Embedding gynaecologists in primary care improves care for Aboriginal women
Derbarl Yerrigan Health Service in Perth has improved care for Aboriginal women with gynaecological conditions such as heavy menstrual bleeding by establishing a gynaecology clinic that ensures culturally safe care.
Derbarl, an Aboriginal community-controlled health organisation (ACCHO) in Perth, established the gynaecology clinic in its East Perth Clinic in 2021.
Visiting gynaecologists from local tertiary hospitals, partly funded by health workforce agency Rural Health West, work in the clinic alongside GPs and Aboriginal health practitioners and nurses to build trust and ensure cultural safety.
The clinic aims to improve care for Aboriginal women, who have higher incidences of gynaecological cancers and poorer survival rates compared to non-Aboriginal women.
It was established by Derbarl Medical Director Dr Richelle Douglas and registered nurse Gail Yarran, a proud Noongar woman, with the help of gynaecologists Dr Mat Epee and Dr Lauren Megaw. The project had the full support of CEO Tracey Brand, a proud Eastern Arrernte woman.
Dr Douglas said reduced access to care in the hospital system contributed to the poorer outcomes. She said it was important to help Aboriginal women access and engage with the health system by improving cultural safety, supporting them to navigate the system, addressing financial and geographical disadvantages, and improving communication from health professionals.
Bringing specialists to the patient
The gynaecology clinic is based on the ACCHO holistic model of care, in which primary care and specialist services work together under one roof. ACCHO GPs refer patients to visiting female gynaecologists, who have links to a local tertiary hospital and can book patients direct to their operating lists.
‘We're bringing specialists to the patient rather than the other way around’ Dr Douglas said.
Heavy menstrual bleeding is one of the most common conditions treated at the gynaecology clinic, which offers medical treatment in line with the Heavy Menstrual Bleeding Clinical Care Standard.
Dr Douglas said sometimes women present with abdominal pain and fatigue but do not say they have heavy menstrual bleeding.
Culturally safe approach
The clinic’s culturally safe approach helps to identify and treat women who have heavy menstrual bleeding and are reluctant to disclose it due to stigma, Dr Douglas said.
‘When patients come to our clinic, we have Aboriginal transport officers, Aboriginal receptionists, and Aboriginal liaison officers. Patients are greeted on arrival by an Aboriginal receptionist and screened by an Aboriginal health practitioner who takes the history before the doctor sees them,’ she said.
A female Aboriginal health practitioner provides care for the patient throughout her journey at the clinic. That care may include coordinating transport and being the interface between the patient and the tertiary hospital if they need specialised treatment, Dr Douglas said.
Since 2021, the gynaecology clinic has seen more than 300 patients. Attendance rates for booked appointments have been over 80% compared to 56% attendance at the tertiary referral centre outpatient clinic.
One hundred per cent of Aboriginal women booked for surgery through the Derbal gynaecology clinic attended hospital for surgery, compared to 73% of patients booked through the tertiary system.
Dr Douglas said the outcomes showed the importance of flexible models of care for all patients, not only Aboriginal people.
‘I hope embedded clinics and a holistic approach to health care is the future of health care in Australia,’ she said. ‘The Aboriginal community-controlled health organisations do that well. We should be learning from the oldest culture on earth.’