Abstract
BackgroundManagement of chronic disease, including diabetes, is a central focus of most Aboriginal Community Controlled Health Services (ACCHSs) in Australia. We have previously demonstrated that diabetes monitoring and outcomes can be improved and maintained over a 10-year period at Derby Aboriginal Health Service (DAHS). While continuous quality improvement (CQI) has been shown to improve service delivery rates and clinical outcome measures, the process of interpreting audit results and developing strategies for improvement is less well described. This paper describes the evaluation of care of patients with type 2 diabetes mellitus (T2DM) and features of effective CQI in ACCHSs in the remote Kimberley region of north Western Australia.MethodsRetrospective audit of records for Aboriginal and Torres Strait Islander primary care patients aged ≥15 years with a confirmed diagnosis of T2DM at four Kimberley ACCHSs from 1 July 2011 to 30 June 2012. Interviews with health service staff and focus group discussions with patients post audit. Main outcome measures: diabetes care related activities, clinical outcome measures and factors influencing good diabetes related care and effective CQI.ResultsA total of 348 patients from the four ACCHSs were included in the study. Clinical care activities were generally high across three of the four health services (at least 71% of patients had cholesterol recorded, 89% blood pressure, 84% HbA1c). Patients from DAHS had lower median cholesterol levels (4.4 mmol/L) and the highest proportion of patients meeting clinical targets for HbA1c (31% v 16% ACCHS-3; P = 0.02). Features that facilitated good care included clearly defined staff roles for diabetes management, support and involvement of Aboriginal Health Workers, efficient recall systems, and well-coordinated allied health services. Effective CQI features included seamless and timely data collection, local ownership of the process, openness to admitting deficiencies and willingness to embrace change.ConclusionsWell-designed health care delivery and CQI systems, with a strong sense of ownership over diabetes management led to increased service delivery rates and improved clinical outcome measures in ACCHSs. Locally run CQI processes may be more responsive to individual health services and more sustainable than externally driven systems.
Highlights
Management of chronic disease, including diabetes, is a central focus of most Aboriginal Community Controlled Health Services (ACCHSs) in Australia
Reported data on quality care indicators and clinical outcome measures relating to diabetes care in other Aboriginal and Torres Strait Islander populations are included in Table 1 and Table 2 [28,29,30,34,35,36,37]
The interviews and focus groups of clinic staff and patients outlined some suggestions for improvement of diabetes care which included: 1) The development of guidelines on how to use MMEx to recall patients for diabetes reviews, and staff education on how to do this, 2) Clarification of roles for organising recalls and undertaking particular investigations and assessments such as regular team meetings to facilitate and maintain these roles, 3) Increase staffing to allow a greater capacity for chronic disease management
Summary
Management of chronic disease, including diabetes, is a central focus of most Aboriginal Community Controlled Health Services (ACCHSs) in Australia. In the Australian Aboriginal setting, self-published reports have shown that selfmanagement support is effective if led by Aboriginal Health Workers (AHWs) and delivered in a culturally appropriate manner [22,23]. This is supported by a larger body of literature worldwide which demonstrates that self-management support delivered by ‘community health workers’ in underserved populations of ethnic minorities can improve clinical outcomes in patients with diabetes [24,25]
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