Preventative medical care in remote Aboriginal communities in the Northern Territory: a follow-up study of the impact of clinical guidelines, computerised recall and reminder systems, and audit and feedback

MIDDLESEX HOUSE,34-42 CLEVELAND ST, LONDON, ENGLAND, W1T 4L

Preventive medical care in remote Aboriginal communities in the Northern Territory: a follow-up study of the impact of clinical guidelines, computerised recall and reminder systems, and audit and feedback

Background Interventions to improve delivery of preventive medical services have been shown to be effective in North America and the UK. However, there are few studies of the extent to which the impact of such interventions has been sustained, or of the impact of such interventions in disadvantaged populations or remote settings. This paper describes the trends in delivery of preventive medical services following a multifaceted intervention in remote community health centres in the Northern Territory of Australia. Methods The intervention comprised the development and dissemination of best practice guidelines supported by an electronic client register, recall and reminder systems and associated staff training, and audit and feedback. Clinical records in seven community health centres were audited at regular intervals against best practice guidelines over a period of three years, with feedback of audit findings to health centre staff and management. Results Levels of service delivery varied between services and between communities. There was an initial improvement in service levels for most services following the intervention, but improvements were in general not fully sustained over the three year period. Conclusions Improvements in service delivery are consistent with the international experience, although baseline and follow-up levels are in many cases higher than reported for comparable studies in North America and the UK. Sustainability of improvements may be achieved by institutionalisation of relevant work practices and enhanced health centre capacity

Results of a participatory needs assessment demonstrate an opportunity to involve people who use alcohol in drug user activism and harm reduction

BACKGROUND: Drug users’ organizations have made progress in recent years in advocating for the health and human rights of people who use illicit drugs but have historically not emphasized the needs of people who drink alcohol. METHODS: This paper reports on a qualitative participatory needs assessment with people who use illicit substances in British Columbia, Canada. We held workshops in 17 communities; these were facilitated by people who use illicit drugs, recorded with ethnographic fieldnotes, and analyzed using critical theory. RESULTS: Although the workshops were targeted to people who use illicit drugs, people who primarily consume alcohol also attended. An unexpected finding was the potential for drug users’ organizations and other harm reduction programs to involve “illicit drinkers”: people who drink non-beverage alcohol (e.g. mouthwash, rubbing alcohol) and those who drink beverage alcohol in criminalized ways (e.g., homeless drinkers). Potential points of alliance between these groups are common priorities (specifically, improving treatment by health professionals and the police, expanding housing options, and implementing harm reduction services), common values (reducing surveillance and improving accountability of services), and polysubstance use. CONCLUSIONS: Despite these potential points of alliance, there has historically been limited involvement of illicit drinkers in drug users’ activism. Possible barriers to involvement of illicit drinkers in drug users’ organizations include racism (as discourses around alcohol use are highly racialized), horizontal violence, the extreme marginalization of illicit drinkers, and knowledge gaps around harm reduction for alcohol. Understanding the commonalities between people who use drugs and people who use alcohol, as well as the potential barriers to alliance between them, may facilitate the greater involvement of illicit drinkers in drug users’ organizations and harm reduction services

Living and coping with diabetes in the Torres Strait and Nort hern Peninsula Area

Issue addressed: Although it is well known that there is a very high prevalence of Type 2 diabetes in the Torres Strait Islands and Northern Peninsula Area (NPA), little has been published on the personal perspectives and situations that the people with diabetes face in daily life, which includes managing their disease. This study provides a baseline of qualitative information so that supportive action from health services and communities\ud can be better tailored to help people meet their needs for self-management.\ud \ud Methods: In-depth interviews and focus groups were conducted involving a total of 26 men and 41 women living with diabetes in eight communities of the Torres Strait and Northern Peninsula Area. The data are presented as case studies and thematic analysis illustrating a range of perspectives and experiences in coming to terms with the disease and in efforts to make lifestyle change, specifically related to eating well and moving more.\ud \ud Results: Broad recommendations are provided on ways to better support people with diabetes that are based on both the data collected and the experience of the Indigenous researchers as health workers and community members