Adequate Primary Health Care Is A Prerequisite for Effective Specialist Care for Indigenous Australians

Dr Warren Walsh, Cardiologist at the Prince of Wales Hospital in Sydney, co-author on the paper says that there are likely to be several reasons for the lower rates of coronary procedures among Indigenous patients, but their high rates of co-morbidities and the association of co-morbidities with lower procedure rates is an important finding.

These Indigenous people have many co morbidities and this puts them at higher cardiovascular risk.

These characteristics and the lower rates of coronary procedures are associated with a significantly worse outcome as shown by the lower survival rates at one year.

This first Australian analysis, based on administrative data, of racial differences in coronary procedures rates compared rates of percutaneous coronary interventions (PCI) and bypass surgery after acute myocardial infarction (AMI) in Indigenous and non-Indigenous patients. The authors followed up 14 683 patients admitted to Queensland public hospitals for AMI between 1998 and 2002. Of these 558 (3.8 per cent) identified as Indigenous.

"There are at least several possible reasons why Indigenous patients with AMI have relatively low rates of coronary procedures in the public hospital sector, despite their clinical need," Dr Walsh says. These include:

Relative contraindications such as co-morbidities, smoking and obesity might be more common.

Indigenous people might prefer not to have a procedure.

Indigenous people might have less access to coronary procedures because they are more likely to live in remote areas or attend small hospitals.

The authors say diabetes, chronic renal failure and pneumonia were at least twice as common among Indigenous patients with AMI as among non-Indigenous patients with AMI; and chronic bronchitis and emphysema and heart failure were at least 60 per cent more common.

"If a patient had at least one co-morbidity, then the probability of that patient having a coronary procedure was reduced by 40 per cent.

The authors say there is some evidence that primary care can reduce the prevalence and severity of co-morbidities among Indigenous Australians.

"More accessible and culturally appropriate primary health care might enable Indigenous people with coronary artery disease to be identified earlier in the course of their illness and have any co-morbidities treated.

Commenting on the treatment gap for Indigenous Australians in the same issue of the Journal, Associate Professor, Joan Cunningham and colleagues, say a crucial issue is the increasing conflict between 'efficiency' and equity.

They say the responsibility for reducing ethnic disparities rests primarily with the health care system and its providers and that system level changes are clearly needed, such as adequate funding for primary care, an adequate Indigenous health workforce, and improvements in the interface between primary care and specialist services.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT Dr Warren WALSH (02) 9382 0770 / 0409 399 519

Associate Professor Joan CUNNINGHAM (08) 8922 8797 (w) (08) 8948 1028 (h)

Judith TOKLEY, AMA Public Affairs, 0408 824 306 / 02 6270 5471