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Tually PJ, Currie G, Lenzo NP, Hendrie DV, Meadows JW, Janssen JHA. Potential utility of B-Type natriuretic peptides in secondary prevention following percutaneous coronary intervention in remote communities of Western Australia. Biomarkers 2023:1-8. [PMID: 37128799 DOI: 10.1080/1354750x.2023.2209705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Introduction: A third of all acute coronary events that present in the Australian population occur in patients with established coronary heart disease. This study assessed the prognostic value of combined B-type natriuretic peptides (BNP) measurement and quantitative myocardial perfusion scan (MPS) data for cardiac events (CE).Material and methods: This retrospective cohort study involved 133 patients from rural Western Australia. The cut-off for normality was 6.0 for qualitative summed difference scores (SDS) of MPS and 400 pg/mL for BNP.Results: Patients with no CE had a mean SDS and BNP (1.52 with a 95% CI of 0.34 to 2.69), (175.9 with a 95% CI of 112.7-239.1) that was lower than patients with CE (6.54 with 95% CI 4.18-9.89) (P = 0.0003), (669.1 with 95% CI 543.9-794.3) (P < 0.0001). The sensitivity and specificity of combined testing for predicting CE respectively were 79.6% and 86.3% for SDS, 84.6% and 94.1% for BNP, and 100% and 92.7% for SDS and BNP combined.Discussion and conclusion: Elevated BNP is marginally superior to MPS in predicting CEs in patients who have previously undergone percutaneous coronary intervention (PCI); however, MPS can identify the region of myocardium most at risk. Routine BNP monitoring in this subgroup may serve as secondary prevention by identifying subclinical disease.
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Affiliation(s)
- Peter J Tually
- Department of Nuclear Medicine, Telemed Health, 20 Maritana St, Kalgoorlie, 6430, WA Australia
- Centre for Population Health Research, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Geoff Currie
- School of Dentistry and Health Sciences, Charles Sturt University, Wagga Wagga, 2678 New South Wales, Australia
| | - Nat P Lenzo
- Department of Nuclear Medicine, Telemed Health, 20 Maritana St, Kalgoorlie, 6430, WA Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Delia V Hendrie
- Centre for Population Health Research, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Jack W Meadows
- Department of Nuclear Medicine, Telemed Health, 20 Maritana St, Kalgoorlie, 6430, WA Australia
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Fiebig DG, van Gool K, Hall J, Mu C. Health care use in response to health shocks: Does socio-economic status matter? HEALTH ECONOMICS 2021; 30:3032-3050. [PMID: 34510621 DOI: 10.1002/hec.4427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/20/2021] [Accepted: 08/25/2021] [Indexed: 06/13/2023]
Abstract
We investigate how utilization of primary care, specialist care, and emergency department (ED) care (and the mix across the three) changes in response to a change in health need. We determine whether any changes in utilization are impacted by socio-economic status. The use of a unique Australian data set that consists of a large survey linked to multiple years of detailed administrative records enables us to better control for individual heterogeneity and allows us to exploit changes in health that are related to the onset of two health shocks: a new diagnosis of diabetes and heart disease. We extend the analysis by also examining changes to patient out-of-pocket costs. We find significant differences in the mix between primary and specialist care use according to income and type of health shock but no evidence of using ED as a substitute for other care. Our results indicate that low- and high-income patients navigate very different pathways for their care following the onset of diabetes and to a lesser extent heart disease. These pathways appear to be chosen on the basis of ability to pay, rather than the most effective or efficient bundle of care delivered through a combination of GP and specialist care.
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Affiliation(s)
- Denzil G Fiebig
- School of Economics, University of New South Wales, Sydney, New South Wales, Australia
| | - Kees van Gool
- Center for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Broadway, New South Wales, Australia
| | - Jane Hall
- Center for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Broadway, New South Wales, Australia
| | - Chunzhou Mu
- Center for Quantitative Economics, Jilin University, Changchun, China
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Beks H, Versace VL, Zwolak R, Chatfield T. Opportunities for further changes to the Medicare Benefits Schedule to support Aboriginal Community Controlled Health Organisations. AUST HEALTH REV 2021; 46:170-172. [PMID: 34818512 DOI: 10.1071/ah21234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/03/2021] [Indexed: 11/23/2022]
Abstract
The Australian Government responded promptly to the need for minimising patient-clinician contact in the primary care setting during COVID-19 by introducing new funding for telehealth services as part of the Medicare Benefits Schedule (MBS). Funding for both telephone and videoconferencing provided primary care organisations, including Aboriginal Community Controlled Health Organisations (ACCHOs), with the ability to continue meeting the healthcare needs of their Communities, particularly given that Aboriginal and Torres Strait Islander Peoples were identified as susceptible to COVID-19. This perspective considers the need for proactive changes to the MBS to support the delivery of culturally appropriate primary healthcare services, including by mobile clinics, to Aboriginal and Torres Strait Islander Peoples by ACCHOs beyond the COVID-19 pandemic.
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Affiliation(s)
- H Beks
- Deakin Rural Health, School of Medicine, Geelong, Vic., Australia
| | - V L Versace
- Deakin Rural Health, School of Medicine, Geelong, Vic., Australia
| | - R Zwolak
- Budja Budja Aboriginal Cooperative, Halls Gap, Vic., Australia
| | - T Chatfield
- Budja Budja Aboriginal Cooperative, Halls Gap, Vic., Australia
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Orr N, Gwynne K, Sohn W, Skinner J. Inequalities in the utilisation of the Child Dental Benefits Schedule between Aboriginal and non-Aboriginal children. AUST HEALTH REV 2021; 45:274-280. [PMID: 34078533 DOI: 10.1071/ah20028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 10/16/2020] [Indexed: 11/23/2022]
Abstract
Objectives The Child Dental Benefits Schedule (CDBS) is an Australian Government initiative providing basic dental care to children from low-income households. We sought to investigate levels of utilisation of the CDBS among Aboriginal and non-Aboriginal children to determine whether there is equal access to dental services provided through the schedule. Methods CDBS data were obtained for four financial (July-June) years (from 2013-14 to 2016-17). The data captured all claims made during this period. The data included estimates of usage by Aboriginal status, age group and Dental Benefits groups (administrative categories of related dental procedures). Results The utilisation of CDBS services was lower for Aboriginal children. However, in 2013-14, although the odds of using the schedule were higher for non-Aboriginal children (odds ratio (OR) 0.89; P<0.0001) this was reversed in 2015-16 and 2016-17 (OR 1.11 and 1.21 respectively; P<0.0001 in both years). The odds of Aboriginal children using preventive services was below that of non-Aboriginal children in 2013-14 (OR 0.82), 2014-15 (OR 0.76), 2015-16 (OR 0.83) and 2016-17 (OR 0.90; P<0.0001) in all years. Conclusions The data are encouraging with regard to equity because they show that for services overall, Australian Aboriginal and non-Aboriginal children have similar levels of utilisation. However, lower levels of the use of preventive services may indicate future inequalities in oral health among Aboriginal children. What is known about the topic? The CDBS is an Australian Government initiative aimed at improving access to dental care for children from low-income households, including for Aboriginal people. By facilitating greater access to dental care, the schedule has the potential to help address inequalities in oral health for both Aboriginal and non-Aboriginal children. What does this paper add? There are no analyses available comparing the utilisation of the CDBS by Aboriginal and non-Aboriginal children. This study compared levels of utilisation of the schedule overall and specifically for preventive services. What are the implications for practitioners? Greater efforts should be made to address inequalities in the utilisation of the CDBS between Aboriginal and non-Aboriginal children. Although there are some hopeful signs, inequalities remain that may affect the oral health of Aboriginal children. There is also potential to encourage utilisation of the CDBS for greater provision of preventive services, including targeted population oral health initiatives.
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Affiliation(s)
- Neil Orr
- Poche Centre for Indigenous Health, Edward Ford Building (A27), The University of Sydney, 2006. ; ; and The Faculty of Medicine, Health and Human Sciences, Level 3, 75 Talavera Rd, Macquarie University, NSW 2109, Australia; and Corresponding author.
| | - Kylie Gwynne
- Poche Centre for Indigenous Health, Edward Ford Building (A27), The University of Sydney, 2006. ; ; and The Faculty of Medicine, Health and Human Sciences, Level 3, 75 Talavera Rd, Macquarie University, NSW 2109, Australia
| | - Woosung Sohn
- Sydney Dental School, Westmead Centre for Oral Health, Darcy Road, Westmead, NSW 2145, Australia.
| | - John Skinner
- Poche Centre for Indigenous Health, Edward Ford Building (A27), The University of Sydney, 2006. ;
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Coffey C, Zhao Y, Condon JR, Li S, Guthridge S. Acute myocardial infarction incidence and survival in Aboriginal and non-Aboriginal populations: an observational study in the Northern Territory of Australia, 1992-2014. BMJ Open 2020; 10:e036979. [PMID: 33033086 PMCID: PMC7545622 DOI: 10.1136/bmjopen-2020-036979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To examine long-term trends in acute myocardial infarction (AMI) incidence and survival among Aboriginal and non-Aboriginal people. DESIGN Retrospective cohort study. SETTING, PARTICIPANTS All first AMI hospital cases and deaths due to ischaemic heart disease in the Northern Territory of Australia (NT), 1992-2014. MAIN OUTCOME MEASURES Age standardised incidence, survival and mortality. RESULTS The upward trend in Aboriginal AMI incidence plateaued around 2007 for males and 2001 for females. AMI incidence decreased for non-Aboriginal population, consistent with the national trends. AMI incidence was higher and survival lower for males, for Aboriginal people and in older age groups. In 2014, the age standardised incidence was 881 and 579 per 100 000 for Aboriginal males and females, respectively, compared with 290 and 187 per 100 000 for non-Aboriginal counterparts. The incidence disparity between Aboriginal and non-Aboriginal population was much greater in younger than older age groups. Survival after an AMI improved over time, and more so for Aboriginal than non-Aboriginal patients, because of a decrease in prehospital deaths and improved survival of hospitalised cases. CONCLUSIONS There was an important breakpoint in increasing trends of Aboriginal AMI incidence between 2001 and 2007. The disparity in AMI survival between the NT Aboriginal and non-Aboriginal populations reduced over time as survival improved for both populations.
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Affiliation(s)
- Cushla Coffey
- Health Gains Planning, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Yuejen Zhao
- Health Gains Planning, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - John R Condon
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Shu Li
- Health Gains Planning, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Steven Guthridge
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245126. [PMID: 31847490 PMCID: PMC6950682 DOI: 10.3390/ijerph16245126] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 12/11/2022]
Abstract
This narrative review explores relevant literature that is related to the challenges in implementing evidence-based management for clinicians in rural and remote areas, while primarily focussing on management of acute coronary syndrome (ACS) and follow up care. A targeted literature search around rural/urban differences in the management of ACS, cardiovascular disease, and cardiac rehabilitation identified multiple issues that are related to access, including the ability to pay, transport and geographic distances, delays in patients seeking care, access to diagnostic testing, and timely treatment in an appropriate facility. Workforce shortages or lack of ready access to relevant expertise, cultural differences, and complexity that arises from comorbidities and from geographical isolation amplified diagnostic challenges. Given the urgency in management of ACS, rural clinicians must act quickly to achieve optimal patient outcomes. New technologies and quality improvement approaches enable better access to rapid diagnosis, as well as specialist input and care. Achieving an uptake of cardiac rehabilitation in rural and remote settings poses challenges that may reduce with the use of alternative models to centre-based rehabilitation and use of modern technologies. Expediting improvement in cardiovascular outcomes and reducing rural disparities requires system changes and that clinicians embrace attention to prevention, emergency management, and follow up care in rural contexts.
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