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Goddard L, Kaestli M, Makalic E, Ralph AP. Outcomes of possible and probable rheumatic fever: A cohort study using northern Australian register data, 2013-2019. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002064. [PMID: 38170692 PMCID: PMC10763935 DOI: 10.1371/journal.pgph.0002064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/24/2023] [Indexed: 01/05/2024]
Abstract
In Australia, there is a high burden of acute rheumatic fever (ARF) among Aboriginal and Torres Strait Islander peoples. Clinical diagnostic criteria can result in a diagnosis of 'definite', 'probable' or 'possible' ARF and outcomes range from recovery to severe rheumatic heart disease (RHD). We compared outcomes by ARF diagnosis, where the main outcome was defined as disease progression from: possible to probable ARF, definite ARF or RHD; probable to definite ARF or RHD; or definite ARF to definite ARF recurrence or RHD. Data were extracted from the Northern Territory RHD register for Indigenous Australians with an initial diagnosis of ARF during the 5.5-year study period (01/01/2013-30/06/2019). Descriptive statistics were used to describe cohort characteristics, probability of survival, and cumulative incidence risk of disease progression. Cox proportional hazards regression was used to determine whether time to disease progression differed according to ARF diagnosis. Sub-analyses on RHD outcome, clinical manifestations, and antibiotic adherence were also performed. In total there were 913 cases with an initial ARF diagnosis. Of these, 92 (13%) experienced disease progression. The probability of disease progression significantly differed between ARF diagnoses (p = 0.0043; log rank test). Cumulative incidence risk of disease progression at 5.5 years was 33.6% (95% CI 23.6-46.2) for definite, 13.5% (95% CI 8.8-20.6) for probable and 11.4% (95% CI 6.0-21.3) for possible ARF. Disease progression was 2.19 times more likely in those with definite ARF than those with possible ARF (p = 0.026). Progression to RHD was reported in 52/732 (7%) of ARF cases with normal baseline echocardiography. There was a significantly higher risk of progression from no RHD to RHD if the initial diagnosis was definite compared to possible ARF (p<0.001). These data provide a useful way to stratify risk and guide prognosis for people diagnosed with ARF and can help inform practice.
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Affiliation(s)
- Laura Goddard
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- School of Global and Population Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Mirjam Kaestli
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Research Institute for the Environment and Livelihoods, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Enes Makalic
- School of Global and Population Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Anna P. Ralph
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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2
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Govender K, Müller A. Secondary Prophylaxis Among First Nations People With Acute Rheumatic Fever in Australia: An Integrative Review. J Transcult Nurs 2023; 34:443-452. [PMID: 37572036 PMCID: PMC10637076 DOI: 10.1177/10436596231191248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023] Open
Abstract
INTRODUCTION The prevalence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) among Australia's First Nations populations are some of the highest in the world, accounting for 95% of the 2,244 ARF notifications between 2015 and 2019 in Australia. A key issue in treating ARF is long-term secondary prophylaxis, yet only one in five patients received treatment in 2019. This review identifies barriers to secondary prophylaxis of ARF in Australia's First Nations people. METHODS An integrative review was undertaken utilizing PubMed, CINAHL, ProQuest, and Wiley Online. Joanna Briggs Institute critical appraisal tools were used, followed by thematic analysis. RESULTS The key themes uncovered included: issues with database and recall systems, patient/family characteristics, service delivery location and site, pain of injection, education (including language barriers), and patient-clinician relationship. CONCLUSIONS A national RHD register, change in operation model, improved pain management, improved education, and need for consistent personnel is suggested.
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Affiliation(s)
| | - Amanda Müller
- Flinders University, Adelaide, South Australia, Australia
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3
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Ralph AP, Webb R, Moreland NJ, McGregor R, Bosco A, Broadhurst D, Lassmann T, Barnett TC, Benothman R, Yan J, Remenyi B, Bennett J, Wilson N, Mayo M, Pearson G, Kollmann T, Carapetis JR. Searching for a technology-driven acute rheumatic fever test: the START study protocol. BMJ Open 2021; 11:e053720. [PMID: 34526345 PMCID: PMC8444258 DOI: 10.1136/bmjopen-2021-053720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The absence of a diagnostic test for acute rheumatic fever (ARF) is a major impediment in managing this serious childhood condition. ARF is an autoimmune condition triggered by infection with group A Streptococcus. It is the precursor to rheumatic heart disease (RHD), a leading cause of health inequity and premature mortality for Indigenous peoples of Australia, New Zealand and internationally. METHODS AND ANALYSIS: 'Searching for a Technology-Driven Acute Rheumatic Fever Test' (START) is a biomarker discovery study that aims to detect and test a biomarker signature that distinguishes ARF cases from non-ARF, and use systems biology and serology to better understand ARF pathogenesis. Eligible participants with ARF diagnosed by an expert clinical panel according to the 2015 Revised Jones Criteria, aged 5-30 years, will be recruited from three hospitals in Australia and New Zealand. Age, sex and ethnicity-matched individuals who are healthy or have non-ARF acute diagnoses or RHD, will be recruited as controls. In the discovery cohort, blood samples collected at baseline, and during convalescence in a subset, will be interrogated by comprehensive profiling to generate possible diagnostic biomarker signatures. A biomarker validation cohort will subsequently be used to test promising combinations of biomarkers. By defining the first biomarker signatures able to discriminate between ARF and other clinical conditions, the START study has the potential to transform the approach to ARF diagnosis and RHD prevention. ETHICS AND DISSEMINATION The study has approval from the Northern Territory Department of Health and Menzies School of Health Research ethics committee and the New Zealand Health and Disability Ethics Committee. It will be conducted according to ethical standards for research involving Indigenous Australians and New Zealand Māori and Pacific Peoples. Indigenous investigators and governance groups will provide oversight of study processes and advise on cultural matters.
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Affiliation(s)
- Anna P Ralph
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Rachel Webb
- KidzFirst Hospital, Counties Manukau District Health Board, Auckland, New Zealand
- Starship Children's Hospital, Auckland, New Zealand
- Department of Paediatrics; Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Nicole J Moreland
- School of Medical Sciences and Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
| | - Reuben McGregor
- School of Medical Sciences and Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
| | - Anthony Bosco
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - David Broadhurst
- Centre for Integrative Metabolomics and Computational Biology, Edith Cowan University, Perth, Western Australia, Australia
| | - Timo Lassmann
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Timothy C Barnett
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Rym Benothman
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Jennifer Yan
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Bo Remenyi
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Julie Bennett
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nigel Wilson
- Starship Children's Hospital, Auckland, New Zealand
| | - Mark Mayo
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Glenn Pearson
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Tobias Kollmann
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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4
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Torres RPDA, Torres RFDA, de Crombrugghe G, Moraes da Silva SP, Cordeiro SLV, Bosi KA, Smeesters PR, Torres RSLDA. Improvement of Rheumatic Valvular Heart Disease in Patients Undergoing Prolonged Antibiotic Prophylaxis. Front Cardiovasc Med 2021; 8:676098. [PMID: 34250039 PMCID: PMC8260676 DOI: 10.3389/fcvm.2021.676098] [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] [Received: 03/04/2021] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
Secondary prophylaxis of rheumatic heart diseases is efficient in reducing disease recurrence, heart damage, and cardiac impairment. We aimed to monitor the clinical evolution of a large Brazilian cohort of rheumatic patients under prolonged secondary prophylaxis. From 1986 to 2018, a cohort of 593 patients with rheumatic fever was followed every 6 months by the Reference Center for the Control and Prevention of Rheumatic Fever and Rheumatic Cardiopathy (CPCFR), Paraná, Brazil. In this cohort, 243 (41%) patients did not present cardiac damage (group I), while 350 (59%) were diagnosed with rheumatic heart disease (RHD) (group II) using the latest case definition. Among group II, 233 and 15 patients had impairment of the mitral and aortic valves, respectively, while 102 patients had impairment of both valves. Lesions on the mitral and aortic valves presented a regression in 69.9 and 48.7% of the patients, respectively. Active patient recruitment in the reference center and early detection of oropharyngeal GAS were important factors for optimal adherence to the prophylactic treatment. Patients with disease progression were associated with noncompliance to secondary prophylaxis. No patients undergoing regular prophylaxis presented progression of the rheumatic cardiac disease. Eighteen valvular surgeries were performed, and four (0.7%) patients died. This study confirmed that tailored and active efforts invested in rheumatic heart disease secondary prevention allowed for significant clinical improvement.
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Affiliation(s)
| | | | - Gabrielle de Crombrugghe
- Division of Pediatric Infectious Diseases and Infection Prevention and Control, Hospital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | | | | | | | - Pierre R Smeesters
- Division of Pediatric Infectious Diseases and Infection Prevention and Control, Hospital Universitaire des Enfants Reine Fabiola, Brussels, Belgium.,Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Molecular Bacteriology Laboratory, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
| | - Rosângela Stadnick Lauth de Almeida Torres
- Department of Medicine, Universidade Positivo, Curitiba, Brazil.,Epidemiology Laboratory and Disease Control Division, Laboratório Central do Estado do Paraná, Curitiba, Brazil
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5
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Dooley LM, Ahmad TB, Pandey M, Good MF, Kotiw M. Rheumatic heart disease: A review of the current status of global research activity. Autoimmun Rev 2020; 20:102740. [PMID: 33333234 DOI: 10.1016/j.autrev.2020.102740] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/04/2020] [Indexed: 01/17/2023]
Abstract
Rheumatic heart disease (RHD) is a serious and long-term consequence of acute rheumatic fever (ARF), an autoimmune sequela of a mucosal infection by Streptococcus pyogenes (Group A Streptococcus, Strep A). The pathogenesis of ARF and RHD is complex and not fully understood but involves host and bacterial factors, molecular mimicry, and aberrant host innate and adaptive immune responses that result in loss of self-tolerance and subsequent cross-reactivity with host tissues. RHD is entirely preventable yet claims an estimated 320 000 lives annually. The major burden of disease is carried by developing nations and Indigenous populations within developed nations, including Australia. This review will focus on the epidemiology, pathogenesis and treatment of ARF and RHD in Australia, where: streptococcal pyoderma, rather than streptococcal pharyngitis, and Group C and Group G Streptococcus, have been implicated as antecedents to ARF; the rates of RHD in remote Indigenous communities are persistently among the highest in the world; government register-based programs coordinate disease screening and delivery of prophylaxis with variable success; and researchers are making significant progress in the development of a broad-spectrum vaccine against Strep A.
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Affiliation(s)
- Leanne M Dooley
- School of Health and Wellbeing, University of Southern Queensland, Toowoomba, Queensland, Australia; Institute for Life Sciences and the Environment, University of Southern Queensland, Toowoomba, Queensland, Australia.
| | - Tarek B Ahmad
- School of Health and Wellbeing, University of Southern Queensland, Toowoomba, Queensland, Australia; Institute for Life Sciences and the Environment, University of Southern Queensland, Toowoomba, Queensland, Australia.
| | - Manisha Pandey
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia.
| | - Michael F Good
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia.
| | - Michael Kotiw
- School of Health and Wellbeing, University of Southern Queensland, Toowoomba, Queensland, Australia; Institute for Life Sciences and the Environment, University of Southern Queensland, Toowoomba, Queensland, Australia.
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6
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Adem A, Dukessa Gemechu T, Jarso H, Reta W. Rheumatic Heart Disease Patients' Adherence to Secondary Prophylaxis and Associated Factors at Hospitals in Jimma Zone, Southwest Ethiopia: A Multicenter Study. Patient Prefer Adherence 2020; 14:2399-2406. [PMID: 33304095 PMCID: PMC7723230 DOI: 10.2147/ppa.s281413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/12/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a major cause of preventable premature cardiovascular-related death in developing countries. However, information regarding adherence rates and associated factors is limited and inconsistent in Ethiopia. METHODS A cross-sectional study was conducted from August to November 2019 among selected RHD patients on follow-up at four hospitals in Jimma zone. Data were collected using a structured questionnaire. Adherence of RHD patients to secondary prophylaxis in the previous consecutive 12 months was assessed based on the annual frequency of received prophylaxis (monthly injection of benzathine penicillin). Good adherence was considered the patient receiving >80% of the annual dose. The collected data were entered into Epidata 3.1 and analysed using SPSS 23. RESULTS A total of 253 RHD patients taking prophylaxis were included in the analysis, and of those 178 (70.4%) were female, giving a male:female ratio of 1:2.4. The mean age was 24±11 (6-65) years. About 63% had good adherence to benzathine penicillin prophylaxis. New York Heart Association functional class I and II, rural residence, >30 km from health facility, and duration of prophylaxis >5 years were associated with poor adherence (respectively: AOR 12.6 [95% CI 2.5-63], P=0.016; AOR 6.8 [95% CI 1.9-24.4], P=0.003; AOR 5.5 [95% CI 1.2-26.7], P=0.046; AOR 1.2 [95% CI 1.1-3.2], P=0.021). Leading barriers to good adherence were long distance from the treatment setting (56.9%), followed by lack of money (38%). CONCLUSION Patients with class I and II heart failure and those living in rural areas, especially >30 km from a hospital, were identified to be poorly adherent to secondary prophylaxis.
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Affiliation(s)
- Alinur Adem
- Department of Internal Medicine, Institute of Health Science, Jimma University, Jimma, Oromia, Ethiopia
| | - Tadesse Dukessa Gemechu
- Department of Internal Medicine, Institute of Health Science, Jimma University, Jimma, Oromia, Ethiopia
| | - Habtemu Jarso
- Department of Biostatistics and Epidemiology, Institute of Health Science, Jimma University, Jimma, Oromia, Ethiopia
| | - Wondu Reta
- Department of Biomedical Sciences, Institute of Health Science, Jimma University, Jimma, Oromia, Ethiopia
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7
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Liaw JY, White AV, Gorton S, Axford-Haines L. Lessons to be learned: Using National Immunisation strategies to improve adherence to acute rheumatic fever secondary prophylaxis. J Paediatr Child Health 2019; 55:1170-1176. [PMID: 31410921 DOI: 10.1111/jpc.14596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/22/2019] [Accepted: 07/25/2019] [Indexed: 11/29/2022]
Abstract
Rheumatic heart disease, as a result of a single or recurrent episode of acute rheumatic fever (ARF), remains a significant cause of morbidity and mortality in northern and remote Australia; ARF has a peak incidence among 5-14-year-old Aboriginal and Torres Strait Islander children. Long-term regular benzathine penicillin G injections are the only currently successful secondary prevention strategy; however, rates of adherence remain critically low. In contrast, rates of adherence to immunisations on the National Immunisation Program (NIP) Schedule are high, even among this target population. This article compares strategies used to implement and improve ARF secondary prophylaxis with those used in the NIP. Some successful NIP strategies, such as Service Incentive Payment for health providers, home-visiting delivery models and integration into the National Immunisation Register, if applied to ARF secondary prophylaxis have the potential to improve benzathine penicillin G adherence.
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Affiliation(s)
- Joshua Y Liaw
- Discipline of Child and Adolescent Health, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Andrew V White
- Discipline of Child and Adolescent Health, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Department of Paediatrics, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Susan Gorton
- Discipline of Child and Adolescent Health, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Louise Axford-Haines
- Rheumatic Heart Disease Register and Control Program (Queensland) Public Health Unit, Townsville Hospital and Health Service, Townsville, Queensland, Australia
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8
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Osowicki J, Azzopardi KI, Baker C, Waddington CS, Pandey M, Schuster T, Grobler A, Cheng AC, Pollard AJ, McCarthy JS, Good MF, Walker MJ, Dale JB, Batzloff MR, Carapetis JR, Smeesters PR, Steer AC. Controlled human infection for vaccination against Streptococcus pyogenes (CHIVAS): Establishing a group A Streptococcus pharyngitis human infection study. Vaccine 2019; 37:3485-3494. [PMID: 31101422 DOI: 10.1016/j.vaccine.2019.03.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/14/2019] [Accepted: 03/26/2019] [Indexed: 12/17/2022]
Abstract
Group A Streptococcus (GAS) is a highly-adapted and human-restricted pathogen responsible for a high global burden of disease across a diverse clinical spectrum. Vaccine development has been impeded by scientific, regulatory, and commercial obstacles. Human infection studies (HIS) are increasingly contributing to drug, diagnostics, and vaccine development, reducing uncertainty at early stages, especially for pathogens with animal models that incompletely reproduce key elements of human disease. We review the small number of historical GAS HIS and present the study protocol for a dose-ranging inpatient study in healthy adults. The primary objective of the study is to establish a new GAS pharyngitis HIS with an attack rate of at least 60% as a safe and reliable platform for vaccine evaluation and pathogenesis research. According to an adaptive dose-ranging study design, emm75 GAS doses manufactured in keeping with principles of Good Manufacturing Practice will be directly applied by swab to the pharynx of carefully screened healthy adult volunteers at low risk of severe complicated GAS disease. Participants will remain as closely monitored inpatients for up to six days, observed for development of the primary outcome of acute symptomatic pharyngitis, as defined by clinical and microbiological criteria. All participants will be treated with antibiotics and followed as outpatients for six months. An intensive sampling schedule will facilitate extensive studies of host and organism dynamics during experimental pharyngitis. Ethics approval has been obtained and the study has been registered at ClinicalTrials.gov (NCT03361163).
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Affiliation(s)
- Joshua Osowicki
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Victoria, Australia.
| | - Kristy I Azzopardi
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Ciara Baker
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Claire S Waddington
- Telethon Kids Institute, University of Western Australia and Perth Children's Hospital, Perth, Australia; Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Manisha Pandey
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Tibor Schuster
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Anneke Grobler
- Department of Paediatrics, University of Melbourne, Victoria, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, The Alfred Hospital, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - James S McCarthy
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Michael F Good
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Mark J Walker
- School of Chemistry and Molecular Biosciences and Australian Infectious Diseases Research Centre, The University of Queensland, St Lucia, Queensland, Australia
| | - James B Dale
- University of Tennessee Health Science Center, Department of Medicine, Memphis, TN, USA
| | - Michael R Batzloff
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Jonathan R Carapetis
- Telethon Kids Institute, University of Western Australia and Perth Children's Hospital, Perth, Australia
| | - Pierre R Smeesters
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Paediatric Department, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium; Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew C Steer
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Victoria, Australia
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Francis JR, Gargan C, Remenyi B, Ralph AP, Draper A, Holt D, Krause V, Hardie K. A cluster of acute rheumatic fever cases among Aboriginal Australians in a remote community with high baseline incidence. Aust N Z J Public Health 2019; 43:288-293. [PMID: 30994967 DOI: 10.1111/1753-6405.12893] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 12/01/2018] [Accepted: 02/01/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES We report a cluster of acute rheumatic fever (ARF) cases and the public health response in a high-burden Australian setting. METHODS The public health unit was notified of an increase in ARF cases in a remote Australian Aboriginal community. A multi-disciplinary group coordinated the response. Household contacts were screened for ARF or group A Streptococcus (GAS) infection by questionnaire and swab collection, offered an echocardiogram if aged 5-20 years, and intramuscular benzathine benzylpenicillin if aged over one year or if less than one year with impetigo. RESULTS Fifteen definite and seven probable ARF cases were diagnosed in the community in July-December 2014 (all-age incidence of definite ARF: 1,473/100,000). The public health response identified two additional cases of ARF. A total of 81 contacts were screened; GAS was detected in 3/76 (4%) throat swabs and 11/24 (46%) skin swabs. Molecular typing revealed high GAS strain diversity. CONCLUSIONS The incidence of ARF during this cluster was very high. Carriage and infection with GAS was observed, but no outbreak strain identified. Implications for public health: A national public health guideline has since been developed that includes advice on the investigation of an ARF outbreak/cluster. Sustained efforts with strong community engagement are required to tackle high ARF rates.
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Affiliation(s)
- Joshua R Francis
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,Royal Darwin Hospital, Northern Territory
| | - Catherine Gargan
- Top End Health Service - Primary Health Care Branch, Northern Territory
| | - Bo Remenyi
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Anna P Ralph
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,Royal Darwin Hospital, Northern Territory
| | - Anthony Draper
- Northern Territory Centre for Disease Control, Northern Territory
| | - Deborah Holt
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Vicki Krause
- Northern Territory Centre for Disease Control, Northern Territory
| | - Kate Hardie
- Northern Territory Centre for Disease Control, Northern Territory
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10
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Mitchell AG, Belton S, Johnston V, Gondarra W, Ralph AP. "That Heart Sickness": Young Aboriginal People's Understanding of Rheumatic Fever. Med Anthropol 2018; 38:1-14. [PMID: 30067382 DOI: 10.1080/01459740.2018.1482549] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
High rates of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in Australia predominate in young Aboriginal people highlighting underlying racial and equity issues. This article focuses on the perceptions of the disease among young Aboriginal people living in remote Australia. Participant understanding was constrained by clinicians' use of language rooted in biomedicine and delivered through English, a second language for all participants. Clinicians' communicative competency is a social determinant of Aboriginal health. We recommend that the use of Aboriginal languages be prioritized in health services caring for Aboriginal people and that biomedical dominance in the services be relinquished.
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Affiliation(s)
- Alice G Mitchell
- a Menzies School of Health Research , Charles Darwin University , Darwin , Australia
| | - Suzanne Belton
- a Menzies School of Health Research , Charles Darwin University , Darwin , Australia
| | - Vanessa Johnston
- a Menzies School of Health Research , Charles Darwin University , Darwin , Australia
| | - Wopurruwuy Gondarra
- b Miwatj Health Aboriginal Corporation , Charles Darwin University , Nhulunbuy , Australia
| | - Anna P Ralph
- a Menzies School of Health Research , Charles Darwin University , Darwin , Australia.,c Royal Darwin Hospital, Division of Medicine , Charles Darwin University , Darwin , Australia
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11
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Read C, Mitchell AG, de Dassel JL, Scrine C, Hendrickx D, Bailie RS, Johnston V, Maguire GP, Schultz R, Carapetis JR, Ralph AP. Qualitative Evaluation of a Complex Intervention to Improve Rheumatic Heart Disease Secondary Prophylaxis. J Am Heart Assoc 2018; 7:e009376. [PMID: 30018166 PMCID: PMC6064865 DOI: 10.1161/jaha.118.009376] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/14/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rheumatic heart disease is a high-burden condition in Australian Aboriginal communities. We evaluated a stepped-wedge, community, randomized trial at 10 Aboriginal communities from 2013 to 2015. A multifaceted intervention was implemented using quality improvement and chronic care model approaches to improve delivery of penicillin prophylaxis for rheumatic heart disease. The trial did not improve penicillin adherence. This mixed-methods evaluation, designed a priori, aimed to determine the association between methodological approaches and outcomes. METHODS AND RESULTS An evaluation framework was developed to measure the success of project implementation and of the underlying program theory. The program theory posited that penicillin delivery would be improved through activities implemented at clinics that addressed elements of the chronic care model. Qualitative data were derived from interviews with health-center staff, informants, and clients; participant observation; and project officer reports. Quantitative data comprised numbers and types of "action items," which were developed by participating clinic staff with project officers to improve delivery of penicillin injections. Interview data from 121 health-center staff, 22 informants, and 72 clients revealed barriers to achieving the trial's aims, including project-level factors (short trial duration), implementation factors (types of activities implemented), and contextual factors (high staff turnover and the complex sociocultural environment). Insufficient actions were implemented addressing "self-management support" and "community linkage" streams of the chronic care model. Increased momentum was evident in later stages of the study. CONCLUSIONS The program theory underpinning the study was sound. The limited impact made by the study on adherence was attributable to complex implementation challenges.
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Affiliation(s)
- Clancy Read
- Telethon Kids Institute, University of Western Australia, Western Australia, Australia
| | | | | | - Clair Scrine
- Telethon Kids Institute, University of Western Australia, Western Australia, Australia
| | - David Hendrickx
- Telethon Kids Institute, University of Western Australia, Western Australia, Australia
| | - Ross S Bailie
- University of Sydney University Centre for Rural Health, Lismore, New South Wales, Australia
| | - Vanessa Johnston
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Graeme P Maguire
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Rosalie Schultz
- Centre For Remote Health, Alice Springs, Northern Territory, Australia
| | - Jonathan R Carapetis
- Telethon Kids Institute, University of Western Australia, Western Australia, Australia
- Perth Children's Hospital, Perth, Western Australia, Australia
| | - Anna P Ralph
- Charles Darwin University, Darwin, Northern Territory, Australia
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
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12
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Ralph AP, de Dassel JL, Kirby A, Read C, Mitchell AG, Maguire GP, Currie BJ, Bailie RS, Johnston V, Carapetis JR. Improving Delivery of Secondary Prophylaxis for Rheumatic Heart Disease in a High-Burden Setting: Outcome of a Stepped-Wedge, Community, Randomized Trial. J Am Heart Assoc 2018; 7:JAHA.118.009308. [PMID: 30018165 PMCID: PMC6064833 DOI: 10.1161/jaha.118.009308] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health system strengthening is needed to improve delivery of secondary prophylaxis against rheumatic heart disease. METHODS AND RESULTS We undertook a stepped-wedge, randomized trial in northern Australia. Five pairs of Indigenous community clinics entered the study at 3-month steps. Study phases comprised a 12 month baseline phase, 3 month transition phase, 12 month intensive phase and a 3- to 12-month maintenance phase. Clinics received a multicomponent intervention supporting activities to improve penicillin delivery, aligned with the chronic care model, with continuous quality-improvement feedback on adherence. The primary outcome was the proportion receiving ≥80% of scheduled penicillin injections. Secondary outcomes included "days at risk" of acute rheumatic fever recurrence related to late penicillin and acute rheumatic fever recurrence rates. Overall, 304 patients requiring prophylaxis were eligible. The proportion receiving ≥80% of scheduled injections during baseline was 141 of 304 (46%)-higher than anticipated. No effect attributable to the study was evident: in the intensive phase, 126 of 304 (41%) received ≥80% of scheduled injections (odds ratio compared with baseline: 0.78; 95% confidence interval, 0.54-1.11). There was modest improvement in the maintenance phase among high-adhering patients (43% received ≥90% of injections versus 30% [baseline] and 28% [intensive], P<0.001). Also, the proportion of days at risk in the whole cohort decreased in the maintenance phase (0.28 versus 0.32 [baseline] and 0.34 [intensive], P=0.001). Acute rheumatic fever recurrence rates did not differ between study sites during the intensive phase and the whole jurisdiction (3.0 versus 3.5 recurrences per 100 patient-years, P=0.65). CONCLUSIONS This strategy did not improve adherence to rheumatic heart disease secondary prophylaxis within the study time frame. Longer term primary care strengthening strategies are needed. CLINICAL TRIAL REGISTRATION URL: www.anzctr.org.au. Unique identifier: ACTRN12613000223730.
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Affiliation(s)
- Anna P Ralph
- Menzies School of Health Research, Darwin, Northern Territory, Australia .,Charles Darwin University, Darwin, Northern Territory, Australia.,Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | | | - Adrienne Kirby
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia
| | - Clancy Read
- Telethon Kids Institute University of Western Australia, Perth, Western Australia, Australia.,Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Alison G Mitchell
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Graeme P Maguire
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Bart J Currie
- Menzies School of Health Research, Darwin, Northern Territory, Australia.,Charles Darwin University, Darwin, Northern Territory, Australia.,Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Ross S Bailie
- University of Sydney University Centre for Rural Health, Lismore, New South Wales, Australia
| | - Vanessa Johnston
- Menzies School of Health Research, Darwin, Northern Territory, Australia.,Medical School, Australian National University, Australian Capital Territory, Canberra, Australia
| | - Jonathan R Carapetis
- Telethon Kids Institute University of Western Australia, Perth, Western Australia, Australia.,Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,Perth Children's Hospital, Perth, Western Australia, Australia
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13
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Gardner K, Sibthorpe B, Chan M, Sargent G, Dowden M, McAullay D. Implementation of continuous quality improvement in Aboriginal and Torres Strait Islander primary health care in Australia: a scoping systematic review. BMC Health Serv Res 2018; 18:541. [PMID: 29996836 PMCID: PMC6042325 DOI: 10.1186/s12913-018-3308-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 04/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Continuous Quality Improvement (CQI) programs have been taken up widely by Indigenous primary health care (PHC) services in Australia and there has been national policy commitment to support this. However, international evidence shows that implementing CQI is challenging, impacts are variable and little is known about the factors that impede or enhance effectiveness. A scoping review was undertaken to explore uptake and implementation in Indigenous PHC, including barriers and enablers to embedding CQI in routine practice. We provide guidance on how research and evaluation might be intensified to support implementation. METHODS Searches were conducted in MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews. Key websites and publications were handsearched. Studies conducted in Indigenous PHC which demonstrated some combination of CQI characteristics and assessed some aspect of implementation were included. A two stage analysis was undertaken. Stage 1 identified the breadth and focus of literature. Stage 2 investigated barriers and enablers. The Framework for Performance Assessment in PHC (2008) was used to frame the analysis. Data were extracted on the study type, approach, timeframes, CQI strategies, barriers and enablers. RESULTS Sixty articles were included in Stage 1 and 21 in Stage 2. Barriers to implementing CQI processes relate primarily to professional and organisational processes and operate at multiple levels (individual, team, service, health system) whereas barriers to improved care relate more directly to knowledge of best practice and team processes that facilitate appropriate care. Few studies described implementation timeframes, number of CQI cycles or improvement strategies implemented and only two applied a change theory. CONCLUSION Investigating barriers and enablers that modify implementation and impacts of CQI poses conceptual and methodological challenges. More complete description of CQI processes, implementation strategies, and barriers and enablers could enhance capacity for comparisons across settings and contribute to better understanding of key success factors.
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Affiliation(s)
- Karen Gardner
- Public Service Research Group, Business School, UNSW Canberra, Canberra, Australia
| | | | - Mier Chan
- Australian Primary Health Care Research Institute, Australian National University, Canberra, ACT 0200 Australia
| | - Ginny Sargent
- Research, Evaluation and Public Health Nutrition Section, Population Health Division, Health Improvement Branch, ACT Health, Canberra, ACT 260 Australia
| | - Michelle Dowden
- One Disease, Menzies Building, RDH Campus, Rocklands Drive, Tiwi, NT 0810 Australia
| | - Daniel McAullay
- Kurongkurl Katitjin, Edith Cowan University, 2 Bradford St, Mount Lawley, WA 6050 Australia
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14
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Holland JV, Hardie K, de Dassel J, Ralph AP. Rheumatic Heart Disease Prophylaxis in Older Patients: A Register-Based Audit of Adherence to Guidelines. Open Forum Infect Dis 2018; 5:ofy125. [PMID: 29942824 PMCID: PMC6009701 DOI: 10.1093/ofid/ofy125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/26/2018] [Indexed: 11/13/2022] Open
Abstract
Background Prevention of rheumatic heart disease (RHD) remains challenging in high-burden settings globally. After acute rheumatic fever (ARF), secondary antibiotic prophylaxis is required to prevent RHD. International guidelines on recommended durations of secondary prophylaxis differ, with scope for clinician discretion. Because ARF risk decreases with age, ongoing prophylaxis is generally considered unnecessary beyond approximately the third decade. Concordance with guidelines on timely cessation of prophylaxis is unknown. Methods We undertook a register-based audit to determine the appropriateness of antibiotic prophylaxis among clients aged ≥35 years in Australia’s Northern Territory. Data on demographics, ARF episode(s), RHD severity, prophylaxis type, and relevant clinical notes were extracted. The determination of guideline concordance was based on whether (1) national guidelines were followed; (2) a reason for departure from guidelines was documented; (3) lifelong continuation was considered appropriate in all cases of severe RHD. Results We identified 343 clients aged ≥35 years prescribed secondary prophylaxis. Guideline concordance was 39% according to national guidelines, 68% when documented reasons for departures from guidelines were included and 82% if patients with severe RHD were deemed to need lifelong prophylaxis. Shorter times since last echocardiogram or cardiologist review were associated with greater likelihood of guideline concordance (P < .001). The median time since last ARF was 5.9 years in the guideline-concordant group and 24.0 years in the nonconcordant group (P < .001). Thirty-two people had an ARF episode after age 40 years. Conclusions In this setting, appropriate discontinuation of RHD prophylaxis could be improved through timely specialist review to reduce unnecessary burden on clients and health systems.
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Affiliation(s)
| | - Kate Hardie
- Department of Health, Centre for Disease Control, Darwin, Northern Territory, Australia
| | - Jessica de Dassel
- Department of Health, Centre for Disease Control, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anna P Ralph
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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15
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de Dassel JL, Ralph AP, Cass A. A systematic review of adherence in Indigenous Australians: an opportunity to improve chronic condition management. BMC Health Serv Res 2017; 17:845. [PMID: 29282117 PMCID: PMC5745645 DOI: 10.1186/s12913-017-2794-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/13/2017] [Indexed: 12/21/2022] Open
Abstract
Background Indigenous Australians experience high rates of chronic conditions. It is often asserted Indigenous Australians have low adherence to medication; however there has not been a comprehensive examination of the evidence. This systematic literature review presents data from studies of Indigenous Australians on adherence rates and identifies supporting factors and impediments from the perspective of health professionals and patients. Methods Search strategies were used to identify literature in electronic databases and websites. The following databases were searched: Scopus, Medline, CINAHL Plus, PsycINFO, Academic Search Premier, Cochrane Library, Trove, Indigenous Health infonet and Grey Lit.org. Articles in English, reporting original data on adherence to long-term, self-administered medicines in Australia’s Indigenous populations were included. Data were extracted into a standard template and a quality assessment was undertaken. Results Forty-seven articles met inclusion criteria. Varied study methodologies prevented the use of meta-analysis. Key findings: health professionals believe adherence is a significant problem for Indigenous Australians; however, adherence rates are rarely measured. Health professionals and patients often reported the same barriers and facilitators, providing a framework for improvement. Conclusions There is no evidence that medication adherence amongst Indigenous Australians is lower than for the general population. Nevertheless, the heavy burden of morbidity and mortality faced by Indigenous Australians with chronic conditions could be alleviated by enhancing medication adherence. Some evidence supports strategies to improve adherence, including the use of dose administration aids. This evidence should be used by clinicians when prescribing, and to implement and evaluate programs using standard measures to quantify adherence, to drive improvement in health outcomes. Electronic supplementary material The online version of this article (10.1186/s12913-017-2794-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Anna P Ralph
- Menzies School of Health Research, Bld 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, Darwin, NT, 0811, Australia
| | - Alan Cass
- Menzies School of Health Research, Bld 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, Darwin, NT, 0811, Australia
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16
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Katzenellenbogen JM, Ralph AP, Wyber R, Carapetis JR. Rheumatic heart disease: infectious disease origin, chronic care approach. BMC Health Serv Res 2017; 17:793. [PMID: 29187184 PMCID: PMC5708129 DOI: 10.1186/s12913-017-2747-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/20/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a chronic cardiac condition with an infectious aetiology, causing high disease burden in low-income settings. Affected individuals are young and associated morbidity is high. However, RHD is relatively neglected due to the populations involved and its lower incidence relative to other heart diseases. METHODS AND RESULTS In this narrative review, we describe how RHD care can be informed by and integrated with models of care developed for priority non-communicable diseases (coronary heart disease), and high-burden communicable diseases (tuberculosis). Examining the four-level prevention model (primordial through tertiary prevention) suggests primordial and primary prevention of RHD can leverage off existing tuberculosis control efforts, given shared risk factors. Successes in coronary heart disease control provide inspiration for similarly bold initiatives for RHD. Further, we illustrate how the Chronic Care Model (CCM), developed for use in non-communicable diseases, offers a relevant framework to approach RHD care. Systems strengthening through greater integration of services can improve RHD programs. CONCLUSION Strengthening of systems through integration/linkages with other well-performing and resourced services in conjunction with policies to adopt the CCM framework for the secondary and tertiary prevention of RHD in settings with limited resources, has the potential to significantly reduce the burden of RHD globally. More research is required to provide evidence-based recommendations for policy and service design.
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Affiliation(s)
- Judith M Katzenellenbogen
- Telethon Kids Institute, The University of Western Australia, Perth, Western, Australia.
- School of Population and Global Health, The University of Western Australia, Perth, Western, Australia.
| | - Anna P Ralph
- Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Rosemary Wyber
- Telethon Kids Institute, The University of Western Australia, Perth, Western, Australia
| | - Jonathan R Carapetis
- Telethon Kids Institute, The University of Western Australia, Perth, Western, Australia
- Princess Margaret Hospital for Children, Perth, Western, Australia
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17
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Mitchell AG, Belton S, Johnston V, Read C, Scrine C, Ralph AP. Aboriginal children and penicillin injections for rheumatic fever: how much of a problem is injection pain? Aust N Z J Public Health 2017; 42:46-51. [PMID: 29168304 DOI: 10.1111/1753-6405.12737] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 06/01/2017] [Accepted: 09/01/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore young Aboriginal people's and clinicians' experiences of injection pain for the 10 years of penicillin injections children are prescribed to prevent rheumatic fever recurrences. METHODS Aboriginal children on the penicillin regimen and clinicians were purposively recruited from four remote sites in Australia. Semi-structured interviews and participant observations were conducted. Views were synthesised and thematically analysed. RESULTS A total of 29 Aboriginal children and 59 clinicians were interviewed. Sixteen participants appeared to become accustomed to the injection pain, eight did not find pain an issue, and five found injection pain difficult. A further five believed the injections made them unwell. Patients expressed varying abilities to negotiate with clinicians about the use of pain reduction measures. Clinicians revealed good knowledge of pain reduction measures, but offered them inconsistently. All clinicians found administering the injections distressing. CONCLUSION Repeated painful procedures in children necessitate well-planned and child-focused care. Current practices are not in line with guidance from the Royal Australasian College of Physicians about effects of repeated painful procedures on children. Initiating the long-term injection regimen for rheumatic fever is a special event requiring expert input. A newly reported finding of a subset of young people feeling unwell after receiving the injection requires further investigation. Implications for public health: Improvement of local and jurisdictional guidelines on use of pain reduction measures for children who have been prescribed repeated painful injections for rheumatic fever is needed.
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Affiliation(s)
- Alice G Mitchell
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Suzanne Belton
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Vanessa Johnston
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | | | | | - Anna P Ralph
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,Division of Medicine, Royal Darwin Hospital, Northern Territory
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18
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de Dassel JL, Fittock MT, Wilks SC, Poole JE, Carapetis JR, Ralph AP. Adherence to secondary prophylaxis for rheumatic heart disease is underestimated by register data. PLoS One 2017; 12:e0178264. [PMID: 28562621 PMCID: PMC5451029 DOI: 10.1371/journal.pone.0178264] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/01/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE In high-burden Australian states and territories, registers of patients with acute rheumatic fever and rheumatic heart disease are maintained for patient management, monitoring of system performance and research. Data validation was undertaken for the Australian Northern Territory Rheumatic Heart Disease Register to determine quality and impact of data cleaning on reporting against key performance indicators: overall adherence, and proportion of patients receiving ≥80% of scheduled penicillin doses for secondary prophylaxis. METHODS Register data were compared with data from health centres. Inconsistencies were identified and corrected; adherence was calculated before and after cleaning. RESULTS 2780 penicillin doses were validated; 426 inconsistencies were identified, including 102 incorrect dose dates. After cleaning, mean adherence increased (63.5% to 67.3%, p<0.001) and proportion of patients receiving ≥80% of doses increased (34.2% to 42.1%, p = 0.06). CONCLUSIONS The Northern Territory Rheumatic Heart Disease Register underestimates adherence, although the key performance indicator of ≥80% adherence was not significantly affected. Program performance is better than hitherto appreciated. However some errors could affect patient management, as well as accuracy of longitudinal or inter-jurisdictional comparisons. Adequate resources are needed for maintenance of data quality in acute rheumatic fever/rheumatic heart disease registers to ensure provision of evidence-based care and accurate assessment of program impact.
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Affiliation(s)
- Jessica Langloh de Dassel
- Institute of Advanced Studies, Charles Darwin University, Darwin, Northern Territory, Australia
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- * E-mail:
| | - Marea Therese Fittock
- Northern Territory Rheumatic Heart Disease Control Program, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | | | | | - Jonathan Rhys Carapetis
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Perth Children’s Hospital, Perth, Western Australia, Australia
| | - Anna P. Ralph
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
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19
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Wyber R, Boyd BJ, Colquhoun S, Currie BJ, Engel M, Kado J, Karthikeyan G, Sullivan M, Saxena A, Sheel M, Steer A, Mucumbitsi J, Zühlke L, Carapetis J. Preliminary consultation on preferred product characteristics of benzathine penicillin G for secondary prophylaxis of rheumatic fever. Drug Deliv Transl Res 2016; 6:572-8. [DOI: 10.1007/s13346-016-0313-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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