Bailie Ross S, Si Damin, Robinson Gary W, Togni Samantha J, D'Abbs Peter H N
Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia.
Med J Aust. 2004 Aug 16;181(4):195-200. doi: 10.5694/j.1326-5377.2004.tb06235.x.
To examine the trends in processes of diabetes care and in participant outcomes after an intervention in two remote regions of Australia.
Follow-up study over 3 years.
Seven health centres in the Tiwi Islands and the Katherine West region of the Northern Territory.
137 Aboriginal people with type 2 diabetes.
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.
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.
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.
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.
研究澳大利亚两个偏远地区在进行干预后糖尿病护理流程及参与者预后的变化趋势。
为期3年的随访研究。
北领地提维群岛和凯瑟琳西部地区的7个健康中心。
137名2型糖尿病原住民。
实施一项多方面的试验，包括将采购和规划责任移交给当地卫生委员会，制定并传播由电子登记册、召回和提醒系统及相关员工培训支持的临床指南，以及审核与反馈。
原住民按照临床指南接受服务的比例趋势，以及达到特定血压和糖化血红蛋白（HbA1c）水平的比例趋势；卫生工作人员对有效服务提供障碍的看法。
总体服务水平最初从40%提高到49%，但在3年期间并未完全保持。不同社区以及不同时间提供的服务总体比例在22%至64%之间波动。最近HbA1c水平低于7%的参与者比例从19%提高到32%，但血压控制方面变化不大。服务提供的感知障碍包括人员配备不连续、缺乏工作实践支持以及患者对服务的接受情况。
多方面干预可改善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特殊挑战。制定并测试持续改进的策略应是服务提供者和研究人员的首要任务。
