Atlas 2015 - 6. Interventions for chronic disease

Atlas

Key findings

Chronic diseases are the leading cause of illness, disability and death. Australia has higher rates of asthma compared with other countries, but the atlas findings demonstrate that hospitalisation as a result of this disease is low. From 2010–11 to 2012–13, on average 15,111 children and young people were admitted to hospital for asthma in Australia each year. This may reflect a strong emphasis on the use of asthma management plans in primary care. Similarly, the number of admissions among adults was low but admission rates were higher in remote areas of Australia, which reflects the higher prevalence of asthma and chronic obstructive pulmonary disease (COPD) in Aboriginal and Torres Strait Islander peoples. Dispensing of medicines for asthma showed a strong socioeconomic trend, with dispensing rates highest in the lowest socioeconomic groups.

Similar to the patterns of hospital admissions noted for asthma and COPD, hospital admission rates for heart failure in people 40 years and over was markedly higher in remote areas. This may reflect the high prevalence of heart failure among Indigenous peoples. Multidisciplinary heart failure services can decrease the rate of hospital admissions and readmissions for this condition.

In 2012–13, 4,400 people were admitted to hospital for diabetes-related lower limb amputation in Australia. Once again, the rates in remote areas were higher. It is known that Indigenous people are about three times more likely to have diabetes, 10 times more likely to be admitted for diabetic foot complications and 30 times more likely to suffer diabetes-related lower limb amputation than non‑Indigenous people.

Anticholinesterase medicines are used to alleviate symptoms of some types of dementia including Alzheimer’s disease. There was considerable variation in dispensing of these medicines across Australia, and dispensing rates were highest in major cities.

The findings in this chapter demonstrate the continued need for prevention of chronic disease among Indigenous peoples and those living in remote areas. These efforts need to be sustained over decades given that many of these admissions are the result of years of poor health.

Recommendations

6a. The Commission hosts a roundtable of service providers and consumers from remote areas to identify successful strategies for implementing best practice primary and secondary prevention services for patients with chronic diseases in remote Australia.

Asthma and chronic obstructive pulmonary disease medicines dispensing and hospital admissions

6b. The Australian Government Department of Health encourages primary health networks to develop local models of integrated care for asthma and chronic obstructive pulmonary disease to ensure properly coordinated community prevention strategies are implemented.

6c. State and territory health departments and primary health networks jointly review the uptake of vaccinations against respiratory diseases in high-risk populations and their influence on local variation.

Heart failure hospital admissions 40 years and over

6d. Primary health networks, state and territory health departments and clinicians collaborate to improve access for patients with heart failure to comprehensive heart failure programs consistent with evidence-based best practice.

Diabetes-related lower limb amputation hospital admissions 18 years and over

6e. Public and private hospitals and primary health networks adopt risk-stratified levels of support for managing diabetes care, including earlier diagnosis and intervention.

6f. Primary health networks and state and territory health departments collaborate to improve access to coordinated services that deliver evidence based care for those with diabetes, including at multidisciplinary foot clinics, and care by vascular, endocrine and orthopaedic specialists.

Stroke average length of stay in hospital 65 years and over

6g. Hospital and ambulance services ensure patients have access to care that aligns with the Acute Stroke Clinical Care Standard.

6h. State and territory health departments consider mechanisms to improve coding, analytics and collection of outcome data for stroke.

6i. Relevant clinical colleges ensure educational and training material, as well as continuing professional development requirements, are in keeping with the Acute Stroke Clinical Care Standard.

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