Identifying culturally appropriate strategies for coronary heart disease secondary prevention in a regional Aboriginal Medical Service

Abstract

Aboriginal Australians experience high rates of coronary heart disease (CHD) at an early age, highlighting the importance of effective secondary prevention. This study employed a two-stage process to evaluate CHD management in a regional Aboriginal Medical Service. Stage 1 involved an audit of 94 medical records of clients with documented CHD using the Audit and Best Practice in Chronic Disease approach to health service quality improvement. Results from the audit informed themes for focus group discussions with Aboriginal Medical Service clients (n=6) and staff (n=6) to ascertain barriers and facilitators to CHD management. The audit identified that chronic disease management was the focus of appointments more frequently than in national data (P<0.05), with brief interventions for lifestyle modification occurring at similar or greater frequency. However, referrals to follow-up support services for secondary prevention were lower (P<0.05). Focus groups identified psychosocial factors, systemic shortcomings, suboptimal medication use and variable awareness of CHD signs and symptoms as barriers to CHD management, whereas family support and culturally appropriate education promoted health care. To optimise CHD secondary prevention for Aboriginal people, health services require adequate resources to achieve best-practice systems of follow up. Routinely engaging clients is required to ensure services meet diverse community needs.

What Indigenous Australian clients value about primary health care: a systematic review of qualitative evidence

“…The results from the methodological quality assessment are provided in Supplementary file 3. One was rated high quality, 28 seven were rated good quality, 27,29,34 and one, reported in two articles, was rated moderate quality 25,26 . A lack of clarity about how researchers' values and prior knowledge influenced studies was the main methodological concern potentially undermining the credibility of the findings that informed our syntheses.…”

“…All the studies were published between 2004 and 2014. Six used mixed methods 25–27,30,31,33,34 . Four used focus groups and interviews, 27,31–33 four used only interviews, 25,26,28,30 and one used only focus groups.…”

“…home visits), staff who were easily contactable, and staff meeting patients in public areas such as shopping centres 25–27 . Culturally safe care was described as care delivered by providers who were good, 28 who understood clients and knew how to meet their needs, 29 who spent sufficient time with patients and who respected culture, 29 in an environment that made clients feel comfortable 34 . ACCHOs' welcoming environment was described as including an emotional and relational dimension 27,29,33 .…”

Computerised Aboriginal and Torres Strait Islander health assessments in primary health care research

“…159 Other studies used mixed methods to explore social phenomena likely to be priorities for Aboriginal and Torres Strait Islander peoples including smoking cessation, 154 teenage pregnancy, 161 and cardiovascular chronic disease management in primary care. 157 One study, described in Chapter 2, used qualitative methods to explore Aboriginal and Torres Strait Islander peoples' priorities, and then used quantitative methods to respond to these priorities. 241 Consistent with the transformative paradigm, Burgess found Aboriginal people living in a remote community had better health outcomes when they participated in activities consistent with "caring for country".…”

“…4 Despite these limitations, a brief or rapid review involving one relevant database over a recent five year period provides useful information on the quantity of research produced in a given setting which was the aim of the review by Eades et al 4 Moreover, one evaluation of four rapid reviews found that their findings, while not as extensive, did not differ greatly from four completed systematic reviews on the same topics. 101 Cross-sectional design Yes a Gardner et al 2015 102 Cross-sectional design No Lalla et al 2015 103 Cross-sectional design Yes Radford et al 2015 104 Cross-sectional design Yes Hopkins et al 2015 105 Cross-sectional design No Arjunan et al 2015 106 Cross-sectional design No Katzenellenbogen et al 2015 107 Cross-sectional design No Pearce et al 2015 108 Cross-sectional design No Spurling et al 2014 109 Cross-sectional design Yes a Scott et al 2014 110 Cross-sectional design No Timms et al 2014 111 Cross-sectional design No Chung et al 2014 112 Cross-sectional design Yes Askew et al 2013 113 Cross-sectional design Yes a Lopez et al 2014 114 Cross 141 Qualitative Yes 153 Mixed methods Yes Gould et al 2015 154 Mixed methods No Jersky et al 2015 155 Mixed methods No Dennis et al 2015 156 Mixed methods No Govil et al 2014 157 Mixed methods Yes Thomas et al 2013 158 Mixed methods No Canuto et al 2013 159 Mixed methods No Homer et al 2012 160 Mixed methods No Larkins et al 2011 161 Mixed methods No Harris et al 2014 162 Cohort study No McDonald et al 2014 163 Cohort study No Jamieson et al 2013 164 Cohort study No Knight et al 2013 165 Cohort study No Webster et al 2013 166 Cohort study No Davis et al 2012 167 Cohort study No Robinson et al 2012 …”