Rural and urban differentials in primary care management of chronic heart failure: new data from the CASE study

Clark, Robyn A., Eckert, Kerena A., Stewart, Simon, Phillips, Susan M., Yallop, Julie J., Tonkin, Andrew M. and Krum, Henry (2007) Rural and urban differentials in primary care management of chronic heart failure: new data from the CASE study. Medical Journal of Australia, 186 9: 441-445.

Author Clark, Robyn A.
Eckert, Kerena A.
Stewart, Simon
Phillips, Susan M.
Yallop, Julie J.
Tonkin, Andrew M.
Krum, Henry
Title Rural and urban differentials in primary care management of chronic heart failure: new data from the CASE study
Journal name Medical Journal of Australia   Check publisher's open access policy
ISSN 0025-729X
1326-5377
Publication date 2007-05
Sub-type Article (original research)
Volume 186
Issue 9
Start page 441
End page 445
Total pages 5
Place of publication Pyrmont
Publisher Australasian Med Publ Co Ltd
Language eng
Subject 11 Medical and Health Sciences
Formatted abstract
Objective:

To determine whether primary care management of chronic heart failure (CHF) differed between rural and urban areas in Australia.

Design:


A cross-sectional survey stratified by Rural, Remote and Metropolitan Areas (RRMA) classification. The primary source of data was the Cardiac Awareness Survey and Evaluation (CASE) study.

Setting:


Secondary analysis of data obtained from 341 Australian general practitioners and 23 845 adults aged 60 years or more in 1998.

Main outcome measures:


CHF determined by criteria recommended by the World Health Organization, diagnostic practices, use of pharmacotherapy, and CHF-related hospital admissions in the 12 months before the study.

Results:


There was a significantly higher prevalence of CHF among general practice patients in large and small rural towns (16.1%) compared with capital city and metropolitan areas (12.4%) (P < 0.001). Echocardiography was used less often for diagnosis in rural towns compared with metropolitan areas (52.0% v 67.3%, P < 0.001). Rates of specialist referral were also significantly lower in rural towns than in metropolitan areas (59.1% v 69.6%, P < 0.001), as were prescribing rates of angiotensin-converting enzyme inhibitors (51.4% v 60.1%, P < 0.001). There was no geographical variation in prescribing rates of β-blockers (12.6% [rural] v 11.8% [metropolitan], P = 0.32). Overall, few survey participants received recommended “evidence-based practice” diagnosis and management for CHF (metropolitan, 4.6%; rural, 3.9%; and remote areas, 3.7%).

Conclusions:


This study found a higher prevalence of CHF, and significantly lower use of recommended diagnostic methods and pharmacological treatment among patients in rural areas.

Keyword Medicine, General & Internal
Guidelines
Australia
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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Created: Mon, 18 Feb 2008, 17:13:39 EST