Lessons from a West Australian statewide assessment of the implementation of the NHMRC recommendations for strengthening cardiac rehabilitation and secondary prevention of aboriginal and Torres Strait Islander people

Abstract

Abstract:Introduction: In 2005, NHMRC published an outline of processes to guide services on improving cardiac rehabilitation (CR) for Indigenous Australians. This recognised the increased incidence and mortality from cardiovascular causes in Indigenous Australians with onset occurring at a younger age then in other Australians Methods: Site visits and interviews with CR staff in 15 mainstream CR/secondary prevention services (hospitals plus community health) across WA and 9 Aboriginal Community Controlled Health Services. Qualitative and quantitative data regarding CR provision to Indigenous people with CVD, involvement of Aboriginal Health workers, adaptation to local settings, cultural competency and interagency collaboration was collected by a CR nurse (+/-an Aboriginal nurse) using semistructured interviews. Results: Within tertiary hospitals the processes for identifying Indigenous patients were suboptimal, there were few Indigenous staff and processes for linking Indigenous patients into CR services at discharge were suboptimal. Many CR services are private and others operate for very limited hours and see very few Aboriginal clients. Of public CR services, many were unaware of the NHMRC guidelines and no mainstream service had fully implemented its recommendations. Workforce turnover and capacity issues severely constrain efforts to improve CR service delivery. Conclusions: Substantial deficits were identified in linking Aboriginal people post cardiac event into CR services that offer a comprehensive approach to reduce subsequent cardiac events and hospitalisation. Alternative approaches are needed. We recommend further development of CR partnerships between Aboriginal and mainstream services. Programs with a focus on cardiovascular risk reduction should be an important component of the government focus on improving self-management and strengthening community based care for chronic disease

Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review

“…Efforts to link a patient to primary care and rural CR after discharge from a specialist (often metropolitan) facility following an acute event are important in uptake, and they include the medical team stressing the importance of CR and arranging the initial referral/appointment [59]. The critical need for improvements in communication around discharge, better integration with primary care, and attention to the special needs of vulnerable populations has been well described [60,61].…”

“…Nurses are a key component of the health workforce, and particularly so in more remote areas, and they have an important role in many aspects of prevention and management of CVD [94][95][96][97][98]. Pharmacists, allied health professionals, and Indigenous health professionals also make important contributions, including to systems change to better support the needs of patients [32,42,61,[99][100][101].…”

Improving cardiovascular outcomes among Aboriginal Australians: Lessons from research for primary care

“…These interviews were audio-recorded and transcribed and their results were reported. [27][28][29][30][31][32][33][34] Input from Aboriginal consumers through formal interviews was a critical part of our commitment to ensuring research is relevant, contributes to improved practice and positively impacts on health outcomes through actions that address health disparities. Primary care providers interviewed were those with extensive experience in and commitment to improving Aboriginal health.…”