Access and communication for deaf individuals in Australian primary care.

BACKGROUND AND AIMS: The Australian Deaf Community face barriers that impede their access to, and communication within, primary health care settings. This study aimed to identify barriers and facilitators to access and communication for deaf individuals and Auslan interpreters in Australian general practice settings. METHODS: Semi-structured interviews were conducted with eight Auslan interpreters and four deaf participants recruited from interpreter organisations and social media. Transcripts of interviews were coded inductively and deductively based on a model of access to health care. RESULTS: Patient, provider and contextual factors were reported. Patient barriers included English and Auslan fluency levels within the Australian Deaf Community. GP clinics varied in the degree of accommodation to the needs of deaf people. There were barriers related to the communication methods used by health care providers and their use of interpreters. Visual aids and flexibility in terms of the GP clinics' appointment systems facilitated access. Contextual barriers included the shortage of Auslan interpreters and the complexity of the National Disability Insurance Scheme. CONCLUSION: The main barriers identified concerned the availability of interpreters, accommodation by health providers, cultural sensitivity and the adequacy of communication methods. Research is needed to explore the limitations of the National Disability Insurance Scheme and interventions to improve GPs' skills in communicating with Deaf individuals. PATIENT OR PUBLIC CONTRIBUTION: A researcher with a hearing impairment and experience in working with people with hearing impairments was consulted on study design and interview questions. Recruitment was assisted by Auslan interpreter agencies and a Deaf Community Facebook group.

Continuous ambulatory adductor canal catheters for patients undergoing knee arthroplasty surgery.

STUDY OBJECTIVE: To determine after knee arthroplasty surgery the feasibility of discharging patients home on postoperative day 1 with continuous adductor canal blocks. DESIGN: Retrospective case series. SETTING: Outpatient setting after hospital discharge. PATIENTS: Patients undergoing knee arthroplasty surgery from October 2013 to August 2014. INTERVENTIONS: All patients received continuous adductor canal catheters for postoperative analgesia and were discharged to home on postoperative day 1. Continuous catheters were intended to remain intact in the ambulatory setting through postoperative day 3. MEASUREMENTS: Data obtained included demographic information, duration of hospital stay, resting and active pain scores, opioid utilization, opioid-induced adverse effects, complications relating to the perineural catheter, and hospital readmissions. MAIN RESULTS: Sixty-nine of 582 patients (11.9%) were discharged to home on postoperative day 1. The median numerical pain score after discharge with a continuous adductor canal block was ≤2 at rest and ≤4 with activity. After block discontinuation on postoperative day 4, median pain scores were the same. No patients reported any unintentional catheter dislodgements, falls, or dysesthesias. There were no readmissions of any patient in this cohort within 90 days of surgery. CONCLUSIONS: Ambulatory adductor canal catheters are a feasible analgesic modality after knee arthroplasty surgery as pain scores remained low and adverse events were minimal.