Review of Cardiovascular Disease Programs

4. Recommendations

Recommendations - Review of Cardiovascular Disease Programs

Page last updated: 03 May 2012

A number of stakeholders (and in particular, the National Heart Foundation and National Stroke Foundation) have invested in substantial research and analysis of CVD. They have also developed a number of recommendations for improvement of CVD management in Australia and made submissions to the Australian Government and jurisdictions on matters of budget. In developing the recommendations contained in this report, Ernst & Young has referenced these existing reports and submissions and examined a range of evidence relating to CVD programs.

In developing these recommendations it is acknowledged that there is variable opinion and debate about the order and priority of any new investments. There are many strongly held views about what are the most important components of a CVD program and it is unlikely that a consensus on this is achievable. However, Ernst and Young have tested with stakeholders the hypotheses upon which the recommendations are made and received a substantial degree of support.

Recommendations have been grouped into logical bundles using a framework based on a conceptual map of the CVD journey as experienced by individuals. Groups of recommendations have then been listed from highest to lowest priority. The highest priority recommendations in this report are intended to improve capacity in the system through the establishment of a strong foundation based on the elements of clinical governance, information and performance.

These are Foundation recommendations and are pre-fixed with “F”. It should be noted that some Foundation recommendations may have an immediate commencement but a long lead time to full implementation, due to the complexities associated with their implementation. Investments would need to reflect this, with staged investment planned for some recommendations.

The next priority recommendations are contained in Group 1, then Group 2 and so on and are made in the context of the current environment, the Australian health reform agenda, the concerns of key peak bodies and other stakeholders and the available evidence. Improving capacity is an essential prerequisite for a number of further recommendations, particularly those which will result in increases in demand, hence the prioritisation of Foundation recommendations.

Some recommendations depend on the guidance of specific Australian Government endorsed bodies, such as the Australian Commission for Safety and Quality in Health Care, the National Health and Medical Research Council, or the Australian Institute of Health and Welfare. Other recommendations may link with strategic directions for major reforms, such as the National Primary Health Care Strategy or the Health and Hospitals Reform Committee.

In many cases there are existing processes, such as the Australian Primary Care Collaboratives, that have demonstrated success in achieving change and could be used to assist implementation of some recommendations. In addition, some of the jurisdictions have already developed strategies linked to some of the recommendations and are either in the process of implementation or planning to implement. However, a lack of consistency in approach, commitment and progress is evident across the jurisdictions.

Recommendations recognise the common contributing risk factors for CVD and other chronic and complex conditions. Community awareness, primary prevention and risk assessment strategies are generally shared across the range of cardiovascular diseases; strategies to reduce risk factors and improve rates of CVD will be applicable to CVD and a number of other chronic diseases. However, a cardiac event is very different from a stroke; the identification and treatment of an emergency stroke presentation differs from the identification and treatment of an acute cardiac infarction. Similarly the post-acute experiences of a person who has suffered a stroke are very different from those of a person who has experienced as heart attack. Recommendations recognise points on the CVD journey, generally for acute and immediate post-acute care where specific actions are required in order to achieve outcomes for specific diseases.

Finally, it is clear that improved responses are required to meet the needs of Aboriginal and Torres Strait Islander people, people who are socially excluded and many people from culturally and linguistically diverse (CALD) backgrounds. Ordinarily, it would seem logical to group recommendations particularly pertinent to this group into Foundation recommendations. It is our view that there is a need to first establish consistent and high quality responses to CVD across primary and acute health services and through population health responses.

Notwithstanding, specific recommendations to improve outcomes for significantly disadvantaged groups are included high in the list of priorities. It is particularly important that these recommendations are considered in the context of the current significant disadvantage experienced by Indigenous Australians, particularly in remote Indigenous communities and the serious ongoing workforce shortages in these communities.

It should also be taken as a given that all recommendations will need to be considered within the context of relative disadvantage, with priority given to reducing current gaps in health status for those people with the highest levels of social and economic disadvantage