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Improving organisational systems for diabetes care in Australian Indigenous communities

BACKGROUND: 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 diabet...

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Autores principales: Bailie, Ross, Si, Damin, Dowden, Michelle, O'Donoghue, Lynette, Connors, Christine, Robinson, Gary, Cunningham, Joan, Weeramanthri, Tarun
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876220/
https://www.ncbi.nlm.nih.gov/pubmed/17480239
http://dx.doi.org/10.1186/1472-6963-7-67
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author Bailie, Ross
Si, Damin
Dowden, Michelle
O'Donoghue, Lynette
Connors, Christine
Robinson, Gary
Cunningham, Joan
Weeramanthri, Tarun
author_facet Bailie, Ross
Si, Damin
Dowden, Michelle
O'Donoghue, Lynette
Connors, Christine
Robinson, Gary
Cunningham, Joan
Weeramanthri, Tarun
author_sort Bailie, Ross
collection PubMed
description BACKGROUND: 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 improve systems for better diabetes care. METHODS: The intervention featured two annual cycles of assessment, feedback workshops, action planning, and implementation of system changes in 12 Indigenous community health centres. Assessment included a structured review of health service systems and audit of clinical records. Main process of care measures included adherence to guideline-scheduled services and medication adjustment. Main patient outcome measures were HbA1c, blood pressure and total cholesterol levels. RESULTS: There was good engagement of health centre staff, with significant improvements in system development over the study period. Adherence to guideline-scheduled processes improved, including increases in 6 monthly testing of HbA1c from 41% to 74% (Risk ratio 1.93, 95% CI 1.71–2.10), 3 monthly checking of blood pressure from 63% to 76% (1.27, 1.13–1.37), annual testing of total cholesterol from 56% to 74% (1.36, 1.20–1.49), biennial eye checking by a ophthalmologist from 34% to 54% (1.68, 1.39–1.95), and 3 monthly feet checking from 20% to 58% (3.01, 2.52–3.47). Medication adjustment rates following identification of elevated HbA1c and blood pressure were low, increasing from 10% to 24%, and from 13% to 21% respectively at year 1 audit. However, improvements in medication adjustment were not maintained at the year 2 follow-up. Mean HbA1c value improved from 9.3 to 8.9% (mean difference -0.4%, 95% CI -0.7;-0.1), but there was no improvement in blood pressure or cholesterol control. CONCLUSION: This quality improvement (QI) intervention has proved to be highly acceptable in the Indigenous Australian 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 management. Greater improvement in intermediate outcomes may be achieved by specifically addressing system barriers to therapy intensification through more effective engagement of medical staff in QI activities and/or greater use of nurse-practitioners.
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spelling pubmed-18762202007-05-22 Improving organisational systems for diabetes care in Australian Indigenous communities Bailie, Ross Si, Damin Dowden, Michelle O'Donoghue, Lynette Connors, Christine Robinson, Gary Cunningham, Joan Weeramanthri, Tarun BMC Health Serv Res Research Article BACKGROUND: 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 improve systems for better diabetes care. METHODS: The intervention featured two annual cycles of assessment, feedback workshops, action planning, and implementation of system changes in 12 Indigenous community health centres. Assessment included a structured review of health service systems and audit of clinical records. Main process of care measures included adherence to guideline-scheduled services and medication adjustment. Main patient outcome measures were HbA1c, blood pressure and total cholesterol levels. RESULTS: There was good engagement of health centre staff, with significant improvements in system development over the study period. Adherence to guideline-scheduled processes improved, including increases in 6 monthly testing of HbA1c from 41% to 74% (Risk ratio 1.93, 95% CI 1.71–2.10), 3 monthly checking of blood pressure from 63% to 76% (1.27, 1.13–1.37), annual testing of total cholesterol from 56% to 74% (1.36, 1.20–1.49), biennial eye checking by a ophthalmologist from 34% to 54% (1.68, 1.39–1.95), and 3 monthly feet checking from 20% to 58% (3.01, 2.52–3.47). Medication adjustment rates following identification of elevated HbA1c and blood pressure were low, increasing from 10% to 24%, and from 13% to 21% respectively at year 1 audit. However, improvements in medication adjustment were not maintained at the year 2 follow-up. Mean HbA1c value improved from 9.3 to 8.9% (mean difference -0.4%, 95% CI -0.7;-0.1), but there was no improvement in blood pressure or cholesterol control. CONCLUSION: This quality improvement (QI) intervention has proved to be highly acceptable in the Indigenous Australian 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 management. Greater improvement in intermediate outcomes may be achieved by specifically addressing system barriers to therapy intensification through more effective engagement of medical staff in QI activities and/or greater use of nurse-practitioners. BioMed Central 2007-05-06 /pmc/articles/PMC1876220/ /pubmed/17480239 http://dx.doi.org/10.1186/1472-6963-7-67 Text en Copyright © 2007 Bailie et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Bailie, Ross
Si, Damin
Dowden, Michelle
O'Donoghue, Lynette
Connors, Christine
Robinson, Gary
Cunningham, Joan
Weeramanthri, Tarun
Improving organisational systems for diabetes care in Australian Indigenous communities
title Improving organisational systems for diabetes care in Australian Indigenous communities
title_full Improving organisational systems for diabetes care in Australian Indigenous communities
title_fullStr Improving organisational systems for diabetes care in Australian Indigenous communities
title_full_unstemmed Improving organisational systems for diabetes care in Australian Indigenous communities
title_short Improving organisational systems for diabetes care in Australian Indigenous communities
title_sort improving organisational systems for diabetes care in australian indigenous communities
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876220/
https://www.ncbi.nlm.nih.gov/pubmed/17480239
http://dx.doi.org/10.1186/1472-6963-7-67
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