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Queensland Cardiovascular Disease Burden in the Aboriginal and Torres Strait Islander Population. Aboriginal and Torres Strait Islander Health Branch. Overview. Indigenous CVD Burden in Queensland Rheumatic Heart Disease
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Queensland Cardiovascular Disease Burden in the Aboriginal and Torres Strait Islander Population Aboriginal and Torres Strait Islander Health Branch
Overview • Indigenous CVD Burden in Queensland • Rheumatic Heart Disease • Aboriginal and Torres Strait Islander Better Cardiac Care Data Linkage Project
Burden of disease and injury gap 52 per cent of gap
Indigenous CVD in QLD • Compared to non-Indigenous Queenslanders the: • CVD mortality rate was around 25% higher for Aboriginal and Torres Strait Islander Queenslanders in 2011 • CVD separation rate was 73% higher for Aboriginal and Torres Strait Islander Queenslanders in 2013–14 • The rate of CVD burden of disease 2.5 times higher for Aboriginal and Torres Strait Islander Queenslanders in 2011 • The cost to the public inpatient hospital system from Aboriginal and Torres Strait Islander cardiac related SRGs for 2011-13 was $56.4 million higher than it should have been – Indigenous rates equal that of non-Indigenous rates
Queensland CVD Burdenby condition, age & Indigenous status (2011) Indigenous Non-Indigenous
Mortality – cardiovascular Age standardised Aboriginal and Torres Strait Islander cardiovascular disease mortality rate, Queensland 2002 to 2015
Better Cardiac Care Data Linkage - Aims • Identify gaps in the health care continuum for Indigenous people with cardiovascular disease(2010/11 to 2015/16) • Ischaemic heart disease • Chronic heart failure • Stroke • Acute rheumatic fever / Rheumatic heart disease • Examine ARF/RHD trends from 2000 to 2016 • identify targets, timelines, recommendations about optimal primary, secondary & tertiary based interventions to end RHD in Qld
Better Cardiac Care Data Linkage Research Project Identify patients first hospitalised with disease • describe access to primary, secondary, acute, post-acute care • delays & disruptions in continuum of care based on best-practice standards • variation in care (location & population groups) • impact of variation in care on patient outcomes & system costs AusLAB RHD Register NDI EDIS MBS PaWs QHAPDC PBS iPharmacy
Data Linkage – ARF / RHD (2000-2016) Identify patients hospitalised/notified with disease • describe incidence, prevalence, disease progression & outcomes • collaboration with End-RHD Centre for Research Excellence (Telethon Kids Institute) RHD Register NDI QHAPDC
Outcomes • picture of individual patient experience through health system layers • understanding of gaps, service needs • at state & HHS level • at primary, secondary, tertiary levels & their intersects • in-depth understanding of ARF/RHD burden overtime • develop baseline, targets, interventions to end RHD in Qld
Guidelines • Guidelines NHMRC Health Advisory Committee • September 2005 • A guide for health professionals • Strengthening cardiac rehabilitation and secondary prevention for Aboriginal and Torres Strait Islander people • www.nhmrc.gov.au • Review of guidelines
New Accreditation Standards • https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf • https://www.safetyandquality.gov.au/wp-content/uploads/2017/12/National-Safety-and-Quality-Health-Service-Standards-User-Guide-for-Aboriginal-and-Torres-Strait-Islander-Health.
Health care is a humanitarian right but the reality is that economic cost will always be part of the equation • Health professionals often have to straddle and reconcile the divide that can exist
Paradigm Shift • If we are serious about health being a human right and accessible to all, an important paradigm shift needs to occur • We need to base our interactions on kindness compassion and respect • Kindness for all, especially those where it has not been of abundance in that persons life • Compassion for the adversity patients face • Respect for patients lived experience
Identification Processes Ask the question Are you of Aboriginal or Torres Strait Islander Origin? • (AIHW) National best practice guidelines for collecting Indigenous status in health data sets. https://www.aihw.gov.au/reports/indigenous-australians/national-guidelines-collecting-health-data-sets/contents/table-of-contents
Hospital Data • What is kept is there a report that is generated • What is captured in the report • Drill down into the detail • How is it coded
Environment • Welcoming • Health Workers • Referral pathways and Partnerships • Flexible delivery • Health literacy • Resources • Connection to primary health care
National Heart Foundation Lighthouse • 18 sites Nationally • Improving health outcomes for Aboriginal and Torres Strait Islander people with acute coronary syndrome • Domains • Governance • Cultural competence • Workforce • Care pathways
DAMA not the problem symptom of the system What you can influence What you can’t Influence
Most important • What is the outcome? What happens to the them when they leave?
Discharge Against Medical AdviceDAMA Prevent DAMA Unable to prevent Patient stays in Hospital Review medical record & case review with specialist Early contact with patient (within 3 days) Communicate plan with GP, specialist & patient Case manage to ensure appropriate follow up.
Discharge Against Medical AdviceDAMA • Since implementation of flow chart process there have been 19 cases of DAMA (417 episodes of care) = DAMA rate 4.55% • 16 (84%)patients, prompt follow up with their GP and or specialist was arranged • 3 (15%) cases lost to follow up 5 (26%) patients managed back into the acute care setting and received evidence based care • Pacemaker=1 • coronary artery bypass surgery=2 • coronary angioplasty=2 • Early contact, clinical care review and case management post DAMA supports patient in accessing appropriate medical follow up and aids in evidence based care