Essential Service Standards for Equitable National Cardiovascular CarE for Aboriginal and Torres Strait Islander People – An Exemplar Approach to Closing the Gap

Introduction: Cardiovascular diseases (CVD) constitute the biggest cause of death for Aboriginal and Torres Strait Islander people and a most critical target for reducing the life expectancy gap between Aboriginal and Torres Strait Islander people and non-Indigenous Australians.
Objectives: The ESSENCE (Essential Service Standards for Equitable Cardiovascular CarE for Aboriginal and Torres Strait Islander people) project sought to identify disparities in CVD and address these by developing a strategy to improve care across the health care system. In doing so, the objective was to build the foundations on which the disparities in care experienced by Aboriginal and Torres Strait Islander people could be reduced, and develop an exemplar approach to closing the gap.
Methods: Utilising 25 years of national mortality data (1986-2010), the project mapped secular trends in CVD mortality in Australia and differentials in rates of mortality, by Indigenous status. Essential service standards were developed to identify elements of care and service delivery that should be accessible to all people with or at risk of CVD. These standards focused on prevention and management extending across the life course and continuum of care - including primary prevention, risk identification and management, and the management of disease in specialist, acute and post-acute care settings. Utilising this conceptual framework to guide the process, the standards were informed by a targeted literature review of existing evidence and service standards. Standards then underwent a
process of review and validation by external experts prior to final review by the Steering Committee (comprising of leaders in the field of CVD from Australia).
Results: The ESSENCE secular trend data shows that whilst absolute CVD mortality rates for Aboriginal and Torres Strait Islanders has decreased significantly, in relative terms the disparity has increased compared to non-Indigenous Australians. Most alarming is the differential in mortality rates in young age groups. 61 service standards were identified, articulating elements of care necessary to reduce disparity in access and outcomes for five critical cardiovascular conditions. The standards were presented in alignment with 10
policy relevant health reform targets.
Conclusion: The ESSENCE Project has demonstrated differentials in burden of disease and developed a structured and comprehensive approach to improving CVD care in order to reduce disparities experienced by Aboriginal and Torres Strait Islander people.