Integrated clinical decision support systems promote absolute cardiovascular risk assessment: an important primary prevention measure in Aboriginal and Torres Strait Islander primary health care

Matthews, Veronica, Burgess, Christopher P., Connors, Christine, Moore, Elizabeth, Peiris, David, Scrimgeour, David, Thompson, Sandra C., Larkins, Sarah, and Bailie, Ross (2017) Integrated clinical decision support systems promote absolute cardiovascular risk assessment: an important primary prevention measure in Aboriginal and Torres Strait Islander primary health care. Frontiers in Public Health, 5. 233.

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Abstract

Background: Aboriginal and Torres Strait Islander Australians experience a greater burden of disease compared to non-Indigenous Australians. Around one-fifth of the health disparity is caused by cardiovascular disease (CVD). Despite the importance of absolute cardiovascular risk assessment (CVRA) as a screening and early intervention tool, few studies have reported its use within the Australian Indigenous primary health care (PHC) sector. This study utilizes data from a large-scale quality improvement program to examine variation in documented CVRA as a primary prevention strategy for individuals without prior CVD across four Australian jurisdictions. We also examine the proportion with elevated risk and follow-up actions recorded.

Methods: We undertook cross-sectional analysis of 2,052 client records from 97 PHC centers to assess CVRA in Indigenous adults aged >20 years with no recorded chronic disease diagnosis (2012-2014). Multilevel regression was used to quantify the variation in CVRA attributable to health center and client level factors. The main outcome measure was the proportion of eligible adults who had CVRA recorded. Secondary outcomes were the proportion of clients with elevated risk that had follow-up actions recorded.

Results: Approximately 23% (n = 478) of eligible clients had documented CVRA. Almost all assessments (99%) were conducted in the Northern Territory. Within this jurisdiction, there was wide variation between centers in the proportion of clients with documented CVRA (median 38%; range 0-86%). Regression analysis showed health center factors accounted for 48% of the variation. Centers with integrated clinical decision support systems were more likely to document CVRA (OR 21.1; 95% CI 5.4-82.4; p < 0.001). Eleven percent (n = 53) of clients were found with moderate/ high CVD risk, of whom almost one-third were under 35 years (n = 16). Documentationof follow-up varied with respect to the targeted risk factor. Fewer than 30% with abnormal blood lipid or glucose levels had follow-up management plans recorded.

Conclusion: There was wide variation in CVRA between jurisdictions and between PHC centers. Learnings from successful interventions to educate and support centers in CVRA provision should be shared with stakeholders more widely. Where risk has been identified, further improvement in follow-up management is required to prevent CVD onset and reduce future burden in Australia's Indigenous population.

Item ID: 51107
Item Type: Article (Research - C1)
ISSN: 2296-2565
Keywords: cardiovascular disease, risk assessment, Indigenous health, prevention, primary health care
Additional Information:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Funders: National Health and Medical Research Council (NHMRC)
Projects and Grants: NHMRC ABCD National Research Partnership Project #545267, NHMRC Centre for Research Excellence in Integrated Quality Improvement #1078927, Lowitja Institute
Date Deposited: 11 Oct 2017 07:31
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111701 Aboriginal and Torres Strait Islander Health @ 50%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111717 Primary Health Care @ 50%
SEO Codes: 92 HEALTH > 9203 Indigenous Health > 920303 Aboriginal and Torres Strait Islander Health - Health System Performance (incl. Effectiveness of Interventions) @ 40%
92 HEALTH > 9202 Health and Support Services > 920208 Health Inequalities @ 20%
92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920506 Rural Health @ 40%
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