Menzies School of Health Research (Brisbane Office) , Brisbane, QLD , Australia.
Top End Health Services, Primary Health Care Branch, Northern Territory Government , Casuarina, NT , Australia.
Front Public Health. 2016 Mar 8;4:37. doi: 10.3389/fpubh.2016.00037. eCollection 2016.
Absolute cardiovascular risk assessment (CVRA) is based on the combined effects of multiple risk factors and can identify asymptomatic individuals at high risk of cardiovascular disease (CVD). Aboriginal and Torres Strait Islander people, the Indigenous people of Australia, are disproportionately affected by CVD and diabetes. Our study aimed to investigate variations in the use of absolute CVRA in patients with diabetes at Indigenous community healthcare centers and to identify patient and health center characteristics that may contribute to this variation.
Audits of clinical records of 1,728 patients with a known diagnosis of diabetes across 121 health centers in four Australian States/Territories [Northern Territory (NT), South Australia, Western Australia, and Queensland] over the period 2012-2014 were conducted as part of a large-scale continuous quality improvement program. Multilevel regression modeling was used to quantify variation in recording of CVRA attributable to health center and patient characteristics.
The proportion of eligible patients with documented CVRA was 33% (n = 574/1,728). The majority (95%) of assessments were conducted in the NT. Multilevel regression analysis showed health center characteristics accounted for 70% of the variation in assessments in the NT. Government-operated health centers had 18.8 times the odds (95% CI 7.7-46.2) of recording CVRA delivery compared with other health centers.
Health centers in the NT delivered the majority of absolute CVRA to Indigenous patients with diabetes in our study. Health systems factors that may have facilitated provision of CVRA in the NT include decision support tools and a reporting process for CVRA delivery. Implementation of similar systems in other jurisdictions may help improve CVRA delivery. Early identification and treatment of high risk individuals through wider use of CVRA may help reduce the burden of CVD in Indigenous Australians with diabetes.
绝对心血管风险评估（CVRA）基于多种风险因素的综合影响，可以识别出患有心血管疾病（CVD）但无症状的高危人群。澳大利亚原住民和托雷斯海峡岛民受 CVD 和糖尿病的影响不成比例。我们的研究旨在调查原住民社区医疗中心中糖尿病患者使用绝对 CVRA 的情况，并确定可能导致这种差异的患者和医疗中心特征。
作为一项大规模持续质量改进计划的一部分，对 2012-2014 年期间澳大利亚四个州/地区（北领地、南澳大利亚、西澳大利亚和昆士兰）121 个卫生中心的 1728 名已知糖尿病诊断患者的临床记录进行了审核。采用多水平回归模型来量化医疗中心和患者特征对 CVRA 记录差异的影响。
有记录的 CVRA 合格患者比例为 33%（n=1728 例中的 574 例）。评估的大多数（95%）是在北领地进行的。多水平回归分析显示，医疗中心特征占北领地评估差异的 70%。与其他卫生中心相比，政府运营的卫生中心记录 CVRA 提供情况的可能性是其他卫生中心的 18.8 倍（95%CI 7.7-46.2）。
在我们的研究中，北领地的医疗中心为患有糖尿病的原住民患者提供了大多数绝对 CVRA。可能有助于在北领地提供 CVRA 的卫生系统因素包括决策支持工具和 CVRA 提供情况的报告流程。在其他司法管辖区实施类似系统可能有助于提高 CVRA 的提供。通过更广泛地使用 CVRA 尽早识别和治疗高危人群，可能有助于减轻澳大利亚糖尿病原住民 CVD 的负担。
