Improving the Health Care Journey to Cardiac Rehabilitation for Victorian Aboriginal Patients

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1 Improving the Health Care Journey to Cardiac Rehabilitation for Victorian Aboriginal Patients Lorraine Parsons, Manager Programs Raelene Lesniowska, Senior Metropolitan ICAP Project Officer Aboriginal Health Branch, Victorian Department of Health

2 The political context In 2008, bipartisan support to close the gap in life expectancy in Victoria was pledged with all signatories committing to work together to achieve equality in health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-aboriginal Australians by the year 2030 August 2008

3 The life expectancy gap 90 Aboriginal Non-Aboriginal Males Females

4 Disparities in cardiac care Australian Healthcare and Hospitals Association and Heart Foundation report based upon landmark AIHW findings Onemda VicHealth Koori Health Unit at Melbourne University research revealed similar disparities in care for Aboriginal Victorians Heart Foundation and Onemda VicHealth Koori Health Unit hosted a seminar to examine these findings The ICAP developmental review also highlighted the near non-existent access of Aboriginal people to cardiac rehabilitation services in Victoria

5 How is Victoria seeking to improve cardiac care and outcomes for Aboriginal patients? Close the Health Gap Improving Care for Aboriginal and Torres Strait Islander Patients (ICAP) program Aboriginal Health Promotion and Chronic Care (AHPACC) partnerships program Clinical networks including pilot improvement project Stakeholder engagement Alerting health services to the AIHW findings and encouraging strategies to measure and address these

6 The role of hospitals Health services can play a key role in helping to Close the Gap, by ensuring Aboriginal patients receive the care they need They ICAP program provides a key platform for achieving this by encouraging: 1. Continued employment of Aboriginal Hospital Liaison Officers (AHLOs) 2. Relationships with Aboriginal communities; 3. Cultural awareness; and 4. Culturally appropriate referral and discharge planning.

7 Priority Areas for Developmental Review Extent programs have been implemented Have programs been implemented as planned Have the programs outcomes been achieved How could ICAP And KMHLO roles be strengthened to be more strategic Is there potential to strengthen linkages across ICAP and KMHLO Processes of care in four health service areas Review process Data Analysis (VAED, VEMD, RAPID) Situation Analysis Policy background Literature review Site Visit Framework Interviews with: Sentinel Sites x 4 Case study sites x 4 Consultation Process maps *8 Workshop with all services to identify: common issues different approaches consensus view on good practice Service Development Priorities (program wide) Assess Impact of Change Drivers: Funding Organisational Structure IT Governance Process Review Workforce training Culture Relationships & partnerships

8 Aboriginal people and cardiac disease Cardiovascular disease is the greatest single contributor to the gap in life expectancy between Aboriginal and non-aboriginal Australians (Source: National Heart Foundation & Australian Healthcare and Hospitals Association) Age-specific death rates of Aboriginal people are between five and twelve times higher than for non-aboriginal Australians (Source: AIHW, 2004)

9 Aboriginal people s access to cardiac rehabilitation services National Heart Foundation Guidelines recommend that cardiac rehabilitation services should routinely be offered to everyone with cardiovascular disease* Attendance in cardiac rehabilitation services is close to zero: Victorian Admitted Episodes Data (VAED) identified a total of 564 patients across Victoria received inpatient cardiac rehabilitation. Three of these patients (0.06%) identified as being Aboriginal.

10 Key review finding Cardiac Rehabilit ation Most Health Services Plans to develop a culturally responsive model No cardiac rehabilitation program responsive to cultural needs

11 Key review finding LOW AHLO support and Follow up Increased cultural safety MEDIUM ACCHO based rehab AHLO a member of rehab team Accessible information Families and carers Involved in decisions System based referrals Culturally appropriate discharge HIGH Complementary services. Eg: diet and exercise Case manager notified on patient admission and supports patients with complex needs, care planning and discharge Social marketing Organisational effort

12 Cardiac pathway for Aboriginal patient: where the problems occur Fear Loss of contact with ACCHO More fear Loss of contact with local hospital Avoidance Limited follow-up; literacy issues Hard to get to; Inflexible hours; Full of white fellas that lecture you about lifestyle

13 Good practice example. Nurse in the cardiac ward contacts the AHLO to support the patient AHLO facilitates transport to the rehabilitation program Patients who fail to attend are telephoned to see if there are ways the hospital can support their attendance Plans to develop a cardiovascular health mentoring program as part of a MOU between a health service and ACCHO

14 Review recommendations Cardiac rehabilitation programs Strategies are required to design cardiac rehabilitation programs in line with guidelines detailed in the NHMRC Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander Peoples Social marketing Social marketing strategies are required to educate the community about prevention of heart disease, what to do if they are having a heart attack and the importance of cardiac rehabilitation in recovery

15 Review recommendations Transfer of patient care via discharge summary Referral pathways Access to transportation Hospital support

16 Conclusion The Department of Health: Acknowledges the serious gaps in cardiac care and outcomes for Aboriginal Victorians Is committed to addressing these via a range of initiatives across the continuum of care Will strive to undertake these initiatives in line with recommendations arising from the AIHW findings, the ICAP review and NHMRC guidelines

17 Further information Thank you for your time today For more information, visit: Department of Health information stand