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
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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
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