title: Implementing guideline based heart failure care in the Northern Territory: challenges and solutions.
abstract: The Northern Territory of Australia is a vast area serviced by two major tertiary hospitals. It has both a unique demography and geography, which pose challenges for delivering optimal heart failure services. The prevalence of congestive heart failure continues to increase, imposing a significant burden on health infrastructure and health care costs. Specific patient groups suffer disproportionately from increased disease severity or service related issues often represented as a "health care gap". The syndrome itself is characterised by ongoing symptoms interspersed with acute decompensation requiring lifelong therapy and is rarely reversible. For the individual client the overwhelming attention to heart failure care and the impact of health care gaps can be devastating. This gap may also contribute to widening socio-economic differentials for families and communities as they seek to take on some of the care responsibilities. This review explores the challenges of heart failure best practice in the Northern Territory and the opportunities to improve on service delivery. The discussions highlighted could have implications for health service delivery throughout regional centres in Australia and health systems in other countries.
authors.affiliation: Consultant Cardiologist, Senior Lecturer Flinders University, Royal Darwin Hospital, Rocklands Drive, Tiwi, PO Box 41326, Casuarina NT 0811. Electronic address: balaniyngkaran@hotmail.com.
authors.forename: Pupalan
authors.initials: P
authors.lastname: Iyngkaran
authors.affiliation: Senior Research Fellow, Flinders Human Behaviour and Health Research Unit, Flinders University, GPO Box 2100 Adelaide SA 5001. Electronic address: melanie.harris28@flinders.edu.au.
authors.forename: Melanie
authors.initials: M
authors.lastname: Harris
authors.affiliation: Director of Cardiology, Royal Darwin Hospital, Rocklands Drive, Tiwi, PO Box 41326, Casuarina NT 0811. Electronic address: marcus.ilton@gmail.com.
authors.forename: Marcus
authors.initials: M
authors.lastname: Ilton
authors.affiliation: Director of Medicine/Consultant Cardiologist, Royal Darwin Hospital, Rocklands Drive, Tiwi, PO Box 41326, Casuarina NT 0811. Electronic address: kanganada@gmail.com.
authors.forename: Nadarajan
authors.initials: N
authors.lastname: Kangaharan
authors.affiliation: Flinders Human Behaviour and Health Research Unit (FHBHRU), Margaret Tobin Centre, Flinders University, Bedford Park, South Australia, Australia 5001. Electronic address: malcolm.battersby@health.sa.gov.au.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Battersby
authors.affiliation: Director NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne VIC, 3004, Australia. Electronic address: simon.stewart@bakeridi.edu.au.
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
authors.affiliation: Professor of Population Health and Research Chair Aboriginal Health School of Population Health, University of South Australia & South Australian Health & Medical Research Institute, Adelaide. Electronic address: alex.brown@sahmri.com.
authors.forename: Alex
authors.initials: A
authors.lastname: Brown
mesh_terms: D003695:Delivery of Health Care / Q000191:economics* / Q000592:standards; D019983:Guideline Adherence / Q000191:economics* / Q000592:standards; D006333:Heart Failure / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D015876:Northern Territory; D017410:Practice Guidelines as Topic
keywords: Heart Failure; Indigenous; Nurse led care; Remote; Self-Care; Telemedicine