PCD Strategy Evaluation 2007.pdf - NT Health Digital Library ...
PCD Strategy Evaluation 2007.pdf - NT Health Digital Library ... PCD Strategy Evaluation 2007.pdf - NT Health Digital Library ...
The NT Government has partly funded the Preventable Chronic Disease Strategy,which is an overarching framework for the development and delivery ofpreventative services to the chronically ill. Implementation of this strategyrequired further examination of the interventions or „disease management‟strategies that have been proved to be effective or efficacious for chronic diseasemanagement. The findings from this study suggest that adherence to GSATguidelines needs to be better in order to achieve desirable changes in patientoutcomes (104) .There has been considerable public debate regarding the decline in blood pressure control andthe resulting renal death rates reported from the Menzies program at the time of handover toTerritory Health Services in 2002, which were reported in 2005 by Hoy and Kondalsamy-Chennakesavan (100) . In 2006 Bailie reanalysed these data (106) . He found that the trend overtime in the key intermediate outcome indicator of blood pressure control does not support theconclusion they had reached regarding the impact of the handover of the program, and thatthere had been a decline in blood pressure control as early as the 2 nd year after entry into theprogram (106) . That year Hoy stated that a number of „non-renal‟ deaths had been reported inthese data and an intensity of management had been relaxed (107) .Figure 5.8 below demonstrates the trends in monitoring and control of blood pressure of asample of 98 patients with greater than 78 months of follow-up. They were found not to bestatistically different from the rest of the participants on a range of parameters – age, gender,GFR, creatinine, SBP, DBP – except for having a higher proportion with diagnosed hypertension(106) . There was a significantly declining trend from 12 months to the end of follow-up and therewas no significant change in trend at time of handover.Figure 5.8Trends in monitoring and control of blood pressure.Chapter 5: Key Result Areas – Evaluation of the NT Preventable Chronic Disease Strategy 2007 92
5.6 Best practice management5.6.1 Prevention of complications of diabetes (BB/KRA)Diabetic retinopathyResults from cross-sectional surveys of known diabetics in the Katherine region of the NorthernTerritory conducted in 1993 and 1996 were published in 2003 (108) . This study found the rates ofdiabetic retinopathy, 21 per cent, and vision-threatening retinopathy, 7–8 per cent, were similarto those found in the non-Indigenous population in Australia. The results were not age adjusted.Given that the non-Indigenous diabetic population tends to be older, and that the Indigenousdiabetic population tends to die at younger ages, the similar prevalence rates in the twopopulations are probably attributable to a combination of earlier onset of diabetes and poorerglycaemic control.The National Aboriginal and Torres Strait Islander Eye Health Program (EHP) arose fromrecommendations by Taylor in 1997 (109) . Indigenous EHP developed a model of screening fordiabetic retinopathy with a retinal camera by Aboriginal Health Workers, which would then bereviewed by an ophthalmologist. This model was introduced to several centres across the NT.The model has been evaluated in remote Aboriginal community screening (110) . Aboriginal HealthWorkers from ACCHOs in Darwin, Gove and Central Australia were recruited and trained for thesepositions and have been fulfilling the role of screening since 2003. At the time of a 2003 reviewof the program by CRH, data on the effectiveness of this program was not available (109) .Diabetic foot diseaseIn May-June 2004 PHCAP funded the NTDH&CS to conduct a trial of podiatry outreach services toremote Aboriginal communities. Based on the success of this trial, NTDH&CS secured additionalCommonwealth funds to enable development and extension of the program for a further 12months. Although this trial has not yet been fully evaluated, the expected outcomes of thePodiatry Outreach Program were:‣ 50 days of podiatry service delivery to Top End communities‣ 38 days of podiatry service delivery to Central Australian communities‣ Service delivery to include six monthly visits to remote communities that benefited fromthe 2003/04 trial (ref).Chapter 5: Key Result Areas – Evaluation of the NT Preventable Chronic Disease Strategy 2007 93
- Page 59 and 60: are. Indigenous employment is NTDH&
- Page 61 and 62: NTDH&CS Programs that encourage Hea
- Page 63 and 64: 2002 Aboriginal and Torres Strait I
- Page 65 and 66: delivering any prevention and healt
- Page 67 and 68: The Community Services Division - A
- Page 69 and 70: 1 x AHW Central Australia 2001 S100
- Page 71 and 72: One clinic stated it had no care pl
- Page 73 and 74: Identifies priority practices to in
- Page 75 and 76: There has been a significant growth
- Page 77 and 78: about 25 per cent of the hospital b
- Page 79 and 80: The level of funding provided by th
- Page 81 and 82: Central Australia and two zones cur
- Page 83 and 84: The diabetes education teams at HLN
- Page 85 and 86: maintenance group for people with l
- Page 87 and 88: Rebates for participating or arrang
- Page 89 and 90: Use of Medicine Programmes. Althoug
- Page 91 and 92: CHAPTER 4. CLINICAL OUTCOMES OF THE
- Page 93 and 94: improvements have been made to serv
- Page 95 and 96: A recent ten-year follow-up of a co
- Page 97 and 98: The NTDH&CS also collect birthweigh
- Page 99 and 100: Figure 5.3 Vaccination coverage for
- Page 101 and 102: It is also important to note that k
- Page 103 and 104: eported that 50 per cent of the Ind
- Page 105 and 106: The current action plan identifies
- Page 107 and 108: The availability and cost of health
- Page 109: Hoy et al in 1995-2000 (100) , and
- Page 113 and 114: disease care in urban areas regardi
- Page 115 and 116: PCIS was developed by NTDH&CS as th
- Page 117 and 118: emote staff can access training and
- Page 119 and 120: In the Top End there appeared to be
- Page 121 and 122: APPENDIX 1EVALUATION OF THE NT PREV
- Page 123 and 124: 2.10 Generally speaking, on a scale
- Page 125 and 126: 4.4 Briefly recount any anecdotes y
- Page 127 and 128: 5.9 Generally speaking, on a scale
- Page 129 and 130: Section 8 • Summary questions8.1
- Page 131 and 132: Preventable Chronic Disease Program
- Page 133 and 134: Year Type Background What is it? /
- Page 135 and 136: Year Type Background What is it? /
- Page 137 and 138: An important background to this stu
- Page 139 and 140: New beliefs do not replace the old,
- Page 141 and 142: Other services are provided to the
- Page 143 and 144: ecame the main priority in many peo
- Page 145 and 146: to be healthy, how to get rid of di
- Page 147 and 148: (Draft Version - © August 2006 Jan
- Page 149 and 150: References1. Dunham, H., Ministeria
- Page 151 and 152: 35. Smith, J.D., Progress report fo
- Page 153 and 154: Research Centre for Aboriginal Heal
- Page 155: 114. Senior, K., 'A Gudbala Laif? h
5.6 Best practice management5.6.1 Prevention of complications of diabetes (BB/KRA)Diabetic retinopathyResults from cross-sectional surveys of known diabetics in the Katherine region of the NorthernTerritory conducted in 1993 and 1996 were published in 2003 (108) . This study found the rates ofdiabetic retinopathy, 21 per cent, and vision-threatening retinopathy, 7–8 per cent, were similarto those found in the non-Indigenous population in Australia. The results were not age adjusted.Given that the non-Indigenous diabetic population tends to be older, and that the Indigenousdiabetic population tends to die at younger ages, the similar prevalence rates in the twopopulations are probably attributable to a combination of earlier onset of diabetes and poorerglycaemic control.The National Aboriginal and Torres Strait Islander Eye <strong>Health</strong> Program (EHP) arose fromrecommendations by Taylor in 1997 (109) . Indigenous EHP developed a model of screening fordiabetic retinopathy with a retinal camera by Aboriginal <strong>Health</strong> Workers, which would then bereviewed by an ophthalmologist. This model was introduced to several centres across the <strong>NT</strong>.The model has been evaluated in remote Aboriginal community screening (110) . Aboriginal <strong>Health</strong>Workers from ACCHOs in Darwin, Gove and Central Australia were recruited and trained for thesepositions and have been fulfilling the role of screening since 2003. At the time of a 2003 reviewof the program by CRH, data on the effectiveness of this program was not available (109) .Diabetic foot diseaseIn May-June 2004 PHCAP funded the <strong>NT</strong>DH&CS to conduct a trial of podiatry outreach services toremote Aboriginal communities. Based on the success of this trial, <strong>NT</strong>DH&CS secured additionalCommonwealth funds to enable development and extension of the program for a further 12months. Although this trial has not yet been fully evaluated, the expected outcomes of thePodiatry Outreach Program were:‣ 50 days of podiatry service delivery to Top End communities‣ 38 days of podiatry service delivery to Central Australian communities‣ Service delivery to include six monthly visits to remote communities that benefited fromthe 2003/04 trial (ref).Chapter 5: Key Result Areas – <strong>Evaluation</strong> of the <strong>NT</strong> Preventable Chronic Disease <strong>Strategy</strong> 2007 93