Remond, M.G.W., Severin, K.L., Hodder, Y., Martin, J., Nelson, C., Atkinson, D., and Maguire, G.P. (2013) Variability in disease burden and management of rheumatic fever and rheumatic heart disease in two regions of tropical Australia. Internal Medicine Journal, 43 (4). pp. 386-393.

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Abstract

Background:  Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) contribute to Aboriginal Australian and Torres Strait Islander health disadvantage. At the time of this study, specialist ARF/RHD care in the Kimberley region of Western Australia was delivered by a broad range of providers while in far north Queensland (FNQ) a single provider model was used as part of a coordinated RHD control program.

Aims:  To review ARF/RHD management in the Kimberley and FNQ to ascertain whether differing models of service delivery are associated with different disease burden and patient care.

Methods:  An audit of ARF/RHD management. Classification and clinical management data were abstracted from health records, specialist letters, echocardiograms and regional registers using a standardised data collection tool.

Results:  407 patients were identified with 99% being Aboriginal and/or Torres Strait Islanders. ARF without RHD was seen in 0.4% of Aboriginal and/or Torres Strait Islander residents and RHD in 1.1%. The prevalence of RHD was similar in both regions but with more severe disease in the Kimberley. More FNQ RHD patients had specialist review within recommended timeframes (67% versus 45%, χ2, p<0.001). Of patients recommended benzathine penicillin secondary prophylaxis, 17.7% received ≥80% of scheduled doses in the preceding 12 months. Prescription and delivery of secondary prophylaxis was greater in FNQ.

Conclusions:  FNQ's single-provider model of specialist care and centralised RHD control program were associated with improved patient care and may partly account for the fewer cases of severe disease and reduced surgical and other interventions observed in this region.

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