Chronic disease profiles in remote Aboriginal settings and implications for health services planning
Article first published online: 9 FEB 2010
© 2010 The Authors. Journal Compilation © 2010 Public Health Association of Australia
Australian and New Zealand Journal of Public Health
Volume 34, Issue 1, pages 11–18, February 2010
How to Cite
Hoy, W. E., Davey, R. L., Sharma, S., Hoy, P. W., Smith, J. M. and Kondalsamy-Chennakesavan, S. (2010), Chronic disease profiles in remote Aboriginal settings and implications for health services planning. Australian and New Zealand Journal of Public Health, 34: 11–18. doi: 10.1111/j.1753-6405.2010.00467.x
- Issue published online: 9 FEB 2010
- Article first published online: 9 FEB 2010
- Submitted: March 2009 Revision requested: June 2009 Accepted: November 2009
- Chronic disease;
- health profiles;
- health services;
- health services funding
Objective: To report the short-term experiences and outcomes of a program to support chronic disease management in three remote communities in Top End Northern Territory and in two Aboriginal Medical Services (AMSs) in Western Australia, and to discuss the implications of findings for health service delivery and policy.
Methods: Programs were health-worker centred. They espoused regular screening of all adults for chronic disease, initiation and modification of treatment where indicated and rigorous documentation. Process measures were documented and rates of hypertension, renal disease and diabetes among adults were calculated.
Results: Rates of hypertension, proteinuria and diabetes rose throughout adult life and multiple diagnoses were common. Most people with these conditions were young or middle age adults. Rates were uniformly excessive relative to AusDiab data, but varied greatly among settings. Adherence to protocols improved, many new diagnoses were made, treatments were started or modified and blood pressures in treated hypertensive people fell. In the NT, productivity was seriously limited by lack of health workers and their absenteeism. In the WA AMSs, executive and staff support carried the programs forward to a sustainable future, despite various challenges.
Conclusions: Integrated chronic disease testing must be repeated throughout adult life for timely diagnosis. Health workers can perform all tasks well, with appropriate supports. Blood pressure outcomes alone predict lower cardiovascular and renal mortality. The findings support incorporation of chronic disease into lifetime health care plans.