Sustainability & Transferability of an effective community based management system for diabetes in remote indigenous com

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This project aims to improve systems for secondary prevention of CVD among Indigenous adults in remote communities in NW Queensland and ultimately to improve patient outcomes in this high risk group. The intervention is aimed at the three domains of health systems: the community and client group, clinical services and health management systems. The intervention is centred around increasing the capacity of Indigenous health Workers (IHW's) to manage recall and reminder systems for CHD in communities, supported by appropriate training and systems changes. The project will liaise closely with the client and community groups and aim to improve capacity for effective self-management of cardiovascular disease among clients. The study will evaluate the effectiveness of this complex intervention in 3 sites over two years, with 2 control communities