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https://hdl.handle.net/2440/68844
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Type: | Journal article |
Title: | Rural and urban differentials in primary care management of chronic heart failure: new data from the CASE study |
Author: | Robyn, S. Eckert, K. Stewart, S. Phillips, S. Yallop, J. Tonkin, A. Krum, H. |
Citation: | Medical Journal of Australia, 2007; 186(9):441-445 |
Publisher: | Australasian Med Publ Co Ltd |
Issue Date: | 2007 |
ISSN: | 0025-729X 1326-5377 |
Statement of Responsibility: | Robyn A Clark, Kerena A Eckert, Simon Stewart, Susan M Phillips, Julie J Yallop, Andrew M Tonkin and Henry Krum |
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. |
Keywords: | Humans Angiotensin-Converting Enzyme Inhibitors Echocardiography Hospitalization Health Care Surveys Cross-Sectional Studies Evidence-Based Medicine Rural Population Urban Population Rural Health Services Urban Health Services Drug Utilization Referral and Consultation Primary Health Care Australia Heart Failure Practice Patterns, Physicians' |
Rights: | ©The Medical Journal of Australia 2007 |
DOI: | 10.5694/j.1326-5377.2007.tb00993.x |
Published version: | http://dx.doi.org/10.5694/j.1326-5377.2007.tb00993.x |
Appears in Collections: | Aurora harvest 5 Medicine publications |
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