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Iyngkaran P, Buhler M, de Courten M, Hanna F. Effectiveness of self-management programmes for heart failure with reduced ejection fraction: a systematic review protocol. BMJ Open 2024; 14:e079830. [PMID: 38839380 PMCID: PMC11163658 DOI: 10.1136/bmjopen-2023-079830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 05/13/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION Chronic disease self-management (CDSM) is a vital component of congestive heart failure (CHF) programmes. Recent CHF guidelines have downgraded CDSM programmes citing a lack of gold-standard evidence. This protocol describes the aims and methods of a systematic review to collate and synthesise the published research evidence to determine the effectiveness of CDSM programmes and interventions for patients treated for CHF. METHODS Medline, PubMed, Embase, CENTRAL, CINAHL, Cochrane Central Register of Controlled Trials, PsycINFO, SCOPUS, Web of Science, the Science Citation Index and registers of clinical trials will be searched from 1966 to 2024. In addition, the reference lists of shortlisted articles will be reviewed. Randomised controlled trials, with case management interventions of CDSM and CHF with reported major adverse cardiovascular events (MACEs), will be extracted and analysed. There is no restriction on language. Study protocol template developed from Cochrane Collaboration and Reporting adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines for systematic review and meta-analyses 2020. Two independent authors will apply inclusions and exclusion criteria to limit article search and assess bias and certainty of evidence rating. Data extraction and study description of included studies will include quality appraisal of studies and quantitative synthesis of data will then be undertaken to ascertain evidence for the study aims. Subgroup analyses will be conducted for different CDSM programmes. The primary outcome will be a significant change in MACE parameters between intervention and control arms. Meta-analysis will be conducted using statistical software, if feasible. ETHICS AND DISSEMINATION Ethics approval is not sought as the study is not collecting primary patient data. The results of this study will be disseminated through peer-reviewed scientific journals and also presented to audiences through meetings and scientific conferences. PROSPERO REGISTRATION NUMBER CRD42023431539.
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Affiliation(s)
- Pupalan Iyngkaran
- NT Medical School, The University of Notre Dame Australia Melbourne Clinical School, Werribee, Victoria, Australia
- Health and Education, Torrens University Australia, Melbourne, Victoria, Australia
| | - Monika Buhler
- Cardiology, Heart West, Melbourne, Victoria, Australia
| | | | - Fahad Hanna
- Health and Education, Torrens University Australia, Melbourne, Victoria, Australia
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2
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Yogeswaran V, Hidano D, Diaz AE, Van Spall HGC, Mamas MA, Roth GA, Cheng RK. Regional variations in heart failure: a global perspective. Heart 2023; 110:11-18. [PMID: 37353316 DOI: 10.1136/heartjnl-2022-321295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/06/2023] [Indexed: 06/25/2023] Open
Abstract
Heart failure (HF) is a global public health concern that affects millions of people worldwide. While there have been significant therapeutic advancements in HF over the last few decades, there remain major disparities in risk factors, treatment patterns and outcomes across race, ethnicity, socioeconomic status, country and region. Recent research has provided insight into many of these disparities, but there remain large gaps in our understanding of worldwide variations in HF care. Although the majority of the global population resides across Asia, Africa and South America, these regions remain poorly represented in epidemiological studies and HF trials. Recent efforts and registries have provided insight into the clinical profiles and outcomes across HF patterns globally. The prevalence of HF and associated risk factors has been reported and varies by country and region ranges, with minimal data on regional variations in treatment patterns and long-term outcomes. It is critical to improve our understanding of the different factors that contribute to global disparities in HF care so we can build interventions that improve our general cardiovascular health and mitigate the social and economic cost of HF. In this narrative review, we hope to provide an overview of the global and regional variations in HF care and outcomes.
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Affiliation(s)
| | - Danelle Hidano
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Andrea E Diaz
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Harriette G C Van Spall
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Newcastle, UK
| | - Gregory A Roth
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Richard K Cheng
- Division of Cardiology, University of Washington, Seattle, Washington, USA
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3
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Beks H, Wood SM, Clark RA, Vincent VL. Spatial methods for measuring access to health care. Eur J Cardiovasc Nurs 2023; 22:832-840. [PMID: 37590972 DOI: 10.1093/eurjcn/zvad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/19/2023]
Abstract
Access to health care is a universal human right and key indicator of health system performance. Spatial access encompasses geographic factors mediating with the accessibility and availability of health services. Equity of health service access is a global issue, which includes access to the specialized nursing workforce. Nursing research applying spatial methods is in its infancy. Given the use of spatial methods in health research is a rapidly developing field, it is timely to provide guidance to inspire greater application in cardiovascular research. Therefore, the objective of this methods paper is to provide an overview of spatial analysis methods to measure the accessibility and availability of health services, when to consider applying spatial methods, and steps to consider for application in cardiovascular nursing research.
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Affiliation(s)
- Hannah Beks
- Deakin Rural Health, Deakin University, PO Box 423, Princes Highway, Warrnambool, Victoria 3280, Australia
| | - Sarah M Wood
- Deakin Rural Health, Deakin University, PO Box 423, Princes Highway, Warrnambool, Victoria 3280, Australia
| | - Robyn A Clark
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Versace L Vincent
- Deakin Rural Health, Deakin University, PO Box 423, Princes Highway, Warrnambool, Victoria 3280, Australia
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Auld BC, Abell B, Venugopal PS, McPhail S. Geographical challenges and inequity of healthcare access for high-risk paediatric heart disease. Int J Equity Health 2023; 22:229. [PMID: 37915092 PMCID: PMC10619221 DOI: 10.1186/s12939-023-02040-z] [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] [Received: 08/01/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Geographical context is an important consideration for health system design to promote equality in access to care for patients with childhood heart disease (CHD), particularly those living in regional, rural, and remote areas. To help inform future policy and practice recommendations, this study aimed to (i) describe the geographic distribution of high-risk CHD patients accessing an Australian state-wide specialist service and (ii) estimate travel time for accessing healthcare via general practitioners (primary), nearest paediatric centre (secondary) and specialist paediatric cardiac centre (tertiary). METHODS Participants included a cohort of children (0-18 year) who accessed state-wide specialist CHD services over a 3-year period (2019-2021) in Queensland, Australia. Locations for patient residence, general practitioner, closest paediatric centre and tertiary cardiac centre were mapped using geographical information system (GIS) software (ArcGIS Online). Travel distance and times were estimated using a Google Maps Application Programming Interface (API). RESULTS 1019 patients (median age 3.8 years) had cardiac intervention and were included in the sample. Of this cohort, 30.2% lived outside the heavily urbanised South East Queensland (SEQ) area where the tertiary centre is located. These patients travel substantially further and longer to access tertiary level care (but not secondary or primary level care) compared to those in SEQ. Median distance for patients residing outside SEQ to access tertiary care was 953 km with a travel time of 10 h 43 min. This compares to 5.5 km to the general practitioner and 20.6 km to a paediatric service (8.9 and 54 min respectively). CONCLUSION This geographical mapping of CHD services has demonstrated a key challenge inherent in providing specialist cardiac care to children in a large state-based healthcare system. A significant proportion of high-risk patients live large distances from tertiary level care. The greater accessibility of primary care services highlights the importance of supporting primary care physicians outside metropolitan areas to acquire or build the ability and capacity to care for children with CHD. Strengthening local primary and secondary services not only has the potential to improve the outcomes of high-risk patients, but also to reduce costs and burden associated with potentially avoidable travel from regional, rural, or remote areas to access specialist CHD services.
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Affiliation(s)
- Benjamin C Auld
- Queensland Paediatric Cardiac Service, Queensland Children's Hospital, 501 Stanley St, South Brisbane, QLD, 4101, Australia.
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Qld, 4059, Australia.
| | - Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Qld, 4059, Australia
| | - Prem S Venugopal
- Queensland Paediatric Cardiac Service, Queensland Children's Hospital, 501 Stanley St, South Brisbane, QLD, 4101, Australia
| | - Steven McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Qld, 4059, Australia
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5
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Wood SM, Alston L, Beks H, Mc Namara K, Coffee NT, Clark RA, Wong Shee A, Versace VL. The application of spatial measures to analyse health service accessibility in Australia: a systematic review and recommendations for future practice. BMC Health Serv Res 2023; 23:330. [PMID: 37005659 PMCID: PMC10066971 DOI: 10.1186/s12913-023-09342-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/27/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Australia's inequitable distribution of health services is well documented. Spatial access relates to the geographic limitations affecting the availability and accessibility of healthcare practitioners and services. Issues associated with spatial access are often influenced by Australia's vast landmass, challenging environments, uneven population concentration, and sparsely distributed populations in rural and remote areas. Measuring access contributes to a broader understanding of the performance of health systems, particularly in rural/remote areas. This systematic review synthesises the evidence identifying what spatial measures and geographic classifications are used and how they are applied in the Australian peer-reviewed literature. METHODS A systematic search of peer-reviewed literature published between 2002 and 2022 was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Search terms were derived from three major topics, including: [1] Australian population; [2] spatial analysis of health service accessibility; and [3] objective physical access measures. RESULTS Database searches retrieved 1,381 unique records. Records were screened for eligibility, resulting in 82 articles for inclusion. Most articles analysed access to primary health services (n = 50; 61%), followed by specialist care (n = 17; 21%), hospital services (n = 12; 15%), and health promotion and prevention (n = 3; 4%). The geographic scope of the 82 articles included national (n = 33; 40%), state (n = 27; 33%), metropolitan (n = 18; 22%), and specified regional / rural /remote area (n = 4; 5%). Most articles used distance-based physical access measures, including travel time (n = 30; 37%) and travel distance along a road network (n = 21; 26%), and Euclidean distance (n = 24; 29%). CONCLUSION This review is the first comprehensive systematic review to synthesise the evidence on how spatial measures have been applied to measure health service accessibility in the Australian context over the past two decades. Objective and transparent access measures that are fit for purpose are imperative to address persistent health inequities and inform equitable resource distribution and evidence-based policymaking.
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Affiliation(s)
- Sarah M Wood
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia.
| | - Laura Alston
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia
- Research Unit, Colac Area Health, Colac, Vic, Australia
| | - Hannah Beks
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia
| | - Kevin Mc Namara
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia
- Grampians Health, Ballarat, Vic, Australia
| | - Neil T Coffee
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia
- University of Canberra, Canberra, ACT, Australia
| | - Robyn A Clark
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Anna Wong Shee
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia
- Grampians Health, Ballarat, Vic, Australia
| | - Vincent L Versace
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia
- Grampians Health, Ballarat, Vic, Australia
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Al-Omary MS, Majeed T, Al-Khalil H, Sugito S, Clapham M, Ngo DTM, Attia JR, Boyle AJ, Sverdlov AL. Patient characteristics, short-term and long-term outcomes after incident heart failure admissions in a regional Australian setting. Open Heart 2022; 9:e001897. [PMID: 35641098 PMCID: PMC9157343 DOI: 10.1136/openhrt-2021-001897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/11/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS This study aims to (1) define the characteristics of patients with a first admission for heart failure (HF), stratified by type (reduced (HFrEF) vs preserved (HFpEF) ejection fraction) in a regional Australian setting; (2) compare the outcomes in terms of mortality and rehospitalisation and (3) assess adherence to the treatment guidelines. METHODS We identified all index hospitalisations with HF to John Hunter Hospital and Tamworth Rural Referral Hospital in the Hunter New England Local Health District over a 12 months. We used the recent Australian HF guidelines to classify HFrEF and HFpEF and assess adherence to guideline-directed therapy. The primary outcome of the study was to compare short-term (1 year) and long-term all-cause mortality and the composite of all-cause hospitalisation or all-cause mortality of patients with HFrEF and HFpEF. RESULTS There were 664 patients who had an index HF admission to John Hunter and Tamworth hospitals in 2014. The median age was 80 years, 47% were female and 22 (3%) were Aboriginal. In terms of HF type, 29% had HFrEF, 37% had HFpEF, while the remainder (34%) did not have an echocardiogram within 1 year of admission and could not be classified. The median follow-up was 3.3 years. HFrEF patients were predominantly male (64%) and in 48% the aetiology was ischaemic heart disease. The 1-year all-cause mortality was 23% in HFpEF subgroup and 29% in HFrEF subgroup (p=0.15). Five-year mortality was 61% in HFpEF and HFrEF patients. Of the HFrEF patients, only 61% were on renin-angiotensin-aldosterone blockers, 74% were on β-blockers and 39% were on aldosterone antagonist. CONCLUSION HF patients are elderly and about evenly split between HFrEF and HFpEF. In this regional cohort, both HF types are associated with similar 1-year and 5-year mortality following incident HF hospitalisation. Echocardiography and guideline-directed therapies were underused.
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Affiliation(s)
- Mohammed S Al-Omary
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
| | - Tazeen Majeed
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Hafssa Al-Khalil
- John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Stuart Sugito
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Mathew Clapham
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Doan T M Ngo
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - John R Attia
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Andrew J Boyle
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Aaron L Sverdlov
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Klimis H, Chow CK. Are Digital Health Services the Key to Bridging the Gap in Medication Adherence and Optimisation? Heart Lung Circ 2021; 30:943-946. [PMID: 33965305 DOI: 10.1016/j.hlc.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Harry Klimis
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia; Department of Cardiology Westmead Hospital, Sydney, NSW, Australia.
| | - Clara K Chow
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia; Department of Cardiology Westmead Hospital, Sydney, NSW, Australia
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Ferguson C, Inglis SC, Gallagher R, Davidson PM. Reflecting on the Impact of Cardiovascular Nurses in Australia and New Zealand in the International Year of the Nurse and Midwife. Heart Lung Circ 2020; 29:1744-1748. [PMID: 33067125 PMCID: PMC7553902 DOI: 10.1016/j.hlc.2020.09.921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Caleb Ferguson
- Western Sydney Nursing & Midwifery Research Centre, Western Sydney Local Health District & Western Sydney University, Blacktown Hospital, Sydney, NSW, Australia.
| | - Sally C Inglis
- IMPACCT and School of Nursing & Midwifery, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Robyn Gallagher
- Charles Perkins Centre & Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Kinsman L, Radford J, Elmer S, Ogden K, Randles S, Jacob A, Delphin D, Burr N, Goss M. Engaging "hard-to-reach" men in health promotion using the OPHELIA principles: Participants' perspectives. Health Promot J Austr 2020; 32 Suppl 1:33-40. [PMID: 32794616 DOI: 10.1002/hpja.403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/29/2020] [Accepted: 08/07/2020] [Indexed: 11/10/2022] Open
Abstract
ISSUE ADDRESSED Men in the Northern Suburbs of Launceston, Tasmania, experience substantially poorer health outcomes and socio-economic disadvantage than most Australians. They are often described as "hard-to-reach," meaning difficult to engage in research, health promotion, policy and planning. This paper summarises the OPHELIA process to combine health literacy profiling with engagement of local men in health promotion, and their experience of the process and outcomes. METHODS Interviews were conducted to explore the experiences of middle-aged men with the OPHELIA process and subsequent interventions. RESULTS Local data and health literacy profiling revealed experiences of isolation, lack of trust in the system, medication non-adherence, mental illness and chronic pain, which formed the basis for generation of ideas to improve their well-being and understanding of health. Tailored interventions were implemented, including suicide prevention, "Numeracy for Life" and "Healthy Sheds" courses. Interviews with six participants revealed that the process contributed to a sense of worth, social support and ability to break "old habits." CONCLUSIONS Prioritising the lived experience of "hard-to-reach" men through the OPHELIA process resulted in co-design of interventions that were valued by participants. SO WHAT?: Health literacy profiling and genuine community engagement can empower vulnerable, under-represented communities to co-design, and engage in, health promotion.
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Affiliation(s)
- Leigh Kinsman
- Nursing and Midwifery, University of Newcastle, Port Macquarie, NSW, Australia.,Nursing and Midwifery, Mid North Coast Local Health District, Port Macquarie, NSW, Australia
| | - Jan Radford
- Launceston Clinical School, University of Tasmania, Hobart, TAS, Australia
| | - Shandell Elmer
- Faculty Health Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Kathryn Ogden
- Launceston Clinical School, University of Tasmania, Hobart, TAS, Australia
| | - Sarah Randles
- Launceston Clinical School, University of Tasmania, Hobart, TAS, Australia
| | - Alycia Jacob
- Nursing and Midwifery, University of Newcastle, Port Macquarie, NSW, Australia
| | - Denise Delphin
- Northern Suburbs Community Centre, Launceston, TAS, Australia
| | - Nettie Burr
- Starting Point Neighbourhood House, Launceston, TAS, Australia
| | - Mick Goss
- Men's Health Ambassador, Launceston, TAS, Australia
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Cheikh Hassan HI, Chen JH, Murali K. Incidence and factors associated with geographical relocation in patients receiving renal replacement therapy. BMC Nephrol 2020; 21:249. [PMID: 32611323 PMCID: PMC7329545 DOI: 10.1186/s12882-020-01887-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 06/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Renal replacement therapy (RRT) places a burden on patients, and geographical relocation for easier access to healthcare facilities is a necessity for some. Incidence and factors associated with relocation has not been comprehensively examined at a national level. We aimed to determine proportion, incidence, characteristics of RRT patients who relocate and relocation rate by remoteness of residence and dialysis modality. METHODS Retrospective cohort analysis using Australian and New Zealand Dialysis and Transplant Registry to examine RRT patients in Australia from January 2005 to December 2015. Relocation incidence was calculated for remoteness of residence and RRT modality as rate per 100 patient years. Factors associated with relocation were examined using competing risk regression models with death as a competing event. RESULTS Of 24,676 incident patients on RRT, 5888 (23.9%) relocated with a median time of 1.6 years [IQR 0.7-3.4] years. Relocation incidence was 7.9 per 100 patient years and increased from major cities to very remote regions (7.2 to 48.8 per 100 patient years respectively, p < 0.001). Remoteness of residence was associated with geographical relocation in competing risk analysis especially in remote (SHR 1.20, 95%CI 1.01, 1.41 p = 0.034) and very remote regions (SHR 3.51 95% 3.05, 4.04 p < 0.001). Aboriginal or Torres Strait Islander ethnicity, compared to Caucasian, was independently associated with relocation (SHR 1.18, 95% CI 1.06,1.31, p = 0.002) while transplant patients were less likely to relocate compared to haemodialysis patients (HR 0.37, 95%CI 0.34, 0.39, p < 0.001). CONCLUSIONS Relocation in patients receiving RRT is associated with remoteness of residence, RRT modality and ethnicity. Reasons for relocation and its impact on patient wellbeing and outcome should be further explored.
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Affiliation(s)
- Hicham I Cheikh Hassan
- Renal Unit, Wollongong Hospital, Locked Bag 8808, South Coast Mail Centre, Wollongong, NSW, 2521, Australia. .,University of Wollongong, Wollongong, NSW, Australia.
| | - Jenny Hc Chen
- Renal Unit, Wollongong Hospital, Locked Bag 8808, South Coast Mail Centre, Wollongong, NSW, 2521, Australia.,University of Wollongong, Wollongong, NSW, Australia.,The George Institute for Global Health, Wollongong, Australia
| | - Karumathil Murali
- Renal Unit, Wollongong Hospital, Locked Bag 8808, South Coast Mail Centre, Wollongong, NSW, 2521, Australia
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11
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Shukla N, Pradhan B, Dikshit A, Chakraborty S, Alamri AM. A Review of Models Used for Investigating Barriers to Healthcare Access in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4087. [PMID: 32521710 PMCID: PMC7312585 DOI: 10.3390/ijerph17114087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/28/2020] [Accepted: 06/05/2020] [Indexed: 11/16/2022]
Abstract
Understanding barriers to healthcare access is a multifaceted challenge, which is often highly diverse depending on location and the prevalent surroundings. The barriers can range from transport accessibility to socio-economic conditions, ethnicity and various patient characteristics. Australia has one of the best healthcare systems in the world; however, there are several concerns surrounding its accessibility, primarily due to the vast geographical area it encompasses. This review study is an attempt to understand the various modeling approaches used by researchers to analyze diverse barriers related to specific disease types and the various areal distributions in the country. In terms of barriers, the most affected people are those living in rural and remote parts, and the situation is even worse for indigenous people. These models have mostly focused on the use of statistical models and spatial modeling. The review reveals that most of the focus has been on cancer-related studies and understanding accessibility among the rural and urban population. Future work should focus on further categorizing the population based on indigeneity, migration status and the use of advanced computational models. This article should not be considered an exhaustive review of every aspect as each section deserves a separate review of its own. However, it highlights all the key points, covered under several facets which can be used by researchers and policymakers to understand the current limitations and the steps that need to be taken to improve health accessibility.
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Affiliation(s)
- Nagesh Shukla
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), University of Technology Sydney, 2007 NSW, Australia; (N.S.); (A.D.); (S.C.)
| | - Biswajeet Pradhan
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), University of Technology Sydney, 2007 NSW, Australia; (N.S.); (A.D.); (S.C.)
- Department of Energy and Mineral Resources Engineering, Sejong University, Choongmu-gwan, 209 Neungdong-ro, Gwangjin-gu, Seoul 05006, Korea
| | - Abhirup Dikshit
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), University of Technology Sydney, 2007 NSW, Australia; (N.S.); (A.D.); (S.C.)
| | - Subrata Chakraborty
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), University of Technology Sydney, 2007 NSW, Australia; (N.S.); (A.D.); (S.C.)
| | - Abdullah M. Alamri
- Department of Geology & Geophysics, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia;
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12
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Cooper L, Johnston K, Williams M. Airway clearance services (ACSs) in Australia for adults with chronic lung conditions: scoping review of publicly available web-based information. BMC Health Serv Res 2019; 19:808. [PMID: 31694636 PMCID: PMC6836521 DOI: 10.1186/s12913-019-4681-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/27/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Consumers frequently access the internet looking for health information. With the growing burden of chronic disease internationally, strategies are focussing on self-management interventions in community and ambulatory settings. The objective of this scoping review was to describe publicly available information on Australian airway clearance services. METHODS Publicly funded health services network webpages and Google were systematically searched between July and November 2018 using relevant keywords. We identified the number, location and currency of contact information of services; and described the services that were in operation and/or identifiable on the internet. Where specific airway clearance services were not identifiable via searching methods, webpages were navigated for associated physiotherapy services. All identified services were contacted via the listed phone or email to confirm web-based findings. RESULTS Searching 131 publicly funded health service pages and 191 keyword hits identified four publicly funded airway clearance services (two of which were in operation when confirmed by direct contact) and six private services, all in metropolitan areas of capital cities. Webpages described who their services were for (9/10 services), how to gain referral (4/10) and types of airway clearance techniques available (5/10). A further 286 public physiotherapy services were identified, of which 24 (8%) included descriptors of service provision for respiratory patients on their webpage. In contrast, on direct telephone enquiry airway clearance intervention of some kind was confirmed as being available at 174/286 (61%) sites and unavailable at 69/286 (24%) sites. CONCLUSIONS This scoping review demonstrated inconsistencies between airway clearance service information available on the internet and the reported provision of services confirmed by direct phone contact. Services that are available need to make information visible to consumers on the internet and include details such as referral pathways, interventions and current contact details, to support people with airway clearance problems to access appropriate care in the community.
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Affiliation(s)
- Laura Cooper
- Southern Adelaide Local Health Network, Intermediate Care Services, Noarlunga Centre, Adelaide, 5168 South Australia
- School of Health Sciences, University of South Australia, Adelaide, 5000 Australia
| | - Kylie Johnston
- School of Health Sciences, University of South Australia, Adelaide, 5000 Australia
| | - Marie Williams
- School of Health Sciences, University of South Australia, Adelaide, 5000 Australia
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Zhang X, Karunathilaka N, Senanayake S, Subramaniam VN, Chan W, Kostner K, Fraser J, Atherton JJ, Punyadeera C. The potential prognostic utility of salivary galectin-3 concentrations in heart failure. Clin Res Cardiol 2019; 109:685-692. [PMID: 31598750 DOI: 10.1007/s00392-019-01557-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/24/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Patients with HF are at a higher risk of rehospitalisation and, as such, significant costs to our healthcare system. A non-invasive method to collect body fluids and measure Gal-3 could improve the current management of HF. In this study, we investigated the potential prognostic utility of salivary Galectin-3 (Gal-3) in patients with heart failure (HF). METHODS We collected saliva samples from patients with HF (n = 105) either at hospital discharge or during routine clinical visits. Gal-3 concentrations in saliva samples were measured by ELISA. The Kaplan-Meier survival curve analysis and Cox proportional regression model were used to determine the potential prognostic utility of salivary Gal-3 concentrations. RESULTS The primary end point was either cardiovascular death or hospitalisation. Salivary Gal-3 concentrations were significantly higher (p < 0.05) in patients with HF who subsequently experienced the primary endpoint compared to those who did not. HF patients with salivary Gal-3 concentrations > 172.58 ng/mL had a significantly (p < 0.05) higher cumulative risk of the primary endpoint compared to those with lower salivary Gal-3 concentrations. In patients with HF, salivary Gal-3 concentration was a predictor of the primary endpoint even after adjusting for other covariates. CONCLUSIONS In our pilot study, HF patients with salivary Gal-3 concentrations of > 172.58 ng/mL demonstrated a higher cumulative risk of the primary outcome compared to those with lower Gal-3 levels, even after adjusting for other variables. Confirming our findings in a larger multi-centre clinical trial in the future would enable salivary Gal-3 measurements to form part of routine management for patients with HF.
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Affiliation(s)
- Xi Zhang
- Saliva and Liquid Biopsy Translational Research Team, School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Nuwan Karunathilaka
- Saliva and Liquid Biopsy Translational Research Team, School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Sameera Senanayake
- Australian Centre For Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - V Nathan Subramaniam
- School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Wandy Chan
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Karam Kostner
- Department of Cardiology, Mater Adult Hospital, Brisbane, QLD, Australia
| | - John Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - John J Atherton
- Cardiology Department, Royal Brisbane and Women's Hospital and University of Queensland School of Medicine, Brisbane, QLD, Australia
| | - Chamindie Punyadeera
- Saliva and Liquid Biopsy Translational Research Team, School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, GPO Box 2434, Brisbane, QLD, 4001, Australia.
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14
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Al‐Omary MS, Khan AA, Davies AJ, Fletcher PJ, Mcivor D, Bastian B, Oldmeadow C, Sverdlov AL, Attia JR, Boyle AJ. Outcomes following heart failure hospitalization in a regional Australian setting between 2005 and 2014. ESC Heart Fail 2018; 5:271-278. [PMID: 29265710 PMCID: PMC5880667 DOI: 10.1002/ehf2.12239] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/27/2017] [Accepted: 11/07/2017] [Indexed: 12/25/2022] Open
Abstract
AIMS The aim of the current study is to examine 10 year trends in mortality and readmission following heart failure (HF) hospitalization in metropolitan and regional Australian settings. METHODS AND RESULTS We identified all index HF hospitalizations in the Hunter New England region from 2005 to 2014, using a 10 year 'look back' period. The primary endpoint was a composite of all-cause mortality or all-cause readmission at 1 year. Secondary endpoints included all-cause mortality, all-cause readmission, and HF readmission at 30 days and 1 year. We used logistic regression to explore the predictors of the composite outcome of either all-cause death or readmission at 1 year. There were 12 114 patients admitted with a first episode of HF between 2005 and 2014, followed up until death or the end of 2015. The mean age was 78 ± 12 years and 49% (n = 5906) were male. A total of 4831 (40%) resided in regional areas and the remainder in metropolitan areas. One hundred sixty-eight patients (1.4%) were Aboriginal. Approximately 69% of patients had either died or been readmitted for any cause within 12 months of their index event. The 30 day and 1 year all-cause mortality rates were 13% and 32%, respectively, with no change in the trend over the study period. Age, socio-economic disadvantage, ischaemic heart disease, renal failure, and chronic lower respiratory disease were predictors of the primary endpoint. CONCLUSIONS Heart failure hospitalizations are followed by high rates of death or readmission. There was no change in this composite endpoint over the 10 year study period.
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Affiliation(s)
- Mohammed S. Al‐Omary
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
- The University of NewcastleNewcastleNSWAustralia
- Hunter Medical Research InstituteNewcastleNSWAustralia
| | - Arshad A. Khan
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
| | - Allan J. Davies
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
| | - Peter J. Fletcher
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
- The University of NewcastleNewcastleNSWAustralia
| | - Dawn Mcivor
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
| | - Bruce Bastian
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
| | - Christopher Oldmeadow
- The University of NewcastleNewcastleNSWAustralia
- Hunter Medical Research InstituteNewcastleNSWAustralia
| | - Aaron L. Sverdlov
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
- The University of NewcastleNewcastleNSWAustralia
- Hunter Medical Research InstituteNewcastleNSWAustralia
| | - John R. Attia
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
- The University of NewcastleNewcastleNSWAustralia
- Hunter Medical Research InstituteNewcastleNSWAustralia
| | - Andrew J. Boyle
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
- The University of NewcastleNewcastleNSWAustralia
- Hunter Medical Research InstituteNewcastleNSWAustralia
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15
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Soares N, Dewalle J, Marsh B. Utilizing patient geographic information system data to plan telemedicine service locations. J Am Med Inform Assoc 2018; 24:891-896. [PMID: 28339932 DOI: 10.1093/jamia/ocx011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/26/2017] [Indexed: 11/14/2022] Open
Abstract
Objective To understand potential utilization of clinical services at a rural integrated health care system by generating optimal groups of telemedicine locations from electronic health record (EHR) data using geographic information systems (GISs). Methods This retrospective study extracted nonidentifiable grouped data of patients over a 2-year period from the EHR, including geomasked locations. Spatially optimal groupings were created using available telemedicine sites by calculating patients' average travel distance (ATD) to the closest clinic site. Results A total of 4027 visits by 2049 unique patients were analyzed. The best travel distances for site groupings of 3, 4, 5, or 6 site locations were ranked based on increasing ATD. Each one-site increase in the number of available telemedicine sites decreased minimum ATD by about 8%. For a given group size, the best groupings were very similar in minimum travel distance. There were significant differences in predicted patient load imbalance between otherwise similar groupings. A majority of the best site groupings used the same small number of sites, and urban sites were heavily used. Discussion With EHR geospatial data at an individual patient level, we can model potential telemedicine sites for specialty access in a rural geographic area. Relatively few sites could serve most of the population. Direct access to patient GIS data from an EHR provides direct knowledge of the client base compared to methods that allocate aggregated data. Conclusion Geospatial data and methods can assist health care location planning, generating data about load, load balance, and spatial accessibility.
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Affiliation(s)
- Neelkamal Soares
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Joseph Dewalle
- Environmental Health Institute, Center for Health Research, Geisinger Health System, Danville, PA, USA
| | - Ben Marsh
- Department of Geography and Program in Environmental Studies, Bucknell University, Lewisburg, PA, USA
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16
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Thompson S, Wiebe N, Klarenbach S, Pelletier R, Hemmelgarn BR, Gill JS, Manns BJ, Tonelli M. Catheter-related blood stream infections in hemodialysis patients: a prospective cohort study. BMC Nephrol 2017; 18:357. [PMID: 29221439 PMCID: PMC5723103 DOI: 10.1186/s12882-017-0773-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/22/2017] [Indexed: 12/02/2022] Open
Abstract
Background For people requiring hemodialysis, infectious mortality is independently associated with geographic distance from a nephrologist. We aimed to determine if differential management of catheter-related blood stream infections (CRBSIs) could explain poorer outcomes. Methods We prospectively collected data from adults initiating hemodialysis with a central venous catheter between 2005 and 2015 in Alberta, Canada. We collected indicators of CRBSI management (timely catheter removal, relapsing bacteremia); frequency of CRBSIs; hospitalizations; predictors of CRBSIs, and bacteremia. We evaluated indicators and infectious episodes as a function of the shortest distance by road to the closest nephrologist’s practice: <50 (referent); 50–99; and ≥100 km. Results One thousand one hundred thirty-one participants were followed for a median of 755 days (interquartile range (IQR) 219, 1465) and used dialysis catheters for a median of 565 days (IQR 176, 1288). Compared to the referent group, there was no significant difference in the rate ratio (RR) of CRBSI in the 50–100 and >100 km distance categories: RR 1.63; 95% confidence interval (CI) (0.91, 2.91); RR 0.84 (95% CI 0.44, 1.58); p = 0.87, respectively or in bacteremia: RR 1.42; (95% CI 0.83, 2.45); RR 0.79 (95% CI 0.45,1.39) p = 0.74, respectively. There were no differences in indicators of appropriate CRBSI management or hospitalizations according to distance. The overall incidence of CRBSIs was low (0.19 per 1000 catheter days) as was the frequency of relapse. Only liver disease was independently associated with CRBSI (RR 2.11; 95% CI 1.15, 3.86). Conclusions The frequency and management of CRBSIs did not differ by location; however, event rates were low.
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Affiliation(s)
- Stephanie Thompson
- Division of Nephrology and Immunology 11-112 CSB, 152 University Campus NW, University of Alberta, Edmonton, AB, T6G 2G3, Canada
| | - Natasha Wiebe
- Division of Nephrology and Immunology 11-112 CSB, 152 University Campus NW, University of Alberta, Edmonton, AB, T6G 2G3, Canada
| | - Scott Klarenbach
- Division of Nephrology and Immunology 11-112 CSB, 152 University Campus NW, University of Alberta, Edmonton, AB, T6G 2G3, Canada
| | - Rick Pelletier
- Department of Renewable Resources, Faculty of Agriculture, Life and Environmental Sciences, University of Alberta, 442 Earth Sciences Building, Edmonton, AB, T6G 2E3, Canada
| | - Brenda R Hemmelgarn
- Division of Nephrology, University of Calgary, Foothills Medical Centre, 1403-29th Street NW, Calgary, AB, T2N 2T9, Canada
| | - John S Gill
- Division of Nephrology and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, BC 1081 Burrard Street Vancouver, Vancouver, BC, V6Z 1Y6, Canada
| | - Braden J Manns
- Division of Nephrology, University of Calgary, Foothills Medical Centre, 1403-29th Street NW, Calgary, AB, T2N 2T9, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, 7th Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
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17
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Khalil V, Danninger M, Wang W, Khalil H. An audit of adherence to heart failure guidelines in an Australian hospital: A pharmacist perspective. J Eval Clin Pract 2017; 23:1195-1202. [PMID: 28512920 DOI: 10.1111/jep.12760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 03/26/2017] [Accepted: 03/28/2017] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The Australian National Heart Foundation Guidelines have been developed to guide clinicians on how to best manage chronic heart failure (CHF) patients according to the current best available evidence. The primary aim of this study is to evaluate the proportion of patients prescribed evidence-based therapy (EBT) for CHF on discharge at this Australian metropolitan hospital and factors affecting its prescribing. The secondary aims are to examine the proportion of patients prescribed EBT on discharge on cardiac wards compared to medical wards and to explore the role of the pharmacist in the management of these patients. METHOD A retrospective audit of patients' medical notes who were admitted consecutively for CHF management was conducted over 6 months to examine their management. RESULTS The results showed at discharge, a total of 52% of patients were discharged on angiotensin converting enzyme inhibitors/angiotensin receptor blockers, 49% were discharged on β-blockers, 15% were on Aldosterone receptor antagonists, 90% were discharged on diuretics, and 29% were discharged on Digoxin. The main determinants of prescribing EBT on discharge were the presence of prescribing contraindications and patients' comorbidities. Patients discharged from cardiac wards were more likely to be prescribed EBT than if discharged on medical wards. Furthermore, in the subset of the cohort who was reviewed by a pharmacist during admission, a higher percentage of patients were discharged on EBT compared with those who did not have a pharmaceutical input. CONCLUSION This study highlighted existing gaps between the National CHF Guidelines and clinical prescribing practice in this hospital. Patients who were discharged from cardiac wards were more likely to be prescribed medications concordant with the guidelines, and there is further opportunity for pharmacists to assist in closing gaps in prescribing practice by the promotion of adherence to these guidelines.
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Affiliation(s)
- Viviane Khalil
- Pharmacy Department, Frankston Hospital, Frankston, Australia.,Monash University, Parkville, Melbourne, Australia
| | - Melanie Danninger
- Faculty of Natural sciences, Karl-Franzens University Graz, Graz, Austria
| | - Wei Wang
- Peninsula Clinical School, Faculty of Medicine, Nursing and health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Hanan Khalil
- Faculty of Medicine, Nursing and Health Sciences, Monash Rural Health, Monash University, Clayton, Melbourne, Victoria, Australia
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18
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Heart Failure Hospitalisations in the Hunter New England Area Over 10 years. A Changing Trend. Heart Lung Circ 2017; 26:627-630. [DOI: 10.1016/j.hlc.2016.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 11/24/2022]
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Iyngkaran P, Liew D, McDonald P, Thomas MC, Reid C, Chew D, Hare DL. Phase 4 Studies in Heart Failure - What is Done and What is Needed? Curr Cardiol Rev 2016; 12:216-30. [PMID: 27280303 PMCID: PMC5011189 DOI: 10.2174/1573403x12666160606121458] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/18/2015] [Accepted: 01/11/2016] [Indexed: 02/07/2023] Open
Abstract
Congestive heart failure (CHF) therapeutics is generated through a well-described evidence generating process. Phases 1 - 3 of this process are required prior to approval and widespread clinical use. Phase 3 in almost all cases is a methodologically sound randomized controlled trial (RCT). After this phase it is generally accepted that the treatment has a significant, independent and prognostically beneficial effect on the pathophysiological process. A major criticism of RCTs is the population to whom the result is applicable. When this population is significantly different from the trial cohort the external validity comes into question. Should the continuation of the evidence generating process continue these problems might be identified. Post marketing surveillance through phase 4 and comparative effectiveness studies through phase 5 trials are often underperformed in comparison to the RCT. These processes can help identify remote adverse events and define new hypotheses for community level benefits. This review is aimed at exploring the post-marketing scene for CHF therapeutics from an Australian health system perspective. We explore the phases of clinical trials, the level of evidence currently available and options for ensuring greater accountability for community level CHF clinical outcomes.
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Affiliation(s)
- Pupalan Iyngkaran
- Cardiologist & Senior Lecturer NT Medical School, Flinders University, Australia.
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20
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Iyngkaran P, Kangaharan N, Zimmet H, Arstall M, Minson R, Thomas MC, Bergin P, Atherton J, MacDonald P, Hare DL, Horowitz JD, Ilton M. Heart Failure in Minority Populations - Impediments to Optimal Treatment in Australian Aborigines. Curr Cardiol Rev 2016; 12:166-79. [PMID: 27280307 PMCID: PMC5011191 DOI: 10.2174/1573403x12666160606115034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/18/2015] [Accepted: 01/11/2016] [Indexed: 01/30/2023] Open
Abstract
Chronic heart failure (CHF) among Aboriginal/Indigenous Australians is endemic. There are also grave concerns for outcomes once acquired. This point is compounded by a lack of prospective and objective studies to plan care. To capture the essence of the presented topic it is essential to broadly understand Indigenous health. Key words such as ‘worsening’, ‘gaps’, ‘need to do more’, ‘poorly studied’, or ‘future studies should inform’ occur frequently in contrast to CHF research for almost all other groups. This narrative styled opinion piece attempts to discuss future directions for CHF care for Indigenous Australians. We provide a synopsis of the problem, highlight the treatment gaps, and define the impediments that present hurdles in optimising CHF care for Indigenous Australians.
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Affiliation(s)
- Pupalan Iyngkaran
- Cardiologist and Senior Lecturer NT Medical School, Flinders University, Tiwi, NT 0811, Australia.
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Wade V, Stocks N. The Use of Telehealth to Reduce Inequalities in Cardiovascular Outcomes in Australia and New Zealand: A Critical Review. Heart Lung Circ 2016; 26:331-337. [PMID: 27993487 DOI: 10.1016/j.hlc.2016.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 10/07/2016] [Accepted: 10/25/2016] [Indexed: 11/17/2022]
Abstract
Telehealth, the delivery of health care services at a distance using information and communications technology, is one means of redressing inequalities in cardiovascular outcomes for disadvantaged groups in Australia. This critical review argues that there is sufficient evidence to move to larger-scale implementation of telehealth for acute cardiac, acute stroke, and cardiac rehabilitation services. For cardiovascular chronic disease and risk factor management, telehealth-based services can deliver value but the evidence is less compelling, as the outcomes of these programs are variable and depend upon the context of their implementation.
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Affiliation(s)
- Victoria Wade
- Discipline of General Practice, School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, Australia.
| | - Nigel Stocks
- Discipline of General Practice, School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, Australia
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Ranson NE, Terry DR, Glenister K, Adam BR, Wright J. Integrated and consumer-directed care: a necessary paradigm shift for rural chronic ill health. Aust J Prim Health 2016; 22:176-180. [PMID: 27157713 DOI: 10.1071/py15056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 11/05/2015] [Indexed: 11/23/2022]
Abstract
Chronic ill health has recently emerged as the most important health issue on a global scale. Rural communities are disproportionally affected by chronic ill health. Many health systems are centred on the management of acute conditions and are often poorly equipped to deal with chronic ill health. Cardiovascular disease (CVD) is one of the most prominent chronic ill health conditions and the principal cause of mortality worldwide. In this paper, CVD is used as an example to demonstrate the disparity between rural and urban experience of chronic ill health, access to medical care and clinical outcomes. Advances have been made to address chronic ill health through improving self-management strategies, health literacy and access to medical services. However, given the higher incidence of chronic health conditions and poorer clinical outcomes in rural communities, it is imperative that integrated health care emphasises greater collaboration between services. It is also vital that rural GPs are better supported to work with their patients, and that they use consumer-directed approaches to empower patients to direct and coordinate their own care.
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Affiliation(s)
- Nicole E Ranson
- Melbourne Medical School, Level 2 West, Medical Building (181), University of Melbourne, Vic. 3010, Australia
| | - Daniel R Terry
- Department of Rural Health, University of Melbourne, PO Box 6500 Shepparton, Vic. 3632, Australia
| | - Kristen Glenister
- Department of Rural Health, University of Melbourne, PO Box 386 Wangaratta, Vic. 3676, Australia
| | - Bill R Adam
- Department of Rural Health, University of Melbourne, PO Box 6500 Shepparton, Vic. 3632, Australia
| | - Julian Wright
- Department of Rural Health, University of Melbourne, PO Box 6500 Shepparton, Vic. 3632, Australia
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Evans R, Larkins S, Cheffins T, Fleming R, Johnston K, Tennant M. Mapping access to health services as a strategy for planning: access to primary care for older people in regional Queensland. Aust J Prim Health 2016; 23:114-122. [PMID: 27531704 DOI: 10.1071/py15175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 03/24/2016] [Indexed: 11/23/2022]
Abstract
Australia has seen a significant increase in people aged over 65 years accessing general practice services over the last decade. Although people aged 65 years and over comprise 14% of the total population, this age demographic accounts for the largest proportion of general practitioner (GP)-patient encounters. Access to general practice is important for older Australians as the burden of chronic disease increases with age. A geographic information system, ArcGIS, was used to assess geographic access to general practice for older people residing in the regional Queensland towns of Mackay, Townsville and Cairns. Geographic units with high proportions of over 65-year-old people were spatially analysed in relation to proximity to geomapped general practices with a 2-km buffer zone. Modelling of changes in access was performed with the strategic location of a new general practice where gaps existed. Geographic access to general practice for the older population was poorest in Cairns despite a high population density. Addition of a single, strategically placed general practice in Cairns markedly improved access. Socioeconomic analysis suggested that general practices were appropriately located in areas of greatest need. Geographic information systems provide a means to map population characteristics against service locations to assist in strategic development and location of future health services.
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Affiliation(s)
- Rebecca Evans
- College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Qld 4811 Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Qld 4811 Australia
| | - Tracy Cheffins
- College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Qld 4811 Australia
| | - Rhonda Fleming
- Townsville Mackay Medicare Local, James Cook University, 1 James Cook Drive, Townsville, Qld 4811, Australia
| | - Karen Johnston
- College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Qld 4811 Australia
| | - Marc Tennant
- International Research Collaborative - Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
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Rodrigues AL, Ball J, Ski C, Stewart S, Carrington MJ. A systematic review and meta-analysis of primary prevention programmes to improve cardio-metabolic risk in non-urban communities. Prev Med 2016; 87:22-34. [PMID: 26876624 DOI: 10.1016/j.ypmed.2016.02.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Although cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) prevention programmes have been effective in urban residents, their effectiveness in non-urban settings, where cardio-metabolic risk is typically elevated, is unknown. We systematically reviewed the effectiveness of primary prevention programmes aimed at reducing risk factors for CVD/T2DM, including blood pressure, body mass index (BMI), blood lipid and glucose, diet, lifestyle, and knowledge in adults residing in non-urban areas. METHODS Twenty-five manuscripts, globally, from 1990 were selected for review (seven included in the meta-analyses) and classified according to: 1) study design (randomised controlled trial [RCT] or pre-/post-intervention); 2) intervention duration (short [<12months] or long term [≥12months]), and; 3) programme type (community-based programmes or non-community-based programmes). RESULTS Multiple strategies within interventions focusing on health behaviour change effectively reduced cardio-metabolic risk in non-urban individuals. Pre-/post-test design studies showed more favourable improvements generally, while RCTs showed greater improvements in physical activity and disease and risk knowledge. Short-term programmes were more effective than long-term programmes and in pre-/post-test designs reduced systolic blood pressure by 4.02mmHg (95% CI -6.25 to -1.79) versus 3.63mmHg (95% CI -7.34 to 0.08) in long-term programmes. Community-based programmes achieved good results for most risk factors except BMI and (glycated haemoglobin) HbA1c. CONCLUSION The setting for applying cardio-metabolic prevention programmes is important given its likelihood to influence programme efficacy. Further investigation is needed to elucidate the individual determinants of cardio-metabolic risk in non-urban populations and in contrast to urban populations.
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Affiliation(s)
- Andre L Rodrigues
- Dept. of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Jocasta Ball
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Chantal Ski
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Simon Stewart
- Dept. of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Melinda J Carrington
- Dept. of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
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Xanthos PD, Gordon BA, Begg S, Nadurata V, Kingsley MIC. A comparison of age-standardised event rates for acute and chronic coronary heart disease in metropolitan and regional/remote Victoria: a retrospective cohort study. BMC Public Health 2016; 16:391. [PMID: 27169563 PMCID: PMC4865014 DOI: 10.1186/s12889-016-3081-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/04/2016] [Indexed: 11/11/2022] Open
Abstract
Background Acute and chronic coronary heart disease (CHD) pose different burdens on health-care services and require different prevention and treatment strategies. Trends in acute and chronic CHD event rates can guide service implementation. This study evaluated changes in acute and chronic CHD event rates in metropolitan and regional/remote Victoria. Methods Victorian hospital admitted episodes with a principal diagnosis of acute CHD or chronic CHD were identified from 2005 to 2012. Acute and chronic CHD age-standardised event rates were calculated in metropolitan and regional/remote Victoria. Poisson log-link linear regression was used to estimate annual change in acute and chronic CHD event rates. Results Acute CHD age-standardised event rates decreased annually by 2.9 % (95 % CI, −4.3 to −1.4 %) in metropolitan Victoria and 1.7 % (95 % CI, −3.2 to −0.1 %) in regional/remote Victoria. In comparison, chronic CHD age-standardised event rates increased annually by 4.8 % (95 % CI, +3.0 to +6.5 %) in metropolitan Victoria and 3.1 % (95 % CI, +1.3 to +4.9 %) in regional/remote Victoria. On average, age-standardised event rates for regional/remote Victoria were 30.3 % (95 % CI, 23.5 to 37.2 %) higher for acute CHD and 55.3 % (95 % CI, 47.1 to 63.5 %) higher for chronic CHD compared to metropolitan Victoria from 2005 to 2012. Conclusion Annual decreases in acute CHD age-standardised event rates might reflect improvements in primary prevention, while annual increases in chronic CHD age-standardised event rates suggest a need to improve secondary prevention strategies. Consistently higher acute and chronic CHD age-standardised event rates were evident in regional/remote Victoria compared to metropolitan Victoria from 2005 to 2012.
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Affiliation(s)
- Paul D Xanthos
- Discipline of Exercise Physiology, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Brett A Gordon
- Discipline of Exercise Physiology, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Stephen Begg
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Voltaire Nadurata
- Department of Cardiology, Bendigo Health Care Group, Bendigo, Victoria, Australia
| | - Michael I C Kingsley
- Discipline of Exercise Physiology, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.
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Sahle BW, Owen AJ, Mutowo MP, Krum H, Reid CM. Prevalence of heart failure in Australia: a systematic review. BMC Cardiovasc Disord 2016; 16:32. [PMID: 26852410 PMCID: PMC4744379 DOI: 10.1186/s12872-016-0208-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the absence of a systematic collection of data pertaining to heart failure, summarizing the data available from individual studies provides an opportunity to estimate the burden of heart failure. The present study systematically reviewed the literature to estimate the incidence and prevalence rates of heart failure in Australia. METHODS Studies reporting on prevalence or incidence of heart failure published between 1990 and 2015 were identified through a systematic search of Embase, PubMed, Ovid Medline, MeSH, Scopus and websites of the Australian Institute of Health, and Welfare and Australian Bureau of Statistics. RESULTS The search yielded a total of 4978 records, of which thirteen met the inclusion criteria. There were no studies reporting on the incidence of heart failure. The prevalence of heart failure in the Australian population ranged between 1.0% and 2.0%, with a significant proportion of cases being previously undiagnosed. The burden of heart failure was higher among Indigenous than non-Indigenous Australians (age-standardized prevalence rate ratio of 1.7). Heart failure was prevalent in women than men, and in rural and remote regions than in the metropolitan and capital territories. CONCLUSION This systematic review highlights the limited available data on the epidemiology of heart failure in Australia. Population level studies, using standardized approaches, are needed in order to precisely describe the burden of HF in the population.
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Affiliation(s)
- Berhe W Sahle
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Vic, 3004, Australia.
- School of Public Health, Mekelle University, Mekelle, Ethiopia.
| | - Alice J Owen
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Vic, 3004, Australia.
| | - Mutsa P Mutowo
- School of Public Health, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Henry Krum
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Vic, 3004, Australia.
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Vic, 3004, Australia.
- School of Public Health, Curtin University, Perth, Australia.
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Multidisciplinary Management of Chronic Heart Failure: Principles and Future Trends. Clin Ther 2015; 37:2225-33. [DOI: 10.1016/j.clinthera.2015.08.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 08/20/2015] [Accepted: 08/22/2015] [Indexed: 12/31/2022]
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Iyngkaran P, Thomas M. Bedside-to-Bench Translational Research for Chronic Heart Failure: Creating an Agenda for Clients Who Do Not Meet Trial Enrollment Criteria. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 9:121-32. [PMID: 26309418 PMCID: PMC4527366 DOI: 10.4137/cmc.s18737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/09/2015] [Accepted: 03/25/2015] [Indexed: 01/09/2023]
Abstract
Congestive heart failure (CHF) is a chronic condition usually without cure. Significant developments, particularly those addressing pathophysiology, mainly started at the bench. This approach has seen many clinical observations initially explored at the bench, subsequently being trialed at the bedside, and eventually translated into clinical practice. This evidence, however, has several limitations, importantly the generalizability or external validity. We now acknowledge that clinical management of CHF is more complicated than merely translating bench-to-bedside evidence in a linear fashion. This review aims to help explore this evolving area from an Australian perspective. We describe the continuation of research once core evidence is established and describe how clinician-scientist collaboration with a bedside-to-bench view can help enhance evidence translation and generalizability. We describe why an extension of the available evidence or generating new evidence is occasionally needed to address the increasingly diverse cohort of patients. Finally, we explore some of the tools used by basic scientists and clinicians to develop evidence and describe the ones we feel may be most beneficial.
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Affiliation(s)
- P Iyngkaran
- Flinders University, NT Medical School, Darwin, Australia
| | - M Thomas
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Page K, Marwick TH, Lee R, Grenfell R, Abhayaratna WP, Aggarwal A, Briffa TG, Cameron J, Davidson PM, Driscoll A, Garton-Smith J, Gascard DJ, Hickey A, Korczyk D, Mitchell JA, Sanders R, Spicer D, Stewart S, Wade V. A systematic approach to chronic heart failure care: a consensus statement. Med J Aust 2014; 201:146-50. [PMID: 25128948 DOI: 10.5694/mja14.00032] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Indexed: 11/17/2022]
Abstract
The National Heart Foundation of Australia assembled an expert panel to provide guidance on policy and system changes to improve the quality of care for people with chronic heart failure (CHF). The recommendations have the potential to reduce emergency presentations, hospitalisations and premature death among patients with CHF. Best-practice management of CHF involves evidence-based, multidisciplinary, patient-centred care, which leads to better health outcomes. A CHF care model is required to achieve this. Although CHF management programs exist, ensuring access for everyone remains a challenge. This is particularly so for Aboriginal and Torres Strait Islander peoples, those from non-metropolitan areas and lower socioeconomic backgrounds, and culturally and linguistically diverse populations. Lack of data and inadequate identification of people with CHF prevents efficient patient monitoring, limiting information to improve or optimise care. This leads to ineffectiveness in measuring outcomes and evaluating the CHF care provided. Expanding current cardiac registries to include patients with CHF and developing mechanisms to promote data linkage across care transitions are essential. As the prevalence of CHF rises, the demand for multidisciplinary workforce support will increase. Workforce planning should provide access to services outside of large cities, one of the main challenges it is currently facing. To enhance community-based management of CHF, general practitioners should be empowered to lead care. Incentive arrangements should favour provision of care for Aboriginal and Torres Strait Islander peoples, those from lower socioeconomic backgrounds and rural areas, and culturally and linguistically diverse populations. Ongoing research is vital to improving systems of care for people with CHF. Future research activity needs to ensure the translation of valuable knowledge and high-quality evidence into practice.
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Affiliation(s)
- Karen Page
- National Heart Foundation of Australia, Melbourne, VIC, Australia.
| | | | - Rebecca Lee
- National Heart Foundation of Australia, Melbourne, VIC, Australia
| | - Robert Grenfell
- National Heart Foundation of Australia, Melbourne, VIC, Australia
| | | | - Anu Aggarwal
- Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Tom G Briffa
- School of Population Health, University of Western Australia, Perth, WA, Australia
| | - Jan Cameron
- Cardiovascular Research Centre, Australian Catholic University, Melbourne, VIC, Australia
| | - Patricia M Davidson
- Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Sydney, NSW, Australia
| | - Andrea Driscoll
- Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Jacquie Garton-Smith
- Cardiovascular Health Network, Department of Health Western Australia, Perth, WA, Australia
| | - Debra J Gascard
- Heart Failure Care, Monash Health, Melbourne, VIC, Australia
| | - Annabel Hickey
- Advanced Heart Failure and Cardiac Transplant Unit, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Dariusz Korczyk
- Heart Failure Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | | - Rhonda Sanders
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Deborah Spicer
- Community Heart Failure Nursing, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Simon Stewart
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Vicki Wade
- National Heart Foundation of Australia, Sydney, NSW, Australia
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Lyseen AK, Nøhr C, Sørensen EM, Gudes O, Geraghty EM, Shaw NT, Bivona-Tellez C. A Review and Framework for Categorizing Current Research and Development in Health Related Geographical Information Systems (GIS) Studies. Yearb Med Inform 2014; 9:110-24. [PMID: 25123730 DOI: 10.15265/iy-2014-0008] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES The application of GIS in health science has increased over the last decade and new innovative application areas have emerged. This study reviews the literature and builds a framework to provide a conceptual overview of the domain, and to promote strategic planning for further research of GIS in health. METHOD The framework is based on literature from the library databases Scopus and Web of Science. The articles were identified based on keywords and initially selected for further study based on titles and abstracts. A grounded theory-inspired method was applied to categorize the selected articles in main focus areas. Subsequent frequency analysis was performed on the identified articles in areas of infectious and non-infectious diseases and continent of origin. RESULTS A total of 865 articles were included. Four conceptual domains within GIS in health sciences comprise the framework: spatial analysis of disease, spatial analysis of health service planning, public health, health technologies and tools. Frequency analysis by disease status and location show that malaria and schistosomiasis are the most commonly analyzed infectious diseases where cancer and asthma are the most frequently analyzed non-infectious diseases. Across categories, articles from North America predominate, and in the category of spatial analysis of diseases an equal number of studies concern Asia. CONCLUSION Spatial analysis of diseases and health service planning are well-established research areas. The development of future technologies and new application areas for GIS and data-gathering technologies such as GPS, smartphones, remote sensing etc. will be nudging the research in GIS and health.
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Affiliation(s)
- A K Lyseen
- Anders Knørr Lyseen, Department of Development and Planning, Aalborg University, Aalborg, Denmark, E-mail:
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Inglis SC, Clark RA, McAlister FA, Stewart S, Cleland JG. Which components of heart failure programmes are effective? A systematic review and meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8323 patients: Abridged Coc. Eur J Heart Fail 2014; 13:1028-40. [PMID: 21733889 DOI: 10.1093/eurjhf/hfr039] [Citation(s) in RCA: 247] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sally C. Inglis
- Preventative Health, Baker IDI Heart and Diabetes Institute and Faculty of Nursing, Midwifery and Health; University of Technology; Sydney Australia
| | - Robyn A. Clark
- School of Nursing and Midwifery; Queensland University of Technology; Queensland Australia
| | - Finlay A. McAlister
- Division of General Internal Medicine; University of Alberta; Edmonton Canada
| | - Simon Stewart
- Preventative Health, Baker IDI Heart and Diabetes Institute and Faculty of Nursing, Midwifery and Health; University of Technology; Sydney Australia
| | - John G.F. Cleland
- Academic Unit of Cardiology; Castle Hill Hospital; East Yorkshire UK
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Tighe PJ, Fillingim RB, Hurley RW. Geospatial analysis of hospital consumer assessment of healthcare providers and systems pain management experience scores in U.S. hospitals. Pain 2014; 155:1016-1026. [PMID: 24525273 DOI: 10.1016/j.pain.2014.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 01/22/2014] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
Abstract
Although prior work has investigated the interplay between demographic and intrasurvey correlations of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, these prior studies have not included geospatial analyses, or analyses that take into account location effects. Here, we report the results of a geospatial analysis (not equivalent to simple geographical analysis) of patient experience scores pertaining to pain. HCAHPS data collected in 2011 were examined to test the hypothesis that HCAHPS patient experience with pain management (PEPM) scores were geospatially distributed throughout the United States using Moran's Index, which measures the association between PEPM scores and hospital location. After limiting the dataset to hospitals in the continental United States with nonzero HCAHPS response rates, 3645 hospitals were included in the analyses. "Always" responses were geospatially clustered amongst the analyzed hospitals. Clustering was significant in all distances tested from 10 to 5000km (P<0.0001). We identified 6 demarcated groups of hospitals. Taken together, these results strongly suggest a regional geographic effect on PEPM scores. These results may carry policy implications for U.S. hospitals with regard to acute pain outcomes. Further analyses will be necessary to evaluate policy explanations and implications of the regional geographic differences in PEPM results.
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Affiliation(s)
- Patrick J Tighe
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA Department of Community Dentistry, University of Florida College of Dentistry, Gainesville, FL, USA
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Iyngkaran P, Tinsley J, Smith D, Haste M, Nadarajan K, Ilton M, Battersby M, Stewart S, Brown A. Northern Territory Heart Failure Initiative-Clinical Audit (NTHFI-CA)-a prospective database on the quality of care and outcomes for acute decompensated heart failure admission in the Northern Territory: study design and rationale. BMJ Open 2014; 4:e004137. [PMID: 24477314 PMCID: PMC3913022 DOI: 10.1136/bmjopen-2013-004137] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 11/30/2013] [Accepted: 12/04/2013] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Congestive heart failure is a significant cause of morbidity and mortality in Australia. Accurate data for the Northern Territory and Indigenous Australians are not presently available. The economic burden of this chronic cardiovascular disease is felt by all funding bodies and it still remains unclear what impact current measures have on preventing the ongoing disease burden and how much of this filters down to more remote areas. Clear differentials also exist in rural areas including a larger Indigenous community, greater disease burden, differing aetiologies for heart failure as well as service and infrastructure discrepancies. It is becoming increasingly clear that urban solutions will not affect regional outcomes. To understand regional issues relevant to heart failure management, an understanding of the key performance indicators in that setting is critical. METHODS AND ANALYSIS The Northern Territory Heart Failure Initiative-Clinical Audit (NTHFI-CA) is a prospective registry of acute heart failure admissions over a 12-month period across the two main Northern Territory tertiary hospitals. The study collects information across six domains and five dimensions of healthcare. The study aims to set in place an evidenced and reproducible audit system for heart failure and inform the developing heart failure disease management programme. The findings, is believed, will assist the development of solutions to narrow the outcomes divide between remote and urban Australia and between Indigenous and Non-Indigenous Australians, in case they exist. A combination of descriptive statistics and mixed effects modelling will be used to analyse the data. ETHICS AND DISSEMINATION This study has been approved by respective ethics committees of both the admitting institutions. All participants will be provided a written informed consent which will be completed prior to enrolment in the study. The study results will be disseminated through local and international health conferences and peer reviewed manuscripts.
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Affiliation(s)
- Pupalan Iyngkaran
- Department of Cardiology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Jeff Tinsley
- Chronic Disease Coordination Unit, Department of Health, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - David Smith
- Flinders Human Behavior and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
| | - Mark Haste
- Heart Failure CNC—Top End, Chronic Disease Coordination Unit, Department of Health, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Kangaharan Nadarajan
- Division of Medicine, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Marcus Ilton
- Department of Cardiology, Darwin Private Hospital, Rocklands Drive, Tiwi, Northern Territory, Australia
| | - Malcolm Battersby
- Flinders Human Behaviour and Health Research Unit (FHBHRU), Margaret Tobin Centre, Flinders University, South Australia, Australia
| | - Simon Stewart
- Department of Preventative Cardiology, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Alex Brown
- Department of Indigenous Health, SAHMRI, Adelaide, South Australia, Australia
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Iyngkaran P, Majoni V, Nadarajan K, Haste M, Battersby M, Ilton M, Harris M. AUStralian Indigenous Chronic Disease Optimisation Study (AUSI-CDS) prospective observational cohort study to determine if an established chronic disease health care model can be used to deliver better heart failure care among remote Indigenous Australians: Proof of concept-study rationale and protocol. Heart Lung Circ 2013; 22:930-9. [PMID: 23689164 DOI: 10.1016/j.hlc.2013.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 02/03/2013] [Accepted: 04/02/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND The congestive heart failure syndrome has increased to epidemic proportions and is cause for significant morbidity and mortality. Indigenous patients suffer a greater prevalence with greater severity. Upon diagnosis patients require regular follow-up with medical and allied health services. Patients are prescribed life saving, disease modifying and symptom relieving therapies. This can be an overwhelming experience for patients. To compound this, remoteness, differentials in conventional health care and services pose special problems for Indigenous clients in accessing care. Additional barriers of language, culture, socio-economic disadvantage, negative attitudes towards establishment, social stereotyping, stigma and discrimination act as barriers to improved care. Recent focus supported by clinical evidence support the role of chronic disease self-management programs. A patient focused, problem identification, goal setting and psychosocial modification based program should in principal highlight these issues and help tailor a patient focused comprehensive care plan to complement guideline based care. At present there are no Indigenous focused chronic disease self-management programs. There is a need for research on ways to provide chronic disease management to this group. We therefore designed a study to assess a model of patient focussed comprehensive care for Indigenous Australians with heart failure. STUDY DESIGN AUSI-CDS is a prospective, cohort, observational study to evaluate the efficacy of the standard "Flinders Program of Chronic Condition Management" for Indigenous patients with chronic heart failure. Eligible patients will be Indigenous, suffering from chronic heart failure, in the Northern Territory. The primary end-point is the satisfaction score based on the PACIC. The study will recruit 20 patients and is expected to last 12 months. SUMMARY The rationale and design of the AUSI-CDS using the Flinders Model is described.
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Affiliation(s)
- P Iyngkaran
- Flinders Human Behaviour and Health Research Unit (FHBHRU), Margaret Tobin Centre, Flinders University, Bedford Park, SA 5001, Australia; Royal Darwin Hospital, Division of Medicine, Level 7 Royal Darwin Hospital, Rocklands Drive, Tiwi, NT 0810, Australia.
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Clark RA, Coffee N, Turner D, Eckert KA, van Gaans D, Wilkinson D, Stewart S, Tonkin AM. Access to cardiac rehabilitation does not equate to attendance. Eur J Cardiovasc Nurs 2013; 13:235-42. [PMID: 23598464 DOI: 10.1177/1474515113486376] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Timely access to appropriate cardiac care is critical for optimizing positive outcomes after a cardiac event. Attendance at cardiac rehabilitation (CR) remains less than optimal (10%-30%). Our aim was to derive an objective, comparable, geographic measure reflecting access to cardiac services after a cardiac event in Australia. METHODS An expert panel defined a single patient care pathway and a hierarchy of the minimum health services for CR and secondary prevention. Using geographic information systems a numeric/alpha index was modelled to describe access before and after a cardiac event. The aftercare phase was modelled into five alphabetical categories: from category A (access to medical service, pharmacy, CR, pathology within 1 h) to category E (no services available within 1 h). RESULTS Approximately 96% or 19 million people lived within 1 h of the four basic services to support CR and secondary prevention, including 96% of older Australians and 75% of the indigenous population. Conversely, 14% (64,000) indigenous people resided in population locations that had poor access to health services that support CR after a cardiac event. CONCLUSION Results demonstrated that the majority of Australians had excellent 'geographic' access to services to support CR and secondary prevention. Therefore, it appears that it is not the distance to services that affects attendance. Our 'geographic' lens has identified that more research on socioeconomic, sociological or psychological aspects to attendance is needed.
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Affiliation(s)
- Robyn A Clark
- 1School of Nursing and Midwifery, Flinders University, South Australia, Australia
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Artuso S, Cargo M, Brown A, Daniel M. Factors influencing health care utilisation among Aboriginal cardiac patients in central Australia: a qualitative study. BMC Health Serv Res 2013; 13:83. [PMID: 23497140 PMCID: PMC3606832 DOI: 10.1186/1472-6963-13-83] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 02/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aboriginal Australians suffer from poorer overall health compared to the general Australian population, particularly in terms of cardiovascular disease and prognosis following a cardiac event. Despite such disparities, Aboriginal Australians utilise health care services at much lower rates than the general population. Improving health care utilisation (HCU) among Aboriginal cardiac patients requires a better understanding of the factors that constrain or facilitate use. The study aimed to identify ecological factors influencing health care utilisation (HCU) for Aboriginal cardiac patients, from the time of their cardiac event to 6-12 months post-event, in central Australia. METHODS This qualitative descriptive study was guided by an ecological framework. A culturally-sensitive illness narrative focusing on Aboriginal cardiac patients' "typical" journey guided focus groups and semi-structured interviews with Aboriginal cardiac patients, non-cardiac community members, health care providers and community researchers. Analysis utilised a thematic conceptual matrix and mixed coding method. Themes were categorised into Predisposing, Enabling, Need and Reinforcing factors and identified at Individual, Interpersonal, Primary Care and Hospital System levels. RESULTS Compelling barriers to HCU identified at the Primary Care and Hospital System levels included communication, organisation and racism. Individual level factors related to HCU included language, knowledge of illness, perceived need and past experiences. Given these individual and health system barriers patients were reliant on utilising alternate family-level supports at the Interpersonal level to enable their journey. CONCLUSION Aboriginal cardiac patients face significant barriers to HCU, resulting in sub-optimal quality of care, placing them at risk for subsequent cardiovascular events and negative health outcomes. To facilitate HCU amongst Aboriginal people, strategies must be implemented to improve communication on all levels and reduce systemic barriers operating within the health system.
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Affiliation(s)
- Stella Artuso
- Social Epidemiology and Evaluation Research Group, School of Population Health, University of South Australia, Adelaide, Australia
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Excellent outcomes of simultaneous pancreas kidney transplantation in patients from rural and urban Australia: a national service experience. Transplantation 2013; 94:1230-5. [PMID: 23149475 DOI: 10.1097/tp.0b013e3182708e04] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Simultaneous pancreas and kidney (SPK) transplantation is performed to restore normoglycemia and renal function in patients with type 1 diabetes mellitus and end-stage renal failure. The National Pancreas Transplant Unit (NPTU) in Sydney provides a service to a population spread across 7.4 million km. We aimed to see if SPK transplantation outcomes differed between recipients from metropolitan (M) centers and those from nonmetropolitan (NM) regions. METHODS Using a prospectively collected database, patient and graft survival were analyzed. Patients were categorized according to region of residence and by distance from the NPTU. RESULTS Between January 2001 and May 2010, 165 patients underwent first-time SPK transplantation at the NPTU. There were 126 M and 39 NM recipients. Median distance from the NPTU was 732 km for donors (range, 0-3930 km) and 887 km for recipients (range, 1-4114 km). Median follow-up was 5.2 years (range, 1.1-10.3 years). Actuarial 5-year patient survival was 94% in M and 95% in NM groups. At 5 years, non-death-censored pancreas graft survival was 75% and 82% among M and NM patients, respectively, while kidney allograft survival was 88% in M and 92% in NM groups. There was no significant difference in patient and graft survival between groups. Distance of donor and recipient from the NPTU did not influence graft or patient survival. CONCLUSIONS SPK transplantation can be performed with excellent outcomes at a national center with a vast catchment area, irrespective of donor or recipient location.
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Woods JA, Katzenellenbogen JM, Davidson PM, Thompson SC. Heart failure among Indigenous Australians: a systematic review. BMC Cardiovasc Disord 2012; 12:99. [PMID: 23116367 PMCID: PMC3521206 DOI: 10.1186/1471-2261-12-99] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 10/26/2012] [Indexed: 11/26/2022] Open
Abstract
Background Cardiovascular diseases contribute substantially to the poor health and reduced life expectancy of Indigenous Australians. Heart failure is a common, disabling, progressive and costly complication of these disorders. The epidemiology of heart failure and the adequacy of relevant health service provision in Indigenous Australians are not well delineated. Methods A systematic search of the electronic databases PubMed, Embase, Web of Science, Cinahl Plus, Informit and Google Scholar was undertaken in April 2012 for peer-reviewed journal articles relevant to the topic of heart failure in Indigenous Australians. Additionally, a website search was done to identify other pertinent publications, particularly government reports. Results There was a paucity of relevant peer-reviewed research, and government reports dominated the results. Ten journal articles, 1 published conference abstract and 10 reports were eligible for inclusion. Indigenous Australians reportedly have higher morbidity and mortality from heart failure than their non-Indigenous counterparts (age-standardised prevalence ratio 1.7; age-standardised hospital separation ratio ≥3; crude per capita hospital expenditure ratio 1.58; age-adjusted mortality ratio >2). Despite the evident disproportionate burden of heart failure in Indigenous Australians, the accuracy of estimation from administrative data is limited by poor indigenous identification, inadequate case ascertainment and exclusion of younger subjects from mortality statistics. A recent journal article specifically documented a high prevalence of heart failure in Central Australian Aboriginal adults (5.3%), noting frequent undiagnosed disease. One study examined barriers to health service provision for Indigenous Australians in the context of heart failure. Conclusions Despite the shortcomings of available published data, it is clear that Indigenous Australians have an excess burden of heart failure. Emerging data suggest that undiagnosed cases may be common in this population. In order to optimise management and to inform policy, high quality research on heart failure in Indigenous Australians is required to delineate accurate epidemiological indicators and to appraise health service provision.
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Affiliation(s)
- John A Woods
- Combined Universities Centre for Rural Health, PO Box 109, Geraldton, WA 6531, Australia.
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Stewart S. Nurse-Led Care of Heart Failure: Will it Work in Remote Settings? Heart Lung Circ 2012; 21:644-7. [DOI: 10.1016/j.hlc.2012.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 07/04/2012] [Indexed: 12/01/2022]
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Carrington MJ, Jennings GL, Clark RA, Stewart S. Assessing cardiovascular risk in regional areas: the Healthy Hearts Beyond City Limits program. BMC Health Serv Res 2012; 12:296. [PMID: 22943553 PMCID: PMC3465178 DOI: 10.1186/1472-6963-12-296] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 08/01/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is more prevalent in regional and remote Australia compared to metropolitan areas. The aim of Healthy Hearts was to determine age and sex specific CVD risk factor levels and the potential value of national risk clinics. METHODS Healthy Hearts was an observational research study conducted in four purposefully selected higher risk communities in regional Victoria, Australia. The main outcome measures were the proportion of participants with CVD risk factors with group comparisons to determine the adjusted likelihood of elevated risk factor levels. Trained personnel used a standardized protocol over four weeks per community to measure CVD risk factor levels, estimate absolute CVD risk and provide feedback and advice. RESULTS A total of 2125 self-selected participants were assessed (mean age 58 ± 15 years, 57% women). Overall, CVD risk factors were highly prevalent. More men than women had ≥ 2 modifiable CVD risk factors (76% vs. 68%, p < .001), pre-existing CVD (20 vs. 15%, p < .01) and a major ECG abnormality requiring follow-up (15% vs. 7%, p < .001) . Less men reported depressive symptoms compared to women (28% vs. 22%, p < .01). A higher proportion of women were obese (adjusted OR 1.36, 95% CI 1.13 to 1.63), and physically inactive (adjusted OR 1.32, 95% CI 1.07 to 1.63). CONCLUSIONS High CVD risk factor levels were confirmed for regional Victoria. Close engagement with individuals and communities provides scope for the application of regional risk management clinics to reduce the burden of CVD risk in regional Australia.
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Clark RA, Coffee N, Turner D, Eckert KA, van Gaans D, Wilkinson D, Stewart S, Tonkin AM. Application of Geographic Modeling Techniques to Quantify Spatial Access to Health Services Before and After an Acute Cardiac Event. Circulation 2012; 125:2006-14. [PMID: 22451583 DOI: 10.1161/circulationaha.111.083394] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Access to cardiac services is essential for appropriate implementation of evidence-based therapies to improve outcomes. The Cardiac Accessibility and Remoteness Index for Australia (Cardiac ARIA) aimed to derive an objective, geographic measure reflecting access to cardiac services.
Methods and Results
An expert panel defined an evidence-based clinical pathway. Using Geographic Information Systems (GIS), the team developed a numeric/alphabetic index at 2 points along the continuum of care. The acute category (numeric) measured the time from the emergency call to arrival at an appropriate medical facility via road ambulance. The aftercare category (alphabetic) measured access to 4 basic services (family doctor, pharmacy, cardiac rehabilitation, and pathology services) when a patient returned to his or her community. The numeric index ranged from 1 (access to principal referral center with cardiac catheterization service ≤1 hour) to 8 (no ambulance service, >3 hours to medical facility, air transport required). The alphabetic index ranged from A (all 4 services available within a 1-hour drive-time) to E (no services available within 1 hour). The panel found that 13.9 million Australians (71%) resided within Cardiac ARIA 1A locations (hospital with cardiac catheterization laboratory and all aftercare within 1 hour). Those outside Cardiac 1A were overrepresented by people >65 years of age (32%) and indigenous people (60%).
Conclusions
The Cardiac ARIA index demonstrated substantial inequity in access to cardiac services in Australia. This methodology can be used to inform cardiology health service planning and could be applied to other common disease states within other regions of the world.
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Australia's health care reform agenda: Implications for the nurses’ role in chronic heart failure management. Aust Crit Care 2011; 24:189-97. [DOI: 10.1016/j.aucc.2010.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 08/11/2010] [Accepted: 08/17/2010] [Indexed: 11/23/2022] Open
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Williams TA, Leslie GD. Challenges and possible solutions for long-term follow-up of patients surviving critical illness. Aust Crit Care 2011; 24:175-85. [PMID: 21514838 DOI: 10.1016/j.aucc.2011.03.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 03/17/2011] [Accepted: 03/23/2011] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Surviving critical illness can be life-changing and present new healthcare challenges for patients after discharge from hospital. Optimisation of recovery, rather than mere survival, is an important goal of intensive care. Observational studies have identified decreased quality of life and increased healthcare needs for survivors but loss to follow-up can be high with possible selection bias. Patients in need of support may therefore not be included in study results or allocated appropriate follow up support. AIM To examine the frequency and reasons patients admitted to general ICUs who survive critical illness are excluded from study participation or lost to follow-up and consider the possible implications and solutions. METHOD The literature review included searches of the MEDLINE, EMBASE, and CINAHL databases. Studies (2006-2010) were included if they described follow-up of survivors from general ICUs. RESULTS Ten studies were reviewed. Of the 3269 eligible patients, 14% died after hospital discharge, 27% declined, and 22% were lost to follow-up. Reasons for loss to follow-up included no response, inability to contact the patient, too ill or admitted to another facility. CONCLUSION The most appropriate method of care follow-up has yet to be established but is likely to involve an eclectic model that tailors service provision to support individual patient needs. Identifying methods to minimise loss to follow-up may enhance interpretation of patients' recovery, lead to improvements in clinical practice and inform healthcare service decisions and policy.
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Affiliation(s)
- Teresa A Williams
- School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, Western Australia, Australia.
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Riegel B, Driscoll A, Suwanno J, Moser DK, Lennie TA, Chung ML, Wu JR, Dickson VV, Carlson B, Cameron J. Heart failure self-care in developed and developing countries. J Card Fail 2009; 15:508-16. [PMID: 19643362 PMCID: PMC2745342 DOI: 10.1016/j.cardfail.2009.01.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 01/21/2009] [Accepted: 01/26/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heart failure (HF) self-care is poor in developed countries like the United States, but little is known about self-care in developing countries. METHODS AND RESULTS A total of 2082 adults from 2 developed (United States and Australia) and 2 developing countries (Thailand and Mexico) were studied in a descriptive, comparative study. Self-care was measured using the Self-Care of HF Index, which provided scores on self-care maintenance, management, and confidence. Data were analyzed using regression analysis after demographic (age, gender, education), clinical (functional status, experience with the diagnosis, comorbid conditions), and setting of enrollment (hospital or clinic) differences were controlled. When adequate self-care was defined as a standardized score >or=70%, self-care was inadequate in most scales in most groups. Self-care maintenance was highest in the Australian sample and lowest in the Thai sample (P < .001). Self-care management was highest in the US sample and lowest in the Thai sample (P < .001). Self-care confidence was highest in the Mexican sample and lowest in the Thai sample (P < .001). Determinants differed for the three types of self-care (eg, experience with HF was associated only with self-care maintenance). CONCLUSION Interventions aimed at improving self-care are greatly needed in both the developed and the developing countries studied.
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Affiliation(s)
- Barbara Riegel
- University of Pennsylvania School of Nursing, Philadelphia, PA 19104-4217, USA.
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Carrington MJ, Jennings GL, Stewart S. Pattern of blood pressure in Australian adults: results from a national blood pressure screening day of 13,825 adults. Int J Cardiol 2009; 145:461-7. [PMID: 19573941 DOI: 10.1016/j.ijcard.2009.06.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 06/03/2009] [Indexed: 12/01/2022]
Abstract
BACKGROUND Recent national data of cardiovascular disease (CVD) risk factors in Australia are limited. Therefore this study sought to gain a contemporary snapshot of the blood pressure (BP) profile of Australian adults. METHODS We established 100 metropolitan and regional screening sites. Using a standardized protocol and the same automated, validated BP monitor, Registered Nurses recorded the BP and other risk factors for CVD of self-selected volunteers on a single day. RESULTS A total of 13,825 subjects (55% female, aged 48±16 years) were assessed. Mean systolic and diastolic BP was 131±18 and 79±12 mm Hg. Overall, 34% had an elevated BP while 10% being treated for hypertension (HT) were normotensive (combined total 44%). Elevated BP was more common in older individuals, men (42% versus 27% of women), regional dwelling residents (40% versus 32% of metropolitan) and people from lower socio-economic backgrounds (39% versus 30% of higher). Overall, 50% of subjects with a history of HT had elevated BP compared to 30% without a history of HT. Adjusting for age and sex, elevated BP was independently associated with obesity (OR: 1.77, 95% CI 1.52-2.06), regional location (OR: 1.32, 95% CI 1.19-1.45) and modifiable risk factors (OR: 1.28, 95% CI 1.21-1.35); those being treated for CVD or diabetes are less likely to have high BP. CONCLUSIONS In the largest study of its kind in Australia, the findings highlight the need for continued vigilance to detect, monitor and prevent elevated BP within an ageing population in whom metabolic disorders are becoming more frequent.
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Vitry AI, Phillips SM, Semple SJ. Quality and availability of consumer information on heart failure in Australia. BMC Health Serv Res 2008; 8:255. [PMID: 19077257 PMCID: PMC2615440 DOI: 10.1186/1472-6963-8-255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 12/12/2008] [Indexed: 11/17/2022] Open
Abstract
Background Provision of consumer information and patient education are considered an essential part of chronic disease management programmes developed for patients with heart failure. This study aimed to review the quality and availability of consumer information materials for people with heart failure in Australia. Methods The availability of consumer information was assessed through a questionnaire-based survey of the major organisations in Australia known, or thought, to be producing or using consumer materials on heart failure, including hospitals. The questionnaire was designed to explore issues around the use, production and dissemination of consumer materials. Only groups that had produced consumer information on heart failure were asked to complete the totality of the questionnaire. The quality of information booklets was assessed by using a standardised checklist. Results Of 101 organisations which were sent a questionnaire, 33 had produced 61 consumer resources on heart failure including 21 information booklets, 3 videos, 5 reminder fridge magnets, 7 websites, 15 self-management diaries and 10 self-management plans. Questionnaires were completed for 40 separate information resources. Most had been produced by hospitals or health services. Two information booklets had been translated into other languages. There were major gaps in the availability of these resources as more than half of the resources were developed in 2 of the 8 Australian states and territories, New South Wales and Victoria. Quality assessment of 19 information booklets showed that most had good presentation and language. Overall eight high quality booklets were identified. There were gaps in terms of topics covered, provision of references, quantitative information about treatment outcomes and quality and level of scientific evidence to support medical recommendations. In only one case was there evidence that consumers had been involved in the production of the booklets. Conclusion Key findings arising from the study included the need to develop a nationally coordinated approach for increasing the dissemination of information resources on heart failure. While the more recent publication of a booklet by the National Heart Foundation may have improved the situation, dissemination of written information materials may remain sub-optimal, especially among patients who are not enrolled in chronic heart failure management programmes.
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Affiliation(s)
- Agnes I Vitry
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, University of South Australia, Adelaide, Australia.
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Abstract
Cardiovascular disease is the leading cause of death worldwide, with a projected increase in incidence in developed and developing countries. This paper will review the literature on the role of poverty and socioeconomic deprivation in cardiovascular disease and outline ways to tackle poverty. The literature acknowledges the individual risk factors for cardiovascular disease, but highlights the negative effects of neighborhood deprivation on the incidence of cardiovascular disease and its mortality rates. The studies show that equitable access to health care is not evident and those in less affluent neighborhoods have greater disease incidence and increased mortality and morbidity rates, particularly for angina, myocardial infarction, and heart failure. The approach to reducing disease rates needs to be conducted from an individual level to the societal level and needs to prevent and treat heart disease (particularly in deprived neighborhoods). Nurses and health professionals must drive health policy so that progress can be achieved in reducing the disease rates.
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Affiliation(s)
- Geraldine Lee
- Preventative Cardiology, Baker Heart Research Institute, Melbourne, Australia.
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Clark RA, Yallop JJ, Piterman L, Croucher J, Tonkin A, Stewart S, Krum H. Adherence, adaptation and acceptance of elderly chronic heart failure patients to receiving healthcare via telephone-monitoring. Eur J Heart Fail 2007; 9:1104-11. [DOI: 10.1016/j.ejheart.2007.07.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 05/27/2007] [Accepted: 07/16/2007] [Indexed: 10/22/2022] Open
Affiliation(s)
- Robyn A. Clark
- National Heart Foundation South Australian Branch; Australia
- Faculty of Health Sciences; University of South Australia; Australia
| | - Julie J. Yallop
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences; Monash University; Prahran Victoria Australia
- Department of General Practice & Primary Health Care; The University of Auckland; New Zealand
| | - Leon Piterman
- School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences; Monash University; East Bentleigh Vic Australia
| | - Joanne Croucher
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences; Monash University; Prahran Victoria Australia
| | - Andrew Tonkin
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences; Monash University; Prahran Victoria Australia
| | - Simon Stewart
- Department of Preventative Cardiology; Baker Heart Research Institute; Prahran Victoria Australia
| | - Henry Krum
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences; Monash University; Prahran Victoria Australia
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Clark RA, Driscoll A, Nottage J, McLennan S, Coombe DM, Bamford EJ, Wilkinson D, Stewart S. Inequitable provision of optimal health services for patients with chronic heart failure: a national geo‐mapping study. Med J Aust 2007. [DOI: 10.5694/j.1326-5377.2007.tb01264.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Robyn A Clark
- Health Sciences Department, University of South Australia, Adelaide, SA
| | - Andrea Driscoll
- Faculty of Health Sciences, Deakin University, Melbourne, VIC
| | - Justin Nottage
- National Centre for Social Applications of Geographic Information Systems (GISCA), University of Adelaide, Adelaide, SA
| | - Skye McLennan
- Department of Psychology, University of Adelaide, Adelaide, SA
| | - David M Coombe
- National Centre for Social Applications of Geographic Information Systems (GISCA), University of Adelaide, Adelaide, SA
| | - Errol J Bamford
- National Centre for Social Applications of Geographic Information Systems (GISCA), University of Adelaide, Adelaide, SA
| | - David Wilkinson
- Mayne Medical School, University of Queensland, Brisbane, QLD
| | - Simon Stewart
- Preventative Cardiology Division, Baker Heart Research Institute, Melbourne, VIC
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Dodd EA. Inequitable provision of optimal health services for patients with chronic heart failure: a national geo‐mapping study. Med J Aust 2007; 187:318-9; author reply 319. [PMID: 17767445 DOI: 10.5694/j.1326-5377.2007.tb01263.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 06/21/2007] [Indexed: 11/17/2022]
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