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.
GETTING BETTER AT CHRONIC CARE IN
NORTH QUEENSLAND PROJECT
Phase 1
• Randomised controlled trial of
intensive case management by IHWs
Phase 2
• Review of lessons learned
• Implementation plan
Phase 3
• Economic analysis
• Rollout of model
PHASE 1 – CLUSTER RCT
Participants
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Indigenous adults (18-65 yrs) resident in one of the 12 communities
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Diabetes for > 1year (HbA1c>8.5)
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Plus at least one of:
– hypertension
– chronic obstructive pulmonary disease
– coronary heart disease
– chronic renal disease (stages 1-3)
PARTICIPATING COMMUNITIES
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Badu
Bamaga
Injinoo
New Mapoon
Seisia
Umagico
Kowanyama
Mapoon
Mareeba (Mulungu)
Mossman Gorge
Napranum
Yarrabah
PHASE 1 – CLUSTER RCT
Intervention
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Intensive case management by Indigenous Health Workers recruited and
trained specifically for the project
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Indigenous Clinical Support Team will provide ongoing training and support
Comparator
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Usual care
PHASE 1 – CLUSTER RCT
Primary Outcome
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Reduction in HbA1c at 18 months
Secondary Outcomes
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avoidable hospitalisations
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mortality
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clinical care processes (checks and referrals)
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intermediate outcomes (waist circumference, BP, ACR, eGFR, lipids
etc)
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quality of life
WHERE ARE WE NOW?
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213 participants enrolled
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Baseline and Go Live data collected
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IHWs recruited to 6 intervention sites
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Initial 3 week intensive training and orientation completed
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Intervention commenced in March 2012
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2 additional intensive training blocks delivered
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Document review to inform the process evaluation completed
PHASE 1: CLUSTER RCT
SUMMARY OF GOVERNANCE ARRANGEMENTS AND
HEALTH SERVICE PROVIDERS
INTERVENTION COMMUNITIES
Community
Mapoon
Governance of
Health Service
Torres and NPA
HHS
Torres and NPA
HHS
Torres and NPA
HHS
Cape York HHS
Kowanyama
Cape York HHS
Mossman
Gorge
ACYHC
Badu Island
Injinoo
Umagico
Key service providers
Torres and NPA HHS
Cairns and Hinterland HHS
Torres and NPA HHS
Cairns and Hinterland HHS
Torres and NPA HHS
Cairns and Hinterland HHS
Cape York HHS
ACYHC
Cape York HHS
ACYHC
RFDS
Torres and NPA HHS
Cairns and Hinterland HHS
ACYHC
Employer of IHW
Torres and NPA HHS
Torres and NPA HHS
Torres and NPA HHS
ACYHC
Cape York HHS via
service agreement with
ACYHC
ACYHC
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
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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
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IHWs are good at doing care coordination, patient education and
support when provided the training and support to undertake these
tasks.
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IHWs are reporting positive affirmation from their clients and reporting
positive outcomes as a result of their efforts
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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
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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.
ANY QUESTIONS?
NHMRC PARTNERSHIP GRANT