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CHAPTER 3.PROGRESS AGAINST NTPCDS OBJECTIVESThis section provides a narrative report of the process evaluation. It includes: the baselinesituation (if known), in 1999 and highlights key activities that have taken place since that time.An assessment of the degree to which each objective has been met is made based on theinformation discussed. The objectives have been groups under the six core reporting areas:1. Clinical2. Workforce3. Prevention4. Programs5. Funding.6. Systems3.1 CLINICALThe objectives discussed in this section include those that aim to improve the clinical systemsthat support chronic disease prevention and management. This includes evidence basedguidelines and effective patient information and recall systems. Clinical outcomes are reported inChapter 4.3.1.1 Best practice clinical guidelinesObjective 1. All clients will be offered care based on locally produced and up-to-datebest practice guidelines.The EvidenceThe use of a systematic approach to chronic disease prevention, early detection andmanagement will result in improved health outcomes for individuals and the community (31) . Wellorganised systems of care, and not simply good individual health care workers, are important inachieving better health outcomes (32) .Chapter 3: Progress Against PCDS Objectives – Evaluation of the NT Preventable Chronic Disease Strategy 2007 20
Situation at Baseline1. The Guidelines, Standards and Audit Team (GSAT) developed guidelines for chronicdisease as part of the NT Coordinated Care Trials in 1997, to complement and extend theinformation from the CARPA standard treatment manual (33) . They were to be integrated into thecomputer recall systems for these trials. In 1999 they were approved for use in all Top EndCommunity Health Centres, and support for their implementation was provided by the nurses ofthe Total Recall Team.2. The CARPA Standard Treatment Guidelines were first developed in 1991. They were thestandard for clinical practice Central Australia. The CARPA 3 rd edition contained some informationabout chronic disease guidelines, but it was not consistent with the information in the GSATguidelines.Both the GSAT guidelines and the 3 rd edition CARPA Standard Treatment Manual were reviewedby Hampton and Fallon in 2001 (34) . They found widespread acceptance of the CARPA StandardTreatment Manual, which are widely used across remote health services and in AboriginalControlled Community Health Organisations (ACCHOs). They are also frequently used in manyother Australian states (34, 35) . Their use was found to be much less in urban general practices inthe NT, who largely use the Royal Australian College of General Practitioner (RACGP) guidelines.In general practice there were also some guidelines available for diabetes and asthmamanagement but it is not known to what extent these guidelines were utilised. Therefore in 1999there was a proliferation of guidelines being used across the Northern Territory. There was not astrong culture of the use of evidence-based guidelines in general practice at this time.Communities that participated in the KDRP project were using a slightly different set of guidelinesfrom the GSAT guidelines for management of hypertension, diabetes, and renal disease.What best practice guidelines exists today?The 4 th edition of the CARPA guidelines was published in 2003. It incorporated material from theGSAT guidelines and was approved for use in health centres across the entire NT. It was beingevaluated at the time of this report and the 5 th edition was being developed. During stakeholderinterviews all participants advised they were using best practice chronic disease guidelines toinform their practice. All the ACCHOs, the NTDH&CS staff from the Remote Heath Services, andPCD teams stated they used the CARPA Standard Treatment Guidelines, the Women‟s BusinessManual and the Aboriginal Health Worker Medicines to guide and inform their practice. SomeChapter 3: Progress Against PCDS Objectives – Evaluation of the NT Preventable Chronic Disease Strategy 2007 21
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 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: internal project team. It was very
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
Page 67 and 68: The Community Services Division - A
Page 69 and 70: 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
Page 77 and 78: 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
Page 85 and 86: maintenance group for people with l
Page 87 and 88: Rebates for participating or arrang
Page 89 and 90:
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
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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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