Improving Diabetes Care in an Urban Aboriginal Medical Centre

Abstract

The aim of this project was to improve the detection, monitoring, and medical care of Indigenous patients with diabetes in an urban Aboriginal medical centre. The research design and methods entailed the diabetes register being cleaned and updated. A pre- and post-project non-random sample audit of medical records of patients diagnosed with diabetes evaluated the level of care received compared to best practice standard of care. A multi-disciplinary Diabetes Team established procedures to improve the patient care provided. Additional service providers, including a dietitian, podiatrist, ophthalmologist, and endocrinologist, joined the team. A holistic health care approach was implemented with an emphasis on opportunistic care. The percentage of patients having a care plan completed increased from 18% in the 2002 audit to 72% in the 2003 audit. There were significant trends between increased completion of all cycle of care activities and frequency of GP review. Doctors prepared care plans for 50% of patients who attended less than two review visits in 2003, but increased to 89% if receiving six visits or more (p = 0.000). No significant improvement in health outcome was noted. The project showed significantly improved care planning and medical management of urban Aboriginal and Torres Strait Islander patients with diabetes.