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Waikato Community Heart Failure Service—The First Year
Heart, Lung and Circulation 2012;21:648–660
657 ABSTRACTS
Abstracts
DOI of original abstract: http://dx.doi.org/10.1016/j.hlc.2011.04.028 DOI of this abstract: http://dx.doi.org/10.1016/j.hlc.2012.07.041
23 Improving CVS Outcomes in Aboriginal Primary Health Care Christine Connors 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 deliv-
ery of chronic disease care with BP and lipid control both consistently good (70% of diabetics have BP DOI of original abstract: http://dx.doi.org/10.1016/j.hlc.2011.04.029 DOI of this abstract: http://dx.doi.org/10.1016/j.hlc.2012.07.042
24 Waikato Community Heart Failure Service—The First Year 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% attendance rate); 98% had an echo performed within a week prior to their
658
Heart, Lung and Circulation 2012;21:648–660
Abstracts
ABSTRACTS
review (65% of whom had not had a previous echo), and two thirds had their medication optimised. Conclusion: This service has improved diagnosis and management of heart failure in the community. DOI of original abstract: http://dx.doi.org/10.1016/j.hlc.2011.04.030 DOI of this abstract: http://dx.doi.org/10.1016/j.hlc.2012.07.043
25 Improving Prevention and Management of Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD)—Yirrkala’s Story Terence Guyula a , Ana Malupo a , Marea Fittock b a Yirrkala Health Centre – Northern Territory Department of Health, Australia b Northern Territory Coordinator RHD Program, Australia
Objective: RHD remains an important cause of illness and premature death among Aboriginal people. A project was implemented to develop and trial a structured systems approach to improving prevention and management of ARF and RHD. Administrative processes and systems were embedded resulting in improved health outcomes for RHD patients. Methods: A continuous quality improvement (CQI) approach, including an audit of clinical records using a tool that is based on national guidelines was used. Health service staff used audit and systems assessment data to assess quality of care, and develop goals and strategies for improving quality of care for ARF/RHD. Results: Annual audits were conducted over three years. Key results show that 60% of RHD patients identified as requiring regular benzathine penicillin injections had received 80% coverage over 12 months in year 3. An increase of 58% was achieved over three years. Eightyseven percent had received an echocardiogram within the last three years and 93% and 33%, respectively, had a record of review by a doctor and had received dental care within two years. Comparative to other health services in the project, Yirrkala achieved substantially higher levels of performance on several RHD care indicators. Conclusion: Improving the quality of care for prevention and management of ARF/RHD has potential benefits in Indigenous communities. A systematic CQI approach contributes to wider understanding and application of CQI methods in primary care. DOI of original abstract: http://dx.doi.org/10.1016/j.hlc.2011.04.031 DOI of this abstract: http://dx.doi.org/10.1016/j.hlc.2012.07.044
26 Factors Associated with Discharge Against Medical Advice within Year of First-Ever IHD Hospital Admissions in Aboriginal and Non-Aboriginal Western Australians Judith Katzenellenbogen a , Frank Sanfilippo b , Tom Briffa b , Michael Hobbs b , Matthew Knuiman b , Lyn c d Dimer , Kate Taylor , Sandra Thompson d a Combined Universities Centre for Rural Health, University of
Western Australia, Australia b School of Population Health, University of Western Australia, Australia c Heart Foundation, WA, Australia d Combined Universities Centre for Rural Health, Australia Background: While discharges against medical advice (DAMA) are relatively rare, they are over-represented in Aboriginal patients and some diagnoses, and are associated with poorer health outcomes. Objective: To investigate factors related to DAMA within one year of first-ever admission for ischaemic heart disease (IHD) in Western Australia. Methods: First-ever IHD hospital admissions with subsequent re-admissions within one year were identified from a person-based dataset of linked hospital and mortality records. The outcome was DAMA within one year. Logistic regression models investigated which demographic, co-morbidity, index-admission and readmissionrelated variables were independently associated with increased risk of DAMA. We assessed both combined and separate models for Aboriginal and non-Aboriginal patients. Results: Aboriginal cases comprised 6.4% of 11,834 readmitted patients. Of 130 DAMA events, 55 (42%) were in Aboriginal patients. Principal diagnosis at DAMA admission was CVD in 36% of non-Aboriginal and 24% of Aboriginal patients. After adjustment, Aboriginality imparted an excess DAMA risk of 2.5 (95% CI 1.5–4.1) – unadjusted odds ratio = 11.4. DAMA risk was increased with younger age, co-morbidity and readmission to non-metropolitan hospital but decreased in those living in non-metropolitan areas. The strongest association was with a history of alcohol (OR = 2.6) and dual psychiatric-alcohol (OR = 6.0) admissions. Stratification by Aboriginality revealed some differences in risk factors for DAMA. Conclusions: Aboriginal patients are at high risk of DAMA after their first-ever IHD admission. Many factors influence the decision to DAMA and health service managers need specific strategies, which address the cultural, treatment and out-of-hospital factors to reduce DAMA and its associated risks. DOI of original abstract: http://dx.doi.org/10.1016/j.hlc.2011.04.032 DOI of this abstract: http://dx.doi.org/10.1016/j.hlc.2012.07.045
657 ABSTRACTS
Abstracts
DOI of original abstract: http://dx.doi.org/10.1016/j.hlc.2011.04.028 DOI of this abstract: http://dx.doi.org/10.1016/j.hlc.2012.07.041
23 Improving CVS Outcomes in Aboriginal Primary Health Care Christine Connors 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 deliv-
ery of chronic disease care with BP and lipid control both consistently good (70% of diabetics have BP DOI of original abstract: http://dx.doi.org/10.1016/j.hlc.2011.04.029 DOI of this abstract: http://dx.doi.org/10.1016/j.hlc.2012.07.042
24 Waikato Community Heart Failure Service—The First Year 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% attendance rate); 98% had an echo performed within a week prior to their
658
Heart, Lung and Circulation 2012;21:648–660
Abstracts
ABSTRACTS
review (65% of whom had not had a previous echo), and two thirds had their medication optimised. Conclusion: This service has improved diagnosis and management of heart failure in the community. DOI of original abstract: http://dx.doi.org/10.1016/j.hlc.2011.04.030 DOI of this abstract: http://dx.doi.org/10.1016/j.hlc.2012.07.043
25 Improving Prevention and Management of Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD)—Yirrkala’s Story Terence Guyula a , Ana Malupo a , Marea Fittock b a Yirrkala Health Centre – Northern Territory Department of Health, Australia b Northern Territory Coordinator RHD Program, Australia
Objective: RHD remains an important cause of illness and premature death among Aboriginal people. A project was implemented to develop and trial a structured systems approach to improving prevention and management of ARF and RHD. Administrative processes and systems were embedded resulting in improved health outcomes for RHD patients. Methods: A continuous quality improvement (CQI) approach, including an audit of clinical records using a tool that is based on national guidelines was used. Health service staff used audit and systems assessment data to assess quality of care, and develop goals and strategies for improving quality of care for ARF/RHD. Results: Annual audits were conducted over three years. Key results show that 60% of RHD patients identified as requiring regular benzathine penicillin injections had received 80% coverage over 12 months in year 3. An increase of 58% was achieved over three years. Eightyseven percent had received an echocardiogram within the last three years and 93% and 33%, respectively, had a record of review by a doctor and had received dental care within two years. Comparative to other health services in the project, Yirrkala achieved substantially higher levels of performance on several RHD care indicators. Conclusion: Improving the quality of care for prevention and management of ARF/RHD has potential benefits in Indigenous communities. A systematic CQI approach contributes to wider understanding and application of CQI methods in primary care. DOI of original abstract: http://dx.doi.org/10.1016/j.hlc.2011.04.031 DOI of this abstract: http://dx.doi.org/10.1016/j.hlc.2012.07.044
26 Factors Associated with Discharge Against Medical Advice within Year of First-Ever IHD Hospital Admissions in Aboriginal and Non-Aboriginal Western Australians Judith Katzenellenbogen a , Frank Sanfilippo b , Tom Briffa b , Michael Hobbs b , Matthew Knuiman b , Lyn c d Dimer , Kate Taylor , Sandra Thompson d a Combined Universities Centre for Rural Health, University of
Western Australia, Australia b School of Population Health, University of Western Australia, Australia c Heart Foundation, WA, Australia d Combined Universities Centre for Rural Health, Australia Background: While discharges against medical advice (DAMA) are relatively rare, they are over-represented in Aboriginal patients and some diagnoses, and are associated with poorer health outcomes. Objective: To investigate factors related to DAMA within one year of first-ever admission for ischaemic heart disease (IHD) in Western Australia. Methods: First-ever IHD hospital admissions with subsequent re-admissions within one year were identified from a person-based dataset of linked hospital and mortality records. The outcome was DAMA within one year. Logistic regression models investigated which demographic, co-morbidity, index-admission and readmissionrelated variables were independently associated with increased risk of DAMA. We assessed both combined and separate models for Aboriginal and non-Aboriginal patients. Results: Aboriginal cases comprised 6.4% of 11,834 readmitted patients. Of 130 DAMA events, 55 (42%) were in Aboriginal patients. Principal diagnosis at DAMA admission was CVD in 36% of non-Aboriginal and 24% of Aboriginal patients. After adjustment, Aboriginality imparted an excess DAMA risk of 2.5 (95% CI 1.5–4.1) – unadjusted odds ratio = 11.4. DAMA risk was increased with younger age, co-morbidity and readmission to non-metropolitan hospital but decreased in those living in non-metropolitan areas. The strongest association was with a history of alcohol (OR = 2.6) and dual psychiatric-alcohol (OR = 6.0) admissions. Stratification by Aboriginality revealed some differences in risk factors for DAMA. Conclusions: Aboriginal patients are at high risk of DAMA after their first-ever IHD admission. Many factors influence the decision to DAMA and health service managers need specific strategies, which address the cultural, treatment and out-of-hospital factors to reduce DAMA and its associated risks. DOI of original abstract: http://dx.doi.org/10.1016/j.hlc.2011.04.032 DOI of this abstract: http://dx.doi.org/10.1016/j.hlc.2012.07.045