Integrated Clinical Decision Support Systems Promote Absolute Cardiovascular Risk Assessment: An Important Primary Prevention Measure in Aboriginal and Torres Strait Islander Primary Health Care
BackgroundAboriginal 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...
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doaj-3b4f8567d3b54cecae22e115f50d14de2020-11-25T00:12:30ZengFrontiers Media S.A.Frontiers in Public Health2296-25652017-09-01510.3389/fpubh.2017.00233265742Integrated Clinical Decision Support Systems Promote Absolute Cardiovascular Risk Assessment: An Important Primary Prevention Measure in Aboriginal and Torres Strait Islander Primary Health CareVeronica Matthews0Christopher P. Burgess1Christine Connors2Elizabeth Moore3David Peiris4David Scrimgeour5Sandra C. Thompson6Sarah Larkins7Ross Bailie8The University of Sydney, University Centre for Rural Health – North Coast, Lismore, NSW, AustraliaTop End Health Service, Northern Territory Government, Darwin, NT, AustraliaTop End Health Service, Northern Territory Government, Darwin, NT, AustraliaAboriginal Medical Services Alliance Northern Territory, Alice Springs, NT, AustraliaThe George Institute for Global Health, Sydney, NSW, AustraliaSpinifex Health Service, Tjuntjuntjara, WA, AustraliaWestern Australian Centre for Rural Health, University of Western Australia, Geraldton, WA, AustraliaCollege of Medicine and Dentistry, James Cook University, Townsville, QLD, AustraliaThe University of Sydney, University Centre for Rural Health – North Coast, Lismore, NSW, AustraliaBackgroundAboriginal 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.MethodsWe 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.ResultsApproximately 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). Documentation of 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.ConclusionThere 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.http://journal.frontiersin.org/article/10.3389/fpubh.2017.00233/fullcardiovascular diseaserisk assessmentIndigenous healthpreventionprimary health care |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Veronica Matthews Christopher P. Burgess Christine Connors Elizabeth Moore David Peiris David Scrimgeour Sandra C. Thompson Sarah Larkins Ross Bailie |
spellingShingle |
Veronica Matthews Christopher P. Burgess Christine Connors Elizabeth Moore David Peiris David Scrimgeour Sandra C. Thompson Sarah Larkins Ross Bailie 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 cardiovascular disease risk assessment Indigenous health prevention primary health care |
author_facet |
Veronica Matthews Christopher P. Burgess Christine Connors Elizabeth Moore David Peiris David Scrimgeour Sandra C. Thompson Sarah Larkins Ross Bailie |
author_sort |
Veronica Matthews |
title |
Integrated Clinical Decision Support Systems Promote Absolute Cardiovascular Risk Assessment: An Important Primary Prevention Measure in Aboriginal and Torres Strait Islander Primary Health Care |
title_short |
Integrated Clinical Decision Support Systems Promote Absolute Cardiovascular Risk Assessment: An Important Primary Prevention Measure in Aboriginal and Torres Strait Islander Primary Health Care |
title_full |
Integrated Clinical Decision Support Systems Promote Absolute Cardiovascular Risk Assessment: An Important Primary Prevention Measure in Aboriginal and Torres Strait Islander Primary Health Care |
title_fullStr |
Integrated Clinical Decision Support Systems Promote Absolute Cardiovascular Risk Assessment: An Important Primary Prevention Measure in Aboriginal and Torres Strait Islander Primary Health Care |
title_full_unstemmed |
Integrated Clinical Decision Support Systems Promote Absolute Cardiovascular Risk Assessment: An Important Primary Prevention Measure in Aboriginal and Torres Strait Islander Primary Health Care |
title_sort |
integrated clinical decision support systems promote absolute cardiovascular risk assessment: an important primary prevention measure in aboriginal and torres strait islander primary health care |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Public Health |
issn |
2296-2565 |
publishDate |
2017-09-01 |
description |
BackgroundAboriginal 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.MethodsWe 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.ResultsApproximately 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). Documentation of 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.ConclusionThere 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. |
topic |
cardiovascular disease risk assessment Indigenous health prevention primary health care |
url |
http://journal.frontiersin.org/article/10.3389/fpubh.2017.00233/full |
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