delivering cardiac care at the right place and time for ......the problem queensland health (2017)....
TRANSCRIPT
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Delivering cardiac careat the right place and time for
Aboriginal and Torres Strait Islander patients
AN INNOVATIVE URBAN OUTREACH MODEL
Danielle Harrop
Princess Alexandra Hospital, Brisbane
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I acknowledge the Traditional Custodians on whose lands this meeting is taking place and pay my respect to Elders past, present and future
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The Problem
Queensland Health (2017). The burden of disease and injury in
Queensland’s Aboriginal and Torres Strait Islander people 2017 (2011
reference year) Summary report, Queensland Health, Brisbane.
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The Project
• A specific culturally appropriate model of care for Aboriginal and Torres Strait Islander patients with cardiac disease focussed on education and care coordination, developed and implemented in 2015 by a multidisciplinary project team
• setting• Princess Alexandra Hospital in Brisbane, Australia• tertiary referral centre with cardiology and CTS services• large geographic catchment area
• many patients from regional and remote areas
• almost 6000 admissions annually• Aboriginal and Torres Strait Islander patients account for 3.5 – 4.0%
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The Project
Access and Environment
Model of Care
• welcoming environment
• cultural capability training
• improved identification
• relationships with ACCHS
• urban outreach clinics
• multidisciplinary team rounding
• culturally appropriate support and counselling
• patient-specific “teach back” education booklet
• organisation of transition appointments
• SBAR format clinical handover document
• discharge medication summary
• subsidised bridging medication supply (CTG)
• support at outpatient appointments
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Urban Outreach Program
• partnerships established with local ACCHS to deliver specialist clinics in the community
• hospital-based team provides• administrative support (hospital record creation, typing)• cardiologist• cardiac scientist & echo machine for onsite scanning• further care coordination as needed
• ACCHS provides• room, IT equipment and support• appointment booking and reception• patient transport
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Urban Outreach Program Potential Benefits
• supports the Qld Health Specialists Outpatient Strategy• in particular, partnering with community
• overcomes barriers to service access that relate to a range of cultural, social and socio-demographic factors
• facilitates a seamless patient journey between the public health system and community care
• empowers primary health care providers
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Urban Outreach Program
• January – June 2019• 19 clinics
• 137 consultations
• 29 echocardiograms
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Urban Outreach Program
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Case Study
• 23yo male with lupus is admitted with a heart attack• decreased cardiac function / heart failure• coronary artery stent inserted• discharged on three anticoagulants
• on discharge• patient takes home their own TRACS document• pharmacist liaises w community pharmacy to organise Webster pack• clinical handover document to GP• appointment with GP within 7 days• pharmacist liaises with GP and cardiologist re medication titration and
anticoagulant durations
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Case Study
• cardiology follow-up• discussion with GP each month during urban outreach clinic re medication
titration progress, return to work, etc
• formal appointment with patient at 3 months
• echocardiogram at time of appointment• results reviewed and given to patient
• medications adjusted
• return to work discussed
• all cardiology notes recorded in GP medical record and immediately available for review• also copied to hospital-based medical record
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90 Day Outcomes for Indigenous Patients Admitted with ACS
Pre Post Absolute Risk Reduction
Risk Ratio (95% CI) p value
n (%) n (%)
Death 6 (3.0%) 4 (3.2%) +0.2% 1.07 (0.31, 3.73) 0.90
AMI 13(6.4%) 2 (1.6%) -4.8% 0.25 (0.06, 1.08) 0.04
Unplanned Revascularisation 5 (2.5%) 1 (0.8%) -1.7% 0.32 (0.04, 2.73) 0.27
Unplanned Cardiac Readmission 62 (30.5%) 21 (16.7%) -13.8% 0.55 (0.35, 0.85) <0.01
Composite Endpoint 67 (33.0%) 26 (20.6%) -12.4% 0.63 (0.42, 0.93) 0.02
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0
0.2
0.4
0.6
0.8
1
1.2
total chest pain MI heart failure AF syncope
12 Month Readmission Rates for ACS Patients
Pre Post
p < 0.001
p < 0.001
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Thank You
• The Project Team• Viv, Sean, Helen, Sonia, Bing, Claudia, William
• members of the Reference Group
• PA Hospital Aboriginal & Torres Strait Islander Hospital Liaison Officers
• PA Hospital Department of Cardiology
• PA Hospital Pharmacy Department
• Aboriginal & Torres Strait Islander Branch, Qld Department of Health
• The Heart Foundation
Artwork produced for Queensland Health by Gilimbaa