| Project Objectives / Summary:
The Northern Queensland Rural Division of General Practice (NQRDGP) has established a primary care model of cardiac rehabilitation and secondary prevention deliverable to Indigenous people in rural and remote areas. The uptake of this program by Indigenous people has been low. There are a number of issues which might be impacting on the utilisation of this service including: socio-economic factors, suitability of the program, inappropriateness of the patient education material, many Indigenous Australians do not access a regular GP and indications that Indigenous Australians might not be receiving the appropriate support to enrol in cardiac rehabilitation.
The project was divided into two stages. The purpose of stage one was to determine:
- Whether cardiac rehabilitation program is accessible and appropriate for Aboriginal and Torres Strait Islander people in rural and remote towns and communities; and
- The role of the Indigenous Health Workers would have in supporting and caring for Indigenous patients who suffer from cardiovascular disease.
The purpose of stage two of the project was to trial intervention in selected communities.
Project Collaboration:
- Mt Isa Centre for Rural & Remote Health
- Dr Penny Hutchinson & medical students at MICRRH
- Mt Isa Base Hospital
Project Outcomes:
The usual difficulties arose when there is a changeover of project staff mid stream.
Just as the project was implemented in two stages, so too the evaluation was presented in two parts. Stage one reported on the literature review, research methodology, data collection and qualitative and quantitative results from patients as well as health practitioners. Stage two reporting focused on the trial intervention of the program and has been presented in a qualitative rather than quantitative format, as it is written in the form of a narrative (in respect of indigenous culture & traditions). There is little difference in the findings of the three locations which were a focus of this project, that is, Dajarra, Mornington Island and Mt Isa.
Both stages of the project highlighted the lack of understanding and misconceptions that Indigenous people have relating to their illness. The project also highlights the under utilisation and inadequate skilling of Indigenous Health Workers in all areas of health service and delivery but particularly in relation to cardiovascular rehabilitation and secondary prevention programs for indigenous Australians. Many of the IHWs did not have training in CVD treatment or have any understanding of the compounding nature of their patient's illness when coupled with other conditions such as kidney disease, diabetes, high blood pressure & other chronic illnesses etc. For the most part IHWs were referring their patients back to the GP for advice and treatment in matters relating specifically to CVD. Most of the IHWs understanding of shared care were inadequate, understanding it to be a patient pick up and delivery service. So to the GPs did not fully utilise or realise that IHWs were available to assist in the care of their indigenous patients.
It also highlights the necessity to do intensive and ongoing education with the communities involved in relation to CVD rehabilitation and prevention. Many of the project participants were so ill-informed and afraid of heart problems that they felt shamed and embarrassed and did not seek support from their community. This was due primarily to the high death rate associated with heart disease in their communities.
The project developed the following tools to assist in the project and ensure sustainability:
- Development of a paper based reminder / recall sheet for use by Indigenous Health Workers and patients. This is currently with the ethics committee for approval prior to distribution to the Indigenous Health Workers. It is hoped that this will assist indigenous groups in the maintenance of their health and well being and prove to be a means of motivation to make lifestyle changes.
- Adaptation of a cardiovascular questionnaire (developed by Dr Anna Hawkes) to make it more inclusive of indigenous populations. This questionnaire is currently with the ethics committee awaiting approval.
Recommendations:
- Health Worker Training in cardiovascular health is a priority. Resources and other teaching tools need to be adapted to be culturally appropriate.
Commence a Health Support / Reference Group in the community. This could also act as an advisory body for new staff assisting in induction and informing them of current events and what might be applicable to their community.
- A Family approach to health care and encouraging well being is necessary in indigenous communities. Major change cannot occur without the support of family members. Family members need to be included in the education process of cardiovascular disease, causes and treatments.
- Training program for Indigenous Health Workers in relation to diabetes and its impact on CVD.
Disseminating Project Information:
- Heart Story Flip Chart
- Tobacco story flip chart
- Health Worker Resource Kit
- Development and dissemination of medication information sheets
Cardiac Secondary Prevention and Rehabilitation Workshop, Mornington Island, 18-20 October 2000
Lessons / Assessment:
- Several difficulties arose and delays experienced when the original Project Officer resigned mid-project and a new one needed to be recruited.
- The results of this project concentrate on identifying issues that need to be tackled and some ways of finding solutions. They provide a good guide for any future work by this Division and the lessons appear transferable to other Divisions. However, the end result does not appear easily sustainable without additional funding and a targeted, rigorous planned approach to the task.
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