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

I acknowledge the Traditional Custodians on whose lands this meeting is taking place and pay my respect to Elders past, present and future

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.

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%

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

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

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

Urban Outreach Program

• January – June 2019• 19 clinics

• 137 consultations

• 29 echocardiograms

Urban Outreach Program

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

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

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

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

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