PCD Strategy Evaluation 2007.pdf - NT Health Digital Library ...

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EXECUTIVE SUMMARY & RECOMMENDATIONSThe Northern Territory Preventable Chronic Disease Strategy (NTPCDS) was launched in 1999 (1 p2) . It was a strategic attempt to bring about change in the prevention, early detection, andmanagement of chronic diseases in the NT, and at all levels of the health care system. Thestrategy has a 3-year goal, a 10-year goal, and a number of objectives it aims to achieve in keyresult areas. The planned 2002 evaluation did not occur. However the NT Department of Healthand Community Services (NTDH&CS) produced a document review and a draft evaluation reportof Urban Community Care Centres in 2005-06, followed by a gap analysis. In March 2007, RhEDConsulting Pty Ltd was commissioned by the NTDH&CS to complete the evaluation of theNTPCDS. The methodology included undertaking focus group interviews, sourcing informationand data identified in the gap analysis, collating and analysing materials and finalising a reportwith recommendations. This report is based upon the combined findings of these two groups.Assessment against the goals of the NTPCDSThe 3-year goal was to reduce the impact of the five preventable chronic diseases – deaths,hospitalisations and financial costs. The hospitalisation rates of Indigenous Territorians havedoubled since 1999 due to end stage renal disease, with the associated financial burden makingup over 38 per cent of the total 2005 hospitalisation budget. Hospitalisations for respiratorydisease reportedly reduced between 2004-05 (2) . The rate of hospitalisations for diabetes,hypertension and ischaemic heart disease could not be assessed due to a lack of published datasince 2001.Assessment against objectives of the NTPCDSAssessment of progress towards the clinical systems objectives of the NTPCDS revealed thatsignificant progress has been made with the development and use of best practice guidelines toinform the practice. The majority of service providers in the Northern Territory extensively usethe Central Australian Remote Practitioner Alliance (CARPA) Standard Treatment Manualguidelines as the basis for care. However those in the NTDH&CS community health centres andgeneral practices in urban areas did not. Population lists are reported to be in place in all healthservice locations across the Northern Territory to facilitate a population health approach. TheNTDH&CS have chronic disease registers for communities serviced by medical officers. Themajority of Aboriginal Community Controlled Health Organisations (ACCHOs) use computerisedpatient information systems that support a population health approach, including the productionof population lists, chronic disease registers and recall systems.Evaluation of the NT Preventable Chronic Disease Strategy 2007x
However the extraordinary number of recall systems in use across the NT is a major barrier tothe implementation of effective systematic chronic disease prevention and managementactivities. The recall systems are largely paper based in the remote clinics and these arereportedly cumbersome and therefore not used consistently by all staff. As of June 2007, therewas no regular or consistent reporting of chronic disease activities and outcomes, however this isexpected to change as the Aboriginal Health Key Performance Indicator reporting commences inJuly 2007.Assessment against the workforce objectives revealed that most services utilise a process forstaff orientation to ensure their workforce is prepared to deliver effective chronic diseaseprevention and management. A specific training module and programs were identified to supporttraining. While this is occurring the acute paradigm prevails in remote areas and there remainslittle time for preventative or health promotion work. Major barriers to participating in theseprograms were due to the mode of delivery and the lack of backfill to release staff to attendtraining. Systems to monitor attendance numbers, improve communication with the nongovernmentsector, and benchmarks in this area require improvement across all health sectors.Workforce development requires significant dedicated investment; and investigation into thepotential for interprofessional resourcing and activities is required.There was some evidence of a whole of government approach to improve educational outcomesand employment opportunities for the Indigenous population. The achievements of NTIndigenous and non-Indigenous students in achieving the 3 rd Grade National Literacy Benchmark,worsened with remoteness and Indigenousness between 2001-2005 (3) . Unemployment levelshave improved during this time, however it is unclear if this is due to real jobs or the CommunityDevelopment Employment Program (CDEP). The collection of Indigenous workforce data in theNT public sector workforce commenced in 2002 as part of an overall strategy. They report adoubling of the number of Indigenous employees in the NTDH&CS since that time, with only oneat an executive level. However these data are reportedly incomplete (4) . There is no reportedincrease in the number of Indigenous employees working in chronic disease. Concerningly, therehas been a reported significant decrease in the number of Aboriginal Health Worker positions andnumerous positions are vacant. The commencement in July 2007 of the Aboriginal Health WorkerApprenticeship Program and the Central Australian Divisions of Primary Health Care mental healthprogram is encouraging and both are expected to expand, recruiting 24 apprentices and 15Evaluation of the NT Preventable Chronic Disease Strategy 2007xi
Page 1 and 2: Pty LtdABN 82 147 637 101AN EVALUAT
Page 3 and 4: TABLE OF CONTENTSList of figuresLis
Page 5 and 6: 6.6 Indigenous workforce 996.7 Prev
Page 7 and 8: List of AbbreviationsABCDACCHOsACIC
Page 9: ACKNOWLEDGEMENTSWe would like to ac
Page 13 and 14: the establishment of the Sunrise He
Page 15 and 16: RECOMMENDATIONSGeneral recommendati
Page 17 and 18: Exploration of joint funding arrang
Page 19 and 20: CHAPTER 1. INTRODUCTION1.1 Backgrou
Page 21 and 22: Choosing the 5 chronic conditionsTh
Page 23 and 24: Table 1.1Key Result Areas + Best Bu
Page 25 and 26: prior to the launch of NTPCDS, such
Page 27 and 28: Year * Action Outcome1999 S NT Prev
Page 29 and 30: Year * Action Outcome2005 P Aborigi
Page 31 and 32: CHAPTER 2.EVALUATION METHODOLOGYThe
Page 33 and 34: 2.2 Evaluation StagesThe NTPCDS eva
Page 35 and 36: chronic disease activities funded t
Page 37 and 38: internal project team. It was very
Page 39 and 40: Situation at Baseline1. The Guideli
Page 41 and 42: 3.1.2 Patient information and recal
Page 43 and 44: Ferret Miwatj, Numbulwar, Marngarr,
Page 45 and 46: Medicare information is not for pub
Page 47 and 48: was in place in Central Australia i
Page 49 and 50: What orientation and ongoing traini
Page 51 and 52: programs focus on chronic disease p
Page 53 and 54: The information collected as part o
Page 55 and 56: Assessment against objectiveMost se
Page 57 and 58: career development, and retention i
Page 59 and 60: are. Indigenous employment is NTDH&
Page 61 and 62:
NTDH&CS Programs that encourage Hea
Page 63 and 64:
2002 Aboriginal and Torres Strait I
Page 65 and 66:
delivering any prevention and healt
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The Community Services Division - A
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1 x AHW Central Australia 2001 S100
Page 71 and 72:
One clinic stated it had no care pl
Page 73 and 74:
Identifies priority practices to in
Page 75 and 76:
There has been a significant growth
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about 25 per cent of the hospital b
Page 79 and 80:
The level of funding provided by th
Page 81 and 82:
Central Australia and two zones cur
Page 83 and 84:
The diabetes education teams at HLN
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maintenance group for people with l
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Rebates for participating or arrang
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Use of Medicine Programmes. Althoug
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CHAPTER 4. CLINICAL OUTCOMES OF THE
Page 93 and 94:
improvements have been made to serv
Page 95 and 96:
A recent ten-year follow-up of a co
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The NTDH&CS also collect birthweigh
Page 99 and 100:
Figure 5.3 Vaccination coverage for
Page 101 and 102:
It is also important to note that k
Page 103 and 104:
eported that 50 per cent of the Ind
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The current action plan identifies
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The availability and cost of health
Page 109 and 110:
Hoy et al in 1995-2000 (100) , and
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5.6 Best practice management5.6.1 P
Page 113 and 114:
disease care in urban areas regardi
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PCIS was developed by NTDH&CS as th
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emote staff can access training and
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In the Top End there appeared to be
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APPENDIX 1EVALUATION OF THE NT PREV
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2.10 Generally speaking, on a scale
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4.4 Briefly recount any anecdotes y
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5.9 Generally speaking, on a scale
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Section 8 • Summary questions8.1
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Preventable Chronic Disease Program
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Year Type Background What is it? /
Page 135 and 136:
Year Type Background What is it? /
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An important background to this stu
Page 139 and 140:
New beliefs do not replace the old,
Page 141 and 142:
Other services are provided to the
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ecame the main priority in many peo
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to be healthy, how to get rid of di
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(Draft Version - © August 2006 Jan
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References1. Dunham, H., Ministeria
Page 151 and 152:
35. Smith, J.D., Progress report fo
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Research Centre for Aboriginal Heal
Page 155:
114. Senior, K., 'A Gudbala Laif? h
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