Implementing Guideline Based Heart Failure Care in the Northern Territory: Challenges and Solutions

Why it Remains Difficult for Remote Cardiologist to Obtain the Locus of Control for Ambulatory Health Care Conditions Such as Congestive Heart Failure? A Tug of War between General Practice, Administrators and Implementable Research Findings

“…This first hurdle usually does not greatly affect strategies that call for increased resources in staffing and infrastructure. As we have previously highlighted this one-dimensional strategy may not however in the long term achieve the programme goals (1,2 Jou rn a l o f Ge ner a l P r a c tic e for community based interventions. An example we highlight here has been in shaping a CDSMP, as part of a CHF disease management programme.…”

“…These issues becomes more difficult when findings involve implementing a new strategy or if there are more than one choice available. We have previously discussed some of these challenges and potential solutions for the NT [1][2][3][4][5]. In this short commentary, we discuss briefly some issues on the implementation strategies for CHF best practice in the Northern Territory (NT) of Australia and why it remains difficult for the cardiologists who are held to account to also maintain a degree of control on the process.…”

“…• Principles on interpreting external validity of studies [3] • Importance of physiological modulation behind the drug therapies, thus broadening the acceptability for physiological based prescribing principles for future studies in CHF, particularly with comorbidities [2,3] • The axis of control for subspecialty ambulatory health care conditions that require collaborative and multifaceted approaches to research practice [1] It would appear to improve CHF care; there is a need for a broader range of interventional research tools that focus on implementation in a heterogeneous group and allow a broader range of questions to be answered, that can similarly steer policy. We would encourage clinicians in similar clinical settings to contribute further in this area.…”

Northern Territory Perspectives on Heart Failure with Comorbidities – Understanding Trial Validity and Exploring Collaborative Opportunities to Broaden the Evidence Base

“…Its management can be challenging due to disease factors and co-morbidity. In addition there are a number of unique geographical, cultural, socioeconomic and service/support related factors that mean that many remote, and the majority of Indigenous patients in the NT, do not achieve the clinical targets and improved outcomes seen in randomised controlled trials (RCT) and large centre prospective studies [1][2][3][4]. Although there have been many advancements in the management of CHF, the extent to which the results of RCTs and the 'evidence-based' guidelines generated from them are applicable outside of the trial setting (known as relevance, effectiveness or external validity) [5,6], and in particular to Indigenous patients in the NT, is problematic.…”

Extracting the ESSENCE - Cardiovascular Health for Aboriginal and Torres Strait Islander Australians

“…It remains sobering that the prevalence of CHD in Aboriginal and Torres Strait Islanders is twice that of non-Indigenous Australians [6] -a statistic that by itself justifies a national discussion. Chronic Heart Failure also provides a key example of disparities between populations, particularly in remote communities [5,7]. Similarly, the prevalence of cerebrovascular disease in Aboriginal and Torres Strait Islanders is twice that of non-Indigenous Australians and is associated with higher mortality rates [5] -of all the more importance given the problems associated with timely access to care, documented in the ESSENCE Project [1].…”