Design, setting and participants: Review of 1165 randomly selected case records of Indigenous Australian adults, aged ≥ 18 years, regularly attending eight health services in diverse settings in New South Wales, Queensland and Central Australia, October 2007 – May 2008.
Results: More than half the people in the sample (53%) were not adequately screened for CVD risk according to national recommendations. Underscreening was significantly associated with younger age, less frequent attendance, and lower uptake of the Medicare Health Assessment. Of the sample, 9% had established CVD, and 29% of those aged ≥ 30 years were classified as high risk according to the 2004 National Heart Foundation of Australia (NHFA) adjusted Framingham equation. Of those with CVD, 40% (95% CI, 30%–50%) were not prescribed a combination of blood pressure (BP) medicines, statins and antiplatelet agents, and 56% (95% CI, 49%–62%) of high-risk individuals without CVD were not prescribed BP medicines and statins. For high-risk individuals not prescribed BP medicines or statins, 74% (95% CI, 64%–84%) and 30% (95% CI, 23%–39%) respectively, did not meet 2004 NHFA criteria for prescribing of these medications, and of those already prescribed BP medicines or statins, 41% (95% CI, 36%–47%) and 59% (95% CI, 52%–66%) did not meet respective guideline targets.
Conclusions: These management gaps are similar to those found in non-Indigenous health care settings, suggesting deficiencies across the health system. Prescribing guidelines which exclude many high-risk individuals contribute to suboptimal management. Guideline reform and improved health service capacity could substantially improve Indigenous vascular health.
- 1. Aboriginal and Torres Strait Islander Social Justice Commissioner and the Steering Committee for Indigenous Health Equality. Close the Gap. National Indigenous health equality targets. Outcomes from the National Indigenous Health Equality Summit. http://www.hreoc.gov.au/social_justice/health/targets/health_targets.pdf (accessed Aug 2009).
- 2. Vos T, Barker B, Stanley L, Lopez AD. The burden of disease and injury in Aboriginal and Torres Strait Islander peoples, 2003. Brisbane: University of Queensland, 2007.
- 3. Australian Institute of Health and Welfare. Expenditures on health for Aboriginal and Torres Strait Islander peoples, 2004–05. Health and welfare expenditure series no. 33. Canberra: AIHW, 2008. (AIHW Cat. No. HWE 40.)
- 4. Kelaher M, Dunt D, Thomas D, Anderson I. Comparison of the uptake of health assessment items for Aboriginal and Torres Strait Islander people and other Australians: implications for policy. Aust New Zealand Health Policy 2005; 2: 21. doi: 10.1186/1743-8462-2-21.
- 5. Cunningham J. Diagnostic and therapeutic procedures among Australian hospital patients identified as Indigenous. Med J Aust 2002; 176: 58-62. <MJA full text>
- 6. Si D, Bailie R, Cunningham J, et al. Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia’s Northern Territory — use of the Chronic Care Model. BMC Health Serv Res 2008; 8: 112.
- 7. Cass A, Lowell A, Christie M, et al. Sharing the true stories: improving communication between Aboriginal patients and healthcare workers. Med J Aust 2002; 176: 466-470. <MJA full text>
- 8. Si D, Bailie R, Connors C, et al. Assessing health care systems for guiding improvement in diabetes care. BMC Health Serv Res 2005; 5: 56. doi: 10.1186/1472-6963-5-56.
- 9. Vale MJ, Jelinek MV, Best JD. How many patients with coronary heart disease are not achieving their risk-factor targets? Experience in Victoria 1996–1998 versus 1999–2000. Med J Aust 2002; 176: 211-215. <MJA full text>
- 10. Jackson R, Lawes C, Bennet D, et al. Treatment with drugs to lower blood pressure and blood cholesterol based on an individual’s absolute cardiovascular risk. Lancet 2005; 365: 434-441.
- 11. Jackson R, Wells S, Rodgers A. Will screening individuals at high risk of cardiovascular events deliver large benefits? Yes. BMJ 2008; 337: a1371. doi: 10.1136/bmj.a1371.
- 12. Australian Government Department of Health and Ageing, National Aboriginal Community Controlled Health Organisation. A national profile of Australian Government funded Aboriginal and Torres Strait Islander primary health care services. Service activity reporting. 2005–06 key results. Canberra: DoHA, 2008.
- 13. Australian Institute of Health and Welfare. Rural, regional and remote health: a guide to remoteness classifications. Rural health series no. 4. Canberra: AIHW, 2004. (AIHW Cat. No. PHE 53.) http://www.aihw.gov.au/publications/index.cfm/title/9993 (accessed Jun 2009).
- 14. Anderson KM, Odell PM, Wilson PW, Kannel WB. Cardiovascular disease profiles. Am Heart J 1991; 121: 293-298.
- 15. Wang Z, Hoy WE. Is the Framingham coronary heart disease absolute risk function applicable to Aboriginal people? Med J Aust 2005; 182: 66-69. <MJA full text>
- 16. National Heart Foundation of Australia. Hypertension management for doctors 2004. Canberra: NHFA, 2003. http://www.heartfoundtion.org.au/SiteCollectionDocuments/hypertension%20management%20guide.pdf (accessed Aug 2009).
- 17. National Aboriginal Community Controlled Health Organisation. National guide to a preventive health assessment in Aboriginal and Torres Strait Islander peoples. Melbourne: Royal Australian College of General Practitioners, 2005.
- 18. Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 6th ed. Melbourne: RACGP, 2005.
- 19. Kidney Health Australia. Chronic kidney disease (CKD) management in general practice. Melbourne: KHA, 2007.
- 20. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. Position statement on lipid management, 2005. Heart Lung Circ 2005; 14: 275-291.
- 21. Australian Government Department of Health and Ageing. PBS-eligibility criteria for lipid lowering drugs fact sheet. Canberra: DoHA, 2006. http://www.health.gov.au/internet/main/publishing.nsf/Content/lipid_eligibilitycriteria.htm (accessed Apr 2009).
- 22. Webster RJ, Heeley EL, Peiris DP, et al. Gaps in cardiovascular disease risk management in Australian general practice. Med J Aust 2009; 191: 324-329.
- 23. Martin DD, Shephard MDS, Freeman H, et al. Point-of-care testing of HbA1c and blood glucose in a remote Aboriginal Australian community. Med J Aust 2005; 182: 524-527. <MJA full text>
- 24. Peiris D, Murray J, Scully D, et al. Cardiovascular risk management at a Maori-led primary health organisation — findings from a cross-sectional audit. N Z Med J 2008; 121: 35-46.
- 25. Reid C, Nelson MR, Shiel L, et al. Australians at risk: management of cardiovascular risk factors in the REACH Registry. Heart Lung Circ 2008; 17: 114-118.
- 26. Chen L, Rogers SL, Colagiuri S, et al. How do the Australian guidelines for lipid-lowering drugs perform in practice? Cardiovascular disease risk in the AusDiab Study, 1999–2000. Med J Aust 2008; 189: 319-322. <MJA full text>
- 27. National Heart Foundation of Australia. National Vascular Disease Prevention Alliance. Guidelines for the assessment of absolute cardiovascular disease risk. Canberra: NHFA, 2009. http://www.heartfoundation.org.au/SiteCollectionDocuments/A_AR_Guidelines_FINAL %20FOR%20WEB.pdf (accessed Jun 2009).
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