Anaemia in pregnancy among Aboriginal and Torres Strait Islander women of Far North Queensland: a retrospective cohort study

Aim: Anaemia during pregnancy is common worldwide. In Australia between 7.1% and 11% of mothers have been reported to have anaemia in pregnancy. Higher rates are reported for Aboriginal and Torres Strait Islander women (Townsville: 34.2%, remote Northern Territory: 50%). The present study describes anaemia in pregnancy among Aboriginal and Torres Strait Islander women of Far North Queensland. Methods: Health service information was analysed for 2076 Aboriginal and Torres Strait Islander women who gave birth between 2006 and 2010. The prevalence of anaemia in pregnancy, characteristics of the mothers and pregnancy outcomes were described. Logistic regression for bivariate analyses and multivariable linear modelling with and without imputed data were used to compare those mothers who had anaemia in pregnancy with those who did not. Results: More than half of Aboriginal and Torres Strait Islander women (54.5% (95% CI: 52.4%, 56.7%)) had anaemia in pregnancy. For mothers who gave birth in 2009 and 2010 (n = 1796) with more complete data, those who were iron deficient during pregnancy were more likely to be anaemic (RR: 1.40, P = <0.001). Mothers (29.0%) from localities of relative socioeconomic advantage had lower risk of anaemia in pregnancy (RR: 0.86, P = 0.003), as did mothers (31.9%) who were obese (RR: 0.87, P = 0.013). Conclusions: The prevalence of anaemia in pregnancy among Aboriginal and Torres Strait Islander women of Far North Queensland is high. Prevention and treatment of anaemia will improve the health of these mothers, and possibly the health and early development of their children

Variability in disease burden and management of rheumatic fever and rheumatic heart disease in two regions of tropical Australia

Background:  \ud Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) contribute to Aboriginal Australian and Torres Strait Islander health disadvantage. At the time of this study, specialist ARF/RHD care in the Kimberley region of Western Australia was delivered by a broad range of providers while in far north Queensland (FNQ) a single provider model was used as part of a coordinated RHD control program.\ud \ud Aims:  \ud To review ARF/RHD management in the Kimberley and FNQ to ascertain whether differing models of service delivery are associated with different disease burden and patient care.\ud \ud Methods:  \ud An audit of ARF/RHD management. Classification and clinical management data were abstracted from health records, specialist letters, echocardiograms and regional registers using a standardised data collection tool.\ud \ud Results:  \ud 407 patients were identified with 99% being Aboriginal and/or Torres Strait Islanders. ARF without RHD was seen in 0.4% of Aboriginal and/or Torres Strait Islander residents and RHD in 1.1%. The prevalence of RHD was similar in both regions but with more severe disease in the Kimberley. More FNQ RHD patients had specialist review within recommended timeframes (67% versus 45%, χ2, p<0.001). Of patients recommended benzathine penicillin secondary prophylaxis, 17.7% received ≥80% of scheduled doses in the preceding 12 months. Prescription and delivery of secondary prophylaxis was greater in FNQ.\ud \ud Conclusions:  \ud FNQ's single-provider model of specialist care and centralised RHD control program were associated with improved patient care and may partly account for the fewer cases of severe disease and reduced surgical and other interventions observed in this region

Management of chronic Hepatitis B infection in the remote primary health care setting: the search for a suitable guideline

Objective: To identify a regionally appropriate guideline for the primary health care management of chronic Hepatitis B patients in the Torres Strait.\ud \ud Design: Literature review. PubMed (1950–November 2009), Nursing and allied health (CINAHL)-CD (1982–November 2009), and the following databases accessed through INFORMIT: Australian Public Affairs Information Service – Health (1978–November 2009), Aboriginal and Torres Strait Health Bibliography (1900–November 2009), Health & Society Database (1980–November 2009), Health Collection (1980–November 2009), Meditext (1968–November 2009), and Rural and Remote Health Database (1966–January 2006) were searched over a 3-month period from September to November 2009. An Internet search of relevant guidelines and recommendations from professional bodies such as the World Health Organization was also performed.\ud \ud Setting: Remote primary health care.\ud \ud Outcome measures: Initial searching identified 144 articles to include based on the provision of recommendations or guidelines for management of Hepatitis B at the primary care level. Included articles were then reviewed for their appropriateness to the remote primary health care setting against a set of five criteria determined at a consensus meeting of eight local medical officers.\ud \ud Results: Eleven articles were included for final review of which none met all five criteria of appropriateness for the remote primary health care setting.\ud \ud Conclusions: Guidelines need to recognize the difficulties of rural and remote practice and present practical alternatives to urban centred recommendations

A review of the medication pathway in rural Queensland, Australia

Objectives: It is well established that rural areas have compromised access to health services, including medication services. This paper reviews the practice developments for rural health professionals in relation to medication processes, with a focus on regulatory provisions in Queensland, Australia, and a view to identifying opportunities for enhanced pharmacy involvement. Methods: Literature referring to ‘medication/medicine’, ‘rural/remote’, ‘Australia’ and ‘pharmacy/pharmacist/pharmaceutical’ was identified via EBSCOhost, Ovid, Informit, Pubmed, Embase and The Cochrane Library. Australian Government reports and conference proceedings were sourced from relevant websites. Legislative and policy documents reviewed include drugs and poisons legislation, the National Medicines Policy and the Australian Pharmaceutical Advisory Council guidelines. Key findings: The following developments enhance access to medication services in rural Queensland: (1) endorsement of various non-medical prescribers, (2) authorisation of registered nurses, midwives, paramedics and Indigenous health workers to supply medications in sites without pharmacists, (3) skill-mixing of nursing staff in rural areas to ease medication administration tasks, (4) establishment of pharmacist-mediated medication review services, (5) electronic transfer of medical orders or prescriptions and (6) enhanced transfer of medication information between metropolitan and rural, and public and private facilities.Conclusions: This review identified a divide between medication access and medication management services. Initiatives aiming to improve supply of (access to) medications focus on scopes of practice and endorsements for non-pharmacist rural healthcare providers. Medication management remains the domain of pharmacists, and is less well addressed by current initiatives. Pharmacists' involvement in rural communities could be enhanced through tele-pharmacy, outreach support and sessional support