Abstract 17881: Overcoming the Tyranny of Distance- an Analysis of Out-Reach Visits to Optimise Secondary Prevention of Cardiovascular Disease in High Risk Individuals Living in Central Australia
Introduction: Compared to the non-Indigenous of the population, Aboriginal Australians have a life expectancy that is 15-20 years less. Inequitable access to healthcare services (particularly in remote areas) contributes to this phenomenon.
Objectives: We examined the logistical challenges of providing outreach visits, as part of an outreach, secondary prevention program in Central Australia for CVD.
Methods: Prospective data from the Central Australia Heart Protection Study (n=200), a pragmatic, single-center, randomized study of a nurse-led, family-based, secondary prevention program designed to reduce major cardiac events, were analyzed. Clinical and logistic data were used to examine the characteristics of outreach visits for 50 consecutive subjects initially randomized to the study intervention.
Results: Most subjects had presented with an acute coronary syndrome (44/50 [88%]) and 31 (62%) self-identified as Indigenous. Despite a similar gender profile (55% versus 58% Indigenous and non-Indigenous women), Indigenous subjects had a greater risk factor and co-morbid profile, with significantly more diabetes (77% vs. 26% p = 0.0002), hypertension (81% vs. 53% p = 0.04) and renal failure (52% vs. 21% p = 0.03). The community of origin of Indigenous subjects was 230 ± 208 km from the central hospital compared to 61 ± 150 km for the rest (p = 0.004). There was no difference in the number of subjects who missed initial baseline and ad hoc visits attended by the health care team according to ethnicity. However, perhaps reflecting their greater mobility, Indigenous subjects missed a significantly higher number of scheduled visits at 6 months (1.39 ± 2.14 vs. 0.16 ± 0.50 visits; p = 0.02). Finally, multivariate analyses (including all baseline profiling data) suggested that distance from Alice Springs did not influence completion of outreach visits.
Conclusions: These data are invaluable to understanding and improving the cost dynamics and impact of secondary prevention for Indigenous adults living with heart disease remote from specialist health services.
Author Disclosures: C. Tuttle: None. M. Carrington: None. S. Stewart: None. A. Brown: None.
- © 2014 by American Heart Association, Inc.