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Improving diabetes care in Aboriginal communities in the Northern Territory

Si, Damin (2006). Improving diabetes care in Aboriginal communities in the Northern Territory. PhD Thesis, Charles Darwin University.

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Author Si, Damin
Title Improving diabetes care in Aboriginal communities in the Northern Territory
Institution Charles Darwin University
Publication Date 2006
Thesis Type PhD
Subjects 1117 - Public Health and Health Services
Abstract Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from diabetes. There is an urgent need to understand how Indigenous primary care systems are organised to deliver diabetes services to those most in need, to monitor the quality of diabetes care received by Indigenous people, and to take actions to improve systems for better diabetes care.

This study featured two annual cycles of assessment, feedback, action planning, and implementation using a Continuous Quality Improvement approach in 12 Indigenous community health centres. Assessment included a structured review of health centre systems and audit of medical records on diabetes care. Baseline assessment showed that health centre systems were in the low to mid-range of development and had distinct areas of strengths and weaknesses; quality of diabetes care was characterised by relatively high levels of adherence to processes of care, low rates of follow up of abnormal clinical findings and medication adjustment, and inadequacy in metabolic control. These findings were fed back to health centres, and action plans were developed by each centre to make system changes. After completion of two annual cycles of quality improvement, assessment showed that there was good engagement of health centre staff, with significant improvements in system development. Adherence to processes of care and HbA1c control improved over the study period.

This Continuous Quality Improvement intervention proved to be highly acceptable in the Indigenous primary care setting and has been associated with significant improvements in systems and processes of care and some intermediate outcomes. However, improvements appear to be limited by inadequate attention to abnormal clinical findings and medication adjustment. Greater improvement in intermediate outcomes may be achieved by specifically addressing system barriers to therapy intensification through more effective engagement of medical staff in quality improvement activities and/or greater use of nurse-practitioners.

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