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IMPROVING the cardiovascular care of Aboriginal and Torres Strait Islander Australians should be “target number one” in efforts to close the life-expectancy gap between Indigenous and non-Indigenous Australians, says a leading Aboriginal health researcher.
Professor Alex Brown, Aboriginal research program leader at the South Australian Health and Medical Research Institute, said cardiovascular conditions accounted for one third of the life-expectancy gap.
“If we’re serious about making a difference in life-expectancy differentials for Aboriginal and Torres Strait Islander Australians, cardiovascular disease has to be high on our list of priorities and we need a coordinated approach”, said Professor Brown, who is a coauthor of a National Heart Foundation consensus statement on acute coronary syndromes (ACS), published in the MJA. (1)
The statement outlines a generic patient-centred pathway of care to improve management of ACS in Indigenous Australians, who have more than twice the rate of death from coronary heart disease than non-Indigenous Australians.
“Every Indigenous ACS patient, regardless of where they live, should be able to expect a coordinated, patient-centred pathway of care provided by designated provider clinical networks and supported by Indigenous cardiac coordinators, Aboriginal liaison officers and health workers”, the authors wrote.
The pathway would span the continuum of care from the provision of culturally appropriate information on the warning signs of ACS and individualised inpatient care plans to follow-up care plans and secondary prevention programs.
Brisbane cardiologist Dr Arnold Ng welcomed the framework as providing effective and flexible solutions to the many barriers faced in the treatment and management of ACS in Indigenous patients.
“This framework gives you a very broad overview of the different problems that are being faced by Indigenous clinics. What’s very important is that not all Indigenous clinics will face exactly the same problems. You can take [elements from this framework] and apply them to your own individual clinic”, said Dr Ng, from Princess Alexandra Hospital, one of seven hospitals either signed up or negotiating to become a Lighthouse Hospital.
Lighthouse Hospitals, an initiative of the Australian Heart Foundation, are charged with implementing and auditing measures to improve ACS management in Indigenous patients.
Dr Ng said that since adopting strategies similar to those outlined in the framework, as part of the Lighthouse Hospital initiative, there had been significant improvements in care at the hospital’s three Indigenous health clinics.
“Ever since we started this project about 4 years ago, our clinic attendance has increased from about 70% to consistently 90% or higher. We have seen increased use of evidence-based medications such as ACE [angiotensin-converting enzyme] inhibitors and beta blockers in patients with ACS and better blood pressure control. We are getting more patients coming to see us with chest pains and we are also referring more patients to endocrinology clinics for the management of diabetes”, he said.
Dr Ng said providing culturally appropriate messages and staff consistency was also paramount in improving ACS management in Indigenous patients.
“One of the main things [among Indigenous patients] is fear and mistrust — and having that one constant, that one person or persons they can trust, definitely helps in not just their acute management here in hospital, but also in terms of follow-up and clinic attendance.”
The consensus statement authors said while avenues for collection of uptake and outcomes data were in place, the lack of any current data should not delay the establishment of networks.
Professor Brown said there was a need to improve the identification of Aboriginal and Torres Strait Islander people and for a national approach to monitoring outcomes.
“The requirement for monitoring outcomes as a way of understanding how system reform is delivering outcomes for Aboriginal people is an absolute priority”, he said.
Professor Brown said the approaches in the consensus statement had been drawn from pockets of expertise and best practice across Australia and the challenge now was in implementing the strategies.
”This has always been the challenge — where does the rubber hit the road?”
The main issue in Rural and Remote Indigenous Health is the provision of preventative strategies. If appropriate workforce solutions were in place and Primary care was adequate this would go a longway.This is not the case currently for various reasons ( which are well recognised but often not enacted ) in a lot of Rural and Remote areas. The old saying “Shutting the stable door after the horse has bolted” springs to mind. Certainly where workforce solutions are provided the vast majority of care for NIDDM and other chronic diseases can be provided at the Local Clinic level via Primary Care providers. Combined with consistent and appropriately frequent Specialist visits to Clinics this is the appropriate Model. There are no reasons why this shouldn’t apply in the Urban setting as well with appropriately funded and staffed Aboriginal Health Clinics in the Community and visiting Specialists.