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Early identification and preventive care for elevated cardiovascular disease risk within a remote Australian Aboriginal primary health care service
BACKGROUND: Cardiovascular disease (CVD) is the single greatest contributor to the gap in life expectancy between Indigenous and non-Indigenous Australians. Our objective is to determine if holistic CVD risk assessment, introduced as part of the new Aboriginal and Torres Strait Islander Adult Health...
Autores principales: | , , , , , , , , |
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Formato: | Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2011
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3045287/ https://www.ncbi.nlm.nih.gov/pubmed/21281520 http://dx.doi.org/10.1186/1472-6963-11-24 |
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author | Burgess, Christopher P Bailie, Ross S Connors, Christine M Chenhall, Richard D McDermott, Robyn A O'Dea, Kerin Gunabarra, Charlie Matthews, Hellen L Esterman, Adrian J |
author_facet | Burgess, Christopher P Bailie, Ross S Connors, Christine M Chenhall, Richard D McDermott, Robyn A O'Dea, Kerin Gunabarra, Charlie Matthews, Hellen L Esterman, Adrian J |
author_sort | Burgess, Christopher P |
collection | PubMed |
description | BACKGROUND: Cardiovascular disease (CVD) is the single greatest contributor to the gap in life expectancy between Indigenous and non-Indigenous Australians. Our objective is to determine if holistic CVD risk assessment, introduced as part of the new Aboriginal and Torres Strait Islander Adult Health Check (AHC), results in better identification of elevated CVD risk, improved delivery of preventive care for CVD and improvements in the CVD risk profile for Aboriginal adults in a remote community. METHODS: Interrupted time series study over six years in a remote primary health care (PHC) service involving Aboriginal adults identified with elevated CVD risk (N = 64). Several process and outcome measures were audited at 6 monthly intervals for three years prior to the AHC (the intervention) and three years following: (i) the proportion of guideline scheduled CVD preventive care services delivered, (ii) mean CVD medications prescribed and dispensed, (iii) mean PHC consultations, (iv) changes in participants' CVD risk factors and estimated absolute CVD risk and (v) mean number of CVD events and iatrogenic events. RESULTS: Twenty-five percent of AHC participants were identified as having elevated CVD risk. Of these, 84% had not been previously identified during routine care. Following the intervention, there were significant improvements in the recorded delivery of preventive care services for CVD (30% to 53%), and prescription of CVD related medications (28% to 89%) (P < 0.001). Amongst participants there was a 20% relative reduction in estimated absolute CVD risk (P = 0.004) following the intervention. However, there were no significant changes in the mean number of PHC consultations or mean number of CVD events or iatrogenic events. CONCLUSIONS: Holistic CVD risk assessment during an AHC can lead to better and earlier identification of elevated CVD risk, improvement in the recorded delivery of preventive care services for CVD, intensification of treatment for CVD, and improvements in participants' CVD risk profile. Further research is required on strategies to reorient and restructure PHC services to the care of chronic illness for Aboriginal peoples in remote areas for there to be substantial progress in decreasing excess CVD related mortality. |
format | Text |
id | pubmed-3045287 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-30452872011-02-26 Early identification and preventive care for elevated cardiovascular disease risk within a remote Australian Aboriginal primary health care service Burgess, Christopher P Bailie, Ross S Connors, Christine M Chenhall, Richard D McDermott, Robyn A O'Dea, Kerin Gunabarra, Charlie Matthews, Hellen L Esterman, Adrian J BMC Health Serv Res Research Article BACKGROUND: Cardiovascular disease (CVD) is the single greatest contributor to the gap in life expectancy between Indigenous and non-Indigenous Australians. Our objective is to determine if holistic CVD risk assessment, introduced as part of the new Aboriginal and Torres Strait Islander Adult Health Check (AHC), results in better identification of elevated CVD risk, improved delivery of preventive care for CVD and improvements in the CVD risk profile for Aboriginal adults in a remote community. METHODS: Interrupted time series study over six years in a remote primary health care (PHC) service involving Aboriginal adults identified with elevated CVD risk (N = 64). Several process and outcome measures were audited at 6 monthly intervals for three years prior to the AHC (the intervention) and three years following: (i) the proportion of guideline scheduled CVD preventive care services delivered, (ii) mean CVD medications prescribed and dispensed, (iii) mean PHC consultations, (iv) changes in participants' CVD risk factors and estimated absolute CVD risk and (v) mean number of CVD events and iatrogenic events. RESULTS: Twenty-five percent of AHC participants were identified as having elevated CVD risk. Of these, 84% had not been previously identified during routine care. Following the intervention, there were significant improvements in the recorded delivery of preventive care services for CVD (30% to 53%), and prescription of CVD related medications (28% to 89%) (P < 0.001). Amongst participants there was a 20% relative reduction in estimated absolute CVD risk (P = 0.004) following the intervention. However, there were no significant changes in the mean number of PHC consultations or mean number of CVD events or iatrogenic events. CONCLUSIONS: Holistic CVD risk assessment during an AHC can lead to better and earlier identification of elevated CVD risk, improvement in the recorded delivery of preventive care services for CVD, intensification of treatment for CVD, and improvements in participants' CVD risk profile. Further research is required on strategies to reorient and restructure PHC services to the care of chronic illness for Aboriginal peoples in remote areas for there to be substantial progress in decreasing excess CVD related mortality. BioMed Central 2011-01-31 /pmc/articles/PMC3045287/ /pubmed/21281520 http://dx.doi.org/10.1186/1472-6963-11-24 Text en Copyright ©2011 Burgess et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Burgess, Christopher P Bailie, Ross S Connors, Christine M Chenhall, Richard D McDermott, Robyn A O'Dea, Kerin Gunabarra, Charlie Matthews, Hellen L Esterman, Adrian J Early identification and preventive care for elevated cardiovascular disease risk within a remote Australian Aboriginal primary health care service |
title | Early identification and preventive care for elevated cardiovascular disease risk within a remote Australian Aboriginal primary health care service |
title_full | Early identification and preventive care for elevated cardiovascular disease risk within a remote Australian Aboriginal primary health care service |
title_fullStr | Early identification and preventive care for elevated cardiovascular disease risk within a remote Australian Aboriginal primary health care service |
title_full_unstemmed | Early identification and preventive care for elevated cardiovascular disease risk within a remote Australian Aboriginal primary health care service |
title_short | Early identification and preventive care for elevated cardiovascular disease risk within a remote Australian Aboriginal primary health care service |
title_sort | early identification and preventive care for elevated cardiovascular disease risk within a remote australian aboriginal primary health care service |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3045287/ https://www.ncbi.nlm.nih.gov/pubmed/21281520 http://dx.doi.org/10.1186/1472-6963-11-24 |
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