NACCHO Aboriginal Health Pharmacy News : #ACCHO Pharmacy skills will help #closethegap in #heart disease

ACCHOs have a strong history in doing this effectively and appropriately for their communities,

Specifically, ACCHO-embedded non-dispensing pharmacists and community pharmacies have a role in identifying risk factors and encouraging heart health checks within the ACCHO communities.’

Deputy NACCHO CEO Dr Dawn Casey

With new research showing current cardiovascular disease screening guidelines are missing younger at-risk Aboriginal people, a leading Aboriginal health specialist has highlighted the role pharmacists can play in preventative cardiac care.

The statement Dr Dawn Casey comes following research finding up to half of older Australian Aboriginal and Torres Strait Islander people are at high risk of cardiovascular disease (CVD), and that significant numbers of those in their 20s were also at risk.¹

Continued below

Read over 50 NACCHO Aboriginal Heart Health articles published over past 6 years

Read 8 NACCHO Aboriginal Health and Pharmacy articles

Featured article 

 Read above report HERE : NACCHO Aboriginal Heart Health

From Australian Pharmacist 

Australian National University researchers found 1.1% of Aboriginal and Torres Strait Islander 18-24 year olds and 4.7% of 25-34 year olds were at high absolute primary risk of CVD. This is around the same as the proportion of non-Indigenous Australians aged 45-54 who are at high risk.¹

The study of 2820 people from a 2012-13 health survey² revealed many Aboriginal and Torres Strait Islander people are not aware of their risk and most not receiving currently recommended therapy to lower their cholesterol, and are hospitalised for coronary heart disease at a rate up to eight times higher than that of other Australians.¹

Australia’s national guidelines recommend all Aboriginal and Torres Strait Islander peoples aged 35-74 have a heart check. But this new research found the high-risk category starts much earlier than this, and indicates the affected group needs to start receiving CVD checks earlier in life, the study authors said.

Dr Casey echoed the positive results of the study, allowing the entire ACCHS sector to better deliver preventative and holistic care.

‘ACCHOs have a strong history in doing this effectively and appropriately for their communities,’ she told Australian Pharmacist.

‘Specifically, ACCHO-embedded non-dispensing pharmacists and community pharmacies have a role in identifying risk factors and encouraging heart health checks within the ACCHO communities.’

‘Embedded ACCHO pharmacists can use their skills and knowledge work with a range of clinicians in the ACCHO to conduct holistic risk screening and overall management strategy.

NACCHO is currently actively advocating for enhanced integration of pharmacists into ACCHOs models of care.’

NACCHO and PSA are currently working as part of a broader team on two projects to enhance the broader roles that pharmacists’ skills and training can deliver – Integrating Pharmacists within Aboriginal Community Controlled Health Services to improve Chronic Disease Management (IPAC) and Indigenous Medication Review Service (IMeRSe).

‘Pharmacists have a broad range of clinical skills and are often very suitable additions to multidisciplinary clinical teams, especially where chronic disease is prevalent and many medicines required,’ Dr Casey said.

‘Community pharmacists may identify risks within normal client care, for example through a pharmacy-based MedsCheck or an HMR. Where team-based care is working effectively, pharmacies and ACCHOs will liaise and work together to ensure care is optimised across these settings.

‘Pharmacists’ understanding of medicines also involves understanding how medical conditions and risk factors for these conditions apply. Unfortunately there is still sometimes a misconception across Australia that pharmacists really just supply medicines and manage retail businesses. Enhancing professional and clinical services is a key trend across the whole pharmacy sector and NACCHO is an active participant in these developments.’

PSA and NACCHO have collaboratively produced guidelines to support pharmacists caring for Aboriginal and Torres Strait Islander people available at:

http://www.psa.org.au/wp-content/uploads/guide-to-providing-pharmacy-services-to-aboriginal-and-torres-strait-islander-people-2014.pdf

References

1 Calabria B, Korda RJ, Lovett RW, Fernando P, Martin T, Malamoo L, Welsh J, Banks, E. Absolute cardiovascular disease risk and lipid-lowering therapy among Aboriginal and Torres Strait Islander Australians. Med J Aust 2018; 209 (1): 35-41. DOI: 10.5694/mja17.00897

NACCHO Aboriginal Heart Health : Download @AIHW Report on #cardiac care for Indigenous people. Mortality falling but still “much higher” than non-Indigenous pop. Investment needed to #ClosetheGap #ACCHOs @Aus_Lighthouse @END_RHD @HeartAust

 ” Heart-related conditions, such as coronary heart disease, heart failure, and rheumatic heart disease (RHD), contribute substantially to poor health and reduced life expectancy among Aboriginal and Torres Strait Islander people.

Cardiac conditions are more common among Indigenous than non-Indigenous Australians, and there are many interconnected reasons for this, including higher rates of risk factors for cardiac conditions (such as smoking, low levels of physical activity, overweight or obesity, diabetes, and high blood pressure), and poorer access to preventative health services “

AIHW Report Released July 6

aihw-Cardiac Report

Read Previous NACCHO Aboriginal Heart Health : @HeartAust #NickysMessage “Heart disease is the number one killer of Aboriginal and Torres Strait Islander peoples. “

Read also over 50 Aboriginal Health and Heart Articles published over 6 Years

Better Cardiac Care project and selected extracts

The Better Cardiac Care for Aboriginal and Torres Strait Islander People project is an initiative that was developed at the Better Cardiac Care for Aboriginal and Torres Strait Islander People Forum, held in March 2014 (BCCF 2014).

Representatives from various Indigenous and other organisations, as well as Australian Government and jurisdictional health departments attended the forum.

The project aims to reduce mortality and morbidity from cardiac conditions among Indigenous Australians, by increasing access to services, better managing risk factors and treatment, and improving coordination of care.

The forum established 5 priority areas of interventions that health services should undertake to improve cardiac care for Indigenous Australians, which:

  • are aligned with national and international best-practice guidelines for cardiac care and chronic disease
  • were informed by the Essential Service Standards for Equitable National Cardiovascular Care
  • focus on providing sustainable models of care built around partnerships between all health service providers.

SEE AIHW WEBSITE

The 5 priority areas are:

  • primary preventive care—early cardiovascular risk assessment and management
  • clinical suspicion of disease—timely diagnosis of heart disease and heart failure
  • acute episode—guideline-based therapy for acute coronary syndrome
  • ongoing care—optimisation of health status and provision of ongoing preventive care
  • rheumatic heart disease—strengthening the diagnosis, notification, and follow-up of RHD.

A set of 21 Better Cardiac Care measures (Table 1.1) were also developed to track the implementation and monitoring of the priority areas and associated actions

2 Results

Priority area 1: Early cardiovascular risk assessment and management

Priority area 1 of the Better Cardiac Care project is early cardiovascular risk assessment and management. This is based on the premise that all Aboriginal and Torres Strait Islander people with no known cardiac disease should receive:

  • an annual cardiovascular risk assessment
  • appropriate management and follow-up for identified cardiac disease risk factors
  • lifestyle modification advice appropriate to their cardiovascular risk level, as per current guidelines (NACCHO & RACGP 2012).

Primary prevention in the form of early and consistent risk factor identification and management will improve long-term outcomes for Indigenous Australians, reduce the population burden of chronic cardiac disease, and improve the appropriate delivery of care by the health-care system (BCCF 2014).

Three measures were agreed upon within this priority area, and updated data are available for measure 1.1 on health assessments.

The data for measure 1.2 are expected to become available for the next report, which will be provided based on the AIHW data collection on the national key performance indicators for Aboriginal and Torres Strait Islander primary health care.

Measure 1.1: Annual health assessments

This measure reports on the number and proportion of Indigenous Australians who had a Medicare Benefits Schedule (MBS) health assessment in the previous 12 months (Table B.2 in Appendix B contains the list of relevant MBS item numbers included in the measure).

Why is it important?

Health assessments aim to increase preventative health opportunities, detect chronic disease risk factors, manage existing chronic disease, and reduce inequities in access to primary care for Indigenous Australians. Early detection and management of risk factors for cardiac disease (such as smoking, physical inactivity, high blood pressure) can reduce the incidence of cardiac disease and lessen its severity.

All Indigenous Australians are eligible for an annual health assessment, which is listed as item 715 on the MBS.This comprehensive health asessement covers a wide variety of risk factors related to cardiac disease and other chronic diseases, including medical history, nutrition, physical activity, smoking and alcohol intake, living conditions, and body mass index, although it is not a specific cardiovascular risk assessment. People within specified target groups may also be eligible for other types of MBS health assessments (Department of Health 2014), which are referred to as ‘general’ health assessments in this report.

Results

Overall:

  • In 2015–16, more than one-quarter of Indigenous Australians (27%, or an estimated 199,400 people) received a health assessment—about 26% received an MBS item 715 health assessment, and about 1% received a general health assessment (Figure 1.1a).

Time trend:

  • Between 2004–05 and 2015–16, the age-standardised proportion of Indigenous Australians who had an MBS health assessment rose from 2% to 27% for females, and from 2% to 24% for males (Figure 1.1b).
  • From 2014–15 to 2015–16, the overall proportion rose by 3 percentage points.
  • A marked increase occurred from 2010–11, coinciding with the introduction of the Australian Government’s Indigenous Chronic Disease Package.

Sex and age:

In 2015–16:

  • more Indigenous females than males had an MBS health assessment (Figure 1.1b)
  • about one-quarter (25%) of Indigenous children aged under 15 had an MBS health assessment. Among Indigenous Australians aged 15 and over, the proportion rose from 21% among those aged 15–24 to 38% among those aged 65 and over (Figure 1.1c).

State/territory and remoteness area:

In 2015–16, the proportion of Indigenous Australians who had an MBS health assessment was:

  • highest in Queensland (33%), and lowest in Tasmania (9%) (Figure 1.1d)
  • highest in Inner/Outer regional areas combined (29%), and lowest in Major cities (21%)

Priority area 2: Timely diagnosis of heart disease and heart failure

Priority area 2 of the Better Cardiac Care project is timely diagnosis of heart disease and heart failure.

This is based on the premise that all Aboriginal and Torres Strait Islander people suspected of having heart disease or heart failure should receive appropriate initial diagnostic services (such as stress testing or coronary angiography for ischaemic heart disease, or echocardiography for heart failure and rheumatic heart disease) as close to the patient’s home as possible, within acceptable timeframes according to the level of risk and the patient’s condition (BCCF 2014).

Of the 3 measures recommended for this priority area, data are available for:

  • measure 2.1 for Medicare-listed diagnostic items
  • measure 2.3 for cardiologist review of suspected/confirmed cardiac disease

Measure 2.1: Cardiac-related diagnosis

This measure reports on the number and proportion of Indigenous Australians who had 1 or more relevant cardiac-related MBS diagnostic item claims in the previous 12 months, compared with non-Indigenous Australians (Table B.2 in Appendix B contains the list of relevant MBS item numbers included in the measure).The current report includes additional MBS items within measure 2.1, compared with the second national report (AIHW 2016); as such the results are not comparable. Additional MBS items were used to more accurately capture the status of cardiac-related diagnoses, and were obtained from the Cardiac Services Clinical Committee of the Medical Benefit Schedule Review Taskforce (Department of Health 2017).

Why is it important?

People suspected of having cardiac disease should receive appropriate and timely diagnostic services. Categories of diagnostic tests captured by this measure include:

  • diagnostic procedures and investigations—19 items that include various kinds of electrocardiography, and pacemaker and defibrillator testing
  • diagnostic imaging services—25 items that include various kinds of echocardiography, computed tomography scans and angiography (Department of Health 2018).

Results

Overall:

In 2015–16:

  • 64,909 MBS claims for cardiac-related diagnostic items were made for Indigenous patients (age-standardised proportion of 13.2%), compared with 3,178,327 claims for non-Indigenous patients (proportion of 12.1%).
  • 45,932 claims for diagnostic procedures and investigations (age-standardised proportion of 9.3%), and 18,977 claims for diagnostic imaging services (age-standardised proportion of 3.9%) were made for Indigenous patients—both proportions were slightly higher than for non-Indigenous Australians (Figure 2.1a).

Time trend:

  • Between 2004–05 and 2015–16, the age-standardised proportion of Indigenous Australians who had cardiac-related diagnostic items MBS claims rose from 6.8% to 10.4%, with a similar pattern for non-Indigenous Australians (rising from 6.9% to 9.1%) (Figure 2.1b).

Sex and age:

In 2015–16, the proportion of Indigenous Australians who had MBS claims for cardiac-related diagnostic items:

  • rose with increasing age, with the lowest proportion among those aged under 25. It was slightly higher than that of non-Indigenous Australians in all age groups, except for those aged 65 and over, where proportions were higher among non-Indigenous Australians (Figure 2.1c)
  • was lower overall than that of non-Indigenous Australians, for men and women, with Indigenous women having slightly higher proportions than Indigenous men (Figure 2.1d).

Better Cardiac Care measures for Aboriginal and Torres Strait Islander people 2017 11

State/territory and remoteness area:

In 2015–16, the proportions of MBS claims for cardiac-related diagnostic items:

  • ranged from 3% to 13% across states and territories, and from 7% to 8% across remoteness areas among Indigenous Australians (figures 2.1e and 2.1f)
  • were lower among Indigenous Australians living in Major cities and Inner/Outer regional areas combined than their non-Indigenous counterparts (Figure 2.1f).

Priority area 4: Optimisation of health status and provision of ongoing preventive care

Priority area 4 is optimisation of health status and provision of ongoing preventive care. This is based on the premise that all Aboriginal and Torres Strait Islander people with cardiac conditions should receive ongoing multidisciplinary primary health care and specialist physician follow-up as required, to prevent further illness, and to optimise health status (BCCF 2014).

Of the 4 measures recommended for this priority area, MBS data are available for:

  • measure 4.2 for follow-up after receiving a cardiovascular therapeutic procedure
  • measure 4.3 for specialist physician review after a cardiovascular therapeutic procedure

Priority area 5: Strengthening the diagnosis, notification and follow-up of rheumatic heart disease

Priority area 5 of the Better Cardiac Care project is strengthening the diagnosis, notification and follow-up of rheumatic heart disease (RHD) (BCCF 2014). This is based on the premise that:

  • all Aboriginal and Torres Strait Islander people suspected to have acute rheumatic fever (ARF) or RHD should receive an echocardiogram as early as possible
  • new cases should be automatically reported to a central register to help track patients, and ensure ongoing care.

There is no diagnostic pathology test for ARF; instead, its diagnosis is based on a clinical decision (RHD Australia et al. 2012). The clinical manifestation of ARF is non-specific and can be atypical, with delays in both presentation and referral of patients. As a result, ARF can often go undetected in the acute stage, leading to ongoing complications and lifelong morbidity.

Of the 4 measures recommended for this priority area, data are available from RHD registers in Queensland, Western Australia, South Australia, and the Northern Territory for:

  • measure 5.1 for the annual incidence of ARF and RHD
  • measure 5.2 for recurrent ARF
  • measure 5.3 for treatment with benzathine penicillin G doses
  • measure 5.4 for echocardiograms among patients with severe or moderate RHD.

NACCHO Aboriginal Health Heart Map : Our Indigenous Community Hurting in the Heart

Heart

“Aboriginal and Torres Strait Islander peoples are two-and-a-half times more likely to be admitted to hospital for heart events than non-Indigenous Australians.

For both sexes, Aboriginal and Torres Strait Islander peoples are more likely to have high blood pressure, be obese, smoke and a poor diet.

“Many of the hospital admissions for Aboriginal and Torres Strait Islander peoples are preventable and the Heart Foundation is committed to closing the gap in health outcomes for Aboriginal and Torres Strait Islander peoples.”

Heart Foundation National Chief Executive Officer Adjunct Professor John Kelly said these maps brought together for the first time a national picture of hospital admission rates for heart-related conditions at a national, state and regional level.

Or Download report and press release

Australian Heart Maps Report 2016

Australia’s Indigenous Community Hurting in the Heart

Aboriginal and Torres Strait Islander peoples are two-and-a-half times more likely to be admitted to hospital for heart events than non-Indigenous Australians.

Of all the four heart events (STEMI and NSTEMI, unstable angina and heart failure), admission rates for Aboriginal and Torres Strait Islander peoples is at least double that of non-Indigenous Australians.

“For all separations, Aboriginal and Torres Strait Islander peoples have a rate of 117.9 compared to non-Indigenous of 48.9,” Adj Prof John Kelly said.

“If Aboriginal and Torres Strait Islander peoples had the same rate of admissions, there would be 2300 fewer hospital admissions each year including close to 900 fewer admitted for a heart attack.

“For both sexes, Aboriginal and Torres Strait Islander peoples are more likely to have high blood pressure, be obese, smoke and a poor diet.

“Adding to the risk is they’re more likely to have comorbidities, which is having at least two or more conditions/illnesses such as heart disease, respiratory disease and kidney disease.

For almost every social indicator (education, income, housing security etc) Aboriginal and Torres Strait Islander peoples fare worse than their non-indigenous counterparts.

“These poorer social and economic conditions lead to higher rates of smoking, hypertension, and obesity for Aboriginal and Torres Strait Islander peoples.

“Yet, for historical, geographic and cultural reasons, primary healthcare services remain under-used by Aboriginal and Torres Strait Islander peoples.

“As a result, poorer health and lower quality of life becomes the “norm” until a critical event like a heart attack happens.

“Many of the hospital admissions for Aboriginal and Torres Strait Islander peoples are preventable and the Heart Foundation is committed to closing the gap in health outcomes for Aboriginal and Torres Strait Islander peoples.”

Mapping Out Australia’s Heart Health

MAP

 

View and Engage with Heart Map Here

New heart-related hospital admissions data mapped by the Heart Foundation reveals disturbing gaps between those living in the city and those in regional Australia.

A concerning trend among the hotspots was the correlation between access to services, particularly for those considered disadvantaged, and the rates of heart-related hospital admissions.

Heart Foundation has launched Australian Heart Maps, which is an online service highlighting how indicators for heart disease are distributed throughout Australia’s hospital network.

Queensland dominates the list of hotspots with 12 regions included in the top 20.

This compared to four from New South Wales, two from Northern Territory and one each from Western Australia and Victoria.

“This contrasts to areas with the lowest rates – particularly the northern suburbs of Sydney, where there is little disadvantage of the community.

“There is a five-fold difference of hospital admissions between Northern Territory Outback and the region with the lowest admission rates North Sydney & Hornsby, which highlights the association between remoteness, disadvantage and our heart health.

“The lowest rate we see in the northern suburbs of Sydney tells us what is possible, what we should be striving for across the country.”

Adj Prof Kelly added that the Heart Maps would serve as a valuable tool for health professionals, health services, local governments, researchers and policy makers to be used to set strategy, plan services and target prevention initiatives to areas of greatest need.

“What we need is a greater focus on prevention and management of heart disease in rural and remote Australia and in areas of disadvantage,” he said.

“For those with established heart disease, we want to work with health planners to ensure everyone has good access to co-ordinated cardiac services to reduce hospital readmissions and the development of further chronic disease.”

The Heart Foundation Heart Maps display hospital admission rates for two years of hospital separation data, with a separation defined as a completed episode of patient care in hospital resulting in discharge, death, transfer or change in type of care (ie: acute to rehabilitation).

The Heart Maps display separations for four key heart diagnosis – NSTEMI, STEMI, Unstable Angina and Heart Failure, with data for all heart-related admissions presented.

The data is shown on interactive online maps that drill down into each region looking at the number of hospital admissions as well as identify the risk factors for heart problems by high blood pressure, high cholesterol, obesity, smoking and physical inactivity.

Further Away You’re Closer to a Heart Related Hospital Visit

Living in a very remote area, you’re nearly twice as likely to need to visit a hospital for a heart event.

In figures available as part of the Heart Foundation Australian Heart Maps, the further a person lives from a major city the greater the rate of heart related hospitalisations.

Those living in major cities had an ASR of 47.1, with rates increasing for people living in regional areas (inner regional 53.1; outer regional 57.6; remote 62.2; very remote 92.5).

“If Australians in outer regional and beyond had the same hospital admissions rate as those in major cities, there would be more than 3400 avoidable hospital visits for a serious heart event each year,” Adj Prof John Kelly said.

“That would mean 1700 fewer admissions for a heart attack, which is more than four a day.

“The Heart Foundation urges regional service providers and State and local governments to use this information to ensure all Australians have access to preventative health care and facilities to reduce the risk factors.”

“Along with higher rates of smoking, obesity and physical inactivity, remote Australia experiences higher levels of disadvantage, has poorer access to health services and the conditions needed for health such as an environment that supports physical activity, access to affordable healthy food, access to education and secure employment.”

see report in full Australian Heart Maps Report 2016

About the Maps

The Heart Foundation’s Australian Heart Maps bring together for the first time a national picture of hospital admission rates for heart-related conditions at a national, state, regional and where possible, at a local government level.

The Heart Maps show how rates of heart related admissions compare across Australia. Importantly, the Heart Maps also highlight the association between socioeconomic disadvantage and remoteness with heart health outcomes.

The Heart Maps can act as a valuable tool for health professionals, health services, local governments, researchers and policy makers. The Heart Maps can be used to establish health related strategies, to plan for health services and to develop/implement targeted prevention initiatives. Specifically, the Heart Maps show:

  1. The rate of hospital admissions (per 10,000 people) for “All Heart Admissions” at a Local Government level. Local Governments can be compared against the national average and are ranked from highest to lowest admission rate across Australia.
  2. The rate of admissions (per 10,000 people) for “All Heart Admissions”, Heart Attack (both STEMI and Non-STEMI), Heart Failure, and Unstable angina for states/territories and SA4 regions.
  3. Australian Health Survey data (2011/12) for the prevalence of smoking, obesity, insufficient physical activity, hypertension and total high cholesterol for states/territories and SA4 regions.

The Heart Maps provide a national context for the more detailed state level maps available for Victoria and South Australia.

About the Data

Two years of hospital separation data (2012/13 and 2013/14) is presented in the Heart Maps. The separation (admission) data excludes admissions where a patient has been transferred from another hospital.

The admission data was accessed from State and Territory Health departments via the Australian Institute of Health and Welfare (AIHW). Suppression rules have been applied to the Heart Maps, in accordance with the State and Territory Conditions of Data Release. That is, admission rates are suppressed for any population smaller than 1,000 or where there are fewer than five admissions.

A full technical report describing the data and analysis is now available.

Acknowledgments

The Heart Foundation would like to acknowledge the following organisations:

  • The Australian Institute of Health and Welfare (AIHW): in seeking clearance from the State/Territory Data custodians and for undertaking the preliminary data analysis.
  • State/Territory Health departments: for providing initial feedback and recommendations relating to the project.
  • Statistical Consultant and Epidemiologist, Stephen Vander Hoorn: for undertaking comprehensive statistical analysis and for developing the online mapping tool.