Sustaining better diabetes care in remote indigenous Australian communities
Sustaining better diabetes care in remote indigenous Australian communities
复制标题
DOI：
10.1136/bmj.327.7412.428
复制
发表时间：
2003-08-23
影响因子：
105.7
通讯作者：
Sinha, A
中科院分区：
文献类型：
--
作者：
McDermott, R;Tulip, F;Sinha, A
托雷斯海峡群岛的问题居民的糖尿病患病率是澳大利亚最高的，并有许多可预防的并发症。1999年，一项为期一年的随机分组试验表明，当当地土著卫生工作者在专科外展服务的支持下使用登记表、召回和提醒系统以及基本糖尿病护理计划时，糖尿病护理流程得到了改善，入院人数减少了。这项研究考察了这些改善在试验结束两年后是否持续。设计了对21个初级保健中心的三年跟踪临床审计，并回顾了过去12个月的入院情况。背景和背景澳大利亚遥远东北部的偏远土著社区，人口约9600人，其中包括921名糖尿病患者。改善登记人数、护理过程(定期测量体重、血压、血红蛋白A(1c)、尿蛋白浓度以及血脂和肌酐浓度)、适当的临床干预措施(药物治疗和疫苗接种)以及中间患者结局指标(体重、血压和血糖控制)的关键措施。住院。变更审核策略和对临床医生和管理人员的反馈；提供临床指南和明确的管理结构；讲习班和培训。变更的影响登记的人数从1999年的555人增加到2002年的921人。大多数护理流程和临床干预措施都有所改善。血糖控制良好的人(血红蛋白A(1c)，小于或等于7%)的比例从18%增加到25%，这与胰岛素使用量的增加(从7%到16%)一致。控制良好的高血压患者比例(
Problem Inhabitants of Torres Strait Islands have the highest prevalence of diabetes in Australia and many preventable complications. In 1999, a one year randomised cluster trial showed improved diabetes care processes and reduced admissions to hospital when local indigenous health workers used registers, recall and reminder systems, and basic diabetes care plans, supported by a specialist outreach service. This study looked at whether those improvements were sustained two years after the end of the trial.Design Three year follow up clinical audit of 21 primary healthcare centres, and review of admissions to hospital in the previous 12 months.Background and setting Remote indigenous communities in far north east Australia, population about 9600, including 921 people with diabetes.Key measures for improvement Number of people on registers, care processes (regular measures of weight, blood pressure, haemoglobin A(1c), urinary protein concentration, and concentrations of serum lipids and creatinine), appropriate clinical interventions (drug treatment and vaccinations), and intermediate patient outcome measures (weight, blood pressure, and glycaemic control). Admissions to hospital.Strategies for change Audit and feedback to clinicians and managers; provision of clinical guidelines and a clear management structure; workshops and training.Effects of change The number of people on registers increased from 555 in 1999 to 921 in 2002. Most care processes and clinical interventions improved. The proportion of people with good glycaemic control (haemoglobin A(1c), less than or equal to 7%) increased from 18% to 25% in line with increased use of insulin (from 7% to 16%). The proportion of those with well controlled hypertension (