Participants focused on issues closely related to effective and ineffective management of RF/RHD. The lessons learned are indicators for health staff attempting to improve the quality of management that people receive.

Objective: To evaluate the quality of management of Kimberley patients with rheumatic fever (RF) and rheumatic heart disease (RHD). Methods: A retrospective analysis of medical records for 215 residents of the Kimberley region of Western Australia, diagnosed with RF or RHD during the years 1982 to 1996. Results: Among patients prescribed intramuscular penicillin for secondary prophylaxis, 67% of prescribed doses were given, with individuals receiving 8–100% of doses prescribed. Of patients recommended visiting specialist or echocardiographic review, 78% and 64% attended respectively. Only 34% of patients with RHD in 1996 were recommended dental review in 1996 or 1997. Appropriate blood testing occurred in 34% of the months in which people had anticoagulant prescribed. Conclusions: A clinical audit can be used to evaluate the management received by this population and hence identify areas to improve management. We found much room for improvement if optimal clinical outcomes are to be obtained. Disdaimer: The views expressed in this paper do not necessarily reflect the views of the organisations with which the authors are affiliated.

Objective: To describe, from a patient perspective, factors leading to suboptimal management of individuals with rheumatic fever (RF) and rheumatic heart disease (RHD) among members of the Kimberley population.Method: Qualitative in-depth semistructured and repeated interviews of seven Kimberley patients, or parents of children, with rheumatic fever and/or rheumatic heart disease, during 1998. Results: Participants showed variable levels of understanding about RF/RHD, often relating to the need for secondary prophylaxis. Compliance with medication was closely linked with positive patient-staff interactions. From the perspective of health care, living in a remote location was frequently described as a negative influence. Participants desire more accessible and culturally appropriate opportunities for learning about their disease. Conclusions: Participants focused on issues closely related to effective and ineffective management of RF/RHD. The lessons learned are indicators for health staff attempting to improve the quality of management that people receive.