A multifaceted health-service intervention in remote Aboriginal communities: 3-year follow-up of the impact on diabetes care
A multifaceted health-service intervention in remote Aboriginal communities: 3-year follow-up of the impact on diabetes care
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DOI：
10.5694/j.1326-5377.2004.tb06235.x
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发表时间：
2004-08-16
影响因子：
11.4
通讯作者：
d'Abbs, PHN
中科院分区：
文献类型：
--
作者：
Bailie, RS;Si, D;d'Abbs, PHN
目的：研究澳大利亚两个偏远地区干预后糖尿病护理过程和参与者结局的趋势。设计：随访研究3年以上。环境：在提维群岛和北领地的凯瑟琳西地区设有7个保健中心。参与者：137名2型糖尿病原住民。干预措施：实施一项多方面的试验，包括将采购和规划责任移交给地方卫生局，制定和传播由电子登记册、召回和提醒系统和相关工作人员培训支持的临床指南，以及审计和反馈。主要结果测量：根据临床指南接受服务的土著人比例的趋势，以及达到特定血压和糖化血红蛋白（HbA(1c)）水平的比例的趋势；卫生工作人员对有效提供服务的障碍的看法。结果：总体服务水平从最初的40%提高到49%，在3年的时间里并没有完全持续。所提供服务的总体比例因社区和时间而异，从22%到64%不等。最近一次HbA（1c）水平低于7%的参与者比例从19%提高到32%，但血压控制几乎没有变化。人们认为提供服务的障碍包括人员配置不连贯、缺乏工作实践支持和患者接受服务。结论：多方面的干预措施可以提高这种环境下的护理质量，但在一系列服务和当地条件下实现可持续的高质量护理面临着特殊挑战。制定和测试一贯和持续改进的战略应该是服务提供者和研究人员的优先事项。
Objective: To examine the trends in processes of diabetes care and in participant outcomes after an intervention in two remote regions of Australia.Design: Follow-up study over 3 years.Setting: Seven health centres in the Tiwi Islands and the Katherine West region of the Northern Territory.Participants: 137 Aboriginal people with type 2 diabetes.Intervention: Implementation of a multifaceted trial, including transfer of purchasing and planning responsibility to local health boards, the development and dissemination of clinical guidelines supported by electronic registers, recall and reminder systems and associated staff training, and audit and feedback.Main outcome measures: Trends in the proportion of Aboriginal people receiving services in accordance with clinical guidelines and in the proportion for whom specified levels of blood pressure and glycosylated haemoglobin (HbA(1c)) were achieved; health staff perceptions of barriers to effective service delivery.Results: An initial improvement in overall service levels from 40% to 49% was not fully sustained over the 3-year period. The overall proportion of services delivered varied from 22% to 64% between communities and over time. The proportion of participants whose most recent HbA(1c) level was less than 7% improved from 19% to 32%, but there was little change in blood pressure control. Perceived barriers to service delivery included discontinuities in staffing, lack of work-practice support and patients' acceptance of services.Conclusions: Multifaceted interventions can improve quality of care in this environment, but achieving sustainable, high-quality care in a range of services and local conditions presents particular challenges. Developing and testing strategies for consistent and sustained improvement should be a priority for service providers and researchers.