Gaps in Guideline-Recommended Assessment and Management in Primary Health Care for Aboriginal and Torres Strait Islander Women

Introduction: Aboriginal and Torres Strait Islander women experience a high and disparate burden of cardiovascular disease. Accessible and effective assessment and management in primary health care is essential to reducing inequality. This study sought to explore the extent to which the receipt of guideline-based assessment and management is influenced by gender.
Methods: A retrospective medical record review was undertaken at three primary care services in South and Central Australia for the period 6/2018 – 6/2020. Data were extracted for presence of risk factors and provision of risk assessment and management of those at risk/with established disease. Descriptive and regression analysis explored variance in assessment and management by gender.
Results: Records of 600 female and 600 male regular clients aged 18-74 years were analysed. 67% resided in remote/very remote regions and 32% in cities, reflective of service location. A greater proportion of women received absolute cardiovascular risk assessment in the preceding 12 months (37% vs 28%, p=0.036), not significant after adjusting for receipt of MBS715. Women were less likely to be prescribed antiplatelets (31% vs 49%, p=0.024), significant after adjusting for demographics and biomarkers. Other risk and disease management measures did not vary by gender: 42% of eligible women had a GP management plan, 40% a team care arrangement, 61% blood pressure lowering prescription, 54% lipid lowering prescription and 29% of smokers received cessation advice.
Discussion: Whilst there is little difference by gender, there is significant room for improvement in provision of evidence and guideline-based cardiovascular risk assessment and management for Indigenous Australians.