A multifaceted health-service intervention in remote Aboriginal communities: 3-year follow-up of the impact on diabetes care
Bailie, Ross S., Si, Damin, Robinson, Gary W., Togni, Samantha J., and d'Abbs, Peter H.N. (2004) A multifaceted health-service intervention in remote Aboriginal communities: 3-year follow-up of the impact on diabetes care. Medical Journal of Australia, 181 (4). pp. 195-200.
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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 (HbA1c) 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 HbA1c 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.
|Item Type:||Article (Refereed Research - C1)|
|Keywords:||diabetes; evaluation; health services; indigenous health; recall systems|
|FoR Codes:||11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111799 Public Health and Health Services not elsewhere classified @ 40%|
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111711 Health Information Systems (incl Surveillance) @ 30%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111717 Primary Health Care @ 30%
|SEO Codes:||92 HEALTH > 9203 Indigenous Health > 920399 Indigenous Health not elsewhere classified @ 100%|
|Deposited On:||22 Mar 2010 09:06|
|Last Modified:||22 May 2013 00:59|
Last 12 Months: 0
|Citation Counts with External Providers:||Web of Science: 25|
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