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

Bailie, Ross S., Si, Damin, Togni, Samantha J., Robinson, Gary W. 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):195-200.

Document type: Journal Article
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Title A multifaceted health-service intervention in remote Aboriginal communities: 3-year follow-up of the impact on diabetes care
Author Bailie, Ross S.
Si, Damin
Togni, Samantha J.
Robinson, Gary W.
d'Abbs, Peter H. N.
Journal Name Medical Journal of Australia
Publication Date 2004
Volume Number 181
Issue Number 4
ISSN 0025-729X   (check CDU catalogue  open catalogue search in new window)
Start Page 195
End Page 200
Total Pages 6
Place of Publication Australia
Publisher Australasian Medical Publishing Company Pty. Ltd.
Field of Research 1117 - Public Health and Health Services
HERDC Category C1 - Journal Article (DEST)
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 (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.
Description for Link Link to published version
URL https://www.mja.com.au/journal/2004/181/4/multifaceted-health-service-intervention-remote-aboriginal-communities-3-year


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