A multifaceted health‐service intervention in remote Aboriginal communities: 3‐year follow‐up of the impact on diabetes care

Ross Stewart Bailie · Damin Si · Samantha J. Togni · Gary Robinson · Peter H. D'Abbs

63 citations0/0 files storedThe Medical Journal of Australia

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Indigenous Health, Education, and Rights Diabetes Management and Education Health Policy Implementation Science

Abstract

OBJECTIVE: To examine the trends in processes of diabetes care and in participant outcomes after an intervention in two remote regions of Australia. DESIGN: Follow-up study over 3 years. SETTING: Seven health centres in the Tiwi Islands and the Katherine West region of the Northern Territory. PARTICIPANTS: 137 Aboriginal people with type 2 diabetes. INTERVENTION: Implementation of a multifaceted trial, including transfer of purchasing and planning responsibility to local health boards, the development and dissemination of clinical guidelines supported by electronic registers, recall and reminder systems and associated staff training, and audit and feedback. MAIN OUTCOME MEASURES: Trends in the proportion of Aboriginal people receiving services in accordance with clinical guidelines and in the proportion for whom specified levels of blood pressure and glycosylated haemoglobin (HbA(1c)) were achieved; health staff perceptions of barriers to effective service delivery. RESULTS: An initial improvement in overall service levels from 40% to 49% was not fully sustained over the 3-year period. The overall proportion of services delivered varied from 22% to 64% between communities and over time. The proportion of participants whose most recent HbA(1c) level was less than 7% improved from 19% to 32%, but there was little change in blood pressure control. Perceived barriers to service delivery included discontinuities in staffing, lack of work-practice support and patients' acceptance of services. CONCLUSIONS: Multifaceted interventions can improve quality of care in this environment, but achieving sustainable, high-quality care in a range of services and local conditions presents particular challenges. Developing and testing strategies for consistent and sustained improvement should be a priority for service providers and researchers.

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2002Multilevel Statistical Models

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2013Type 2 Diabetes in Aboriginal Peoples 2010Type 2 diabetes in Indigenous populations: Quality of intervention research over 20years 2016Management of diabetes in Indigenous communities: lessons from the Australian Aboriginal population 2013A Review of Programs That Targeted Environmental Determinants of Aboriginal and Torres Strait Islander Health 2015Limited evidence to assess the impact of primary health care system or service level attributes on health outcomes of Indigenous people with type 2 diabetes: a systematic review 2010Improvements in Indicators of Diabetes-related Health Status Among First Nations Individuals Enrolled in a Community-driven Diabetes Complications Mobile Screening Program in Alberta, Canada 2009Disseminating best-evidence health-care to Indigenous health-care settings and programs in Australia: identifying the gaps 2012Getting better at chronic care in remote communities: study protocol for a pragmatic cluster randomised controlled of community based management

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