deck_14854321 Flashcards
What are 4 benefits of identifying aboriginal and torres strait islander patients?
*Eligibility for 1
Access to medications CTG co-payment, preventive care and vaccination recommendations differ, additional MBS items available, some medical conditions more common.
CTG: self identify ATSI, enrolled w medicare, will have setbacks if med not used, unlikely to keep up w treatment w/o help with cost.
How can clinics improve care for ATSI patients?
Cultural safety training for staff, create a welcoming environment, use relevant guidelines (NACCHO), register for PIP, know appropriate local referral pathways, involve family where possible, have a strength based approach - acknowledge benefits of culture/connection.
How can clinics create a welcoming environment for ATSI patients?
Cultural safety training, educate on aboriginal name for location, display signs/flag/acknowledgment of country, seek advice from local community members, employ ATSI staff.
What are 6 barriers to rural ATSI patients accessing healthcare?
4 features of remote areas
Distance to travel, service not available, not affordable, mistrust of western medical practice, lack of culturally safe service, poor health literacy.
Higher rates of smoking/alcohol, fewer doctors and specialists, reduced physical activity, lower income.
What are 8 possible reasons for an ATSI patient not wanting to travel for medical care?
Language barrier, transport limitation, perceived cost/finance limit, lack of understanding of clinical concern, previous negative experience, fear of serious diagnosis or medical system, family commitment, work commitment.
What are the colonial and socioeconomic determinants of health inequity?
C: systemic/interpersonal racism, intergenerational trauma, forced loss of language and cultural practices, lack of self determination/disempowerment. S: housing pressure, education, income/employment.
What are 9 infective conditions more common in ATSI patients?
Rheumatic fever, post strep GN, scabies, impetigo, chronic suppurative otitis media, bronchiectasis, trachoma, leprosy, TB.
What is the role of an Aboriginal health coordinator?
Act as a mediator: help people understand their condition and treatment, help with getting to appointments, direct people to community programs.
What are the factors which affect criminality?
4 groups
I: antisocial behaviour, cognitive development, IQ, social skills. F: abuse, povety, family violence, parental mental illness. P: gangs, bullying. C: academic performance, poverty, child protection involvement.
What are the high risk factors for rheumatic fever?
ATSI in rural/remote area, ATSI or pacific islander in overcrowded condition or socioeconomic disadvantage, previous acute RF or relative with recent RF, residence or frequent travel to an endemic area.
What are the major and minor manifesations of rheumatic fever?
Major: carditis, polyarthritis (mono in high risk), Sydenham chorea, erythema marginatum, subcutaneous nodules. Minor: Fever (>38.5 if low risk), monoarthralgia, ESR/CRP >30, prolonged PR interval.
2 major or 1 major + 2 minor + evidence of preceding S. pyogenes infection for diagnosis of first/recurrent episode. Recurrent can have 3 minor only.
What tests should be done if suspecting acute rheumatic fever?
FBE, ESR, CRP, ECG + echo if prolonged PR, Strep: antistreptolysin O titre + streptococcal Anti-DNAse B). Consider: blood cultures, throat/skin sore swab, joint aspirate.
How is acute rheumatic fever treated?
4 antibiotics, arthralgia, long term
IM benzathine benzylpenicillin 1.2M units (0.6 if < 20kg) OR Oral penicillin V 10 days. Allergy: keflex, severe - azithromycin 5 days. Joints: naproxen (1), ibuprofen, aspirin. Long term monthly IM benzathine benzylpenicillin.
How is impetigo treated in areas with strep pyogenes?
Benzathine benzylpenicillin 1.2M units (0.6 if < 20kg) OR bactrim 160/800 BD for 3 days OR 320/1600 D for 5 days.
Risk of rheumatic fever and PSGN
How does trachoma develop? How does one examine for it?
Recurrent conjunctival inflammation, eyes scar - thicken and turn inward, eyelashes rub eyes (trichiasis), causes corneal opacification. Examine eyelids, cornea and tarsal conjunctiva.
