Research

Are the processes recommended by the NHMRC for improving Cardiac Rehabilitation (CR) for Aboriginal and Torres Strait Islander people being implemented?: an assessment of CR Services across Western Australia

Sandra C Thompson^1,2, Michelle L DiGiacomo^2,3, Julie S Smith^4,5, Kate P Taylor^1,2, Lyn Dimer⁴, Mohammed Ali^1,2, Marianne M Wood^5,6, Timothy G Leahy⁷ and Patricia M Davidson^2,3

¹  Centre for International Health, Curtin University of Technology, Bentley Campus, Perth, Western Australia 6102, Australia

²  Curtin Health Innovation Research Institute (CHIRI), Curtin University, GPO Box U1987 Perth, Western Austrlaia 6845, Australia

³  Centre for Cardiovascular and Chronic Care, School of Nursing and Midwifery, Curtin University, Perth, Western Australia 6845, Australia

⁴  Heart Foundation of Australia (WA), 334 Rokeby Road, Subiaco, Western Australia, 6008, Australia

⁵  Royal Perth Hospital, GPO Box X2213, Perth, Western Australia 6001, Australia

⁶  Derbarl Yerrigan Health Service, 156 Wittenoom Street, East Perth, Western Australia 6004, Australia

⁷  Aboriginal Health Council of Western Australia, PO Box 8493, Stirling Street, Perth, Western Australia 6849, Australia

Australia and New Zealand Health Policy 2009, 6:29doi:10.1186/1743-8462-6-29

Published:	30 December 2009

Abstract

Background

Cardiovascular disease is the major cause of premature death of Indigenous Australians, and despite evidence that cardiac rehabilitation (CR) and secondary prevention can reduce recurrent disease and deaths, CR uptake is suboptimal. The National Health and Medical Research Council (NHMRC) guidelines Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander peoples, published in 2005, provide checklists for services to assist them to reduce the service gap for Indigenous people. This study describes health professionals' awareness, implementation, and perspectives of barriers to implementation of these guidelines based on semi-structured interviews conducted between November 2007 and June 2008 with health professionals involved in CR within mainstream health services in Western Australia (WA). Twenty-four health professionals from 17 services (10 rural, 7 metropolitan) listed in the WA Directory of CR services were interviewed.

Results

The majority of respondents reported that they were unfamiliar with the NHMRC guidelines and as a consequence implementation of the recommendations was minimal and inconsistently applied. Respondents reported that they provided few in-patient CR-related services to Indigenous patients, services upon discharge were erratic, and they had few Indigenous-specific resources for patients. Issues relating to workforce, cultural competence, and service linkages emerged as having most impact on design and delivery of CR services for Indigenous people in WA.

Conclusions

This study has demonstrated limited awareness and poor implementation in WA of the recommendations of the NHMRC Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander Peoples: A Guide for Health Professionals. The disproportionate burden of CVD morbidity and mortality among Indigenous Australians mandates urgent attention to this problem and alternative approaches to CR delivery. Dedicated resources and alternative approaches to CR delivery for Indigenous Australians are needed.