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

Burgess, Christopher P., Bailie, Ross S., Connors, Christine M., Chenhall, Richard D., McDermott, Robyn A., O'Dea, Kerin, Gunabarra, Charlie, Matthews, Hellen L. and Esterman, Adrian J. (2011). Early identification and preventive care for elevated cardiovascular disease risk within a remote Australian Aboriginal primary health care service. BMC Health Services Research,11(1):24-34.

Document type: Journal Article
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Title Early identification and preventive care for elevated cardiovascular disease risk within a remote Australian Aboriginal primary health care service
Author Burgess, Christopher P.
Bailie, Ross S.
Connors, Christine M.
Chenhall, Richard D.
McDermott, Robyn A.
O'Dea, Kerin
Gunabarra, Charlie
Matthews, Hellen L.
Esterman, Adrian J.
Journal Name BMC Health Services Research
Publication Date 2011
Volume Number 11
Issue Number 1
ISSN 1472-6963   (check CDU catalogue  open catalogue search in new window)
Start Page 24
End Page 34
Total Pages 11
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
HERDC Category C1 - Journal Article (DIISR)
Abstract Background: Cardiovascular 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.

Methods: Interrupted 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.

Results: Twenty-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.

Conclusions: Holistic 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.
Keywords Cardiovascular disease (CVD)
life expectancy
Indigenous Australians
non-Indigenous Australians
Aboriginal and Torres Strait Islander Adult Health Check (AHC)
remote community
DOI http://dx.doi.org/10.1186/1472-6963-11-24   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)


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Created: Mon, 22 Oct 2012, 17:47:21 CST by Teresa Haendel