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Jennings G, Raffoul N, Nelson M, Australian Guideline For Assessing And Managing Cardiovascular Disease Risk ESGFT. Assessing, communicating and managing cardiovascular disease risk: a practical summary of the 2023 guideline. Aust Prescr 2024; 47:57-63. [PMID: 38737366 PMCID: PMC11081742 DOI: 10.18773/austprescr.2024.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
The outdated cardiovascular disease risk calculator has been reported to overestimate cardiovascular disease risk for a contemporary Australian population, and does not include relevant variables, such as socioeconomic disadvantage, which has been shown to increase the incidence of both heart attack and stroke. The 2023 Australian Guideline for Assessing and Managing Cardiovascular Disease Risk marks a major milestone as the first update to Australia's cardiovascular disease prevention guideline in over a decade. The new guideline may help to refine and recategorise risk estimates, hence improving the discriminatory and predictive value of the new calculator. The new Australian Cardiovascular Disease Risk Calculator expresses risk scores as a percentage estimate of a person's probability of dying or being hospitalised due to cardiovascular disease within the next 5 years. The new calculator expresses risk scores as low (less than 5%), intermediate (5% to less than 10%), or high (10% or higher) risk over 5 years. Reclassification factors built into the new calculator are designed to help clinicians individualise risk estimates. These factors include ethnicity (e.g. First Nations status), family history of premature cardiovascular disease, severe mental illness, kidney disease and coronary artery calcium score. The new calculator also uses optional diabetes-specific variables (supporting a more granular cardiovascular disease risk assessment of people with type 2 diabetes). People who meet the clinically determined high-risk criteria (chronic kidney disease, familial hypercholesterolaemia) should not progress through the Australian Cardiovascular Disease risk calculator, but move straight to management. For a person with a cardiovascular disease risk score recorded from the outdated calculator, clinicians may want to reassess their risk using the new calculator the next time the person attends.
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Pinero de Plaza MA, Gebremichael L, Brown S, Wu CJ, Clark RA, McBride K, Hines S, Pearson O, Morey K. Health System Enablers and Barriers to Continuity of Care for First Nations Peoples Living with Chronic Disease. Int J Integr Care 2023; 23:17. [PMID: 38107834 PMCID: PMC10723014 DOI: 10.5334/ijic.7643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Failings in providing continuity of care following an acute event for a chronic disease contribute to care inequities for First Nations Peoples in Australia, Canada, and Aotearoa (New Zealand). Methods A rapid narrative review, including primary studies published in English from Medline, Embase, PsycINFO, and Cochrane Central, concerning chronic diseases (cancer, cardiovascular disease, chronic kidney disease, diabetes, and related complications), was conducted. Barriers and enablers to continuity of care for First Nations Peoples were explored considering an empirical lens from the World Health Organization framework on integrated person-centred health services. Results Barriers included a need for more community initiatives, health and social care networks, and coaching and peer support. Enabling strategies included care adapted to patients' cultural beliefs and behavioural, personal, and family influences; continued and trusting relationships among providers, patients, and caregivers; and provision of flexible, consistent, adaptable care along the continuum. Discussion The support and co-creation of care solutions must be a dialogical participatory process adapted to each community. Conclusions Health and social care should be harmonised with First Nations Peoples' cultural beliefs and family influences. Sustainable strategies require a co-design commitment for well-funded flexible care plans considering coaching and peer support across the lifespan.
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Affiliation(s)
- Maria Alejandra Pinero de Plaza
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5000, AU
- The Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence. Alice Springs, NT, 0871, AU
| | - Lemlem Gebremichael
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5000, AU
- The Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence. Alice Springs, NT, 0871, AU
| | | | - Chiung-Jung Wu
- School of Health, University of the Sunshine Coast, Petrie, QLD, 4502, AU
- Royal Brisbane & Women’s Hospital, QLD, 4029, AU
| | - Robyn A. Clark
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5000, AU
- The Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence. Alice Springs, NT, 0871, AU
| | - Katharine McBride
- South Australian Aboriginal Chronic Disease Consortium, Adelaide, SA, 5001, AU
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, 5001, AU
- Telethon Kids Institute, Adelaide, SA, 5000, AU
- The John Curtin School of Medical Research, The Australian National University, Acton, ACT 2601, AU
| | - Sonia Hines
- The Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence. Alice Springs, NT, 0871, AU
- Flinders University, Rural and Remote Health, Alice Springs, Northern Territory, 0871, AU
| | - Odette Pearson
- South Australian Aboriginal Chronic Disease Consortium, Adelaide, SA, 5001, AU
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, 5001, AU
- Adelaide Medical School, The University of Adelaide, SA, 5000, AU
| | - Kim Morey
- South Australian Aboriginal Chronic Disease Consortium, Adelaide, SA, 5001, AU
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, 5001, AU
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McBride K, Howard NJ, Franks C, King V, Wade V, Dowling A, Rigney J, Burton N, Mitchell JA, Hillier S, Nicholls SJ, Paquet C, Brown A. Providing guideline-recommended preventive cardiovascular care to Aboriginal and Torres Strait Islander women: exploring gender differences with a medical record review in primary health care. Aust J Prim Health 2022; 28:498-507. [PMID: 35981938 DOI: 10.1071/py22064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 07/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND For Aboriginal and Torres Strait Islander women, the premature burden of cardiovascular disease is affecting their capacity to fulfil roles in society, and promote the health and wellbeing of future generations. In Australia, there is limited understanding of the difference in primary preventive cardiovascular care experienced by women, despite knowledge of sex and gender differentials in health profile and receipt of guideline-based acute care. This paper sought to explore the health profile and receipt of assessment and management of cardiovascular risk for Aboriginal and Torres Strait Islander women accessing preventive primary health care, and investigate gender differentials. METHOD Records of 1200 current clients, 50% women, aged 18-74years from three Aboriginal Health Services in central and South Australia for the period 7/2018-6/2020 were reviewed. RESULTS Twelve percent had documented cardiovascular disease. Compared with men, women with no recorded cardiovascular disease had a greater likelihood of being overweight or obese, a waist circumference indicative of risk, diabetes, and depression. Women were less likely to report being physically active. CONCLUSIONS The research concluded that gaps exist in the provision and recording of guideline-recommended primary preventive care regardless of sex. These are stark, given the evident burden.
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Affiliation(s)
- Katharine McBride
- Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia; and Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Natasha J Howard
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; and Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Christine Franks
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; and Aboriginal Women's Advisory Group, Adelaide, SA, Australia
| | - Veronica King
- Aboriginal Women's Advisory Group, Adelaide, SA, Australia; and Central Australian Aboriginal Congress, Alice Springs, NT 0870, Australia
| | - Vicki Wade
- Aboriginal Women's Advisory Group, Adelaide, SA, Australia; and Menzies School of Health Research, Casuarina, NT 0811, Australia
| | - Anna Dowling
- Aboriginal Women's Advisory Group, Adelaide, SA, Australia; and College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Janice Rigney
- Aboriginal Women's Advisory Group, Adelaide, SA, Australia
| | - Nyunmiti Burton
- Aboriginal Women's Advisory Group, Adelaide, SA, Australia; and Ngaanyatjarra, Pitjantjatjara, Yankunytjatjara Women's Council, Alice Springs, NT 0870, Australia
| | - Julie Anne Mitchell
- Aboriginal Women's Advisory Group, Adelaide, SA, Australia; and The Heart Foundation of Australia, Woolloomooloo, NSW 2011, Australia
| | - Susan Hillier
- Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
| | - Stephen J Nicholls
- Victorian Heart Institute, Monash University, Clayton, Vic. 3168, Australia
| | - Catherine Paquet
- Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia; and Faculté des Sciences de l'Administration, Université Laval, Québec, QC G1V 0A6, Canada
| | - Alex Brown
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; and Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
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Shelton RC, Philbin MM, Ramanadhan S. Qualitative Research Methods in Chronic Disease: Introduction and Opportunities to Promote Health Equity. Annu Rev Public Health 2022; 43:37-57. [PMID: 34936827 PMCID: PMC10580302 DOI: 10.1146/annurev-publhealth-012420-105104] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Public health research that addresses chronic disease has historically underutilized and undervalued qualitative methods. This has limited the field's ability to advance (a) a more in-depth understanding of the factors and processes that shape health behaviors, (b) contextualized explanations of interventions' impacts (e.g., why and how something did or did not work for recipients and systems), and (c) opportunities for building and testing theories. We introduce frameworks and methodological approaches common to qualitative research, discuss how and when to apply them in order to advance health equity, and highlight relevant strengths and challenges. We provide an overview of data collection, sampling, and analysis for qualitative research, and we describe research questions that can be addressed by applying qualitative methods across the continuum of chronic disease research. Finally, we offer recommendations to promote the strategic application of rigorous qualitative methods, with an emphasis on priority areas to enhance health equity across the evidence generation continuum.
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Affiliation(s)
- Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA; ,
| | - Morgan M Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA; ,
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA;
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Blignault I, Norsa L, Blackburn R, Bloomfield G, Beetson K, Jalaludin B, Jones N. "You Can't Work with My People If You Don't Know How to": Enhancing Transfer of Care from Hospital to Primary Care for Aboriginal Australians with Chronic Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7233. [PMID: 34299688 PMCID: PMC8306914 DOI: 10.3390/ijerph18147233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
Abstract
Indigenous Australians experience significantly poorer health compared to other Australians, with chronic disease contributing to two-thirds of the health gap. We report on an evaluation of an innovative model that leverages mainstream and Aboriginal health resources to enable safe, supported transfer of care for Aboriginal adults with chronic conditions leaving hospital. The multisite evaluation was Aboriginal-led and underpinned by the principles of self-determination and equity and Indigenous research protocols. The qualitative study documented processes and captured service user and provider experiences. We found benefits for patients and their families, the hospital and the health system. The new model enhanced the patient journey and trust in the health service and was a source of staff satisfaction. Challenges included staff availability, patient identification and complexity and the broader issue of cultural safety. Critical success factors included strong governance with joint cultural and clinical leadership and enduring relationships and partnerships at the service delivery, organisation and system levels. A holistic model of care, bringing together cultural and clinical expertise and partnering with Indigenous community organisations, can enhance care coordination and safety across the hospital-community interface. It is important to consider context as well as specific program elements in design, implementation and evaluation.
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Affiliation(s)
- Ilse Blignault
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia;
| | - Liz Norsa
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia;
| | - Raylene Blackburn
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
| | - George Bloomfield
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
| | - Karen Beetson
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
| | - Bin Jalaludin
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
- Ingham Institute for Applied Medical Research, UNSW Sydney, Liverpool, NSW 2170, Australia
| | - Nathan Jones
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
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Good Heart: Telling Stories of Cardiovascular Protective and Risk Factors for Aboriginal Women. Heart Lung Circ 2020; 30:69-77. [PMID: 33160901 DOI: 10.1016/j.hlc.2020.09.931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Aboriginal and Torres Strait Islander peoples' perspectives of health and cultural wellbeing encapsulate the spiritual, social and environmental health of individuals, their communities and country. Strategies designed to reduce the cardiovascular burden of Aboriginal and Torres Strait Islander people often fail to consider their unique knowledge and worldview. METHODS This adapted, grounded theory study sought to explore Aboriginal women's views of cardiovascular protective and risk factors. RESULTS Twenty-eight (28) women from five women's groups across Central and South Australia participated. Women distinguished the heart as core to their spiritual and physical wellbeing. Women identified six attributes that keep a woman's heart strong, four that can make the heart sick, and eight socio-ecological factors which affect a woman's capacity to care for their heart. Women described having a healthy heart when able to identify as Aboriginal women, being connected to family and community, having a healthy life and body, and being engaged in their health and health care. CONCLUSIONS There are gaps in the provision of cardiovascular risk assessment and management, gaps in the cultural safety of primary health care services, and gaps in the communication of the sex-specific warning signs of a heart attack, all of which must be addressed.
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McBride KF, Rolleston A, Grey C, Howard NJ, Paquet C, Brown A. Māori, Pacific, Aboriginal and Torres Strait Islander Women's Cardiovascular Health: Where Are the Opportunities to Make a Real Difference? Heart Lung Circ 2020; 30:52-58. [PMID: 33162366 DOI: 10.1016/j.hlc.2020.06.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022]
Abstract
Māori and Pacific women in New Zealand and Aboriginal and Torres Strait Islander women in Australia are recognised as nurturers and leaders within their families and communities. However, women's wellbeing, and that of their communities, are affected by a high burden of cardiovascular disease experienced at a younger age than women from other ethnic groups. There has been little focus on the cardiovascular outcomes and strategies to address heart health inequities among Māori, Pacific, Aboriginal and Torres Strait Islander women. The factors contributing to these inequities are complex and interrelated but include differences in exposure to risk and protective factors, rates of multi-morbidity, and substantial gaps within the health system, which include barriers to culturally responsive, timely and appropriate cardiovascular care. Evidence demonstrates critical treatment gaps across the continuum of risk and disease, including assessment and management of cardiovascular risk in young women and time-critical access to and receipt of acute services. Cardiovascular disease in women impacts not only the individual, but their family and community, and the burden of living with disease limits women's capacity to fulfil their roles and responsibilities which support and sustain families and communities. Our response must draw on the strengths of Māori, Pacific, Aboriginal and Torres Strait Islander women, acknowledge health and wellbeing holistically, address the health and social needs of individuals, families and communities, and recognise that Indigenous women in New Zealand, Australia and across the Pacific must be involved in the design, development and implementation of solutions affecting their own health.
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Affiliation(s)
- Katharine F McBride
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia; Australian Centre for Precision Health, Cancer Research Institute, University of South Australia, Adelaide, SA, Australia; Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | | | - Corina Grey
- Auckland District Health Board, Auckland, New Zealand
| | - Natasha J Howard
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Catherine Paquet
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia; Australian Centre for Precision Health, Cancer Research Institute, University of South Australia, Adelaide, SA, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.
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