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Factors contributing to frequent attendance to the emergency department of a remote Northern Territory hospital

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Katherine Hospital services a very large (340 000 km2) and remote tropical region in northern Australia. The population of the region (20 000 people, 51% of whom are Aboriginal) is centred on the town of Katherine, 320 km southeast of Darwin.

As with all hospitals, frequent attenders (FAs) to the emergency department (ED) represent a significant proportion of the acute care workload. Local and international medical literature has defined FAs as patients who present to an ED between four and six times within a year;1,2 associations with homelessness, poverty, alcohol misuse and chronic illness have been documented.37 This literature, however, is predominantly focused on urban and non-tropical environments, and problems specific to northern Australian hospitals have not been investigated.

Severe and chronic homelessness is a major problem for Aboriginal people in the Northern Territory. It is closely coupled with social determinants of health and complicated by the harsh and remote environment. More than 7% of Aboriginal people in the region are considered homeless, a rate that is about 15 times the national average.8 Services for homeless people in the region are limited, in terms of both crisis and longer term…