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

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

Burden of disease and injury [This slide shows the breakdown of total burden of disease (both fatal and non-fatal) in Queensland’s Aboriginal and Torres Strait Islander people by the cause of burden.] Our study found that in 2011, 68 per cent of the Indigenous burden was caused by the six leading broad cause groups. Mental disorders were the leading contributor at 20 per cent (which was made up mainly of non-fatal burden), followed by cardiovascular disease at 14 per cent, diabetes, cancer, chronic respiratory disease and then unintentional injuries. These are key areas to focus to improve the health and wellbeing of Queensland’s Aboriginal and Torres Strait Islander people. The majority of burden from cardiovascular disease is ischaemic heart disease; cardiovascular disease occurs earlier compared to non-Indigenous populations; the Indigenous burden of cardiovascular disease is 3.7 times expected (if rates were equal to non-Indigenous population)

Burden of disease and injury gap Explain what is meant by GAP This slide demonstrates the burden of health gap between Aboriginal and Torres Strait Islander Queenslanders and non-Indigenous Queenslanders Looking more closely at the broad causes contributing to the gap: Chronic disease, mental disorders and intentional injuries were significant contributors to the gap in disease and injury burden. These represent priority areas for improving the gap in burden of disease between Aboriginal and Torres Strait Islander and non-Indigenous Queenslanders. - Cardiovascular disease accounts for 20% of the burden of health gap between the two groups 52 per cent of gap

Queensland CVD Burden by age & Indigenous status (2011) Indigenous CVD burden occurs at a younger age (40-64) compared to the non-Indigenous group (70+)

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

Queensland CVD Burden by condition, age & Indigenous status (2011) Non-Indigenous Of the CVD and these six conditions Ischaemic heart disease starts earlier in Indigenous Queenslanders Stroke starts earlier in non-Indigenous Queenslanders Rheumatic heart disease in younger Indigenous Queenslanders and barely visible in the non-Indigenous population

Queensland CVD Burden Indigenous population (2011) Second highest contribution to the burden of disease in the Indigenous Queensland population. Just less than 10% of total burden is fatal cardiovascular disease.

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

Mortality – cardiovascular

Mortality – cardiovascular

Access to Procedures for ACS Hospitalisations

Rheumatic Heart Disease

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

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 EDIS AusLAB NDI MBS iPharmacy PBS PaWs QHAPDC RHD Register

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) NDI QHAPDC RHD Register

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 CVD onset earlier for Indigenous population

Better Cardiac Care

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

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.

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

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

Cultural Competency

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

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

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

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

Discharge Against Medical Advice DAMA Cardiac Strategy 1.1% Target Best case scenario…. Prevent this from occurring If we can’t prevent DAMA then we need a clear process of review and plan

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

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

Discharge Against Medical Advice DAMA 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.

Discharge Against Medical Advice DAMA 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 Good linkage and communication improves continuity of care

Questions