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Improving CVS Outcomes in Aboriginal Primary Health Care
S10
Heart, Lung and Circulation 2011;20S:S1–S13
Abstracts
ABSTRACTS
doi:10.1016/j.hlc.2011.04.028 23
disease care with BP and lipid control both consistently good (70% of diabetics have BP
Improving CVS Outcomes in Aboriginal Primary Health Care
doi:10.1016/j.hlc.2011.04.029
Christine Connors
Waikato Community Heart Failure Service—The First Year
NT Department of Health, Australia The prevalence and mortality of cardiovascular disease amongst Aboriginal Territorians is much higher than Australian rates. Seventy percent of the gap in life expectancy is due to chronic diseases, with cardiovascular disease causing the greatest impact. Over the past 10 years the NT Aboriginal primary health care sector has implemented a population systems approach to screening and management of cardiovascular disease, which has included the development of standard treatment guidelines used across the NT, expanded roles for nurses and Aboriginal health workers, engagement with specialist colleagues, implementation of disease registers and recall systems, development of a shared electronic health record, standardisation of medications, active engagement in quality improvement and collaboration with researchers. Unique features of cardiovascular disease in the NT include: early age of onset, high rates of co-morbidity and high prevalence of risk factors. There have been significant improvements in life expectancy for Aboriginal women (3.4 years from 2000 to 2005) but only limited gains for Aboriginal men (0.6 years). Incidence rates of ischaemic heart disease continue to increase by 3% per annum. Deaths from acute coronary syndrome have reduced by 56% for people in remote areas, although survival post ACS is still lower for Aboriginal Territorians. Clinical audits have shown significant improvements in the delivery of chronic
24
Eileen Gibbons a , Anita Bell a , Veronique Gibbons b , Gerry Devlin a , Raewyn Fisher a , Keith Buswell c , Mark Davis a , Ross Lawrenson b a Waikato b Waikato
District Health Board, New Zealand Clinical School, University of Auckland, New
Zealand c Tekuiti
Medical Practice, New Zealand
Background: A community based Integrated Heart Failure Service was commenced in two rural Waikato pilot sites 2009. The service aim was joint improvement between primary and secondary care, in the diagnosis and management of HF. Methods: Data collection of patients with a coded primary care diagnosis of heart failure. Then assignment to a pathway considered appropriate to the severity of HF. The aim was to optimise evidence based management of HF. Results: 407 patients with a diagnosis of heart failure had baseline data collected (50% male, 54% NZ European and 31% Maori). The median age at HF diagnosis was 66.5 years; non-Maori 70 years and Maori 61 years. Only one in three at baseline had a BNP test and/or echo within a year of their diagnosis. From service assessment of 270; 132 (50%) had a clinic review, 14% had HF but no input was required, and 20% did not have a HF diagnosis. 132 reviewed in their local rural clinic (99%
Heart, Lung and Circulation 2011;20S:S1–S13
Abstracts
ABSTRACTS
doi:10.1016/j.hlc.2011.04.028 23
disease care with BP and lipid control both consistently good (70% of diabetics have BP
Improving CVS Outcomes in Aboriginal Primary Health Care
doi:10.1016/j.hlc.2011.04.029
Christine Connors
Waikato Community Heart Failure Service—The First Year
NT Department of Health, Australia The prevalence and mortality of cardiovascular disease amongst Aboriginal Territorians is much higher than Australian rates. Seventy percent of the gap in life expectancy is due to chronic diseases, with cardiovascular disease causing the greatest impact. Over the past 10 years the NT Aboriginal primary health care sector has implemented a population systems approach to screening and management of cardiovascular disease, which has included the development of standard treatment guidelines used across the NT, expanded roles for nurses and Aboriginal health workers, engagement with specialist colleagues, implementation of disease registers and recall systems, development of a shared electronic health record, standardisation of medications, active engagement in quality improvement and collaboration with researchers. Unique features of cardiovascular disease in the NT include: early age of onset, high rates of co-morbidity and high prevalence of risk factors. There have been significant improvements in life expectancy for Aboriginal women (3.4 years from 2000 to 2005) but only limited gains for Aboriginal men (0.6 years). Incidence rates of ischaemic heart disease continue to increase by 3% per annum. Deaths from acute coronary syndrome have reduced by 56% for people in remote areas, although survival post ACS is still lower for Aboriginal Territorians. Clinical audits have shown significant improvements in the delivery of chronic
24
Eileen Gibbons a , Anita Bell a , Veronique Gibbons b , Gerry Devlin a , Raewyn Fisher a , Keith Buswell c , Mark Davis a , Ross Lawrenson b a Waikato b Waikato
District Health Board, New Zealand Clinical School, University of Auckland, New
Zealand c Tekuiti
Medical Practice, New Zealand
Background: A community based Integrated Heart Failure Service was commenced in two rural Waikato pilot sites 2009. The service aim was joint improvement between primary and secondary care, in the diagnosis and management of HF. Methods: Data collection of patients with a coded primary care diagnosis of heart failure. Then assignment to a pathway considered appropriate to the severity of HF. The aim was to optimise evidence based management of HF. Results: 407 patients with a diagnosis of heart failure had baseline data collected (50% male, 54% NZ European and 31% Maori). The median age at HF diagnosis was 66.5 years; non-Maori 70 years and Maori 61 years. Only one in three at baseline had a BNP test and/or echo within a year of their diagnosis. From service assessment of 270; 132 (50%) had a clinic review, 14% had HF but no input was required, and 20% did not have a HF diagnosis. 132 reviewed in their local rural clinic (99%