Improving primary prevention of acute rheumatic fever in Australia: consensus primary care priorities identified through an eDelphi process

Rosemary Wyber; Catalina Lizama; Vicki Wade; Glenn Pearson; Jonathan Carapetis; Anna P Ralph; Asha C Bowen; David Peiris

doi:10.1136/bmjopen-2021-056239

Improving primary prevention of acute rheumatic fever in Australia: consensus primary care priorities identified through an eDelphi process

BMJ Open. 2022 Mar 10;12(3):e056239. doi: 10.1136/bmjopen-2021-056239.

Authors

Rosemary Wyber^{1

2}, Catalina Lizama², Vicki Wade³, Glenn Pearson⁴, Jonathan Carapetis^{2

5

6}, Anna P Ralph^{3

7}, Asha C Bowen^{2

5

6}, David Peiris⁸

Affiliations

¹ Health Systems Science, The George Institute for Global Health, Newtown, New South Wales, Australia Rosemary.Wyber@telethonkids.org.au.
² Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia.
³ Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.
⁴ Aboriginal Health Institute Leadership Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.
⁵ Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.
⁶ School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
⁷ General Medicine and Inectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
⁸ Health Systems Science, The George Institute for Global Health, Newtown, New South Wales, Australia.

Abstract

Objectives: To establish the priorities of primary care providers to improve assessment and treatment of skin sores and sore throats among Aboriginal and Torres Strait Islander people at risk of acute rheumatic fever (ARF) and rheumatic heart disease (RHD).

Design: Modified eDelphi survey, informed by an expert focus group and literature review.

Setting: Primary care services in any one of the five Australian states or territories with a high burden of ARF.

Participants: People working in any primary care role within the last 5 years in jurisdiction with a high burden of ARF.

Results: Nine people participated in the scoping expert focus group which informed identification of an access framework for subsequent literature review. Fifteen broad concepts, comprising 29 strategies and 63 different actions, were identified on this review. These concepts were presented to participants in a two-round eDelphi survey. Twenty-six participants from five jurisdictions participated, 16/26 (62%) completed both survey rounds. Seven strategies were endorsed as high priorities. Most were demand-side strategies with a focus on engaging communities and individuals in accessible, comprehensive, culturally appropriate primary healthcare. Eight strategies were not endorsed as high priority, all of which were supply-side approaches. Qualitative responses highlighted the importance of a comprehensive primary healthcare approach as standard of care rather than disease-specific strategies related to management of skin sores and sore throat.

Conclusion: Primary care staff priorities should inform Australia's commitments to reduce the burden of RHD. In particular, strategies to support comprehensive Aboriginal and Torres Strait Islander primary care services rather than an exclusive focus on discrete, disease-specific initiatives are needed.

Keywords: primary care; public health; tropical medicine.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Australia
Consensus
Health Services, Indigenous*
Humans
Native Hawaiian or Other Pacific Islander
Primary Health Care
Primary Prevention
Rheumatic Fever* / prevention & control
Rheumatic Heart Disease* / prevention & control