None listed
Conditions
Brief summary
The life expectancy gap for Indigenous people in Australia is 13 years and most of this gap is due to preventable chronic disease (diabetes, heart, lung and renal problems) in adults. Once people have these conditions, many complications can be prevented with good primary-level chronic care. This project aims to introduce and evaluate a new strategy for integrated community-based, intensive chronic condition management in rural and remote Indigenous primary care services: Diabetes, hypertension, coronary heart disease (CHD), renal disease and chronic obstructive pulmonary disease (COPD). Proposed strategy: An intervention in 3 phases over 5 years: 1. A trial of intensive locally delivered chronic care in 6 out of 12 participating sites in FNQ with clear clinical and quality-of-life outcomes; 2. Review of lessons learned in the first phase trial, modified as necessary to reflect findings, a discussion about generalisability to the “control” sites in the trial, with an implementation plan and the development of a curriculum package for the program and; 3. In collaboration with the trial partners(QH, Apunipima CYHC and local AMS where relevant), a more general system rollout of lessons learned, with potential regional implications of a patient-centred service delivery model, including workforce and funding applications.
Interventions
Nutrition, lifestyle support, drug management, physical activity support to participants, workshops and focus groups for participants, care planning with each participant. The intervention will involve treatment intensification including with insulin, nutrition coaching with families, and upskilling of health workers in clinical management. The frequency and duration of these sessions will be tailored to the needs of the community and the participants. This will include engaging with families to
Nutrition, lifestyle support, drug management, physical activity support to participants, workshops and focus groups for participants, care planning with each participant. The intervention will involve treatment intensification including with insulin, nutrition coaching with families, and upskilling of health workers in clinical management. The frequency and duration of these sessions will be tailored to the needs of the community and the participants. This will include engaging with families to discuss nutrition, lifestyle support, smoking cessation and physical exercise, self-monitoring of conditions, and appropriate drug management, and using local resources to support effective client self-management. The unit of intervention is the COMMUNITY, via a designated specialist health worker. This means that out of the 12 participating communities, 6 communities will be randomly selected to undertake the intervention in the first 2 years. The remaining 6 communities (the control communities) will not take part in the intervention. Control communities will participate in the intervention in year 3 of the study with one IHW FTE will be recruited for each intervention site, who is eligible at HW Level 004. An Indigenous clinical support team (ICST) will train and mentor community-based IHWs (and the rest of the PHC team) to deliver intensive management for 5 common chronic conditions, with clear clinical and service goals.
Sponsors
Queensland Health
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
Indigenous patients from clinics in rural north Queensland, in the communities listed below, diagnosed at least one year prior to recruitment with diabetes (with HbA1c> 8.5%) and at least one of the four following conditions: 1. Chronic obstructive pulmonary disease 2. Renal disease 3. Hypertension 4. Coronary heart disease. Communities in rural north Queensland: Bamaga Umagico Seisia New Mapoon Injinoo Badu Island Napranum Old Mapoon Kowanyama Mossman Gorge Yarrabah Mareeba
Exclusion criteria
Over 65 years of age Major mental illness Chronic Renal Failure Stages 4 & 5 Pregnancy
Outcome results
None listed