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Barriers and Facilitators to Uptake and Attendance of Secondary Prevention - the Experience of Indigenous New Zealanders
Abstracts
The patient developed worsening chest pain and tachycardia overnight. Echocardiography showed a loculated pericardial effusion around the right ventricle with tamponade. Straw coloured fluid (∼800ml) was drained surgically. The patient developed collapsed lung, consolidation and left-sided pleural effusion requiring ventilation. Intercostal catheter was inserted with ∼600ml serous fluid drained which also grew MSSA. MRI did not demonstrate definite evidence of myopericarditis. The patient improved and was discharged on long-term antibiotics. This case demonstrates an atypical presentation of staphylococcus aureus pericarditis in an immunocompromised patient. http://dx.doi.org/10.1016/j.hlc.2016.06.740 739 Barriers and Facilitators to Uptake and Attendance of Secondary Prevention - the Experience of Indigenous New Zealanders G. Kira 1,∗ , A. Kira 2 1 Massey
University, New Zealand Research Scientist, New Zealand
2 Independent
Background: Few M¯aori (indigenous New Zealanders) cardiovascular disease patients attend cardiac rehabilitation (CR) programs. Although a systematic review identified 34 international studies that had investigated participation in CR, only one included indigenous people. Our study presents a qualitative study with M¯aori patients who either did not attend or did attend CR. Method and design: Thirty-two semi-structured interviews of M¯aori CVD patients referred to CR from the central region of New Zealand. Interviews were conducted with patients and their family. Interview topics included provision of CR information, perceptions about CR uptake and continuation, and suggested improvements to increase uptake and attendance. The transcripts were inductively coded. Results: The interviews resulted in five main themes being identified. Reasons against uptake or attendance of CR included, lack of perceived need, didn’t fit them individually or wasn’t relevant, didn’t like groups, not receiving or understanding information about CR and practical problems, such as needing to work or lack of transport. Being a lot younger than other clients at CR either stopped them from taking up CR or discontinue going. Few direct instances of racism were reported, but concerns were expressed about the lack of importance of M¯aori needs and a lack of M¯aori HPs in CR. Conclusion: Many of the barriers perceived by the patients, could be incorporated into CR within practical, and simple strategies, such as offering CR outside work hours, providing transport and employing a M¯aori support person to enable rapport building, ensuring information has been understood and continuity of care. http://dx.doi.org/10.1016/j.hlc.2016.06.741
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740 Clinical Follow-Up of Aboriginal and Torres Strait Islander Patients that Discharge Against Medical Advice to Minimise Risk V. Bryce 1,∗ , C. Crick 1 , T. Kitchener 1 , G. Cowburn 1 , L. Richardson 1 , E. Stanford 1 , W. Wang 1,2 1 Princess
Alexandra Hospital, Brisbane, Australia 2 School of Medicine, University of Queensland, Brisbane, Australia Background: Discharge against medical advice (DAMA) results in disruption of treatment, disconnection with services, increased readmission rates, mortality and morbidity impacting health outcomes and expenditure. The burden of cardiovascular disease is higher for Aboriginal and Torres Strait Islander patients. DAMA rates for Aboriginal and Torres Strait Islander patients are 5 times the rate of nonIndigenous patients. Improving clinical follow-up of DAMA patients would minimise potential harm. Methods: A process of medical records review and early contact was developed for DAMA in Aboriginal and Torres Strait Islander patients at Princess Alexandra Hospital Cardiology. After DAMA has occurred, the Cardiologist is contacted for case review. Individual follow-up plan depends on the clinical condition and treatment received at DAMA. The patient is contacted by the Clinical Nurse Consultant (CNC) and Aboriginal and Torres Strait Islander Hospital Liaison, the medical recommendation discussed, plan developed and case managed by the CNC. Information is then communicated to the General Practitioner (GP) and Cardiologist. Results: In first 5 months of the new process (up to February 2016) there were 7 cases of DAMA. For 5 patients, prompt follow-up with their GP was arranged. Two patients were managed back into the acute care setting and received evidence based care including one receiving a pacemaker the other bypass surgery. There were 2 cases lost to follow-up. Conclusions: Early contact, clinical care review and case management post DAMA supports patient in accessing medical follow-up and aids in evidence based care. http://dx.doi.org/10.1016/j.hlc.2016.06.742 741 Differences in Age and Outcomes of Aboriginal and Non-Aboriginal Australians Presenting with Acute Myocardial Infarction A. Davies ∗ , M. McGee, A. Iyengar, T. Senanayake, S. Sugito, A. Boyle Cardiovascular Department, John Hunter Hospital, Newcastle, Australia Background: Mortality rates from acute myocardial infarction (MI) have been declining in Australia, however it is unclear whether this decline has equally benefited all Aus-
The patient developed worsening chest pain and tachycardia overnight. Echocardiography showed a loculated pericardial effusion around the right ventricle with tamponade. Straw coloured fluid (∼800ml) was drained surgically. The patient developed collapsed lung, consolidation and left-sided pleural effusion requiring ventilation. Intercostal catheter was inserted with ∼600ml serous fluid drained which also grew MSSA. MRI did not demonstrate definite evidence of myopericarditis. The patient improved and was discharged on long-term antibiotics. This case demonstrates an atypical presentation of staphylococcus aureus pericarditis in an immunocompromised patient. http://dx.doi.org/10.1016/j.hlc.2016.06.740 739 Barriers and Facilitators to Uptake and Attendance of Secondary Prevention - the Experience of Indigenous New Zealanders G. Kira 1,∗ , A. Kira 2 1 Massey
University, New Zealand Research Scientist, New Zealand
2 Independent
Background: Few M¯aori (indigenous New Zealanders) cardiovascular disease patients attend cardiac rehabilitation (CR) programs. Although a systematic review identified 34 international studies that had investigated participation in CR, only one included indigenous people. Our study presents a qualitative study with M¯aori patients who either did not attend or did attend CR. Method and design: Thirty-two semi-structured interviews of M¯aori CVD patients referred to CR from the central region of New Zealand. Interviews were conducted with patients and their family. Interview topics included provision of CR information, perceptions about CR uptake and continuation, and suggested improvements to increase uptake and attendance. The transcripts were inductively coded. Results: The interviews resulted in five main themes being identified. Reasons against uptake or attendance of CR included, lack of perceived need, didn’t fit them individually or wasn’t relevant, didn’t like groups, not receiving or understanding information about CR and practical problems, such as needing to work or lack of transport. Being a lot younger than other clients at CR either stopped them from taking up CR or discontinue going. Few direct instances of racism were reported, but concerns were expressed about the lack of importance of M¯aori needs and a lack of M¯aori HPs in CR. Conclusion: Many of the barriers perceived by the patients, could be incorporated into CR within practical, and simple strategies, such as offering CR outside work hours, providing transport and employing a M¯aori support person to enable rapport building, ensuring information has been understood and continuity of care. http://dx.doi.org/10.1016/j.hlc.2016.06.741
S313
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .
740 Clinical Follow-Up of Aboriginal and Torres Strait Islander Patients that Discharge Against Medical Advice to Minimise Risk V. Bryce 1,∗ , C. Crick 1 , T. Kitchener 1 , G. Cowburn 1 , L. Richardson 1 , E. Stanford 1 , W. Wang 1,2 1 Princess
Alexandra Hospital, Brisbane, Australia 2 School of Medicine, University of Queensland, Brisbane, Australia Background: Discharge against medical advice (DAMA) results in disruption of treatment, disconnection with services, increased readmission rates, mortality and morbidity impacting health outcomes and expenditure. The burden of cardiovascular disease is higher for Aboriginal and Torres Strait Islander patients. DAMA rates for Aboriginal and Torres Strait Islander patients are 5 times the rate of nonIndigenous patients. Improving clinical follow-up of DAMA patients would minimise potential harm. Methods: A process of medical records review and early contact was developed for DAMA in Aboriginal and Torres Strait Islander patients at Princess Alexandra Hospital Cardiology. After DAMA has occurred, the Cardiologist is contacted for case review. Individual follow-up plan depends on the clinical condition and treatment received at DAMA. The patient is contacted by the Clinical Nurse Consultant (CNC) and Aboriginal and Torres Strait Islander Hospital Liaison, the medical recommendation discussed, plan developed and case managed by the CNC. Information is then communicated to the General Practitioner (GP) and Cardiologist. Results: In first 5 months of the new process (up to February 2016) there were 7 cases of DAMA. For 5 patients, prompt follow-up with their GP was arranged. Two patients were managed back into the acute care setting and received evidence based care including one receiving a pacemaker the other bypass surgery. There were 2 cases lost to follow-up. Conclusions: Early contact, clinical care review and case management post DAMA supports patient in accessing medical follow-up and aids in evidence based care. http://dx.doi.org/10.1016/j.hlc.2016.06.742 741 Differences in Age and Outcomes of Aboriginal and Non-Aboriginal Australians Presenting with Acute Myocardial Infarction A. Davies ∗ , M. McGee, A. Iyengar, T. Senanayake, S. Sugito, A. Boyle Cardiovascular Department, John Hunter Hospital, Newcastle, Australia Background: Mortality rates from acute myocardial infarction (MI) have been declining in Australia, however it is unclear whether this decline has equally benefited all Aus-