Aust Fam Physician
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About 6% of Australian births are to an Aboriginal or Torres Strait Islander parent and there is a clear disparity in birth outcomes between Aboriginal and Torres Strait Islander and non-Indigenous Australians. Some issues affecting birth outcomes are similar nationally whilst others will be more particular to certain areas. ⋯ A key component of improving pregnancy outcomes is early and ongoing engagement in antenatal care, which is facilitated by the provision of culturally appropriate and evidence based care relevant to the local community. The majority of Aboriginal and Torres Strait Islander peoples live in urban or inner regional areas and receive healthcare through mainstream services and it is important therefore for all practitioners to be aware of how to optimise care to Aboriginal and Torres Strait Islander women.
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In the BEACH program between April 2008 and March 2013, general practitioners (GPs) recorded details of 7380 patient encounters with people who identified themselves as Aboriginal and Torres Strait Islander, which accounted for 1.5% of all BEACH encounters. The rates at which type 2 diabetes and asthma were managed at encounters with patients who identified as Aboriginal and Torres Strait Islander people were compared with those of other patients.
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There are a number of challenges facing people in the last days of life who wish to receive care in their home environment. This includes timely access to medicines for symptom control. ⋯ A list of core medicines can facilitate timely prescribing and supply of essential medicines for end-of-life symptom management. However, the development of this list should not replace planning and routine involvement of community resources. Multidisciplinary education strategies are needed to ensure that the core medicines list is utilised effectively by doctors, pharmacists and community nurses.
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Although all Australian healthcare providers are acutely aware of the health outcomes for Aboriginal and Torres Strait Islander peoples, many general practitioners may feel unprepared to take on the challenge of working in an Aboriginal medical service or in a remote Indigenous community. To highlight the immense rewards, without minimising the challenges, AFP invited Dr Lara Wieland, a GP with longstanding experience in the front-line of providing primary care for Aboriginal peoples, to share her thoughts.
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Smoking is the most important preventable cause of adverse outcomes in pregnancy. However, most smokers who become pregnant continue to smoke and most of those who quit relapse after delivery. ⋯ Continuing to smoke during pregnancy is strongly associated with socioeconomic disadvantage, mental illness and Aboriginal and Torres Strait Islander populations. Quitting is more difficult for these groups and interventions assist only sixin every 100 pregnant smokers to quit. Behavioural counselling is the first-line treatment. Nicotine replacement therapy (NRT) can be offered if the smoker is unable to quit without it, although its efficacy is uncertain. Adequate doses of nicotine and good adherance may be required for the best results. The use of NRT in pregnancy is likely to be less harmful than continuing to smoke. Women should be encouraged to quit smoking before becoming pregnant.