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

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