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Chronic Care Coordination by Indigenous Health Workers – A solution for better care? Barbara Schmidt & Frank Hollingsworth. AIM OF PRESENTATION. Explain the context and project design for the Getting Better at Chronic Care in North Queensland project.
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Chronic Care Coordination by Indigenous Health Workers – A solution for better care?Barbara Schmidt & Frank Hollingsworth
AIM OF PRESENTATION • Explain the context and project design for the Getting Better at Chronic Care in North Queensland project. • Describe the issues encountered by IHWs during the first 12 months of project implementation; and • Share examples of the innovation by IHWs and the impact the project has had on IHWs and patients.
PHASE 1 – CLUSTER RCT Participants • Indigenous adults (18-65 yrs) resident in one of the 12 communities • Diabetes for > 1year (HbA1c>8.5) • Plus at least one of: • hypertension • chronic obstructive pulmonary disease • coronary heart disease • chronic renal disease (stages 1-3)
PARTICIPATING COMMUNITIES • Badu • Bamaga • Injinoo • New Mapoon • Seisia • Umagico • Kowanyama • Mapoon • Mareeba (Mulungu) • Mossman Gorge • Napranum • Yarrabah
PHASE 1 – CLUSTER RCT Intervention • Intensive case management by Indigenous Health Workers recruited and trained specifically for the project • Indigenous Clinical Support Team will provide ongoing training and support Comparator • Usual care
PHASE 1 – CLUSTER RCT Primary Outcome • Reduction in HbA1c at 18 months Secondary Outcomes • avoidable hospitalisations • mortality • clinical care processes (checks and referrals) • intermediate outcomes (waist circumference, BP, ACR, eGFR, lipids etc) • quality of life
WHERE ARE WE NOW? • 213 participants enrolled • Baseline and Go Live data collected • IHWs recruited to 6 intervention sites • Initial 3 week intensive training and orientation completed • Intervention commenced in March 2012 • 2 additional intensive training blocks delivered • Document review to inform the process evaluation completed
SUMMARY OF GOVERNANCE ARRANGEMENTS ANDHEALTH SERVICE PROVIDERS INTERVENTION COMMUNITIES
METHODOLOGY FOR DATA COLLECTION Document review • Weekly reports of IHWs • Weekly supervision reports written by Clinical support team • Fortnightly Project team minutes
KEY THEMES • High level of professional satisfaction with the role of care coordinator • Positive outcomes as a result of education, support and assistance provided by IHW • Frustration due to issues related to local service context and professional matters
ISSUES ENCOUNTERED BY IHWS • transport, • staffing levels, • consistency of support services, • quality of service provision, • access to information systems, • office accommodation and • professional management issues
WHAT HAS BEEN SATISFYING IN MY ROLE? • Gradual change in attitudes from the clients through education (of what are the causes of chronic diseases). • Working at grass root level @ the coal face. • Respect and inclusion from community. • Working with a number of allied health professionals towards goals. • Making better life choices (education that I provide).
ISSUES I HAVE ENCOUNTERED • Transport - lack of vehicle to conduct home visits. 6 staff from Mossman Gorge utilise (1) work vehicle. • Work-space. (Open space within waiting room, cramped and no privacy). • Medication compliance by clients through lack of understanding the importance of taking their medication as prescribed. • Community issues (dogs and alcohol) Easy access to Mossman-township where alcohol and illicit drugs is easily accessible.
ISSUES I HAVE ENCOUNTERED • Work space. Now have the use of a larger office at the Flying Doctor’s well-being centre, which is great for client privacy. • Co-ordinated home medicine reviews with local pharmacist so that clients have a better understanding of their medications and insulin, and what benefit comes with compliance in keeping up with their medication and the benefit they will receive in the long term. • Co-ordinate with all staff and give as much notice when I am completing home visits to use vehicle. • Spoken to community council member to ensure dogs are restrained when completing home visits.
SOLUTIONS TO OVERCOME ISSUES • Discussions have taken place with Mossman Gorge community to have no alcohol within the community. • Being an open community this will be extremely difficult to police as all community members will have to agree with such a decision to be implemented. • With the gradual changes that I see happening with the clients taking a more responsible attitude towards taking better care of their own health we could be seeing a new beginning that is the start of CTG. • My future role is for me to maintain encouragement and close support with these clients in Getting Better At Chronic Care (GBACC)
SUMMARY • IHWs are good at doing care coordination, patient education and support when provided the training and support to undertake these tasks. • IHWs are reporting positive affirmation from their clients and reporting positive outcomes as a result of their efforts • IHWs are frustrated when they cant deliver the best care possible or these see when their client is not receiving all the care they should • Challenge for health service managers, policy makers and planners is to remove these low level professional and operational barriers to enable IHWs reach their full potential.
