Queensland Cardiovascular Disease Burden in the Aboriginal and Torres Strait Islander Population

1. Queensland Cardiovascular Disease Burden in the Aboriginal and Torres Strait Islander Population Aboriginal and Torres Strait Islander Health Branch

2. Overview • Indigenous CVD Burden in Queensland • Rheumatic Heart Disease • Aboriginal and Torres Strait Islander Better Cardiac Care Data Linkage Project

3. Burden of disease and injury

4. Burden of disease and injury gap 52 per cent of gap

5. Queensland CVD Burdenby age & Indigenous status (2011)

6. Indigenous CVD in QLD • Compared to non-Indigenous Queenslanders the: • CVD mortality rate was around 25% higher for Aboriginal and Torres Strait Islander Queenslanders in 2011 • CVD separation rate was 73% higher for Aboriginal and Torres Strait Islander Queenslanders in 2013–14 • The rate of CVD burden of disease 2.5 times higher for Aboriginal and Torres Strait Islander Queenslanders in 2011 • The cost to the public inpatient hospital system from Aboriginal and Torres Strait Islander cardiac related SRGs for 2011-13 was $56.4 million higher than it should have been – Indigenous rates equal that of non-Indigenous rates

7. Queensland CVD Burdenby condition, age & Indigenous status (2011) Indigenous Non-Indigenous

8. Queensland CVD BurdenIndigenous population (2011)

9. Mortality – cardiovascular Age standardised Aboriginal and Torres Strait Islander cardiovascular disease mortality rate, Queensland 2002 to 2015

10. Mortality – cardiovascular

11. Mortality – cardiovascular

12. Access to Procedures for ACS Hospitalisations

13. Rheumatic Heart Disease

14. Better Cardiac Care Data Linkage - Aims • Identify gaps in the health care continuum for Indigenous people with cardiovascular disease(2010/11 to 2015/16) • Ischaemic heart disease • Chronic heart failure • Stroke • Acute rheumatic fever / Rheumatic heart disease • Examine ARF/RHD trends from 2000 to 2016 • identify targets, timelines, recommendations about optimal primary, secondary & tertiary based interventions to end RHD in Qld

15. Better Cardiac Care Data Linkage Research Project Identify patients first hospitalised with disease • describe access to primary, secondary, acute, post-acute care • delays & disruptions in continuum of care based on best-practice standards • variation in care (location & population groups) • impact of variation in care on patient outcomes & system costs AusLAB RHD Register NDI EDIS MBS PaWs QHAPDC PBS iPharmacy

16. Data Linkage – ARF / RHD (2000-2016) Identify patients hospitalised/notified with disease • describe incidence, prevalence, disease progression & outcomes • collaboration with End-RHD Centre for Research Excellence (Telethon Kids Institute) RHD Register NDI QHAPDC

17. Outcomes • picture of individual patient experience through health system layers • understanding of gaps, service needs • at state & HHS level • at primary, secondary, tertiary levels & their intersects • in-depth understanding of ARF/RHD burden overtime • develop baseline, targets, interventions to end RHD in Qld

18. Better Cardiac Care

19. Guidelines • Guidelines NHMRC Health Advisory Committee • September 2005 • A guide for health professionals • Strengthening cardiac rehabilitation and secondary prevention for Aboriginal and Torres Strait Islander people • www.nhmrc.gov.au • Review of guidelines

20. New Accreditation Standards • https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf • https://www.safetyandquality.gov.au/wp-content/uploads/2017/12/National-Safety-and-Quality-Health-Service-Standards-User-Guide-for-Aboriginal-and-Torres-Strait-Islander-Health.

22. Health care is a humanitarian right but the reality is that economic cost will always be part of the equation • Health professionals often have to straddle and reconcile the divide that can exist

23. Paradigm Shift • If we are serious about health being a human right and accessible to all, an important paradigm shift needs to occur • We need to base our interactions on kindness compassion and respect • Kindness for all, especially those where it has not been of abundance in that persons life • Compassion for the adversity patients face • Respect for patients lived experience

24. Cultural Competency

25. Identification Processes Ask the question Are you of Aboriginal or Torres Strait Islander Origin? • (AIHW) National best practice guidelines for collecting Indigenous status in health data sets. https://www.aihw.gov.au/reports/indigenous-australians/national-guidelines-collecting-health-data-sets/contents/table-of-contents

26. Hospital Data • What is kept is there a report that is generated • What is captured in the report • Drill down into the detail • How is it coded

27. Environment • Welcoming • Health Workers • Referral pathways and Partnerships • Flexible delivery • Health literacy • Resources • Connection to primary health care

28. National Heart Foundation Lighthouse • 18 sites Nationally • Improving health outcomes for Aboriginal and Torres Strait Islander people with acute coronary syndrome • Domains • Governance • Cultural competence • Workforce • Care pathways

29. Discharge Against Medical AdviceDAMA

30. DAMA not the problem symptom of the system What you can influence What you can’t Influence

31. Most important • What is the outcome? What happens to the them when they leave?

32. Discharge Against Medical AdviceDAMA Prevent DAMA Unable to prevent Patient stays in Hospital Review medical record & case review with specialist Early contact with patient (within 3 days) Communicate plan with GP, specialist & patient Case manage to ensure appropriate follow up.

33. Discharge Against Medical AdviceDAMA • Since implementation of flow chart process there have been 19 cases of DAMA (417 episodes of care) = DAMA rate 4.55% • 16 (84%)patients, prompt follow up with their GP and or specialist was arranged • 3 (15%) cases lost to follow up 5 (26%) patients managed back into the acute care setting and received evidence based care • Pacemaker=1 • coronary artery bypass surgery=2 • coronary angioplasty=2 • Early contact, clinical care review and case management post DAMA supports patient in accessing appropriate medical follow up and aids in evidence based care

34. Questions