Primary health care

Many types of cardiovascular disease (CVD) are preventable. At a population level, all Australians are encouraged to reduce their cardiovascular risk by eating a healthy and varied diet, being physically active on a regular basis, maintaining a healthy weight, and quitting smoking [39274]. The management of biomedical risk factors, such as high blood pressure and blood lipids, is also important for preventing CVD.

Primary health care (PHC) has a major role to play in detecting and managing  CVD risk among Aboriginal and Torres Strait Islander people early, therefore preventing the advancement of the disease [33326][42101]. Aboriginal and Torres Strait Islander people access PHC through both private general practice, and primary health services specifically designed to meet the needs of Aboriginal and Torres Strait Islander peoples [31077]. These include Aboriginal community controlled health services (ACCHS) and government operated Indigenous-specific services. There is evidence that the PHC models utilised by ACCHSs have better CVD outcomes for Aboriginal and Torres Strait Islander people compared to mainstream services [35581]. ACCHSs do this by providing culturally informed, holistic services that treat both the present health care needs but also the wider social determinants of health  [42080].

A key way that PHC services detect and manage CVD risk for Aboriginal and Torres Strait Islander peoples is through the provision of preventive health assessments [50139]. Preventive health assessments are regular health checks that include an assessment of a person’s risk factors for chronic disease. The Royal Australian College of General Practitioners’ national guide to conducting a preventive health assessment for Aboriginal and Torres Strait Islander people includes a recommendation to assess an adult’s CVD risk. The delivery of preventive health assessments to Aboriginal and Torres Strait Islander people is incentivised by Medicare Benefit Schedule (MBS) Item 715.

The National Aboriginal and Torres Strait Islander Health Plan 2021–2031 outlines the importance of early access to PHC to avoid late-stage presentation of CVD with priority given to chronic conditions including CVD and rheumatic heart disease [44419].

Aboriginal and Torres Strait Islander people face some barriers to accessing PHC. These include geography and cost [32583]. It is important that Aboriginal and Torres Strait Islander people are able to access affordable preventive medication for CVD. It is also critical that Aboriginal and Torres Strait Islander people who have CVD and who live remotely are able to access high-quality specialist care that is expertly integrated with local PHC. Continuous quality improvement (CQI) in the PHC setting has been shown to improve the delivery of preventive care to Aboriginal and Torres Strait Islander people [31077].