Nashid Hafiz1, Karice Hyun2, Andrew Knight3, Charlotte Hespe4, Clara K Chow5, Tom Briffa6, Robyn Gallagher7, Christopher M Reid8, David L Hare9, Nicholas Zwar10, Mark Woodward11, Stephen Jan12, Emily R Atkins12, Tracey-Lea Laba13, Elizabeth Halcomb14, Timothy Usherwood15, Julie Redfern16. 1. School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. Electronic address: https://twitter.com/HafizNashid. 2. School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. 3. Primary and Integrated Care Unit, South Western Sydney Local Health District, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia. 4. The University of Notre Dame, School of Medicine, Sydney, NSW, Australia. 5. Western Sydney Local Health District, Sydney, NSW, Australia; Westmead Applied Research Centre, The University of Sydney, Sydney, NSW, Australia. 6. School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Sydney, NSW, Australia. 7. Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. 8. School of Public Health, Curtin University, Perth, WA, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia. 9. Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia; Austin Health, Melbourne, Vic, Australia. 10. Faculty of Health Sciences & Medicine, Bond University, Brisbane, Qld, Australia. 11. University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia. 12. The George Institute for Global Health, Sydney, NSW, Australia. 13. University of Technology Sydney Centre for Health Economics Research and Evaluation, Sydney, NSW, Australia. 14. School of Nursing, University of Wollongong, Wollongong, NSW, Australia. 15. The George Institute for Global Health, Sydney, NSW, Australia; The University of Sydney, Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. 16. School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia. Electronic address: julie.redfern@sydney.edu.au.
Abstract
BACKGROUND: Cardiovascular disease (CVD) and risk factors remains a major burden in terms of disease, disability, and death in the Australian population and mental health is considered as an important risk factor affecting cardiovascular disease. A multidisciplinary collaborative approach in primary care is required to ensure an optimal outcome for managing cardiovascular patients with mental health issues. Medicare introduced numerous primary care health services and medications that are subsidised by the Australian government in order to provide a more structured approach to reduce and manage CVD. However, the utilisation of these services nor gender comparison for CVD management in primary care has been explored. Therefore, the aim is to compare the provision of subsidised chronic disease management plans (CDMPs), mental health care and prescription of guideline-indicated medications to men and women with CVD in primary care practices for secondary prevention. METHODS: De-identified data for all active patients with CVD were extracted from 50 Australian primary care practices. Outcomes included the frequency of receipt of CDMPs, mental health care and prescription of evidence-based medications. Analyses adjusted for demography and clinical characteristics, stratified by gender, were performed using logistic regression and accounted for clustering effects by practices. RESULTS: Data for 14,601 patients with CVD (39.4% women) were collected. The odds of receiving the CDMPs was significantly greater amongst women than men (preparation of general practice management plan [GPMP]: (46% vs 43%; adjusted OR [95% CI]: 1.22 [1.12, 1.34]). Women were more likely to have diagnosed with mental health issues (32% vs 20%, p<0.0001), however, the adjusted odds of men and women receiving any government-subsidised mental health care were similar. Women were less often prescribed blood pressure, lipid-lowering and antiplatelet medications. After adjustment, only an antiplatelet medication or agent was less likely to be prescribed to women than men (44% vs 51%; adjusted OR [95% CI]: 0.84 [0.76, 0.94]). CONCLUSION: Women were more likely to receive CDMPs but less likely to receive antiplatelet medications than men, no gender difference was observed in the receipt of mental health care. However, the receipt of the CDMPs and the mental health treatment consultations were suboptimal and better use of these existing services could improve ongoing CVD management.
BACKGROUND: Cardiovascular disease (CVD) and risk factors remains a major burden in terms of disease, disability, and death in the Australian population and mental health is considered as an important risk factor affecting cardiovascular disease. A multidisciplinary collaborative approach in primary care is required to ensure an optimal outcome for managing cardiovascular patients with mental health issues. Medicare introduced numerous primary care health services and medications that are subsidised by the Australian government in order to provide a more structured approach to reduce and manage CVD. However, the utilisation of these services nor gender comparison for CVD management in primary care has been explored. Therefore, the aim is to compare the provision of subsidised chronic disease management plans (CDMPs), mental health care and prescription of guideline-indicated medications to men and women with CVD in primary care practices for secondary prevention. METHODS: De-identified data for all active patients with CVD were extracted from 50 Australian primary care practices. Outcomes included the frequency of receipt of CDMPs, mental health care and prescription of evidence-based medications. Analyses adjusted for demography and clinical characteristics, stratified by gender, were performed using logistic regression and accounted for clustering effects by practices. RESULTS: Data for 14,601 patients with CVD (39.4% women) were collected. The odds of receiving the CDMPs was significantly greater amongst women than men (preparation of general practice management plan [GPMP]: (46% vs 43%; adjusted OR [95% CI]: 1.22 [1.12, 1.34]). Women were more likely to have diagnosed with mental health issues (32% vs 20%, p<0.0001), however, the adjusted odds of men and women receiving any government-subsidised mental health care were similar. Women were less often prescribed blood pressure, lipid-lowering and antiplatelet medications. After adjustment, only an antiplatelet medication or agent was less likely to be prescribed to women than men (44% vs 51%; adjusted OR [95% CI]: 0.84 [0.76, 0.94]). CONCLUSION: Women were more likely to receive CDMPs but less likely to receive antiplatelet medications than men, no gender difference was observed in the receipt of mental health care. However, the receipt of the CDMPs and the mental health treatment consultations were suboptimal and better use of these existing services could improve ongoing CVD management.
Authors: Qiang Tu; Karice Hyun; Nashid Hafiz; Andrew Knight; Charlotte Hespe; Clara K Chow; Tom Briffa; Robyn Gallagher; Christopher M Reid; David L Hare; Nicholas Zwar; Mark Woodward; Stephen Jan; Emily R Atkins; Tracey-Lea Laba; Elizabeth Halcomb; Tim Usherwood; Laurent Billot; Julie Redfern Journal: Int J Environ Res Public Health Date: 2022-08-29 Impact factor: 4.614