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

In the Top End there appeared to be a good coordination of services between the Remote HealthServices and the Preventable Chronic Disease Team. However this was not the case in CentralAustralia. Poor coordination of service delivery between the PCD team and the remote healthservices in Central Australia was a major issue identified by stakeholders. Structures need to beestablished to facilitate coordinated planning of services delivered to avoid the silo approach toservice delivery at the community level. For example: it was reported during interviews thatmany remote area nurses employed by NTDH&CS do not see chronic disease as core business forthem and that this is the responsibility of the PCD team. It is clear that this is not the philosophyof the managers of the Remote Health Services, nor the PCD team. Yet due to the split in theorganisational structure this is what is occurring on the ground.Evidence shows that improving capacity for self-management in chronic care is how major gainsin chronic disease outcomes occur. Many services reported they had received training in selfmanagementand that it had been recognised as a key aspect of chronic disease prevention andmanagement. Yet very few services were able to demonstrate that they had structured andintegrated a self-management as part of the care planning process. The barriers to supportingself-management relate to the lack of time and appropriate workforce to support this activity.All of these issues raised require dedicated and recurrent funding to support them and ongoingstructured evaluation to measure the impact they are having.Chapter 6: Discussion – Evaluation of the NT Preventable Chronic Disease Strategy 2007 101