Liaw Joshua, Gorton Susan, Heal Clare, White Andrew
College of Medicine and Dentistry, James Cook University, Queensland.
Department of Paediatrics, Townsville University Hospital, Queensland.
Aust N Z J Public Health. 2022 Dec;46(6):758-763. doi: 10.1111/1753-6405.13250. Epub 2022 May 26.
To evaluate the secondary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in the Townsville region, Australia.
Adherence to benzathine benzylpenicillin G (BPG) was determined for 196 children and young adults aged under 22 years between January 2009 and December 2019, and factors associated with BPG adherence were analysed. Secondary outcomes included attendance at specialist reviews and echocardiograms.
Adequate adherence (80%) to regular BPG injections was met by 51.1% of the cohort. Adequate BPG adherence more likely occurred for those that attended the Paediatric Outreach Clinic (OR4.15, 95%CI:2.13-8.05) or a school delivery program (OR1.87, 95%CI:1.11-3.45). People with moderate/severe RHD had greater BPG adherence (OR1.76,95%CI:1.00-3.10). People in rural/remote areas were less likely to have adequate BPG adherence compared to urban counterparts (OR0.31, 95%CI:0.15-0.65). Adherence to echocardiography was 66% and specialist review attendance was 12.5-50%.
Half of the cohort in the Townsville region received adequate BPG prophylaxis to prevent ARF/RHD. Although rates were relatively higher than those reported in other Australian regions, health delivery goals should be close to 100%. Low attendance at specialist services was reported. Implication for public health: Delivery models with dedicated services, case management and family support could improve BPG adherence in individuals with ARF/RHD. Further resources in rural and remote areas are needed.
评估澳大利亚汤斯维尔地区急性风湿热（ARF）和风湿性心脏病（RHD）的二级预防情况。
确定了2009年1月至2019年12月期间196名22岁以下儿童和年轻人对苄星青霉素G（BPG）的依从性，并分析了与BPG依从性相关的因素。次要结果包括专科复诊和超声心动图检查的就诊情况。
该队列中51.1%的人对定期注射BPG的依从性良好（80%）。参加儿科外展诊所（OR4.15，95%CI：2.13 - 8.05）或学校给药项目（OR1.87，95%CI：1.11 - 3.45）的人更有可能有良好的BPG依从性。中度/重度RHD患者的BPG依从性更高（OR1.76，95%CI：1.00 - 3.10）。与城市地区的人相比，农村/偏远地区的人BPG依从性良好的可能性较小（OR0.31，95%CI：0.15 - 0.65）。超声心动图检查的依从率为66%，专科复诊就诊率为12.5% - 50%。
汤斯维尔地区队列中有一半的人接受了足够的BPG预防以预防ARF/RHD。尽管该比率相对高于澳大利亚其他地区报告的比率，但医疗服务目标应接近100%。报告显示专科服务就诊率较低。对公共卫生的启示：提供专门服务、病例管理和家庭支持的服务模式可以提高ARF/RHD患者对BPG的依从性。农村和偏远地区需要更多资源。
