CARPA STM 5th edition
Chronic disease chapter
Christine Connors
Section Leader, Chronic Disease Chapter
CARPA STM Editorial Board
• Authors and primary reviewers Chronic Disease chapter
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Steve Brady
Paul Burgess
Christine Connors
Alex Hope
Diane Howard
Marcus Ilton
Rowena Ivers
Jenni Judd
Paul Lawton
Louise Maple-Brown
Alison McLay
Ciara O’Sullivan
Bhavini Patel
Jo Sheppingen
Jo Wright
Trends in avoidable hospitalisation 1998 - 2006
Hospital
separations
per 100 000
18000
16000
NT Indigenous
Vaccine
Acute
Chronic
Hospital
separations
per 100 000
18000
16000
14000
14000
12000
12000
10000
10000
8000
8000
6000
6000
4000
4000
2000
2000
0
0
NT non-Indigenous
Vaccine
Acute
Chronic
Li SQ et al. (2009) Avoidable Hospitalisation in Aboriginal and non-Aboriginal people in the Northern
Territory MJA 2009
Incidence of acute myocardial infarction 1992 to 2004
Males
Females
Male
Indigenous
Per 100 000
Indigenous
Per 100 000
Non-Indigenous
Non-Indigenous
1200
1200
+3%
900
900
600
600
300
+5%
300
-1%
-1%
0
0
92
94
96
98
00
02
04
92
94
96
98
00
02
04
You, J. et al. (2008) Incidence and survival after acute myocardial infarctions in Indigenous and non-Indigenous people
in the Northern Territory, 1992-2004 Med J Aust 2009; 190:298-302
Changes in death rates following heart attack 1992 to 2004
Pre-hospital
non-Indigenous
Indigenous
Hospital and beyond
unchanged
-75%
- 56%
-50%
You, J. et al. (2008) Incidence and survival after acute myocardial infarctions in Indigenous
and non-Indigenous people in the Northern Territory, 1992-2004 Med J Aust 2009; 190:298-302
Changes in relative rank of common specific conditions
Between 1994-1998 & 1999-2003
Rank
Change
1994-1998
1999-2003
DALY
Rank
2
10
1
14
7
3
19
9
21
1
2
3
4
5
6
7
8
9
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1
11
2
13
10
4
3
6
8
9
1
2
3
4
5
6
7
8
9
10
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
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Aboriginal
Type 2 diabetes *
Anxiety & depression *
Ischaemic heart disease
Nephritis and nephrosis *
COPD *
Road traffic accidents
Suicide & self-inflicted *
Homicide & violence *
Vision loss *
Non-Aboriginal
Anxiety & depression
Type 2 diabetes *
Ischaemic heart disease
Vision loss *
COPD *
Road traffic accidents
Substance abuse
Suicide & self-inflicted
Lung cancer
Asthma
CD chapter focused on vascular risk
and vascular disease
• Resp in general section
• Screen shot index
New additions
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Expanded tobacco guidelines
Assessing and reducing cardiovascular risk
Interpreting results in one guideline
Combined checks for chronic disease
Each disease guideline now focused on
specific information for that disease
– Symptoms
– Management
– medicines
Chapter layout
Start with adult health
check
(or clinical record
review)
Confirm chronic
disease diagnosis
(interpreting results)
and assess CVS risk
CVS risk determines review
frequency and treatment
intensity
High absolute CVS risk
3 monthly review
Chronic disease
(vascular)
Low-Moderate CVS risk
Adult health check
including CVS risk
assessment
6 monthly review
No chronic disease
2 yearly check low CVS risk
Yearly check moderate CVS risk
Business Rule
Prior to commencing any chronic disease care plan a Cardio
Vascular Risk Assessment must be completed.