Clinical outcomes associated with changes in a chronic disease treatment program in an Australian Aboriginal community

Abstract

In late 1995, a treatment program for renal disease and hypertension was introduced into a remote Aboriginal community. Over the next 3.5 years, mean blood pressure levels were markedly reduced, renal function stabilised, and rates of both renal and non‐renal deaths declined significantly. In 1999–2000, responsibility for the program was passed to the community's local Health Board, which subsequently faced deficiencies in clinical information systems and a shortfall in funding. After the handover, the intensity of the program declined, and compliance with medicines fell. Blood pressures in the treatment cohort increased, renal function deteriorated, and rates of deaths from natural causes subsequently rose. From 2002 to mid‐2003, the adjusted risks of renal and non‐renal deaths in the treatment cohort were three and 9.5 times the respective risks of people during the first 18 months of treatment in the systematic phase of the program. Sustained vigorous activity, both in treatment of people already identified and in community screening for treatment eligibility, is required to maintain good results in any chronic disease program. Adequate resources and well supported staff are essential, and constant evaluation is needed to follow outcomes and modify strategies as necessary.

The outcome of critically ill Indigenous patients

“…It is not surprising that the well described differences in the access that Indigenous patients have to primary health care, chronic disease screening and treatment, vaccination, and specialist care are reflected in a different pattern of critical illness 8 . ‐ 12 It is hoped that if improvements in access to comprehensive medical care occur, this will be reflected in a reduction in the severity of illness and crude mortality in ICU admissions.…”

“…Reduction in the burden of chronic illnesses and the incidence of high acuity acute illnesses is likely to require an improvement in primary health care, screening and early treatment of chronic diseases, vaccination, and health promotion in remote communities 8 . ‐ 12 There are 83 communities in WA with fewer than 50 people that are more than 50 km from a community health clinic 2 . Three‐quarters of these communities are not visited at least once a month by any health care professionals 2 .…”

“…Training more Indigenous health care workers for the Indigenous community has been suggested as an important step to improve the effectiveness of health care programs to Indigenous communities 23 . Further improvement in the outcomes of critically ill Indigenous patients relies on a sustained improvement in access and effectiveness of preventive and primary health care services to Indigenous communities in rural Australia 12 . A reduction in severity of illness and crude mortality rate in critically ill Indigenous patients may be a useful indicator of improving health outcomes in Indigenous Australians.…”

Sharing the secrets of success: conversations with the Medical Journal of Australia / Wyeth Research Award winners, 1995–2006

“…“Endorsement, intellectually, of chronic preventable disease strategies is no longer the issue; now, it's resources and staffing to execute them in remote areas where the people have disastrous disease profiles”, said Hoy. After handover of the treatment program to the local health board in the Tiwi Islands, the intensity of the program declined and compliance with medicines use fell for a time, due to inadequate resources 10 …”

How nurses address the burden of disease in remote or isolated areas in Queensland

“…A comprehensive primary health‐care approach is the most effective way to address Indigenous health needs in Australia, 27,28 in which adequate resources and well‐supported staff are essential 29 . Such an approach will go a long way towards addressing the total burden of disease in remote areas.…”