在澳大利亚偏远地区的原住民初级保健服务中，早期识别和预防心血管疾病高危因素。

Early identification and preventive care for elevated cardiovascular disease risk within a remote Australian Aboriginal primary health care service.

机构信息

Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia.

出版信息

BMC Health Serv Res. 2011 Jan 31;11:24. doi: 10.1186/1472-6963-11-24.

DOI:10.1186/1472-6963-11-24

PMID:21281520

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3045287/

Abstract

BACKGROUND

Cardiovascular disease (CVD) is the single greatest contributor to the gap in life expectancy between Indigenous and non-Indigenous Australians. Our objective is to determine if holistic CVD risk assessment, introduced as part of the new Aboriginal and Torres Strait Islander Adult Health Check (AHC), results in better identification of elevated CVD risk, improved delivery of preventive care for CVD and improvements in the CVD risk profile for Aboriginal adults in a remote community.

METHODS

Interrupted time series study over six years in a remote primary health care (PHC) service involving Aboriginal adults identified with elevated CVD risk (N = 64). Several process and outcome measures were audited at 6 monthly intervals for three years prior to the AHC (the intervention) and three years following: (i) the proportion of guideline scheduled CVD preventive care services delivered, (ii) mean CVD medications prescribed and dispensed, (iii) mean PHC consultations, (iv) changes in participants' CVD risk factors and estimated absolute CVD risk and (v) mean number of CVD events and iatrogenic events.

RESULTS

Twenty-five percent of AHC participants were identified as having elevated CVD risk. Of these, 84% had not been previously identified during routine care. Following the intervention, there were significant improvements in the recorded delivery of preventive care services for CVD (30% to 53%), and prescription of CVD related medications (28% to 89%) (P < 0.001). Amongst participants there was a 20% relative reduction in estimated absolute CVD risk (P = 0.004) following the intervention. However, there were no significant changes in the mean number of PHC consultations or mean number of CVD events or iatrogenic events.

CONCLUSIONS

Holistic CVD risk assessment during an AHC can lead to better and earlier identification of elevated CVD risk, improvement in the recorded delivery of preventive care services for CVD, intensification of treatment for CVD, and improvements in participants' CVD risk profile. Further research is required on strategies to reorient and restructure PHC services to the care of chronic illness for Aboriginal peoples in remote areas for there to be substantial progress in decreasing excess CVD related mortality.

摘要

背景

心血管疾病（CVD）是导致澳大利亚原住民和非原住民预期寿命差距的最大单一因素。我们的目标是确定整体 CVD 风险评估是否可以更好地识别升高的 CVD 风险，改善 CVD 的预防保健服务提供，并改善偏远社区中成年原住民的 CVD 风险状况。

方法

在涉及已识别出 CVD 风险升高的原住民成年人的偏远初级保健 (PHC) 服务中，进行了六年的中断时间序列研究。在 AHC（干预措施）之前的三年内，每六个月审核一次以下几个过程和结果指标：（i）计划提供的 CVD 预防保健服务的比例，（ii）规定的 CVD 药物的平均处方和配药数量，（iii）PHC 就诊的平均次数，（iv）参与者 CVD 风险因素和估计的绝对 CVD 风险的变化，以及（v）CVD 事件和医源性事件的平均数量。

结果

25%的 AHC 参与者被确定为 CVD 风险升高。其中，84%在常规护理中并未被识别。干预后，CVD 预防保健服务的记录提供显著改善（30%至 53%），CVD 相关药物的处方也显著增加（28%至 89%）（P < 0.001）。在参与者中，估计的绝对 CVD 风险相对降低了 20%（P = 0.004）。然而，PHC 就诊次数或 CVD 事件或医源性事件的平均数量没有显著变化。

结论

在 AHC 期间进行整体 CVD 风险评估可以更好地更早地识别升高的 CVD 风险，改善 CVD 的预防保健服务的记录提供，加强 CVD 的治疗，并改善参与者的 CVD 风险状况。需要进一步研究如何重新调整和重构偏远地区原住民的 PHC 服务，以治疗慢性疾病，以便在降低与 CVD 相关的超额死亡率方面取得实质性进展。