Complex diabetes screening guidelines for high-risk adolescent Aboriginal Australians: a barrier to implementation in primary health care
Andreana Manifold A F , David Atkinson A , Julia V. Marley A B , Lydia Scott C , Gavin Cleland C , Paula Edgill D E and Sally Singleton A
+ Author Affiliations
- Author Affiliations
A The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, WA 6725, Australia.
B Kimberley Aboriginal Medical Services Ltd, PO Box 1377, Broome, WA 6725, Australia.
C Western Australia Country Health Service Kimberley, PO Box 62, Broome, WA 6725, Australia.
D Derbarl Yerrigan Health Service, 156–172 Wittenoom Street, East Perth, WA 6004, Australia.
E Centre for Aboriginal Medical and Dental Health, The University of Western Australia (M303), 35 Stirling Highway, Perth, WA 6009, Australia.
F Corresponding author. Email: andreana.manifold@rcswa.edu.au
Australian Journal of Primary Health 25(5) 501-508 https://doi.org/10.1071/PY19030
Submitted: 13 February 2019 Accepted: 16 September 2019 Published: 22 October 2019
Abstract
The aim of this study is to ascertain whether a simplified screening algorithm incorporating glycated haemoglobin (HbA1c) tests increases type 2 diabetes (T2D) screening in 10- to 14-year-old Aboriginal Australians presenting to primary healthcare (PHC) services. The study involved a 6-month pilot of a locally developed evidence-based screening algorithm in a remote Western Australian Kimberley town. A retrospective audit of electronic health records for the pilot period (27 June–26 December 2016) and a 6-month period before the screening algorithm was introduced (1 October 2015–31 March 2016) was conducted. Interviews were held with 30 PHC staff at participating PHC services, an Aboriginal Community Controlled Health Service (ACCHS) and a hospital-based general practice service. During the pilot, significantly more patients received an initial T2D screening test at the ACCHS (28/130 (22%) v. 50/139 (36%), P = 0.011), but there was no change at the hospital (0.02% v. 0.02%, P = 0.615). Staff feedback suggested measures to improve screening; these include simple guidelines, targeted screening, patient and staff education, point-of-care HbA1c tests and a whole-of-clinic approach to implementation. Implementing a screening algorithm for young-onset diabetes in Aboriginal Australians is challenging, but practical measures can be taken to improve screening.
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