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Improvement in rheumatic fever and rheumatic heart disease management and prevention using a health centre-based continuous quality improvement approach.


ABSTRACT:

Background

Rheumatic heart disease (RHD) remains a major health concern for Aboriginal Australians. A key component of RHD control is prevention of recurrent acute rheumatic fever (ARF) using long-term secondary prophylaxis with intramuscular benzathine penicillin (BPG). This is the most important and cost-effective step in RHD control. However, there are significant challenges to effective implementation of secondary prophylaxis programs. This project aimed to increase understanding and improve quality of RHD care through development and implementation of a continuous quality improvement (CQI) strategy.

Methods

We used a CQI strategy to promote implementation of national best-practice ARF/RHD management guidelines at primary health care level in Indigenous communities of the Northern Territory (NT), Australia, 2008-2010. Participatory action research methods were employed to identify system barriers to delivery of high quality care. This entailed facilitated discussion with primary care staff aided by a system assessment tool (SAT). Participants were encouraged to develop and implement strategies to overcome identified barriers, including better record-keeping, triage systems and strategies for patient follow-up. To assess performance, clinical records were audited at baseline, then annually for two years. Key performance indicators included proportion of people receiving adequate secondary prophylaxis (?80% of scheduled 4-weekly penicillin injections) and quality of documentation.

Results

Six health centres participated, servicing approximately 154 people with ARF/RHD. Improvements occurred in indicators of service delivery including proportion of people receiving ?40% of their scheduled BPG (increasing from 81/116 [70%] at baseline to 84/103 [82%] in year three, p?=?0.04), proportion of people reviewed by a doctor within the past two years (112/154 [73%] and 134/156 [86%], p?=?0.003), and proportion of people who received influenza vaccination (57/154 [37%] to 86/156 [55%], p?=?0.001). However, the proportion receiving ?80% of scheduled BPG did not change. Documentation in medical files improved: ARF episode documentation increased from 31/55 (56%) to 50/62 (81%) (p?=?0.004), and RHD risk category documentation from 87/154 (56%) to 103/145 (76%) (p?ConclusionsA CQI process using a systems approach and participatory action research methodology can significantly improve delivery of ARF/RHD care.

SUBMITTER: Ralph AP 

PROVIDER: S-EPMC3878366 | biostudies-literature | 2013 Dec

REPOSITORIES: biostudies-literature

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Publications

Improvement in rheumatic fever and rheumatic heart disease management and prevention using a health centre-based continuous quality improvement approach.

Ralph Anna P AP   Fittock Marea M   Schultz Rosalie R   Thompson Dale D   Dowden Michelle M   Clemens Tom T   Parnaby Matthew G MG   Clark Michele M   McDonald Malcolm I MI   Edwards Keith N KN   Carapetis Jonathan R JR   Bailie Ross S RS  

BMC health services research 20131218


<h4>Background</h4>Rheumatic heart disease (RHD) remains a major health concern for Aboriginal Australians. A key component of RHD control is prevention of recurrent acute rheumatic fever (ARF) using long-term secondary prophylaxis with intramuscular benzathine penicillin (BPG). This is the most important and cost-effective step in RHD control. However, there are significant challenges to effective implementation of secondary prophylaxis programs. This project aimed to increase understanding and  ...[more]

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