Equity of Access to CVD Risk Management Using Electronic Clinical Decision Support in the Coronary Care Unit

Abstract

Background: Cardiovascular (CVD) risk management post myocardial infarction is inconsistently delivered with those who need the most receiving the least -the 'inverse care law.' The Acute PREDICT Initiative is a nurse led computerised decision support system (CDSS), to provide point-of-care guideline-based, patient-specific CVD risk management recommendations to all. Methods: All patients admitted to Middlemore Hospital CCU over 2 years with acute CVD-related events potentially 'eligible' for PREDICT assessment were identified. Age, gender, ethnicity and a small area measure of socioeconomic status (NZDep01) were assessed. Results: 1813/2246 (81%) of people admitted were eligible for a PREDICT assessment. Of those, 973 (54%) received a complete assessment. There were no important differences by quintile of deprivation or ethnicity between the patients receiving PREDICT and the rest. PREDICT assessments were less likely for the elderly (35.7% of N75 years compared with 57.7% of b75 years), for women (47.1% of women and 56.5% of men), and for those who had 5 or more previous admissions. Conclusions: Patients potentially at higher risk because of their ethnic or socioeconomic background received equitable access to in-hospital CVD risk management post MI using PREDICT. However, some other high-risk groups under-utilised the system.

How many individuals must be screened to reduce oral cancer mortality rate in the Western context? A challenge

“…Indeed, OC prevalence rate among lower socioeconomic strata in the UK is double that among higher social classes (Conway et al, 2010). This phenomenon is because of the so-called Inverse Care Law, which states that 'individuals and groups who are in minor need of an intervention benefit more from it than those who are in major need' (Hart, 1971;Tudor Hart, 2000), and this certainly applies to oro-dental healthcare (Petti and Polimeni, 2011) and screening programs (McLachlan et al, 2010;Dryden et al, 2012;Lian et al, 2013). OC awareness, essential to increase the number of participants in screening campaigns (Paudyal et al, 2014), is also affected by socioeconomic status and lifestyle and tends to follow the Inverse Care Law (Tomar and Logan, 2005;Petti and Scully, 2007;Oh et al, 2008).…”

Cardiovascular care research for immigrant or ethnic groups

“…Of note is who represents an ‘immigrant’ or ‘ethnic’ group will vary depending on the country of origin of the research. For example, McLachlan et al 7 revealed that ethnic cardiac patients (i.e. Maori, Pacific, South Asian and other Asian) residing in New Zealand received the same access to a nurse-led risk management programme (PREDICT Initiative) as patients of European/related other descents.…”