Culturally Safe and Decentralised Care: Patient Experiences of a Dermatology Clinic Embedded in an Aboriginal and Torres Strait Islander Primary Health Care Service

BACKGROUND: Skin disease is a major cause of morbidity in Australia and a leading reason for primary care visits. Aboriginal and Torres Strait Islander peoples experience a disproportionate burden of skin conditions but face barriers to accessing culturally safe specialist services. This study described patient demographics, presentations and experiences at a new community-based dermatology clinic. METHODS: A mixed-methods study was conducted at an urban Aboriginal and Torres Strait Islander primary health care dermatology clinic in South East Queensland. Retrospective analysis of medical records (March 2021-December 2023) examined demographics, attendance and diagnoses. Verbal semi-structured interviews were undertaken with patients to explore their experiences, and data were analysed thematically. RESULTS: Across 338 encounters, 76% of patients identified as Aboriginal and/or Torres Strait Islander and 72% were female. Attendance was 55%. 27% had previously accessed specialist dermatology care. In this urban cohort, inflammatory dermatoses predominated, including atopic dermatitis (n = 26), acne (n = 15), chronic spontaneous urticaria (n = 12) and psoriasis (n = 12). This differs from existing literature in rural and remote settings where infectious dermatoses often predominate. Seventeen patients participated in interviews led by Aboriginal and Torres Strait Islander Research Officers. Participants valued the clinic's accessibility, shorter wait times compared with hospital services and culturally safe environment. Barriers included transport, scheduling challenges and medication costs. CONCLUSIONS: A community-based, culturally tailored clinic was perceived by patients as more accessible, culturally safe and responsive to their needs. Supporting similar models may help close the gap in dermatological care and outcomes for Aboriginal and Torres Strait Islander peoples.