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 http://dx.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.
ReferencesAustralian Bureau of Statistics and Australian Institute of Health and Welfare (2008). ‘The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples.’ ABS Catalogue No. 4704.0. AIHW Catalogue No. IHW 21. (ABS and AIHW: Canberra)
Australian Institute of Health and Welfare (2010). ‘Cardiovascular medicines and primary health care: a regional analysis.’ Catalogue No. CVD 48. (AIHW: Canberra)
Bailie RS, Si D, O’Donoghue L, Dowden M (2007) Indigenous health: effective and sustainable health services through continuous quality improvement. The Medical Journal of Australia 186, 525–527.
Bryman A (1995) ‘Quantity and quality in social research.’ (Routledge: London)
Couzos S, Murray R (2003). ‘Aboriginal primary health care: an evidence-based approach.’ (Oxford University Press: Melbourne)
Cunningham J, Cass A, Arnold PC (2005) Bridging the treatment gap for Indigenous Australians. The Medical Journal of Australia 182, 505–506.
DiGiacomo ML, Davidson PM, Taylor KP, Smith JS, Dimer LA, Ali MA, Wood MM, Leahy TG, Thompson SC (2010a) Health information system linkage and coordination are critical for increasing access to secondary prevention in Aboriginal health: a qualitative study. Quality in Primary Care 18, 17–26.
DiGiacomo ML, Thompson SC, Smith JS, Taylor KP, Dimer LA, Ali MA, Wood MM, Leahy TG, Davidson PM (2010b) ‘I don’t know why they don’t come’: barriers to participation in cardiac rehabilitation. Australian Health Review 34, 452–457.
| ‘I don’t know why they don’t come’: barriers to participation in cardiac rehabilitation.CrossRef | 21108907PubMed |
Dimer L, Dowling T, Jones J, Cheetham C, Thomas T, Smith J, McManus A, Maiorana AJ (2013) Build it and they will come: Outcomes from a successful cardiac rehabilitation program at an Aboriginal Medical Service. Australian Health Review 37, 79–82.
| Build it and they will come: Outcomes from a successful cardiac rehabilitation program at an Aboriginal Medical Service.CrossRef | 23257265PubMed |
Eckerman A, Dowd T, Chong E, Nixon L, Gray R, Johnson S (eds) (2010) ‘Binan Goonj: Bridging Cultures in Aboriginal Health.’ (Elsevier Australia: Armidale, NSW)
Foster MM, Mitchell G, Haines T, Tweedy S, Cornwell P, Fleming F (2008) Does enhanced primary care enhance primary care? Policy-induced dilemmas for allied health professionals. The Medical Journal of Australia 188, 29–32.
Halcomb EJ, Davidson PM, Brown N (2010) Uptake of Medicare chronic disease items in Australia by general practice nurses and Aboriginal health workers. Collegian (Royal College of Nursing, Australia) 17, 57–61.
| Uptake of Medicare chronic disease items in Australia by general practice nurses and Aboriginal health workers.CrossRef |
Heeley EL, Peiris DP, Patel AA, Cass A, Weekes A, Morgan C, Anderson CS, Chalmers JP (2010) Cardiovascular risk perception and evidence-practice gaps in Australian general practice (the AusHEART study). The Medical Journal of Australia 192, 254–259.
Huffman MD, Galloway JM (2010) Cardiovascular health in Indigenous communities: successful programs. Heart Lung and Circulation 19, 351–360.
| Cardiovascular health in Indigenous communities: successful programs.CrossRef |
Katzenellenbogen JM, Sanfilippo FM, Hobbs MST, Briffa TG, Ridout SC, Knuiman MW, Dimer LA, Taylor KL, Thompson PL, Thompson SC (2010) Incidence of and case fatality following acute myocardial infarction in Aboriginal and Non-Aboriginal Western Australians (2000–2004): a linked data study. Heart Lung and Circulation 19, 717–725.
| Incidence of and case fatality following acute myocardial infarction in Aboriginal and Non-Aboriginal Western Australians (2000–2004): a linked data study.CrossRef |
Moffatt S, White W, Mackintosh J, Howel D (2006) Using quantitative and qualitative data in health services research – what happens when mixed method findings conflict? BMC Health Services Research 6, 28
| Using quantitative and qualitative data in health services research – what happens when mixed method findings conflict?CrossRef | 16524479PubMed |
National Health and Medical Research Council (2003) Values and ethics: guidelines for ethical conduct in Aboriginal and Torres Strait Islander Health Research. Available at http://www.nhmrc.gov.au/guidelines/publications/e52 [Verified 14 January 2013]
National Health and Medical Research Council (2010) The NHMRC road map II: a strategic framework for improving the health of Aboriginal and Torres Strait Islander people through research. NHMRC, Canberra.
One21seventy (2011) National Centre for Quality Improvement in Indigenous Primary Health Care. Available at http://www.one21seventy.org.au/ [Verified 14 January 2013]
Østbye T, Yarnall KSH, Krause KM, Pollak KI, Gradison M, Michener JL (2005) Is there time for management of patients with chronic diseases in primary care? Annals of Family Medicine 3, 209–214.
| Is there time for management of patients with chronic diseases in primary care?CrossRef | 15928223PubMed |
Pierce D (2009) Identifying and addressing barriers to the use of enhanced primary care plans for chronic disease in rural practices. The Australian Journal of Rural Health 17, 220–221.
| Identifying and addressing barriers to the use of enhanced primary care plans for chronic disease in rural practices.CrossRef | 19664089PubMed |
Redfern J, Maiorana A, Neubeck L, Clark A, Briffa T (2011) Achieving coordinated secondary prevention of coronary heart disease for all in need (SPAN). International Journal of Cardiology 146, 1–3.
| Achieving coordinated secondary prevention of coronary heart disease for all in need (SPAN).CrossRef | 20826024PubMed |
Schofield D (1999) Ancillary and specialist health services: the relationship between income, user rates and equity of access. The Australian Journal of Social Issues 34, 79–96.
Shepherd F, Battye K, Chalmers E (2003) Improving access to cardiac rehabilitation for remote Indigenous clients. Australian and New Zealand Journal of Public Health 27, 632–636.
Stoneman J, Taylor SJ (2007) Improving access to medicines in urban, regional and rural Aboriginal communities-is expansion of Section 100 the answer? Rural and Remote Health 7, 738
Thompson SC, Walker AT (2011) Use of modern technology as an aid to medication adherence: an overview. Patient Intelligence 3, 49–55.
| Use of modern technology as an aid to medication adherence: an overview.CrossRef |
Vos T, Barker B, Begg S, Stanley L, Lopez AD (2009) Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap. International Journal of Epidemiology 38, 470–477.
| Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap.CrossRef | 19047078PubMed |