboriginal and tortes islander people. Additionally, the lack of an
effective community care structure also resulted in poor care support delivery to the
indigenous Australians. The support from the multilevel channels of the national and the
federal level government has also found to be effective. One of the main reasons for the
health disparity found in the indigenous population could be attributed to the high amounts of
social exclusion. Hence, implementation of more social inclusion policies can help in
removing the gap in the heath and support care services.

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References
Discharge against medical advice Aboriginal and Torres Strait Islander Health
Performance Framework 2014 Report (2018). Pmc.gov.au. Retrieved 16 April 2018,
from https://www.pmc.gov.au/sites/default/files/publications/indigenous/Health-
Performance-Framework-2014/tier-3-health-system-performance/309-discharge-
against-medical-advice.html
Best, O. (2014). The cultural safety journey: an Australian nursing context. In Yatdjuligin
aboriginal and Torres strait islander nursing and midwifery care (pp. 51-73).
Cambridge, Melbourne, Australia.
Chapman, R., Smith, T., & Martin, C. (2014). Qualitative exploration of the perceived
barriers and enablers to Aboriginal and Torres Strait Islander people accessing
healthcare through one Victorian Emergency Department. Contemporary
nurse, 48(1), 48-58.
Davies, A., McGee, M., Iyengar, A., Senanayake, T., Sugito, S., & Boyle, A. (2016).
Differences in Age and Outcomes of Aboriginal and Non-Aboriginal Australians
Presenting with Acute Myocardial Infarction. Heart, Lung and Circulation, 25, S313-
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Durey, A., & Thompson, S. C. (2012). Reducing the health disparities of Indigenous
Australians: time to change focus. BMC health services research, 12(1), 151.
Katzenellenbogen, J. M., Miller, L. J., Somerford, P., McEvoy, S., & Bessarab, D. (2015).
Strategic information for hospital service planning: a linked data study to inform an
urban Aboriginal Health Liaison Officer program in Western Australia. Australian
Health Review, 39(4), 429-436.

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Katzenellenbogen, J. M., Sanfilippo, F. M., Hobbs, M. S., Knuiman, M. W., Bessarab, D.,
Durey, A., & Thompson, S. C. (2013). Voting with their feet - predictors of discharge
against medical advice in Aboriginal and non-Aboriginal ischaemic heart disease
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Priest, N. C., Paradies, Y. C., Gunthorpe, W., Cairney, S. J., & Sayers, S. M. (2011). Racism
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Tavella, R., McBride, K., Keech, W., Kelly, J., Rischbieth, A., Zeitz, C., ... & Brown, A.
(2016). Disparities in acute in-hospital cardiovascular care for Aboriginal and non-
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van der Meer, D. M., Weiland, T. J., Philip, J., Jelinek, G. A., Boughey, M., Knott, J., ... &
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