Rural and urban differentials in primary care management of chronic heart failure: new data from the CASE study

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dc.contributor.authorRobyn, S.
dc.contributor.authorEckert, K.
dc.contributor.authorStewart, S.
dc.contributor.authorPhillips, S.
dc.contributor.authorYallop, J.
dc.contributor.authorTonkin, A.
dc.contributor.authorKrum, H.
dc.date.issued2007
dc.description.abstractObjective: 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.
dc.description.statementofresponsibilityRobyn A Clark, Kerena A Eckert, Simon Stewart, Susan M Phillips, Julie J Yallop, Andrew M Tonkin and Henry Krum
dc.identifier.citationMedical Journal of Australia, 2007; 186(9):441-445
dc.identifier.doi10.5694/j.1326-5377.2007.tb00993.x
dc.identifier.issn0025-729X
dc.identifier.issn1326-5377
dc.identifier.orcidStewart, S. [0000-0001-9032-8998]
dc.identifier.urihttp://hdl.handle.net/2440/68844
dc.language.isoen
dc.publisherAustralasian Med Publ Co Ltd
dc.rights©The Medical Journal of Australia 2007
dc.source.urihttps://doi.org/10.5694/j.1326-5377.2007.tb00993.x
dc.subjectHumans
dc.subjectAngiotensin-Converting Enzyme Inhibitors
dc.subjectEchocardiography
dc.subjectHospitalization
dc.subjectHealth Care Surveys
dc.subjectCross-Sectional Studies
dc.subjectEvidence-Based Medicine
dc.subjectRural Population
dc.subjectUrban Population
dc.subjectRural Health Services
dc.subjectUrban Health Services
dc.subjectDrug Utilization
dc.subjectReferral and Consultation
dc.subjectPrimary Health Care
dc.subjectAustralia
dc.subjectHeart Failure
dc.subjectPractice Patterns, Physicians'
dc.titleRural and urban differentials in primary care management of chronic heart failure: new data from the CASE study
dc.typeJournal article
pubs.publication-statusPublished

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