Leave events among Aboriginal and Torres Strait Islander people: A systematic review

Coombes et al. BMC Public Health (2022) 22:1488

https://doi.org/10.1186/s12889-022-13896-1

RESEARCH

Leave events among Aboriginal and Torres

Strait Islander people: a systematic review

J Coombes1*, K Hunter1,2, K Bennett‑Brook1

, B Porykali1

, C Ryder1,3, M Banks4

, N Egana4

, T Mackean1,3, S Sazali1

,

E Bourke1 and C Kairuz1

Abstract

Background: Leave events are a public health concern resulting in poorer health outcomes. In Australia, leave events

disproportionally impact Aboriginal and Torres Strait Islander people. A systematic review was conducted to explore

the causes of leave events among Aboriginal and Torres Strait Islander people and strategies to reduce them.

Methods: A systematic review was conducted using Medline, Web of Science, Embase and Informit, a database with

a strong focus on relevant Australian content. Additionally, we examined the references of the records included, and

performed a manual search using Google, Google scholar and the Australia’s National Institute for Aboriginal and Tor‑

res Strait Islander Health Research. Two independent reviewers screened the records. One author extracted the data

and a second author reviewed it. To appraise the quality of the studies the Mixed Methods Appraisal Tool was used as

well as the Aboriginal and Torres Strait Islander Quality Appraisal Tool. A narrative synthesis was used to report quanti‑

tative fndings and an inductive thematic analysis for qualitative studies and reports.

Results: We located 421 records. Ten records met eligibility criteria and were included in the systematic review.

From those, four were quantitative studies, three were qualitative studies and three reports. Five records studied data

from the Northern Territory, two from Western Australia, two from New South Whales and one from Queensland. The

quantitative studies focused on the characteristics of the patients and found associations between leave events and

male gender, age younger than 45 years and town camp residency. Qualitative fndings yielded more in depth causes

of leave events evidencing that they are associated with health care quality gaps. There were multiple strategies

suggested to reduce leave events through adapting health care service delivery. Aboriginal and Torres Strait Islander

representation is needed in a variety of roles within health care provision and during decision-making.

Conclusion: This systematic review found that multiple gaps within Australian health care delivery are associated

with leave events among Aboriginal and Torres Strait Islander people. The fndings suggest that reducing leave events

requires better representation of Aboriginal and Torres Strait Islander people within the health workforce. In addition,

partnership with Aboriginal and Torres Strait Islander people is needed during the decision-making process in provid‑

ing health services that meet Aboriginal and Torres Strait Islander cultural needs.

Keywords: Aboriginal, Leave events, Quality of care, Torres Strait Islander

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Background

Leave events, Discharge Against Medical Advice

(DAMA) or self-discharge, describe events where a

patient leaves a health service before being seen by a

health professional or before discharge by their clinician

[1]. Tese are a public health concern [2, 3] given the

Open Access

*Correspondence: [email protected]

1

The George Institute for Global Health, Newtown, Australia

Full list of author information is available at the end of the article