ABSTRACT
IN AUSTRALIA, cardiovascular disease (CVD) is the leading cause of death and accounts for 9% of total disease expenditure ($10.4 billion).1,2 If current Australian guidelines were fully implemented, using absolute CVD risk assessment to guide the prescribing of medication for high-risk patients, an estimated $5.4 billion would be saved per year.3'4 MedicineInsight data suggest that only 17% of Australian patients aged 45-74 years attending general practice have the required risk factors recorded to enable an absolute CVD risk assessment, although this may not be representative and is limited to data recorded in specified fields.5 Health assessment Medicare Benefits Schedule (MBS) items are time-based consultation items targeted towards the prevention and management of chronic diseases that include taking a patient's history, physical measurements and providing management advice about medication and lifestyle change (Table 1). To increase the uptake of CVD primary prevention guidelines, a dedicated 'Heart Health Check' MBS item (699) was introduced on 1 April 2019, under which medical practitioners could claim a fee ($85.60) for a dedicated CVD risk consultation that lasts at least 20 minutes.6 Item 699 has a specific focus on identifying CVD risk factors and initiating CVD risk management strategies for high-risk patients. From April 2020 there have been multiple changes to the delivery of primary health services in response to the COVID-19 pandemic.7 Despite effective COVID-19 control measures in Australia, national general practitioner (GP) surveys conducted in 2020 and 2021 indicated a high impact of and concern about the pandemic, including the safety of staff, the rapid move to telehealth, reduced income due to a drop in patient presentation, increased workload during the vaccination rollout and inadequate government support, including a lack of safety equipment.8'9 In addition, the National Heart Foundation of Australia has estimated that 27,000 fewer Heart Health Checks were conducted due to COVID-19.10 As such, this study aimed to explore the uptake of Item 699 since its introduction and changes in existing health assessment item claims. Methods Study overview Publicly available databases were used for MBS item claims and population estimates.11 Data were available by age range, sex and state or territory. Because it was not possible to determine race or ethnicity, data for all adults aged >35 years were included in accordance with national guideline recommendations at the time of data collection for absolute CVD risk assessment in Aboriginal and Torres Strait Islander people aged >35 years and all other adults aged >45 years.3 MBS claims data for health assessment Items 699, 701, 703, 705, 707 and 715 were downloaded and compared between three time periods: the 12-month period before the introduction of Item 699 (1 April 2018-31 March 2019);the 12-month period after the introduction of Item 699 (1 April 2019-31 March 2020);and the 12-month period with COVID-19 outbreaks affecting the delivery of health services through primary care (1 April 2020-31 March 2021).12 Subsequently, health assessment item claims were assessed by age, sex and state/territory for the 24-month period after Item 699 was introduced (1 April 2019-31 March 2021).
ABSTRACT
Objectives: Rapid Access Chest Pain Clinics (RACPCs) provide safe and efficient follow-up for outpatients presenting with new-onset chest pain. RACPC delivery by telehealth has not been reported. We sought to evaluate a telehealth RACPC established during the coronavirus disease 2019 (COVID-19) pandemic. There was a need to reduce the frequency of additional testing arranged by the RACPC during this time, and the safety of this approach was also explored. Methods: This was a prospective evaluation of a cohort of RACPC patients reviewed by telehealth during the COVID-19 pandemic compared with a historical control group of face-to-face consultations. The main outcomes included emergency department re-presentation at 30 days and 12 months, major adverse cardiovascular events at 12 months, and patient satisfaction scores. Results: One hundred forty patients seen in the telehealth clinic were compared with 1,479 in-person RACPC controls. Baseline demographics were similar; however, telehealth patients were less likely to have a normal prereferral electrocardiogram than RACPC controls (81.4% vs. 88.1%, p = 0.03). Additional testing was ordered less often for telehealth patients (35.0% vs. 80.7%, p < 0.001). Rates of adverse cardiovascular events were low in both groups. One hundred twenty (85.7%) patients reported being satisfied or highly satisfied with the telehealth clinic service. Conclusions: In the setting of COVID-19, a telehealth RACPC model with reduced use of additional testing facilitated social distancing and achieved clinical outcomes equivalent to a face-to-face RACPC control. Telehealth may have an ongoing role beyond the pandemic, supporting specialist chest pain assessment for rural and remote communities. Pending further study, it may be safe to reduce the frequency of additional testing following RACPC review.
ABSTRACT
Detection, diagnosis, and treatment of hypertension require accurate blood pressure assessment. However, in clinical practice, lack of training in or nonadherence to measurement recommendations, lack of patient preparation, unsuitable environments where blood pressure is measured, and inaccurate and inappropriate equipment are widespread and commonly lead to inaccurate blood pressure readings. This has led to calls to require regular training and certification for people assessing blood pressure. Hence, the Pan American Health Organization in collaboration with Resolve to Save Lives, the World Hypertension League, Lancet Commission on Hypertension Group, and Hypertension Canada has developed a free brief training and certification course in blood pressure measurement. The course is available at www. The release of the online certification course is timed to help support World Hypertension Day. This year World Hypertension Day has been delayed to October 17 due to the COVID-19 pandemic. For 2020, the World Hypertension League calls on all health care professionals, health care professional organizations, and indeed all of society, to assess the blood pressure of all adults, measure blood pressure accurately, and achieve blood pressure control in those with hypertension.