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There is good evidence of the implementation of early detection and screening processes inprojects such as the coordinated care trials and the ABCD program, and pleasing results in theuse of systems to improve chronic care (7) . The changes in Medicare in 2004, through theintroduction of an Enhanced Primary Care item for Aboriginal adult health checks, were reportedsignificantly under-utilised, however this is envisaged to change as programs further develop.Adult immunisation rates have increased for influenza vaccine and pneumococcal since 2000.Two specific programs report on different best practice management approaches to reduce bloodpressure, to prevent renal disease and the complications of diabetes – The Menzies RenalTreatment Program and the Tiwi Coordinated Care Trials. Results suggest that the PCDS is notpreventing renal failure as effectively as an MRTP-type program would, as renal failure ratescontinue to rise. However, there are unresolved questions about whether an MRTP programwould be sustainable across the Territory in the long term. There was an increase in podiatryoutreach services in remote communities due to PHCAP funds between 2003-05.There have been a number of limitations to this evaluation process. The main limitation was theabsence of an implementation plan for the NTPCDS, upon which this evaluation could be based.This meant that it was difficult to identify the intent of the implementation process and ifoutcomes were due to the PCDS or other national initiatives. Also a Statistical Report for theNTPCDS was produced in 2000 that provides an excellent baseline upon which to measure theimpact of the NTPCDS (8) . There has however not been another report and very limited recentdata exists in some of the reporting clinical areas. Since 1999 there were three NTDH&CSrestructures and within the time constraints and the internal and external evaluation process itwas not possible to gain a sense of the impact of corporate policy directions.While this evaluation has identified advancements and a general movement in the right directionof the NTPCDS, there is also significant room for improvement. This is particularly so in the areasof prevention and health promotion activities, Indigenous employment within the PCDS staff, andthe simplification, standardisation and coordination of information systems that can communicateacross regions. Additionally, the organisational structures that facilitate easy communicationbetween those providing chronic disease programs and education require improvement.The following recommendations are made to assist the NTDH&CS to improve their efforts in theprevention, early detection and management of chronic disease in what is no doubt one of themost challenging environments to do so in Australia. We wish them every success.Evaluation of the NT Preventable Chronic Disease Strategy 2007xiv
RECOMMENDATIONSGeneral recommendationsRepresentative Committee1. The NTDH&CS establish a representative committee of the providers of health careservices across the whole of the Northern Territory to review the PCDS using therecommendations of the evaluation report as the basis for discussion and planning.Implementation Strategy2. The representative committee oversee the development an implementation strategy. Thiswill include: Revising the objectives of the PCDS to include clearly defined benchmarks andperformance indicators against each objective and a timeline and process for theirimplementation. Developing a model for chronic disease prevention and care in urban areas to linkservice providers. Establishing a system for collecting information against each benchmark and aprocess to do so, as a priority.Linking NT Aboriginal Health Key Performance Indicator measures to the Key ResultAreas of the NTPCDS to provide a framework for ongoing evaluation.Linking position vacancies and turnover rates to health outcomes dataIncluding preventable cancers, rheumatic heart disease, mental illness anddepression in this revision of the NTPCDS.Including ischaemic heart disease and hypertension under cardiovascular disease asone reporting area.This revision is supported with an investment from NTDH&CS as a priority, andincludes a realistic evaluation budget to review progress.Statistical report3. The reproduction of the 2000 Statistical Report is undertaken on a regular five yearlybasis, to assist in the monitoring of progress in the achievement of the PCDS.4. A dedicated and recurrent budget allocation is identified and committed to do so.Evaluation of the NT Preventable Chronic Disease Strategy 2007xv
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 and 10: ACKNOWLEDGEMENTSWe would like to ac
Page 11 and 12: However the extraordinary number of
Page 13: the establishment of the Sunrise He
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
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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
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One clinic stated it had no care pl
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Identifies priority practices to in
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There has been a significant growth
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about 25 per cent of the hospital b
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The level of funding provided by th
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Central Australia and two zones cur
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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
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improvements have been made to serv
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A recent ten-year follow-up of a co
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The NTDH&CS also collect birthweigh
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Figure 5.3 Vaccination coverage for
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It is also important to note that k
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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
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Hoy et al in 1995-2000 (100) , and
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5.6 Best practice management5.6.1 P
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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? /
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Year Type Background What is it? /
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An important background to this stu
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New beliefs do not replace the old,
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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
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35. Smith, J.D., Progress report fo
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Research Centre for Aboriginal Heal
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114. Senior, K., 'A Gudbala Laif? h
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