Pharmacy skills will help close the gap in heart disease

With new research showing current cardiovascular disease screening guidelines are missing younger at-risk Aboriginal people, a leading Aboriginal health specialist has highlighted the role pharmacists can play in preventative cardiac care.

The statement from National Aboriginal Community Controlled Health Organisation (NACCHO) Deputy CEO Dr Dawn Casey comes following research finding up to half of older Australian Aboriginal and Torres Strait Islander people are at high risk of cardiovascular disease (CVD), and that significant numbers of those in their 20s were also at risk.¹

Australian National University researchers found 1.1% of Aboriginal and Torres Strait Islander 18-24 year olds and 4.7% of 25-34 year olds were at high absolute primary risk of CVD. This is around the same as the proportion of non-Indigenous Australians aged 45-54 who are at high risk.¹

The study of 2820 people from a 2012-13 health survey² revealed many Aboriginal and Torres Strait Islander people are not aware of their risk and most not receiving currently recommended therapy to lower their cholesterol, and are hospitalised for coronary heart disease at a rate up to eight times higher than that of other Australians.¹

Australia’s national guidelines recommend all Aboriginal and Torres Strait Islander peoples aged 35-74 have a heart check. But this new research found the high-risk category starts much earlier than this, and indicates the affected group needs to start receiving CVD checks earlier in life, the study authors said.

Dr Casey echoed the positive results of the study, allowing the entire ACCHS sector to better deliver preventative and holistic care.

‘ACCHOs have a strong history in doing this effectively and appropriately for their communities,’ she told Australian Pharmacist.

‘Specifically, ACCHO-embedded non-dispensing pharmacists and community pharmacies have a role in identifying risk factors and encouraging heart health checks within the ACCHO communities.’

‘Embedded ACCHO pharmacists can use their skills and knowledge work with a range of clinicians in the ACCHO to conduct holistic risk screening and overall management strategy.      

NACCHO is currently actively advocating for enhanced integration of pharmacists into ACCHOs models of care.’

NACCHO and PSA are currently working as part of a broader team on two projects to enhance the broader roles that pharmacists’ skills and training can deliver – Integrating Pharmacists within Aboriginal Community Controlled Health Services to improve Chronic Disease Management (IPAC) and Indigenous Medication Review Service (IMeRSe).

‘Pharmacists have a broad range of clinical skills and are often very suitable additions to multidisciplinary clinical teams, especially where chronic disease is prevalent and many medicines required,’ Dr Casey said.

‘Community pharmacists may identify risks within normal client care, for example through a pharmacy-based MedsCheck or an HMR. Where team-based care is working effectively, pharmacies and ACCHOs will liaise and work together to ensure care is optimised across these settings.

‘Pharmacists’ understanding of medicines also involves understanding how medical conditions and risk factors for these conditions apply. Unfortunately there is still sometimes a misconception across Australia that pharmacists really just supply medicines and manage retail businesses. Enhancing professional and clinical services is a key trend across the whole pharmacy sector and NACCHO is an active participant in these developments.’

PSA and NACCHO have collaboratively produced guidelines to support pharmacists caring for Aboriginal and Torres Strait Islander people available at:

http://www.psa.org.au/wp-content/uploads/guide-to-providing-pharmacy-services-to-aboriginal-and-torres-strait-islander-people-2014.pdf

References

1 Calabria B, Korda RJ, Lovett RW, Fernando P, Martin T, Malamoo L, Welsh J, Banks, E. Absolute cardiovascular disease risk and lipid-lowering therapy among Aboriginal and Torres Strait Islander Australians. Med J Aust 2018; 209 (1): 35-41. DOI: 10.5694/mja17.00897

2 Australian Bureau of Statistics. 4727.0.55.002. Australian Aboriginal and Torres Strait Islander Health Survey: users’ guide, 2012–13. Nov 2013.