Skip to main content
Top
Published in: BMC Health Services Research 1/2015

Open Access 01-12-2015 | Research article

Community health workers improve diabetes care in remote Australian Indigenous communities: results of a pragmatic cluster randomized controlled trial

Authors: Robyn A McDermott, Barbara Schmidt, Cilla Preece, Vickie Owens, Sean Taylor, Ming Li, Adrian Esterman

Published in: BMC Health Services Research | Issue 1/2015

Login to get access

Abstract

Background

Health outcomes for Indigenous Australians with diabetes in remote areas remain poor, including high rates of avoidable complications which could be reduced with better primary level care. We aimed to evaluate the effectiveness of a community-based health-worker led case management approach to the care of Indigenous adults with poorly controlled type 2 diabetes in primary care services in remote northern Australia.

Methods

Two hundred and thirteen adults with poorly controlled diabetes (HbA1c > 8.5%) and significant comorbidities in 12 remote communities were randomly assigned by service cluster to receive chronic care co-ordination from a community-based health worker supported by a clinical outreach team, or to a waitlist control group which received usual care.

Results

At baseline, mean age of participants was 47.9 years, 62.4% were female, half were Aboriginal and half identified as Torres Strait Islander, 67% had less than 12 years of education, 39% were smokers, median income was $18,200 and 47% were unemployed. Mean HbA1c was 10.7% (93 mmol/mol) and BMI 32.5. At follow-up after 18 months, HbA1c reduction was significantly greater in the intervention group (−1.0% vs −0.2%, SE (diff) = 0.2, p = 0.02). There were no significant differences between the groups for blood pressure, lipid profile, BMI or renal function. Intervention group participants were more likely to receive nutrition and dental services according to scheduled care plans. Smoking rates were unchanged.

Conclusions

A culturally safe, community level health-worker led model of diabetes care for high risk patients can be effective in improving diabetes control in remote Indigenous Australian communities where there is poor access to mainstream services. This approach can be effective in other remote settings, but requires longer term evaluation to capture accrued benefits.

Trial registration

ANZCTR 12610000812099, Registered 29 September 2010.
Literature
1.
go back to reference McDermott RA, Li M, Campbell SK. Incidence of type 2 diabetes in two Indigenous Australian populations: a 6-year follow-up study. Med J Aust. 2010;192(10):562–5.PubMed McDermott RA, Li M, Campbell SK. Incidence of type 2 diabetes in two Indigenous Australian populations: a 6-year follow-up study. Med J Aust. 2010;192(10):562–5.PubMed
2.
go back to reference Australian Institute of Health and Welfare. The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples. Canberra: AIHW, 2008 AIHW Cat No IHW 21. Australian Institute of Health and Welfare. The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples. Canberra: AIHW, 2008 AIHW Cat No IHW 21.
3.
go back to reference McDermott R, Tulip F, Schmidt B. Diabetes care in remote northern Australian Indigenous communities. Med J Aust. 2004;180(10):512–6.PubMed McDermott R, Tulip F, Schmidt B. Diabetes care in remote northern Australian Indigenous communities. Med J Aust. 2004;180(10):512–6.PubMed
4.
go back to reference Queensland Health. The health of Queenslanders 2012: advancing good health. Fourth report of the Chief Health Officer Queensland. Brisbane: Queensland Health; 2012. Queensland Health. The health of Queenslanders 2012: advancing good health. Fourth report of the Chief Health Officer Queensland. Brisbane: Queensland Health; 2012.
5.
go back to reference McDermott R, Schmidt B, Sinha A, Mills P. Improving diabetes care in the primary healthcare setting: a randomised cluster trial in remote Indigenous communities. Med J Aust. 2001;174:497–502.PubMed McDermott R, Schmidt B, Sinha A, Mills P. Improving diabetes care in the primary healthcare setting: a randomised cluster trial in remote Indigenous communities. Med J Aust. 2001;174:497–502.PubMed
6.
go back to reference Si D, Bailie RS, Togni SJ, D’Abbs PHN, Robinson GW. Aboriginal health workers and diabetes care in remote community health centres: a mixed method analysis. Med J Aust. 2006;185(1):40–5.PubMed Si D, Bailie RS, Togni SJ, D’Abbs PHN, Robinson GW. Aboriginal health workers and diabetes care in remote community health centres: a mixed method analysis. Med J Aust. 2006;185(1):40–5.PubMed
7.
go back to reference Glazier RH, Bajcar J, Kennie NR, Willson K. A systematic review of interventions to improve diabetes care in socially disadvantaged populations. Diabetes Care. 2006;29(7):1675–88.CrossRefPubMed Glazier RH, Bajcar J, Kennie NR, Willson K. A systematic review of interventions to improve diabetes care in socially disadvantaged populations. Diabetes Care. 2006;29(7):1675–88.CrossRefPubMed
8.
go back to reference Campbell MK, Piaggio G, Elbourne DR, Altman DG. Consort 2010 statement: extension to cluster randomised trials. BMJ. 2012;345:e5661.CrossRefPubMed Campbell MK, Piaggio G, Elbourne DR, Altman DG. Consort 2010 statement: extension to cluster randomised trials. BMJ. 2012;345:e5661.CrossRefPubMed
9.
go back to reference Karter A, Moffet H, Liu J, Parker M, Ahmed A, Ferrara A, et al. Achieving good glycemic control: initiation of new antihyperglycemic therapies in patients with type 2 diabetes from the Kaiser Permanante Northern California Diabetes Registry. Am J Manag Care. 2005;11(4):262–70.PubMedPubMedCentral Karter A, Moffet H, Liu J, Parker M, Ahmed A, Ferrara A, et al. Achieving good glycemic control: initiation of new antihyperglycemic therapies in patients with type 2 diabetes from the Kaiser Permanante Northern California Diabetes Registry. Am J Manag Care. 2005;11(4):262–70.PubMedPubMedCentral
10.
go back to reference Littenberg B, Maclean D. Intra-cluster correlation coefficients in adults with diabetes in primary care practices: the Vermont Diabetes Information System field survey. BMC Med Res Methodol. 2006;6:20.CrossRefPubMedPubMedCentral Littenberg B, Maclean D. Intra-cluster correlation coefficients in adults with diabetes in primary care practices: the Vermont Diabetes Information System field survey. BMC Med Res Methodol. 2006;6:20.CrossRefPubMedPubMedCentral
11.
go back to reference Parker RM, Baker DW, Williams MV JRN. The test of functional health literacy in adults: a new instrument for measuring patients’ literacy skills. J Gen Intern Med. 1995;10(10):537–41.CrossRefPubMed Parker RM, Baker DW, Williams MV JRN. The test of functional health literacy in adults: a new instrument for measuring patients’ literacy skills. J Gen Intern Med. 1995;10(10):537–41.CrossRefPubMed
12.
go back to reference Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro 3rd AF, Feldman HI, et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) a new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12.CrossRefPubMedPubMedCentral Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro 3rd AF, Feldman HI, et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) a new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12.CrossRefPubMedPubMedCentral
13.
go back to reference Richardson J, Atherton Day N, Peacock S, Iezzi A. Measurement of the quality of Life for economic evaluation and the assessment of quality of life (AQoL) mark 2 instrument. Aust Econ Rev. 2004;37(1):62–88.CrossRef Richardson J, Atherton Day N, Peacock S, Iezzi A. Measurement of the quality of Life for economic evaluation and the assessment of quality of life (AQoL) mark 2 instrument. Aust Econ Rev. 2004;37(1):62–88.CrossRef
14.
go back to reference Diabetes Australia. Diabetes management in General Practice. Canberra: Diabetes Australia, 2011 July 2011. Report No. Diabetes Australia. Diabetes management in General Practice. Canberra: Diabetes Australia, 2011 July 2011. Report No.
15.
go back to reference Vos T, Barker B, Begg S, Stanley L, Lopez A. Burden of disease and injury in Aboriginal and Torres Strait islander Peoples: the Indigenous health gap. Int J Epidemiol. 2009;38:470–7.CrossRefPubMed Vos T, Barker B, Begg S, Stanley L, Lopez A. Burden of disease and injury in Aboriginal and Torres Strait islander Peoples: the Indigenous health gap. Int J Epidemiol. 2009;38:470–7.CrossRefPubMed
16.
go back to reference DePue JD, Dunsiger S, Seiden AD, Blume J, Rosen RK, Goldstein MG, et al. Nurse–community health worker team improves diabetes care in American Samoa: results of a randomized controlled trial. Diabetes Care. 2013;36(7):1947–53.CrossRefPubMedPubMedCentral DePue JD, Dunsiger S, Seiden AD, Blume J, Rosen RK, Goldstein MG, et al. Nurse–community health worker team improves diabetes care in American Samoa: results of a randomized controlled trial. Diabetes Care. 2013;36(7):1947–53.CrossRefPubMedPubMedCentral
17.
go back to reference Spencer MS, Rosland A-M, Kieffer EC, Sinco BR, Valerio M, Palmisano G, et al. Effectiveness of a community health worker intervention among African American and latino adults with type 2 diabetes: a randomized controlled trial. Am J Public Health. 2011;101(12):2253–60.CrossRefPubMedPubMedCentral Spencer MS, Rosland A-M, Kieffer EC, Sinco BR, Valerio M, Palmisano G, et al. Effectiveness of a community health worker intervention among African American and latino adults with type 2 diabetes: a randomized controlled trial. Am J Public Health. 2011;101(12):2253–60.CrossRefPubMedPubMedCentral
18.
go back to reference Prezio EA, Cheng D, Balasubramanian BA, Shuval K, Kendzor DE, Culica D. Community diabetes education (CoDE) for uninsured Mexican Americans: a randomized controlled trial of a culturally tailored diabetes education and management program led by a community health worker. Diabetes Res Clin Pract. 2013;100(1):19–28.CrossRefPubMed Prezio EA, Cheng D, Balasubramanian BA, Shuval K, Kendzor DE, Culica D. Community diabetes education (CoDE) for uninsured Mexican Americans: a randomized controlled trial of a culturally tailored diabetes education and management program led by a community health worker. Diabetes Res Clin Pract. 2013;100(1):19–28.CrossRefPubMed
19.
go back to reference Mohamed H, Al-Lenjawi B, Amuna P, Zotor F, Elmahdi H. Culturally sensitive patient-centred educational programme for self-management of type 2 diabetes: a randomized controlled trial. Primary Care Diabetes. 2013;7(3):199–206.CrossRefPubMed Mohamed H, Al-Lenjawi B, Amuna P, Zotor F, Elmahdi H. Culturally sensitive patient-centred educational programme for self-management of type 2 diabetes: a randomized controlled trial. Primary Care Diabetes. 2013;7(3):199–206.CrossRefPubMed
20.
go back to reference Brownson CA, Hoerger TJ, Fisher EB, Kilpatrick KE. Cost-effectiveness of diabetes self-management programs in community primary care settings. The Diabetes Educator. 2009;35(5):761–9.CrossRefPubMed Brownson CA, Hoerger TJ, Fisher EB, Kilpatrick KE. Cost-effectiveness of diabetes self-management programs in community primary care settings. The Diabetes Educator. 2009;35(5):761–9.CrossRefPubMed
21.
22.
go back to reference Perry Henry B, Zullinger Rose MRM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014;35:22. 1-.3. Perry Henry B, Zullinger Rose MRM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014;35:22. 1-.3.
23.
go back to reference Palmas W, Findley SE, Mejia M, Batista M, Teresi J, Kong J, et al. Results of the Northern Manhattan Diabetes Community Outreach Project: a randomized trial studying a community health worker intervention to improve diabetes care in hispanic adults. Diabetes Care. 2014;37(4):963–9.CrossRefPubMedPubMedCentral Palmas W, Findley SE, Mejia M, Batista M, Teresi J, Kong J, et al. Results of the Northern Manhattan Diabetes Community Outreach Project: a randomized trial studying a community health worker intervention to improve diabetes care in hispanic adults. Diabetes Care. 2014;37(4):963–9.CrossRefPubMedPubMedCentral
Metadata
Title
Community health workers improve diabetes care in remote Australian Indigenous communities: results of a pragmatic cluster randomized controlled trial
Authors
Robyn A McDermott
Barbara Schmidt
Cilla Preece
Vickie Owens
Sean Taylor
Ming Li
Adrian Esterman
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-0695-5

Other articles of this Issue 1/2015

BMC Health Services Research 1/2015 Go to the issue