Abstract
BackgroundAboriginal people in Australia experience the highest prevalence of diabetes in the country, an excess of preventable complications and early death. There is increasing evidence demonstrating the importance of healthcare systems for improvement of chronic illness care. The aims of this study were to assess the status of systems for chronic illness care in Aboriginal community health centres, and to explore whether more developed systems were associated with better quality of diabetes care.MethodsThis cross-sectional study was conducted in 12 Aboriginal community health centres in the Northern Territory of Australia. Assessment of Chronic Illness Care scale was adapted to measure system development in health centres, and administered by interview with health centre staff and managers. Based on a random sample of 295 clinical records from attending clients with diagnosed type 2 diabetes, processes of diabetes care were measured by rating of health service delivery against best-practice guidelines. Intermediate outcomes included the control of HbA1c, blood pressure, and total cholesterol.ResultsHealth centre systems were in the low to mid-range of development and had distinct areas of strength and weakness. Four of the six system components were independently associated with quality of diabetes care: an increase of 1 unit of score for organisational influence, community linkages, and clinical information systems, respectively, was associated with 4.3%, 3.8%, and 4.5% improvement in adherence to process standards; likewise, organisational influence, delivery system design and clinical information systems were related to control of HbA1c, blood pressure, and total cholesterol.ConclusionThe state of development of health centre systems is reflected in quality of care outcome measures for patients. The health centre systems assessment tool should be useful in assessing and guiding development of systems for improvement of diabetes care in similar settings in Australia and internationally.
Highlights
Aboriginal people in Australia experience the highest prevalence of diabetes in the country, an excess of preventable complications and early death
Reported approaches to improving quality of care include use of recall and reminder systems, audit and feedback of clinical performance, structured clinical care, and specialist involvement in primary care. This evidence on the effectiveness of approaches to care in the Indigenous Australian population is consistent with the approach reflected in the Chronic Care Model developed in the USA [5,6]
This study shows that participating Aboriginal community health centres in Australia had implemented basic systems to support chronic illness care, but there was considerable room for improvement in all system components
Summary
Aboriginal people in Australia experience the highest prevalence of diabetes in the country, an excess of preventable complications and early death. Reported approaches to improving quality of care include use of recall and reminder systems, audit and feedback of clinical performance, structured clinical care, and specialist involvement in primary care This evidence on the effectiveness of approaches to care in the Indigenous Australian population is consistent with the approach reflected in the Chronic Care Model developed in the USA [5,6]. The Chronic Care Model is comprised of six major components that have been shown to be important internationally to chronic illness care: 1) health care organisation, 2) community linkages, 3) selfmanagement support, 4) decision support, 5) delivery system design, and 6) clinical information systems This model has been extensively implemented in community health centres and hospitals in the USA to assess system support for chronic care and to identify areas for further improvement [7]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
