Investigating factors that impede and enable optimal implementation of regional rheumatic heart disease control in primary health care settings - strategies and interventions

The End Rheumatic Heart Disease in Australia: Study of Epidemiology (ERASE) was conducted to support recommendations made in the Endgame Strategy endorsed in 2020 by the END Rheumatic Heart Disease (RHD) Coalition. Besides epidemiological research, a health systems component of ERASE aimed to identify barriers and enablers within Australia’s primary healthcare system for suitably managing RHD and its precursor condition, acute rheumatic fever. The study focused specifically on the influences, enablers and barriers that permit or preclude achievement of health service goals, including prevention and clinical management. These were considered in two separate sub-studies from the perspectives of primary health care service providers and senior Indigenous health stakeholders. The World Health Organization framework for analysing and strengthening health systems was used, including their six building blocks, adapted to the Australian context. Data from New South Wales, Northern Territory, Queensland, South Australia, and Western Australia were collected using a mixed-methods approach, including survey and yarning interview methodologies in the two separate sub-studies.

This report provides a detailed outline of the methods and results of these sub-studies,
synthesising the findings and recommendations by examining findings in the context of enabling the implementation of the RHD Guidelines and Endgame (2020). We use the six World Health Organization Health System pillars to map four sources of information: 1) primary health care recommendations drawn from the Endgame; 2) principles for service delivery drawn from the Guidelines; 3) survey responses from participants reflecting on the health services they currently work in; and 4) interviews with prominent RHD stakeholders taking a broad health systems view. Finally, these RHD-specific recommendations are incorporated using the World Health Organization Innovative Care for Chronic Conditions Framework.