Prevention of cardiovascular disease in rural Australian primary care: an exploratory study of the perspectives of clinicians and high-risk men

Abstract

Abstract. Rural primary care services have the potential to play a major role in reducing the gap in cardiovascular disease (CVD) outcomes between rural and metropolitan Australians, particularly in men at high risk of CVD. The aim of this study was to explore the self-reported behaviours and satisfaction with their general practice/practitioner of men at high risk of CVD, and attitudes of rural primary care clinicians regarding the role of primary care in CVD prevention. This observational research was addressed through survey questionnaires with rural men at high risk of CVD and semi-structured interviews with rural primary care clinicians. Fourteen rural primary care practices from towns with populations less than 25 000 participated. One hundred and fifty-eight high-risk men completed the questionnaire. Their responses demonstrated poorly controlled risk factors despite a willingness to change. Alternatively, rural primary care clinicians (n = 20) reported that patients were unlikely to change and that illness-based funding models inhibited cardiovascular preventive activities. Australians living in rural areas have worse CVD outcomes. In addition, there is a disparity in the assumptions of health providers and male patients at high risk of CVD in rural areas. This necessitates innovative rural primary care models that include a blended payment system that incentivises or funds preventive care alongside an emphasis on lifestyle advice, as well as an explicit strategy to influence clinician and patient behaviour to help address the disparity.Additional keywords: health policy, health services research, primary health care, primary prevention, rural health.

Association between received treatment elements and satisfaction with care for patients with knee osteoarthritis seen in general practice in Denmark

“…However, findings from this study contradict GP beliefs about patients generally getting irritated when advised on lifestyle [ 16 , 22 ]. GP beliefs were similarly demonstrated as incorrect in a study of patients presenting in general practice with a high risk of cardiovascular disease in Australia [ 28 , 29 ]. While the patients reported a willingness to change their lifestyle, GPs did not assume so and therefore withheld providing lifestyle advice [ 28 ].…”

“…GP beliefs were similarly demonstrated as incorrect in a study of patients presenting in general practice with a high risk of cardiovascular disease in Australia [ 28 , 29 ]. While the patients reported a willingness to change their lifestyle, GPs did not assume so and therefore withheld providing lifestyle advice [ 28 ]. Our findings indicated that this could very well be the same for GPs treating patients with knee OA in Denmark.…”

A qualitative analysis of the barriers and enablers faced by Australian rural general practitioners in the non-pharmacological management of congestive heart failure in community dwelling patients

“…Within the Environmental Context and Resources domain, geography, distance from rural practices, and long referral wait-times were identified as potential barriers [ 23 , 35 , 38 – 40 ]. This was further complicated by a lack of key resources, including consultation time, community-based rehabilitation facilities, low cost or subsidised treatments, end-of-life care, and an adequately trained workforce [ 2 , 23 , 27 – 30 , 35 , 38 ].…”

“…Within the Environmental Context and Resources domain, geography, distance from rural practices, and long referral wait-times were identified as potential barriers [ 23 , 35 , 38 – 40 ]. This was further complicated by a lack of key resources, including consultation time, community-based rehabilitation facilities, low cost or subsidised treatments, end-of-life care, and an adequately trained workforce [ 2 , 23 , 27 – 30 , 35 , 38 ]. Low socioeconomic status (SES) was identified as a barrier to patient engagement with health services and adherence to management, while those with family support demonstrated better self-management [ 41 , 42 ].…”

“…Despite extensive literature on the barriers and enablers of CHF management, much of it focuses explicitly on pharmacological management, with scarce literature available on non-pharmacological management. In addition, while the experiences of both international and Australian GPs who manage patients with CHF in urban environments have been widely represented, the experience of rural GPs remains largely unknown [ 1 , 22 – 31 , 34 , 35 , 37 , 38 , 44 ]. Australian rural GPs are distinct on both an international (Australia versus other developed countries) and domestic (rural versus metropolitan) level, given Australia’s unique geography and healthcare system.…”