Indigenous Australians have been suffering from poor health since long time and their life expectancy is 17 years lesser than the non-indigenous Australians as they are not accessing the available health services or they are discharging themselves against medical advice before full treatment  (Einsiedel, et al., 2013)

Discharge Against Medical Advice  without completing the treatment is higher in Indigenous Australian in comparison  to non-indigenous Australians (Ministers, 2017).  Around 12,000 Indigenous Australians presented in Emergency Department left the hospital at their own risk in the year 2015-2016 resulting in  readmission, higher  mortality and morbidity rate and high health system expenses (Katzenellenbogen, et al., 2013). High number of DAMA in indigenous population advocates  that acute care settings are not efficiently tackling the needs and concerns of Indigenous  patients in order to make them feel better, engaged and stay until they finish their full treatment. 

The common health factors  associated with DAMA are complex and diverse such as institutionalised  racism, miscommunication, language barriers between patient and staff, isolation, family and social obligation, loneliness, distrust of the health system, lack of knowledge and understanding of the treatment they were taking (Shaw, 2016). 

One health system improvement strategy that I think could reduce the rate of DAMA in Indigenous community is doing a survey for all age groups although it is  more common in people of age 25-54 years and getting feedback from indigenous patients asking them reasons behind self-discharging themselves before completing their treatment. This will give us an clear idea of what's lacking in health care system and help us to respond, plan and focus on Indigenous health needs (Ministers, 2017).

According to the survey done in July 2006 to August 2007, the main reason behind self-discharge  was a massive failure to interact effectively with Indigenous patients.  Majority of the patients were totally unaware of their treatment plans and diagnosis. So, cross cultural communication skills should be developed between all the medical staff on how to deal and look after indigenous population (Einsiedel, et al., 2013).

Introduction

Aboriginal and Torres Island people continue to experience adverse health issues with reduced life expectancy (Phillips, et al., 2017). DAMA (Discharge Against Medical Advice) indicates the responsiveness of the physicians and nurses to the treatment challenges and individualized healthcare requirements of the aboriginal people. Indeed, DAMA is a high-risk event that leads to malpractice litigation (Sayed, Jabbour, Maatouk, Bachir, & Dagher, 2016). The increased DAMA level experienced by the aboriginal people is indicative of the sustained disparities practiced in the healthcare environment. The lack of effective engagement of the aboriginal people in their healthcare interventions leads to a consistent decrease in their quality of life and treatment outcomes. The stratification of the aboriginal people in the Australian regions directly impacts their psychosocial outcomes across the community environment. The consistent disconnection with the mainstream society make them more vulnerable and subjected to healthcare as well as socioeconomic disparities. Institutional racism, miscommunication, cultural insecurity, and distrust are some of the significant factors that lead to the frequent discharge of the aboriginal patients against the medical recommendation. DAMA is indicative of self-discharge by the treated patient in the absence of an actual discharge summary from the treating physician (Richardson & Stanbrook, 2015).

Indeed, lack of admission planning for the aboriginal people also results in DAMA and resultant patient complications (Katzenellenbogen, et al., 2013). The healthcare inconsistencies and inappropriate treatment methodologies drastically impact the trust and confidence of the aboriginal people on the Australian healthcare system. They remain dissatisfied throughout their healthcare duration and resultantly leave the inpatient settings against the medical advice. Eventually, they experience a high risk of co-morbidity and mortality in the absence of appropriate follow-up sessions. These evidence-based findings necessitate the requirement of exploring the healthcare experience and treatment challenges of the aboriginal patients. This research paper attempts to identify the health system attributes that reciprocally elevate the DAMA rate of the indigenous patients in the hospital setting. The paper also discusses the significant health improvement strategies that require implementation across the healthcare environment to effectively improve the health and wellness of the aboriginal natives while reducing their risk of DAMA elevation.  

(Some parts of the solution has been blurred due to privacy protection policy)