Identifying culturally appropriate strategies for coronary heart disease secondary prevention in a regional Aboriginal Medical ServiceDhruv Govil A , Ivan Lin B C , Tony Dodd C , Rhonda Cox B , Penny Moss A , Sandra Thompson B and Andrew Maiorana A D E
A School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
B Combined Universities Centre for Rural Health, University of Western Australia, PO Box 109 Geraldton, WA 6531, Australia.
C Geraldton Regional Aboriginal Medical Service, Rifle Range Road, Rangeway, WA 6530, Australia.
D Advanced Heart Failure and Cardiac Transplant Service, Royal Perth Hospital, Box X2213 GPO, Perth, WA 6847, Australia.
E Corresponding author. Email: A.Maiorana@curtin.edu.au
Australian Journal of Primary Health 20(3) 266-272 https://doi.org/10.1071/PY12117
Submitted: 14 September 2012 Accepted: 23 April 2013 Published: 12 June 2013
Aboriginal Australians experience high rates of coronary heart disease (CHD) at an early age, highlighting the importance of effective secondary prevention. This study employed a two-stage process to evaluate CHD management in a regional Aboriginal Medical Service. Stage 1 involved an audit of 94 medical records of clients with documented CHD using the Audit and Best Practice in Chronic Disease approach to health service quality improvement. Results from the audit informed themes for focus group discussions with Aboriginal Medical Service clients (n = 6) and staff (n = 6) to ascertain barriers and facilitators to CHD management. The audit identified that chronic disease management was the focus of appointments more frequently than in national data (P < 0.05), with brief interventions for lifestyle modification occurring at similar or greater frequency. However, referrals to follow-up support services for secondary prevention were lower (P < 0.05). Focus groups identified psychosocial factors, systemic shortcomings, suboptimal medication use and variable awareness of CHD signs and symptoms as barriers to CHD management, whereas family support and culturally appropriate education promoted health care. To optimise CHD secondary prevention for Aboriginal people, health services require adequate resources to achieve best-practice systems of follow up. Routinely engaging clients is required to ensure services meet diverse community needs.
Additional keywords: cardiac rehabilitation, cardiovascular disease, cultural security, medication, risk factors.
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