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A metropolitan Aboriginal podiatry and diabetes outreach clinic to ameliorate foot‐related complications in Aboriginal people

A metropolitan Aboriginal podiatry and diabetes outreach clinic to ameliorate foot‐related... Diabetes‐related foot problems are among the most severe and frequent complications of diabetes and are of particular concern for the Aboriginal community. 1 Culturally appropriate ways of delivering health care to this population are needed. We report on a recent Aboriginal podiatry and diabetes outreach program in Perth, Western Australia (WA). The program, named Moorditj Djena, meaning Good or Strong Feet in the local Noongar language, is showing early success. The Moorditj Djena program is an Aboriginal community initiative initially funded by the National Partnership Agreement for ‘Closing the Gap’ in Indigenous Health Outcomes. It is a partnership between the metropolitan Aboriginal community; Derbarl Yerrigan Health Service (the metropolitan Perth Aboriginal Medical Service); and the North and South Metropolitan Health Services (NMHS, SMHS) of the WA Department of Health (WA DOH). The program provides a culturally secure, high‐risk foot and diabetes education outreach service for Aboriginal people to identify, manage and prevent foot complications resulting from chronic disease and to improve diabetes self‐management. The target population comprises Aboriginal adults with one or more of the following conditions: diabetes mellitus, particularly with poor control or understanding of management; recent foot ulcer or non‐traumatic amputation; peripheral arterial disease; and/or peripheral neuropathy. Aboriginal adults at risk of any of these conditions and their families are also welcome. We report on the implementation and early findings of the program within the southern region of Perth. The estimated Aboriginal population of SMHS is 15,504 (1.8% of the total population); 9,208 of whom are adults (Source: Epidemiology Branch, WA DOH, 2013 estimate). In this region, the program is led by the Aboriginal health team of the South Metropolitan Population Health Unit. The operational team comprises a coordinator, two podiatrists, one Aboriginal diabetes educator, one Aboriginal health professional and one Aboriginal administration secretary; equivalent to 5.0 full‐time positions. An evaluation was conducted to assess the delivery of the program, the quality of its implementation, the organisational context, structures and procedures and the program's cultural security. A mixed methods approach was used to collect data including focus groups and face‐to‐face interviews with staff, a review of program documents, clinic visits to conduct the environmental scan and an analysis of the program's administrative database. Extensive consultation with the local Aboriginal community and other stakeholders was undertaken and informed the development of the service delivery model. Consequently, fixed and mobile clinics were introduced gradually from January 2011. Locations include three community centres, three Medicare Locals with Aboriginal primary health care teams, one Aboriginal medical service, one hospital and one satellite population health unit office. Mobile clinics are serviced by a fully‐fitted podiatry van. The locations are distributed across all health districts and disability access is appropriate. In keeping with previously identified elements of culturally appropriate programs, 2–4 strategies to make the program evidence based and culturally secure included evidence based protocols and policies, 1 community and inter‐sectoral collaboration, employment of Aboriginal staff, cultural awareness training of non‐Aboriginal staff, accessible clinics, commitment to quality improvement, and a holistic approach to client health. Clinical services include diabetes and high‐risk foot assessment and management, and diabetes self‐management skills for clients and families. All clients are managed in conjunction with their general practitioners. Staff also assist with transport, arrange medication reviews, and help with social issues. Glycosylated haemoglobin (HbA1c) testing is offered to all clients with diabetes. The team receives client referrals from general practices, hospitals, community health centres, word of mouth, self‐referrals and community referrals. The flexible nature and outreach capacity has proved a strength and, despite its gradual implementation, 702 individual clients had attended the service by 30 June 2013. Almost all were Aboriginal. More than half (382, 54.5%) self‐referred having heard of the program through word of mouth; the remainder were referred by primary or tertiary healthcare professionals, including Aboriginal health services and Aboriginal hospital liaison officers. Females made up 64.8% of clients (n=455). Ages ranged from 8–87 years (mean age 51.2 years, median age 52 years, interquartile range 43–60 years). The majority of clients (528, 75.2%) had at least one chronic condition such as diabetes (407, 58.0%). If a diabetes prevalence of up to 30% among Aboriginal adults is assumed, 4 more than 14.5% of the estimated 2,762 Aboriginal adults with diabetes in the region have been seen, as of the audit date. More than 3,500 occasions of service (OOS) had been delivered in the first 2.5 years of the program (Aboriginal health professional: 895; diabetes educator: 715; podiatrists: 1,914). More than 100 OOS were delivered at each of eight sites; numbering more than 500 at three of these. Some home visits and OOS at other smaller clinics were also recorded. Challenges have included: planning and coordination of outreach clinics; recruitment of staff and staff turnover; van procurement; launch and ongoing promotion of the clinical service; ordering of equipment and logistical organisation; the development of a database for electronic record keeping; and negotiating the fees for optical and orthotic products to minimise cost to the clients. Partnerships with the Aboriginal community take time and resources. The Moorditj Djena program is demonstrating the benefits of having a responsive health service, as indicated by the level of attendance and the high regard for the program within the local community. A clinical outcome evaluation is now planned, including a data linkage study to assess hospitalisation rates among high risk clients before and after enrolment in the Moorditj Djena program. Acknowledgement The establishment of the metropolitan‐ wide Moorditj Djena program was led by the NMHS in partnership with the SMHS. Acknowledgement is given to the Aboriginal Podiatry and Nutrition Outreach Program Steering Committee and the SMHS Moorditj Djena team in the development of the project plan, protocols and policies, and the implementation of the service. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

A metropolitan Aboriginal podiatry and diabetes outreach clinic to ameliorate foot‐related complications in Aboriginal people

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References (2)

Publisher
Wiley
Copyright
© 2014 Public Health Association of Australia
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/1753-6405.12268
pmid
25167893
Publisher site
See Article on Publisher Site

Abstract

Diabetes‐related foot problems are among the most severe and frequent complications of diabetes and are of particular concern for the Aboriginal community. 1 Culturally appropriate ways of delivering health care to this population are needed. We report on a recent Aboriginal podiatry and diabetes outreach program in Perth, Western Australia (WA). The program, named Moorditj Djena, meaning Good or Strong Feet in the local Noongar language, is showing early success. The Moorditj Djena program is an Aboriginal community initiative initially funded by the National Partnership Agreement for ‘Closing the Gap’ in Indigenous Health Outcomes. It is a partnership between the metropolitan Aboriginal community; Derbarl Yerrigan Health Service (the metropolitan Perth Aboriginal Medical Service); and the North and South Metropolitan Health Services (NMHS, SMHS) of the WA Department of Health (WA DOH). The program provides a culturally secure, high‐risk foot and diabetes education outreach service for Aboriginal people to identify, manage and prevent foot complications resulting from chronic disease and to improve diabetes self‐management. The target population comprises Aboriginal adults with one or more of the following conditions: diabetes mellitus, particularly with poor control or understanding of management; recent foot ulcer or non‐traumatic amputation; peripheral arterial disease; and/or peripheral neuropathy. Aboriginal adults at risk of any of these conditions and their families are also welcome. We report on the implementation and early findings of the program within the southern region of Perth. The estimated Aboriginal population of SMHS is 15,504 (1.8% of the total population); 9,208 of whom are adults (Source: Epidemiology Branch, WA DOH, 2013 estimate). In this region, the program is led by the Aboriginal health team of the South Metropolitan Population Health Unit. The operational team comprises a coordinator, two podiatrists, one Aboriginal diabetes educator, one Aboriginal health professional and one Aboriginal administration secretary; equivalent to 5.0 full‐time positions. An evaluation was conducted to assess the delivery of the program, the quality of its implementation, the organisational context, structures and procedures and the program's cultural security. A mixed methods approach was used to collect data including focus groups and face‐to‐face interviews with staff, a review of program documents, clinic visits to conduct the environmental scan and an analysis of the program's administrative database. Extensive consultation with the local Aboriginal community and other stakeholders was undertaken and informed the development of the service delivery model. Consequently, fixed and mobile clinics were introduced gradually from January 2011. Locations include three community centres, three Medicare Locals with Aboriginal primary health care teams, one Aboriginal medical service, one hospital and one satellite population health unit office. Mobile clinics are serviced by a fully‐fitted podiatry van. The locations are distributed across all health districts and disability access is appropriate. In keeping with previously identified elements of culturally appropriate programs, 2–4 strategies to make the program evidence based and culturally secure included evidence based protocols and policies, 1 community and inter‐sectoral collaboration, employment of Aboriginal staff, cultural awareness training of non‐Aboriginal staff, accessible clinics, commitment to quality improvement, and a holistic approach to client health. Clinical services include diabetes and high‐risk foot assessment and management, and diabetes self‐management skills for clients and families. All clients are managed in conjunction with their general practitioners. Staff also assist with transport, arrange medication reviews, and help with social issues. Glycosylated haemoglobin (HbA1c) testing is offered to all clients with diabetes. The team receives client referrals from general practices, hospitals, community health centres, word of mouth, self‐referrals and community referrals. The flexible nature and outreach capacity has proved a strength and, despite its gradual implementation, 702 individual clients had attended the service by 30 June 2013. Almost all were Aboriginal. More than half (382, 54.5%) self‐referred having heard of the program through word of mouth; the remainder were referred by primary or tertiary healthcare professionals, including Aboriginal health services and Aboriginal hospital liaison officers. Females made up 64.8% of clients (n=455). Ages ranged from 8–87 years (mean age 51.2 years, median age 52 years, interquartile range 43–60 years). The majority of clients (528, 75.2%) had at least one chronic condition such as diabetes (407, 58.0%). If a diabetes prevalence of up to 30% among Aboriginal adults is assumed, 4 more than 14.5% of the estimated 2,762 Aboriginal adults with diabetes in the region have been seen, as of the audit date. More than 3,500 occasions of service (OOS) had been delivered in the first 2.5 years of the program (Aboriginal health professional: 895; diabetes educator: 715; podiatrists: 1,914). More than 100 OOS were delivered at each of eight sites; numbering more than 500 at three of these. Some home visits and OOS at other smaller clinics were also recorded. Challenges have included: planning and coordination of outreach clinics; recruitment of staff and staff turnover; van procurement; launch and ongoing promotion of the clinical service; ordering of equipment and logistical organisation; the development of a database for electronic record keeping; and negotiating the fees for optical and orthotic products to minimise cost to the clients. Partnerships with the Aboriginal community take time and resources. The Moorditj Djena program is demonstrating the benefits of having a responsive health service, as indicated by the level of attendance and the high regard for the program within the local community. A clinical outcome evaluation is now planned, including a data linkage study to assess hospitalisation rates among high risk clients before and after enrolment in the Moorditj Djena program. Acknowledgement The establishment of the metropolitan‐ wide Moorditj Djena program was led by the NMHS in partnership with the SMHS. Acknowledgement is given to the Aboriginal Podiatry and Nutrition Outreach Program Steering Committee and the SMHS Moorditj Djena team in the development of the project plan, protocols and policies, and the implementation of the service.

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Oct 1, 2014

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