title: Improving the management of acute coronary syndrome for Aboriginal and non-Aboriginal patients in a regional hospital.
abstract: OBJECTIVE
  To determine inequities in clinical adherence to national diagnostic and management guidelines for acute coronary syndrome (ACS) for Aboriginal and non-Aboriginal ACS patients at a regional hospital.
  
  
  METHODS
  Covering two study periods (2011-12; 2013-14), records of Aboriginal (n=276) and a random selection of non-Aboriginal patients (n=333) presenting to the Emergency Department with chest pain were retrospectively reviewed using an audit protocol. Groups were compared using logistic regression, controlling for age, sex and comorbidity.
  
  
  RESULTS
  Pathway utilisation improved overall, but risk stratification improved only for non-Aboriginal patients (OR=3.34, 95%CI 1.88-5.94). Performance of two troponin measurements increased to 88% for both Aboriginal and non-Aboriginal presentations. Although initially higher for non-Aboriginal presentations, the likelihood of admission was found to be similar in the repeat audit (75.6% vs 78.6%; p=0.60), reflecting a rise in Aboriginal presentations being admitted (OR=2.30, 95%CI 1.27-4.15). There was no significant difference in proportions transferred, receiving angiograms or for ST Elevation Acute Coronary Syndrome (a severe form of Acute Coronary Syndrome) being thrombolysed. Discharge against medical advice remained higher among Aboriginal presentations (OR=4.22, 95%CI 0.88-20.29).
  
  
  CONCLUSIONS
  Although there was a general improvement in adherence to the chest pain pathway and a reduction in inequity in the treatment of Aboriginal people, there is continuing need for improvement in adherence to guidelines to optimise the management of ACS in this regional setting.
authors.affiliation: Midwest Population Health Unit, WA Country Health Service, Western Australia.|WA Centre for Rural Health, University of Western Australia.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Scalley
authors.affiliation: Midwest Population Health Unit, WA Country Health Service, Western Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Gee
authors.affiliation: WA Centre for Rural Health, University of Western Australia.
authors.forename: Judith M
authors.initials: JM
authors.lastname: Katzenellenbogen
authors.affiliation: Midwest Population Health Unit, WA Country Health Service, Western Australia.|WA Centre for Rural Health, University of Western Australia.
authors.forename: Marisa
authors.initials: M
authors.lastname: Gilles
authors.affiliation: School of Public Health, University of Sydney, New South Wales.
authors.forename: Edward
authors.initials: E
authors.lastname: Jegasothy
authors.affiliation: WA Centre for Rural Health, University of Western Australia.
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Thompson
mesh_terms: D054058:Acute Coronary Syndrome / Q000208:ethnology* / Q000628:therapy*; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D054625:Healthcare Disparities; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D058996:Quality Improvement; D012189:Retrospective Studies
keywords: Aboriginal; Acute coronary syndrome; care pathway; inequity; quality improvement; regional hospital