Getting better at chronic care in remote communities: study protocol for a pragmatic cluster randomised controlled of community based management

Schmidt, Barbara, Wenitong, Mark, Esterman, Adrian, Hoy, Wendy, Segal, Leonie, Taylor, Sean, Preece, Cilla, Sticpewich, Alex and McDermott, Robyn (2012) Getting better at chronic care in remote communities: study protocol for a pragmatic cluster randomised controlled of community based management. BMC Public Health, 12 1 Article No.1017: 1017-1-1017-8. doi:10.1186/1471-2458-12-1017


Author Schmidt, Barbara
Wenitong, Mark
Esterman, Adrian
Hoy, Wendy
Segal, Leonie
Taylor, Sean
Preece, Cilla
Sticpewich, Alex
McDermott, Robyn
Title Getting better at chronic care in remote communities: study protocol for a pragmatic cluster randomised controlled of community based management
Journal name BMC Public Health   Check publisher's open access policy
ISSN 1471-2458
Publication date 2012-11
Sub-type Article (original research)
DOI 10.1186/1471-2458-12-1017
Open Access Status DOI
Volume 12
Issue 1 Article No.1017
Start page 1017-1
End page 1017-8
Total pages 8
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2013
Language eng
Formatted abstract
Background
Prevalence and incidence of diabetes and other common comorbid conditions (hypertension, coronary heart disease, renal disease and chronic lung disease) are extremely high among Indigenous Australians. Recent measures to improve quality of preventive care in Indigenous community settings, while apparently successful at increasing screening and routine check-up rates, have shown only modest or little improvements in appropriate care such as the introduction of insulin and other scaled-up drug regimens in line with evidence-based guidelines, together with support for risk factor reduction. A new strategy is required to ensure high quality integrated family-centred care is available locally, with continuity and cultural safety, by community-based care coordinators with appropriate system supports.
Methods/design
The trial design is open parallel cluster randomised controlled trial. The objective of this pragmatic trial is to test the effectiveness of a model of health service delivery that facilitates integrated community-based, intensive chronic condition management, compared with usual care, in rural and remote Indigenous primary health care services in north Queensland. Participants are Indigenous adults (aged 18–65 years) with poorly controlled diabetes (HbA1c>=8.5) and at least one other chronic condition. The intervention is to employ an Indigenous Health Worker to case manage the care of a maximum caseload of 30 participants. The Indigenous Health Workers receive intensive clinical training initially, and throughout the study, to ensure they are competent to coordinate care for people with chronic conditions. The Indigenous Health Workers, supported by the local primary health care (PHC) team and an Indigenous Clinical Support Team, will manage care, including coordinating access to multidisciplinary team care based on best practice standards. Allocation by cluster to the intervention and control groups is by simple randomisation after participant enrolment. Participants in the control group will receive usual care, and will be wait-listed to receive a revised model of the intervention informed by the data analysis. The primary outcome is reduction in HbA1c measured at 18 months. Implementation fidelity will be monitored and a qualitative investigation (methods to be determined) will aim to identify elements of the model which may influence health outcomes for Indigenous people with chronic conditions.
Discussion
This pragmatic trial will test a culturally-sound family-centred model of care with supported case management by IHWs to improve outcomes for people with complex chronic care needs. This trial is now in the intervention phase.
Keyword Aboriginal and Torres Strait Islander
Diabetes
Indigenous Health Worker
Diabetes Care
Glycemic Control
Aboriginal Communities
Indigenous Communities
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
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