Cardiovascular risk management at a Maori-led Primary Health Organisation--findings from a cross-sectional audit.
OBJECTIVE
To examine the cardiovascular disease (CVD) risk profile and management for the first 12 months of an electronic risk assessment program at Tamaki Healthcare, Auckland.


METHODS
An audit of risk assessment and medication data supplemented by a manual case record review.


RESULTS
1522 people were screened representing around 15.5% of the eligible population. Of the 1420 people with data available, 248 (17.5%) had a calculated 5-year CVD risk > or = 15% and another 177 (12.5%) had previous CVD. Maori were significantly more likely to be at high CVD risk than non-Maori (OR 2.07 (1.51-2.84); p<0.001). For Pacific peoples (mostly of Samoan, Tongan, Niuean, Fijian, or Cook Islands origin) there was no increased likelihood of high CVD risk. Medication data were available for 399 (95.5%) people at high CVD risk. Prescribing rates for this group were 78.1% for blood pressure lowering, 71.9% for lipid-lowering, 65.3% for anti-platelet ,and 50.3% for all three therapies. Whilst this group may represent the better end of the management spectrum, success in achieving treatment targets was modest. For 451 people with either diabetes or established CVD, 65.9% and 66.1% were not meeting blood pressure and lipid management recommendations respectively. There were very few disparities in prescribing rates and attainment of target levels by ethnic group.


CONCLUSIONS
This study has shown that a primary care electronic risk assessment program can be rapidly implemented within 12 months. Although the sample may not be representative due to a small proportion screened so far, major disparities in risk factor prevalence rates were found- particularly for Maori. Furthermore, substantial guideline-practice gaps were encountered in the appropriate prescribing of cardiovascular medicines and attainment of recommended targets. Several Tamaki Healthcare initiatives to address these findings are discussed.
Peiris
David
D
The George Institute For International Health, PO Box M201 Missenden Rd NSW 2050, Sydney, Australia. dpeiris@george.org.au
Murray
Jonathan
J
Scully
Doreen
D
Tilakawardene
Virantha
V
Hetaraka-Stevens
Lorraine
L
Stewart
Tereki
T
Patel
Anushka
A
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017677:Age Distribution; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000517:prevention & control; D006303:Health Services, Indigenous / Q000706:statistics & numerical data; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D008485:Medical Audit; D016347:Medical Records Systems, Computerized; D009520:New Zealand / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods; D000095284:Maori People