Assessing Māori/non-Māori differences in cardiovascular disease risk and risk management in routine primary care practice using web-based clinical decision support: (PREDICT CVD-2).
OBJECTIVE
To describe the cardiovascular disease risk factor status and risk management of Māori compared with non-Māori patients opportunistically assessed in routine practice using PREDICT-CVD, an electronic clinical decision support programme.


METHODS
In August 2002, a primary healthcare organisation, ProCare, implemented PREDICT-CVD as an opportunistic cardiovascular risk assessment and management programme. Between 2002 and February 2006, over 20,000 cardiovascular risk assessments were undertaken on Māori and non-Māori patients. Odds ratios and mean differences in cardiovascular risk factors and risk management for Māori compared to non-Māori (European and other, Pacific, Indian, and other Asian) patients were calculated.


RESULTS
Baseline risk assessments were completed for 1450 (7%) Māori patients and 19, 164 (93%) non-Māori patients. On average, Māori were risk assessed 3 years younger than non-Māori. Māori patients were three times more likely to be smokers, had higher blood pressure and TC/HDL levels, and twice the prevalence of diabetes and history of cardiovascular disease as non-Māori. Among patients with a personal history of cardiovascular disease, Māori were more likely than non-Māori to receive anticoagulants, blood pressure-lowering and lipid-lowering medications. However, of those patients with a history of ischaemic heart disease, Māori were only half as likely as non-Māori to have had a revascularisation procedure.


CONCLUSIONS
An electronic decision support programme can be used to systematically generate cardiovascular disease risk burden and risk management data for Māori and non-Māori populations in routine clinical practice in real-time. Moreover, the PREDICT-CVD programme has established one of the largest cohorts of Māori and non-Māori ever assembled in New Zealand. Initial findings suggest that Māori are more likely than non-Māori to receive drug-based cardiovascular risk management if they have a personal history of cardiovascular disease. In contrast, among the subgroup of patients with a history of ischaemic heart disease, Māori appear to receive significantly fewer revascularisations than non-Māori.
Riddell
Tania
T
Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland. t.riddell@auckland.ac.nz
Jackson
Rod T
RT
Wells
Susan
S
Broad
Joanna
J
Bannink
Lot
L
D001208:Asia / Q000208:ethnology; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D020000:Decision Support Systems, Clinical; D005060:Europe / Q000208:ethnology; D005260:Female; D006801:Humans; D007194:India / Q000208:ethnology; D020407:Internet; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D009520:New Zealand / Q000453:epidemiology; D010139:Pacific Islands / Q000208:ethnology; D011114:Polynesia / Q000208:ethnology; D011320:Primary Health Care; D018570:Risk Assessment; D012307:Risk Factors; D012308:Risk Management
D002317:Cardiovascular Agents