Improving primary prevention of acute rheumatic fever in Australia: consensus primary care priorities identified through an eDelphi process

Abstract

ObjectivesTo establish the priorities of primary care providers to improve assessment and treatment of skin sores and sore throats among Aboriginal and Torres Strait Islander people at risk of acute rheumatic fever (ARF) and rheumatic heart disease (RHD).DesignModified eDelphi survey, informed by an expert focus group and literature review.SettingPrimary care services in any one of the five Australian states or territories with a high burden of ARF.ParticipantsPeople working in any primary care role within the last 5 years in jurisdiction with a high burden of ARF.ResultsNine people participated in the scoping expert focus group which informed identification of an access framework for subsequent literature review. Fifteen broad concepts, comprising 29 strategies and 63 different actions, were identified on this review. These concepts were presented to participants in a two-round eDelphi survey. Twenty-six participants from five jurisdictions participated, 16/26 (62%) completed both survey rounds. Seven strategies were endorsed as high priorities. Most were demand-side strategies with a focus on engaging communities and individuals in accessible, comprehensive, culturally appropriate primary healthcare. Eight strategies were not endorsed as high priority, all of which were supply-side approaches. Qualitative responses highlighted the importance of a comprehensive primary healthcare approach as standard of care rather than disease-specific strategies related to management of skin sores and sore throat.ConclusionPrimary care staff priorities should inform Australia’s commitments to reduce the burden of RHD. In particular, strategies to support comprehensive Aboriginal and Torres Strait Islander primary care services rather than an exclusive focus on discrete, disease-specific initiatives are needed.

Improving primary care for Aboriginal and Torres Strait Islander people with rheumatic heart disease: What can I do?

“…Similarly, a recent eDelphi study about prevention of ARF revealed that primary care staff wanted greater focus on environmental health and housing, employment of Aboriginal and Torres Strait Islander health professionals and genuine community engagement, but they felt they had limited opportunity to influence these factors from primary care roles. 8 Many of these themes mirror the perspectives of hospital-based healthcare workers in tertiary Aboriginal health services in northern Australia, who have expressed dismay at systems barriers to culturally safe care. 9,10 In the wake of the Four Corners program, this article offers a constructive foundation for reflection by primary care staff and identifies some of the ways that individual practitioners may be able to contribute to better health and healthcare experiences for Aboriginal and Torres Strait Islander people.…”

Nursing practices to optimise rheumatic fever prevention in a high‐risk country: An integrative review

“…Wyber et al. (2022) emphasised the importance of culturally responsive care in RF prevention for indigenous populations, as it encourages engagement and participation in services. However, the Westernised medical model of healthcare in Aotearoa, NZ does not align with Māori and Pacific holistic approaches to health (Office of the Prime Minister’s Chief Science Advisor, 2021).…”

The projections of global and regional rheumatic heart disease burden from 2020 to 2030

“…This situation could be associated with the following facts. First, there is no uniform consensus in Australasia on how to improve the primary prevention of RHD (40). Second, there are disparities in diverse practices among various indigenous populations, restricting their access to healthcare, housing, and education (41)(42)(43)(44).…”