Early identification and preventive care for elevated cardiovascular disease risk within a remote Australian Aboriginal primary health care service

Abstract

BackgroundCardiovascular disease (CVD) is the single greatest contributor to the gap in life expectancy between Indigenous and non-Indigenous Australians. Our objective is to determine if holistic CVD risk assessment, introduced as part of the new Aboriginal and Torres Strait Islander Adult Health Check (AHC), results in better identification of elevated CVD risk, improved delivery of preventive care for CVD and improvements in the CVD risk profile for Aboriginal adults in a remote community.MethodsInterrupted time series study over six years in a remote primary health care (PHC) service involving Aboriginal adults identified with elevated CVD risk (N = 64). Several process and outcome measures were audited at 6 monthly intervals for three years prior to the AHC (the intervention) and three years following: (i) the proportion of guideline scheduled CVD preventive care services delivered, (ii) mean CVD medications prescribed and dispensed, (iii) mean PHC consultations, (iv) changes in participants' CVD risk factors and estimated absolute CVD risk and (v) mean number of CVD events and iatrogenic events.ResultsTwenty-five percent of AHC participants were identified as having elevated CVD risk. Of these, 84% had not been previously identified during routine care. Following the intervention, there were significant improvements in the recorded delivery of preventive care services for CVD (30% to 53%), and prescription of CVD related medications (28% to 89%) (P < 0.001). Amongst participants there was a 20% relative reduction in estimated absolute CVD risk (P = 0.004) following the intervention. However, there were no significant changes in the mean number of PHC consultations or mean number of CVD events or iatrogenic events.ConclusionsHolistic CVD risk assessment during an AHC can lead to better and earlier identification of elevated CVD risk, improvement in the recorded delivery of preventive care services for CVD, intensification of treatment for CVD, and improvements in participants' CVD risk profile. Further research is required on strategies to reorient and restructure PHC services to the care of chronic illness for Aboriginal peoples in remote areas for there to be substantial progress in decreasing excess CVD related mortality.

Cardiovascular disease risk in young Indigenous Australians: a snapshot of current preventive health care

“…Lack of follow‐up may relate to the use of case‐finding rather than participation in screening programs that ensure systematic follow‐up of abnormal findings. Comprehensive cardiovascular risk assessment during a dedicated Adult Health Check has been found to be an effective way to increase early identification of elevated cardiovascular risk and improve provision of preventive care services in Indigenous adults 38,39 . This may offer an opportunity to increase preventive health care provision and improve follow‐up without imposing on acute care.…”

All-cause mortality following low-dose aspirin treatment for patients with high cardiovascular risk in remote Australian Aboriginal communities: an observational study

“…Furthermore, our results were based on intention-to-treat analysis and we did not account for adherence to medications. MSM used data on start date and finish date of prescription, but there were no data on compliance, which has been reported to be low in remote Aboriginal communities (non-adherence rate for a general medication after prescription was up to 33%) 44. Finally, as the mean follow-up period in our study was <5 years, we were unable to assess the contribution of cancer to the reduced mortality observed 42…”

Computerised Aboriginal and Torres Strait Islander health assessments in primary health care research

“…113 Outside of the IIHS, this search yielded only two studies, both in the same remote Northern Territory Australian Aboriginal community. 214,215 One study used HA data to respond to a traditional land-owner's request for an investigation of links between "caring for country" and health. 214 In this study, caring for country was defined as "Indigenous participation in interrelated activities with the objective of promoting ecological and human health".…”

“…One year after the HA, participants were found to have improvements in cardiovascular risk detection and management, which the authors attributed to the HA as an intervention. 215 These benefits of HAs are based on a historical rather than a parallel control group, so these findings need to be treated with some caution as there may have been a cohort effect operating in the community to improve cardiovascular risk management. 215 I was unable to find any other research papers based on HA data either in Australia or internationally for Indigenous peoples.…”

“…215 These benefits of HAs are based on a historical rather than a parallel control group, so these findings need to be treated with some caution as there may have been a cohort effect operating in the community to improve cardiovascular risk management. 215 I was unable to find any other research papers based on HA data either in Australia or internationally for Indigenous peoples. However, HA data have been used in large research projects in a number of countries including the United Kingdom 217 Islander peoples to find out what future relevant health research will be needed by the health sector.…”