Type 2 diabetes mellitus is one of the common serious causes of death and morbidity for Aboriginal and Torres Strait Islander people, with prevalence estimated to be as high as 32%.
The complications of diabetes lead to reduced quality of life, increased hospitalisation and premature mortality. If diabetes is not closely monitored it can lead to blindness, renal failure, lower limb amputation, heart disease and stroke. These complications can be delayed and / or prevented with intensive management provided by primary healthcare services. This has led to an increased focus in Aboriginal community controlled health services (ACCHS) on enhancing the existing approaches to diabetes management. However less support has been provided to ensure thorough analysis of the process and outcomes of these increased efforts and what has been published suggests sustainability over time is one of the most difficult issues.
We aim to address some of the significant gaps in our understanding of the impact of ACCHS on health outcomes of Aboriginal people. We will do this by measuring the impact of transition to Aboriginal community control of health services in Derby (from 1998 onwards) on the health outcomes of diabetic clients in the Derby area of WA.
This project focuses on measurement of important long-term health outcomes and intermediate variables related to chronic disease outcomes as well as on active participation of the health service, with emphasis on the value of the research process itself and its value to this and other ACCHS.
The project also supports a cycle of learning, sharing and positive change. The setting of the research agenda, project planning and approval, conduct of research as well as the analysis, publication and dissemination of findings will be consistent with principles of Aboriginal community control.
We have completed the first phase of this study. Over the 10 years of the study (1999-2009):
- The proportion of clinical care activities undertaken according to regional protocols increased significantly, with very high levels recorded in the last 3 years (at least 70% of patients had each activity recorded).
- There were significant improvements in systolic BP, diastolic BP and cholesterol levels over the 10 years (P < 0.001 for all) and there were small improvements in HbA1c levels that approached statistical significance (P = 0.05).
- This study shows that diabetes monitoring and outcomes can be improved and maintained over a 10-year period in a well supported remote Aboriginal community-controlled health service setting.
Julia V Marley,Carmel Nelson, Vicki O’Donnell and David Atkinson. Quality indicators of diabetes care: an example of remote-area Aboriginal primary health care over 10 years. Med J Aust 2012; 197 (7): 404-408.
- Assoc Prof Julia Marley
- Dr Carmel Nelson
- Vicki O’Donnell
- Assoc Prof David Atkinson