- Email: [email protected]
Towards Better Outcomes in Indigenous Cardiovascular Health: Directions from the First and Second Indigenous Cardiovascular Health Care Conferences
EDITORIAL
Editorial
Towards Better Outcomes in Indigenous Cardiovascular Health: Directions from the First and Second Indigenous Cardiovascular Health Care Conferences Richmond Jeremy and James Cameron ∗ Prince Charles Hospital, St. Andrews Hospital, 82 Wynnum Road, Norman Park, Qld. 4170, Australia
T
he Cardiac Society of Australia and New Zealand (CSANZ), in recognition of the tremendous gap in life expectancy between Indigenous and non-Indigenous people in Australia and New Zealand, made a decision some years ago to become actively involved in promoting improvements in Indigenous cardiovascular health. This initiative culminated in the first Indigenous Cardiovascular Health Conference held in Sydney in August 2009 subsequent to the CSANZ Annual Scientific Meeting. The success of this meeting prompted organisation of a second Indigenous cardiovascular health meeting held in Alice Springs in June 2011. Both meetings were notable for a wide-ranging involvement from many in the field of Indigenous cardiovascular health, including researchers, physicians, nurses, and other allied health care workers. The conferences focused on recognition of problems and views to progress solutions. A series of articles summarising the first meeting were subsequently published in Heart, Lung and Circulation and the results of the second conference are now the subject of further publication in Heart, Lung and Circulation. The paper by Brown and Kritharides provides an overview of the second meeting, its aims, outcomes and recommendations. The standard of presentations, abstracts and papers was high and provided a comprehensive review of relevant issues. Several consistent themes emerged from papers which were presented with some of these including: 1. Persisting disparities in outcome for Indigenous patients with heart attack and stroke (Anderson, Wade). 2. Awareness of higher Indigenous primary and secondary risk with development of risk prediction models in primary care (Riddell). 3. Need for better access to primary care with specialist input through outreach programs; better access to medicines; better access to secondary preven-
Available online 25 August 2012 ∗
Corresponding author. E-mail address: [email protected] (J. Cameron).
tion and rehabilitation (Buchanan, Parore, Dimer), including systems for recognition of access/priority (Clark, ARIA). 4. Integration of the Indigenous health team into acute care providing liaison between the primary referrer and secondary/tertiary pathways (Bolton, Page). 5. Importance of cultural awareness and inclusion of cultural competence in healthcare education (Jansen). Key components of the second Indigenous Cardiovascular Health Care Conference included both plenary sessions and workshops which covered areas of: 1. Building an Aboriginal Health workforce; 2. Improving chronic care and risk management in cardiovascular disease with a particular focus on primary care; 3. Reducing the burden of rheumatic heart disease; 4. Reducing disparities in hospital care for Indigenous people; Several recommendations from these workshops have now been taken forward as initiatives by the Society including: 1. Continuing focus on ongoing educational forums on Indigenous cardiovascular health with plans to have a further Indigenous cardiovascular health care meeting as a stream within the upcoming World Congress of Cardiology meeting in Melbourne in 2014. 2. Support for research by a restructure of the CSANZ Indigenous cardiovascular scholarship program with the creation of an annual scholarship worth $70,000 to support Indigenous health care workers wishing to undertake a research project in the Indigenous cardiovascular health area. A scholarship has been awarded for the current financial year and for the next financial year, with recipients being Ray Mahoney from QUT in Queensland, who is exploring methods to better identify Indigenous people in relation to health care events such as hospitalisation, and the second recipient Roy Hoerara, Massey University, Wellington, New Zealand, whose project “One Heart, Many Lives – a compara-
© 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2012.07.002
614 EDITORIAL
3.
4.
5.
6.
Jeremy and Cameron Towards Better Outcomes in Indigenous Cardiovascular Health
Heart, Lung and Circulation 2012;21:613–614
tive discourse into cardiovascular disease in Indigenous men” seeks to use a family-centred approach to identify attitudes and risks that confront Indigenous men with cardiovascular disease, with a further aim to locate culturally appropriate solutions which might contribute to better health and well-being of Indigenous men. Applications will be sought for the next scholarship for the 2013–14 year at the end of this year. Development of an online web-based teaching program for Indigenous cardiovascular health in partnership with the RACP, supported by a grant award from the Rural Health CPD program. This project will provide an important education resource for our advanced trainees, practicing Fellows, other Fellows of the RACP and other healthcare workers. Identification of Indigenous people in the upcoming National Procedures Registry, providing a measure of outcomes for procedures for Indigenous people in Australia and New Zealand. Developing a set of essential minimal standards for Indigenous cardiovascular care for Australia in metropolitan, regional and rural areas through involvement in “Essence” (Essential Service Standards for Equitable Cardiovascular Care for Aboriginal and Torres Strait Islanders), a joint collaborative project with Baker IDI, DOHA, CSANZ and other stakeholders. Developing a Registry to document outcomes of Indigenous patients who undergo valve surgical therapies for rheumatic valve disease, in a joint initiative with CSANZ, the Australian and New Zealand Society of Cardiothoracic Surgeons, and Monash Department of Epidemiology. This project hopes to build on existing data from the National Surgical Database, with a view to prospectively documenting outcomes at 30 days and 12 months for patients undergoing rheumatic heart
valve surgery. Information from this Registry is hoped to provide guidance to improve long term outcomes for this surgical cohort. 7. Comprehensive assessment of current specialist outreach services in regional and rural Australia, with particular regard to delivery of care to Indigenous patients. At the beginning of the year we conducted a survey, which identified both practitioners involved in Indigenous cardiovascular care, and also importantly, those who were not involved but might be interested in contributing. CSANZ has had feedback from our members involved in Indigenous cardiovascular health care indicating that the Cardiac Society of Australia and New Zealand, although not a direct healthcare provider, does have a key role in supporting training, education, research, along with advocacy in approaches to Government, state fund-holders, cardiac networks, other providers, stakeholders such as the ARIA project and the National Heart, and interest groups to promote improvements in care. Finally, we believe the CSANZ does have a role in recognising inequities in service and hopes to work with primary healthcare providers, state network fund-holders and private members, through advocacy, assistance in development of appropriate guidelines and clinical pathways, support for provision of capital equipment, support and expansion of networks of allied health workers, and particularly Indigenous health workers. The two conferences on Indigenous cardiovascular health have proven to be an important platform for progression of the Society’s involvement. Our hope is that this issue takes on more importance for the wider cardiology community, and in fact, activates our members to become involved as this will be essential in the next stage of progressing these issues.
Editorial
Towards Better Outcomes in Indigenous Cardiovascular Health: Directions from the First and Second Indigenous Cardiovascular Health Care Conferences Richmond Jeremy and James Cameron ∗ Prince Charles Hospital, St. Andrews Hospital, 82 Wynnum Road, Norman Park, Qld. 4170, Australia
T
he Cardiac Society of Australia and New Zealand (CSANZ), in recognition of the tremendous gap in life expectancy between Indigenous and non-Indigenous people in Australia and New Zealand, made a decision some years ago to become actively involved in promoting improvements in Indigenous cardiovascular health. This initiative culminated in the first Indigenous Cardiovascular Health Conference held in Sydney in August 2009 subsequent to the CSANZ Annual Scientific Meeting. The success of this meeting prompted organisation of a second Indigenous cardiovascular health meeting held in Alice Springs in June 2011. Both meetings were notable for a wide-ranging involvement from many in the field of Indigenous cardiovascular health, including researchers, physicians, nurses, and other allied health care workers. The conferences focused on recognition of problems and views to progress solutions. A series of articles summarising the first meeting were subsequently published in Heart, Lung and Circulation and the results of the second conference are now the subject of further publication in Heart, Lung and Circulation. The paper by Brown and Kritharides provides an overview of the second meeting, its aims, outcomes and recommendations. The standard of presentations, abstracts and papers was high and provided a comprehensive review of relevant issues. Several consistent themes emerged from papers which were presented with some of these including: 1. Persisting disparities in outcome for Indigenous patients with heart attack and stroke (Anderson, Wade). 2. Awareness of higher Indigenous primary and secondary risk with development of risk prediction models in primary care (Riddell). 3. Need for better access to primary care with specialist input through outreach programs; better access to medicines; better access to secondary preven-
Available online 25 August 2012 ∗
Corresponding author. E-mail address: [email protected] (J. Cameron).
tion and rehabilitation (Buchanan, Parore, Dimer), including systems for recognition of access/priority (Clark, ARIA). 4. Integration of the Indigenous health team into acute care providing liaison between the primary referrer and secondary/tertiary pathways (Bolton, Page). 5. Importance of cultural awareness and inclusion of cultural competence in healthcare education (Jansen). Key components of the second Indigenous Cardiovascular Health Care Conference included both plenary sessions and workshops which covered areas of: 1. Building an Aboriginal Health workforce; 2. Improving chronic care and risk management in cardiovascular disease with a particular focus on primary care; 3. Reducing the burden of rheumatic heart disease; 4. Reducing disparities in hospital care for Indigenous people; Several recommendations from these workshops have now been taken forward as initiatives by the Society including: 1. Continuing focus on ongoing educational forums on Indigenous cardiovascular health with plans to have a further Indigenous cardiovascular health care meeting as a stream within the upcoming World Congress of Cardiology meeting in Melbourne in 2014. 2. Support for research by a restructure of the CSANZ Indigenous cardiovascular scholarship program with the creation of an annual scholarship worth $70,000 to support Indigenous health care workers wishing to undertake a research project in the Indigenous cardiovascular health area. A scholarship has been awarded for the current financial year and for the next financial year, with recipients being Ray Mahoney from QUT in Queensland, who is exploring methods to better identify Indigenous people in relation to health care events such as hospitalisation, and the second recipient Roy Hoerara, Massey University, Wellington, New Zealand, whose project “One Heart, Many Lives – a compara-
© 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2012.07.002
614 EDITORIAL
3.
4.
5.
6.
Jeremy and Cameron Towards Better Outcomes in Indigenous Cardiovascular Health
Heart, Lung and Circulation 2012;21:613–614
tive discourse into cardiovascular disease in Indigenous men” seeks to use a family-centred approach to identify attitudes and risks that confront Indigenous men with cardiovascular disease, with a further aim to locate culturally appropriate solutions which might contribute to better health and well-being of Indigenous men. Applications will be sought for the next scholarship for the 2013–14 year at the end of this year. Development of an online web-based teaching program for Indigenous cardiovascular health in partnership with the RACP, supported by a grant award from the Rural Health CPD program. This project will provide an important education resource for our advanced trainees, practicing Fellows, other Fellows of the RACP and other healthcare workers. Identification of Indigenous people in the upcoming National Procedures Registry, providing a measure of outcomes for procedures for Indigenous people in Australia and New Zealand. Developing a set of essential minimal standards for Indigenous cardiovascular care for Australia in metropolitan, regional and rural areas through involvement in “Essence” (Essential Service Standards for Equitable Cardiovascular Care for Aboriginal and Torres Strait Islanders), a joint collaborative project with Baker IDI, DOHA, CSANZ and other stakeholders. Developing a Registry to document outcomes of Indigenous patients who undergo valve surgical therapies for rheumatic valve disease, in a joint initiative with CSANZ, the Australian and New Zealand Society of Cardiothoracic Surgeons, and Monash Department of Epidemiology. This project hopes to build on existing data from the National Surgical Database, with a view to prospectively documenting outcomes at 30 days and 12 months for patients undergoing rheumatic heart
valve surgery. Information from this Registry is hoped to provide guidance to improve long term outcomes for this surgical cohort. 7. Comprehensive assessment of current specialist outreach services in regional and rural Australia, with particular regard to delivery of care to Indigenous patients. At the beginning of the year we conducted a survey, which identified both practitioners involved in Indigenous cardiovascular care, and also importantly, those who were not involved but might be interested in contributing. CSANZ has had feedback from our members involved in Indigenous cardiovascular health care indicating that the Cardiac Society of Australia and New Zealand, although not a direct healthcare provider, does have a key role in supporting training, education, research, along with advocacy in approaches to Government, state fund-holders, cardiac networks, other providers, stakeholders such as the ARIA project and the National Heart, and interest groups to promote improvements in care. Finally, we believe the CSANZ does have a role in recognising inequities in service and hopes to work with primary healthcare providers, state network fund-holders and private members, through advocacy, assistance in development of appropriate guidelines and clinical pathways, support for provision of capital equipment, support and expansion of networks of allied health workers, and particularly Indigenous health workers. The two conferences on Indigenous cardiovascular health have proven to be an important platform for progression of the Society’s involvement. Our hope is that this issue takes on more importance for the wider cardiology community, and in fact, activates our members to become involved as this will be essential in the next stage of progressing these issues.