Exploring equity of care for Aboriginal and Torres Strait Islander peoples within the state-wide Musculoskeletal Physiotherapy Screening Clinic and Multi-disciplinary Service in Queensland Health.

ObjectiveThis study aimed to explore equity of care for Aboriginal and Torres Strait Islander peoples compared to non-Indigenous Australians within a Queensland-wide musculoskeletal service.MethodThe service database was analysed between July 2018 and April 2022 across 18 Queensland Health facilities. Representation of Aboriginal and Torres Strait Islander peoples within the service's patient population was first explored. Second, service and patient-related characteristics and outcomes between Aboriginal and Torres Strait Islander patients and non-Indigenous patients undergoing an episode of care in the service were compared using analysis of variance and chi-squared tests.ResultsA greater proportion of Aboriginal and Torres Strait Islander peoples (4.34%) were represented within the service's patient population than in the general population (3.61%) state-wide. Aboriginal and Torres Strait Islander patients presented with a generally higher severity of clinical presentation across measures at initial consult. Very similar proportions of Aboriginal and Torres Strait Islander (63.2%) and non-Indigenous (64.3%) patients reported clinically meaningful treatment benefits. While a higher proportion of Aboriginal and Torres Strait Islander patients (69.7%) were discharged from the service without requiring specialist review compared to non-Indigenous patients (65.6%), Aboriginal and Torres Strait Islander patients had higher rates of discharge due to non-attendance (20.8%) when compared to non-Indigenous (10.6%) patients (P<0.01).ConclusionsDisparity in care retention for Aboriginal and Torres Strait Islander patients compared to non-Indigenous patients was observed within the musculoskeletal service. Consultation with Aboriginal and Torres Strait Islander communities is needed to address access barriers once in the service to guide service improvement.

Follow-up echocardiographic changes in children and youth aged <25 years with latent rheumatic heart disease: A systematic review and meta-analysis of global data.

OBJECTIVES: To estimate progression, regression and persistence rates for borderline and mild-definite latent RHD in children and youth diagnosed at age < 25 years. METHODS: A review was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Electronic databases were searched for latent RHD echocardiography follow-up studies which used World Heart Federation diagnostic criteria. A meta-analysis of outcomes was conducted for borderline and mild-definite disease subcategories. RESULTS: Data for 1618 individuals from 12 studies were included. For borderline cases, 48.51% regressed (95%CI 45.10-51.93), 13.99% progressed (95%CI 9.72-18.25), and 38.61% had persistent (unchanged) disease at follow-up (95%CI 29.68-47.54). For mild-definite cases, 34.01% regressed (95%CI 28.88-39.15), 8.06% progressed (95%CI 3.65-16.90), and 60.23% had persistent disease (95%CI 55.08-67.38). CONCLUSIONS: Borderline and mild-definite latent RHD show variable evolution following initial diagnosis. While 8% of mild-definite and 14% borderline cases had signs of disease progression at follow-up, a third of mild-definite and half of borderline cases had disease regression, even with sub adequate antibiotic prophylaxis. The significant variability between study cohorts suggests latent RHD natural history is likely variable between different endemic regions globally. Future research is needed to identify those individuals who would most benefit from antibiotic prophylaxis and determine regional natural history of latent RHD.

The evidence that rheumatic heart disease control programs in Australia are making an impact.

OBJECTIVE: Rheumatic heart disease (RHD) comprises heart-valve damage caused by acute rheumatic fever (ARF). The Australian Government Rheumatic Fever Strategy funds RHD Control Programs to support detection and management of ARF and RHD. We assessed epidemiological changes during the years of RHD Control Program operation. METHODS: Linked RHD register, hospital and death data from four Australian jurisdictions were used to measure ARF/RHD outcomes between 2010 and 2017, including: 2-year progression to severe RHD/death; ARF recurrence; secondary prophylaxis delivery and earlier disease detection. RESULTS: Delivery of secondary prophylaxis improved from 53% median proportion of days covered (95%CI: 46-61%, 2010) to 70% (95%CI: 71-68%, 2017). Secondary prophylaxis adherence protected against progression to severe RHD/death (hazard ratio 0.2, 95% CI 0.1-0.8). Other measures of program effectiveness (ARF recurrences, progression to severe RHD/death) remained stable. ARF case numbers and concurrent ARF/RHD diagnoses increased. CONCLUSIONS: RHD Control Programs have contributed to major success in the management of ARF/RHD through increased delivery of secondary prevention yet ARF case numbers, not impacted by secondary prophylaxis and sensitive to increased awareness/surveillance, increased. IMPLICATIONS FOR PUBLIC HEALTH: RHD Control Programs have a major role in delivering cost-effective RHD prevention. Sustained investment is needed but with greatly strengthened primordial and primary prevention.