Implementing a working together model for Aboriginal patients with acute coronary syndrome: an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse working together to improve hospital care

Abstract

Abstract.Acute coronary syndrome (ACS) contributes to the disparity in life expectancy between Aboriginal and nonAboriginal Australians. Improving hospital care for Aboriginal patients has been identified as a means of addressing this disparity. This project developed and implemented a working together model of care, comprising an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse, providing care coordination specifically directed at improving attendance at cardiac rehabilitation services for Aboriginal Australians in a large metropolitan hospital in Melbourne. A quality improvement framework using a retrospective case notes audit evaluated Aboriginal patients' admissions to hospital and identified low attendance rates at cardiac rehabilitation services. A working together model of care coordination by an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse was implemented to improve cardiac rehabilitation attendance in Aboriginal patients admitted with ACS to the cardiac wards of the hospital. A retrospective medical records audit showed that there were 68 Aboriginal patients admitted to the cardiac wards with ACS from 1 July 2008 to 30 June 2011. A referral to cardiac rehabilitation was recorded for 42% of these. During the implementation of the model of care, 13 of 15 patients (86%) received a referral to cardiac rehabilitation and eight of the 13 (62%) attended. Implementation of the working together model demonstrated improved referral to and attendance at cardiac rehabilitation services, thereby, has potential to prevent complications and mortality.What is known about the topic? Aboriginal Australians experience disparities in access to recommended care for acute coronary syndrome. This may contribute to the life expectancy gap between Aboriginal and non-Aboriginal Australians. What does this paper add? This paper describes a model of care involving an Aboriginal Hospital Liaisons Officer and a specialist cardiac nurse working together to improve hospital care and attendance at cardiac rehabilitation services for Aboriginal Australians with acute coronary syndrome. What are the implications for practitioners? The working together model of care could be implemented across mainstream health services where Aboriginal people attend for specialist care.

Effectiveness of programs to promote cardiovascular health of Indigenous Australians: a systematic review

“…The model forged partnerships. Daws, et al, 2014 [ 37 ] Pre- and post -evaluation program Rehabilitation/ secondary prevention Working together model of care - (Aboriginal hospital liaison officer and specialist cardiac nurse team) Aboriginal and Torres Strait Islander participants ( n = 13); metropolitan tertiary public hospital, Victoria Retrospective audit Increased referral rate (15 to 86%) and attendance rate (0 to 62%) The partnership model approach to care coordination and system changes that were implemented led to improved attendance at cardiac rehabilitation in the participating group Dimer, et al, 2013 [ 35 ] Mixed methods Pre- and post-program measures Rehabilitation Cardiac rehabilitation program; weekly exercise and education sessions Indigenous participants ( n = 48); Aboriginal medical services, Western Australia Evaluation of exercise and educational program Decreased weight, BMI, BP, waist girth; improved 6-min walk test Aboriginal Medical Service based cardiac rehabilitation proved to be effective in improving attendance, and cardiac risk factor and health management Peiris et al, 2015 [ 32 ] Parallel arm cluster-randomized controlled trial Management/ treatment Computer-guided quality improvement intervention Aboriginal and Torres Strait Islander participants ( n = 38,725); Australian primary healthcare centres ( n = 60 services), New South Wales and Queensland Implementation of computerised screening and management algorithm The intervention was associated with improved overall risk factor measurements There was minimal support required to implement the tool and had positive effects on improving cardiac risk measurement BMI body mass index, BP blood pressure, CVD cardiovascular disease …”

“…The other six studies were of various designs, of which three employed mixed methods [ 33 – 35 ]. The two randomised studies were judged to be of moderate quality (see Table 3 ), while four of the quasi-experimental studies were judged to be of good quality, with one assessed as moderate [ 36 ] and another as poor [ 37 ] (see Table 4 ).…”

“…With the exception of two studies [ 32 , 36 ] samples sizes were small ( < 100). Two studies compared different cohorts before and after the intervention [ 36 , 37 ] whereas the remainder reported repeated measures. Two studies did not report any statistical significance of outcomes [ 36 , 37 ] and one [ 33 ] reported several outcomes as being “statistically significant” but did not cite associated values.…”

“…Two studies compared different cohorts before and after the intervention [ 36 , 37 ] whereas the remainder reported repeated measures. Two studies did not report any statistical significance of outcomes [ 36 , 37 ] and one [ 33 ] reported several outcomes as being “statistically significant” but did not cite associated values. Only one study [ 33 ] reported effect sizes, but did not provide associated significance values, although it was stated in the text that the outcomes were not statistically significant.…”

“…Considerable heterogeneity of cardiovascular health programs and settings was represented in the eight included studies (see Table 2 ), which were conducted within the following Australian states and territories: New South Wales [ 34 ]; New South Wales and Queensland [ 32 ]; Northern Territory [ 36 , 38 ]; South Australia [ 31 ]; Tasmania [ 33 ]; Victoria [ 37 ]; and Western Australia [ 35 ]. The studies were conducted in several settings: Aboriginal medical services [ 33 , 35 ]; metropolitan [ 31 , 34 , 37 ] and primary care [ 31 , 36 , 38 ].…”