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Eer ASY, Ho RCY, Hearn T, Hachem M, Freund M, Burchill LJ, Atkinson-Briggs S, Singh S, Eades S, O'Brien RC, Furler JS, O'Neal DN, Story DA, Zajac JD, Braat S, Brown A, Clarke P, Sinha AK, McLean AG, Twigg SM, Ekinci EI. Feasibility and acceptability of the use of flash glucose monitoring encountered by Indigenous Australians with type 2 diabetes mellitus: initial experiences from a pilot study. BMC Health Serv Res 2023; 23:1377. [PMID: 38066492 PMCID: PMC10704698 DOI: 10.1186/s12913-023-10121-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 10/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is highly prevalent within the Indigenous Australian community. Novel glucose monitoring technology offers an accurate approach to glycaemic management, providing real-time information on glucose levels and trends. The acceptability and feasibilility of this technology in Indigenous Australians with T2DM has not been investigated. OBJECTIVE This feasibility phenomenological study aims to understand the experiences of Indigenous Australians with T2DM using flash glucose monitoring (FGM). METHODS Indigenous Australians with T2DM receiving injectable therapy (n = 8) who used FGM (Abbott Freestyle Libre) for 6-months, as part of a clinical trial, participated in semi-structured interviews. Thematic analysis of the interviews was performed using NVivo12 Plus qualitative data analysis software (QSR International). RESULTS Six major themes emerged: 1) FGM was highly acceptable to the individual; 2) FGM's convenience was its biggest benefit; 3) data from FGM was a tool to modify lifestyle choices; 4) FGM needed to be complemented with health professional support; 5) FGM can be a tool to engage communities in diabetes management; and 6) cost of the device is a barrier to future use. CONCLUSIONS Indigenous Australians with T2DM had positive experiences with FGM. This study highlights future steps to ensure likelihood of FGM is acceptable and effective within the wider Indigenous Australian community.
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Affiliation(s)
- Audrey Sing Yi Eer
- Austin Health, Heidelberg, VIC, Australia
- The University of Melbourne (Austin Health), Melbourne, VIC, Australia
| | | | - Tracey Hearn
- The University of Melbourne, Melbourne, VIC, Australia
- Rumbalara Aboriginal Co-Operative, Mooroopna, VIC, Australia
| | - Mariam Hachem
- The University of Melbourne (Austin Health), Melbourne, VIC, Australia
- Centre for Research and Education in Diabetes and Obesity (CREDO), Faculty of Dentistry Health Sciences and Medicine, The University of Melbourne, Austin Health, Melbourne, Australia
- The Australian Centre for Accelerating Diabetes Innovation (ACADI), The University of Melbourne, Parkville, Australia
| | - Megan Freund
- Research Academic, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Luke James Burchill
- Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Medicine (Royal Melbourne Hospital), Aboriginal Cardiovascular Health Equity Research Group, The University of Melbourne, Melbourne, VIC, Australia
| | - Sharon Atkinson-Briggs
- Rumbalara Aboriginal Co-Operative, Mooroopna, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Satpal Singh
- Rumbalara Aboriginal Co-Operative, Mooroopna, VIC, Australia
| | - Sandra Eades
- Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Richard Charles O'Brien
- Austin Clinical School, The University of Melbourne, Melbourne, VIC, Australia
- Graduate Programs and Executive Education, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
- Lipid Services, Austin Health, Heidelberg, VIC, Australia
| | - John Stuart Furler
- Department of General Practice, Faculty of Medicine Dentisty and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - David Norman O'Neal
- The Australian Centre for Accelerating Diabetes Innovation (ACADI), The University of Melbourne, Parkville, Australia
- St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
- The University of Melbourne (St. Vincent's Hospital), Melbourne, VIC, Australia
| | - David Andrew Story
- Austin Health, Heidelberg, VIC, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Australia
- Melbourne Academic Centre for Health (MACH), Melbourne, VIC, Australia
| | - Jeffrey David Zajac
- The University of Melbourne (Austin Health), Melbourne, VIC, Australia
- Division of Medicine, Medical Services CSU and Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- MISCH (Methods and Implementation Support for Clinical Health) research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Alex Brown
- Indigenous Genomics, Australian National University and Telethon Kids Institute, Canberra, Australian Capital Territory, Australia
| | - Phillip Clarke
- The Australian Centre for Accelerating Diabetes Innovation (ACADI), The University of Melbourne, Parkville, Australia
- Health Economics, Nuffield Department of Public Health, Univeristy of Oxford, Oxford, UK
- Academic, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Ashim Kumar Sinha
- Diabetes and Endocrinology, Cairns Hospital, Cairns, QLD, Australia
- James Cook University, Cairns, QLD, Australia
| | - Anna Gerardina McLean
- Endocrinology and General Medicine, Cairns Hospital, Cairns, QLD, Australia
- Menzies School of Health Research, Darwin, NT, Australia
| | - Stephen Morris Twigg
- The Australian Centre for Accelerating Diabetes Innovation (ACADI), The University of Melbourne, Parkville, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Endocrinology, Stan Clark Chair in Diabetes, Faculty in Diabetes, The University of Sydney, Sydney, NSW, Australia
| | - Elif Ilhan Ekinci
- Austin Health, Heidelberg, VIC, Australia.
- The Australian Centre for Accelerating Diabetes Innovation (ACADI), The University of Melbourne, Parkville, Australia.
- Sir Edward Weary Dunlop Principal Research Fellow in Metabolic Medicine, University of Melbourne, Melbourne, VIC, Australia.
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Atkinson-Briggs S, Jenkins A, Keech A, Ryan C, Brazionis L. Prevalence of diabetic retinopathy and reduced vision among indigenous Australians in the nurse-led integrated Diabetes Education and Eye Screening study in a regional primary care clinic. Intern Med J 2023; 53:1188-1195. [PMID: 34779559 DOI: 10.1111/imj.15625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nationally, Indigenous Australians are more likely to have diabetes and diabetic retinopathy (DR) than non-Indigenous Australians. However, the prevalence of DR and impaired vision in regional primary care settings is unclear. AIM To describe the prevalence and severity of DR and presenting vision level among Indigenous Australian adults with diabetes attending an indigenous primary care clinic in regional Australia. METHODS Participants underwent nurse-led retinal imaging and DR screening with offsite retinal grading in the integrated Diabetes Education and Eye Screening (iDEES) project implemented at a regional indigenous primary healthcare setting between January 2018 and March 2020. RESULTS Of 172 eligible adults, 135 (79%) were recruited and screened for DR and vision level. The median age was 56 (46-67) years, 130 (96%) had type 2 diabetes of median (interquartile range) duration 6 (2-12) years and 48 (36%) were male. Images from 132 (97.8%) participants were gradable. DR was present in 38 (29%) participants: mild non-proliferative in 33 (25%); moderate-severe in three (2.5%); and sight-threatening two (1.5%). Subnormal presenting vision was present in 33%. CONCLUSIONS A nurse-led model of care integrating diabetes eye screening and education at a single visit was successful at recruiting Indigenous Australian adults with diabetes, screening their vision and acquiring a high rate of gradable images. Even for a short duration of known diabetes, DR was present in three out of 10 patients screened.
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Affiliation(s)
- Sharon Atkinson-Briggs
- Department of Medicine, University of Melbourne (St Vincent's Hospital), Melbourne, Victoria, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Ryan
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Laima Brazionis
- Department of Medicine, University of Melbourne (St Vincent's Hospital), Melbourne, Victoria, Australia
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Eer ASY, Hearn T, Atkinson-Briggs S, Drake S, Singh S, Neoh S, Pyrlis F, Hachem M, Zajac JD, Burchill LJ, Ekinci EI. Improved metabolic parameters of people with diabetes attending an aboriginal health service in regional victoria. Intern Med J 2022; 53:787-797. [PMID: 35717668 DOI: 10.1111/imj.15856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 06/14/2022] [Indexed: 12/01/2022]
Abstract
AIMS To evaluate the baseline metabolic parameters and presence of diabetes complications in people with type 2 diabetes attending Rumbalara Aboriginal Co-operative in 2017 and compare it with other Aboriginal and Torres Strait Islander studies and Australian specialist diabetes services. METHODS Clinical and biochemical characteristics were determined, including diabetes type, age, weight, body mass index (BMI), blood pressure, micro- and macrovascular complications, glycosylated haemoglobin (HbA1c), haemoglobin, renal function, lipid profile, urine albumin:creatinine ratio, diabetes medications, renin angiotensin system inhibition therapies, HMG-CoA reductase inhibitors, and antiplatelet agents. RESULTS 126 individuals had diabetes, 121 had type 2 diabetes. 113 identified as Aboriginal and/or Torres Strait Islander. Median age was 57.5 (48 - 68) years, median HbA1c was 7.8% (6.8 - 9.6), and median BMI 33.4kg/m2 (29 - 42.3). Compared to other Australian Aboriginal and Torres Strait Islander populations, this population was older, had more obesity but with better glycaemia management. Compared to specialist diabetes services, this population was of similar age, with greater BMI but comparable HbA1c. CONCLUSIONS Aboriginal people living with type 2 diabetes attending this regional Aboriginal health service have comparable glycaemic management to specialist diabetes services in Australia, managed largely by primary care physicians with limited access to specialist care for the last five years. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Audrey Sing Yi Eer
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine, The University of Melbourne (Austin Health)
| | - Tracey Hearn
- Rumbalara Aboriginal Co-operative, Mooroopna, VIC, Australia
| | | | - Shannon Drake
- Rumbalara Aboriginal Co-operative, Mooroopna, VIC, Australia
| | - Satpal Singh
- Rumbalara Aboriginal Co-operative, Mooroopna, VIC, Australia
| | - Sandra Neoh
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Felicity Pyrlis
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Mariam Hachem
- Department of Medicine, The University of Melbourne (Austin Health)
| | - Jeffrey David Zajac
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine, The University of Melbourne (Austin Health)
| | - Luke James Burchill
- Department of Medicine, The University of Melbourne (Royal Melbourne Hospital)
| | - Elif Ilhan Ekinci
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine, The University of Melbourne (Austin Health)
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Atkinson-Briggs S, Ryan C, Keech A, Jenkins A, Brazionis L. Nurse-led vascular risk assessment in a regional Victorian Indigenous primary care diabetes clinic: An integrated Diabetes Education and Eye disease Screening [iDEES] study. J Adv Nurs 2022; 78:3652-3661. [PMID: 35441731 DOI: 10.1111/jan.15260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 12/06/2021] [Accepted: 12/24/2021] [Indexed: 12/15/2022]
Abstract
AIM The aim was to describe vascular risk factors in Australian adults with diabetes attending an Indigenous primary care nurse-led diabetes clinic. DESIGN This was a cross-sectional descriptive single-site study. METHODS Vascular risk factor data were extracted from the electronic health records of participants in the nurse-led integrated Diabetes Education and Eye disease Screening (iDEES) study at a regional Victorian Indigenous primary health-care clinic between January 2018 and March 2020. RESULTS Of 172 eligible adults, 135 (79%) provided data. Median (IQR) age was 56 (46-67) years; 89% were Indigenous; 95% had Type 2 diabetes of median (IQR) duration of 6 (2-12) years and 48 (36%) were male. Median HbA1c, blood pressure, cholesterol (total; LDL and HDL), triglycerides, eGFR, CRP and BMI were 8.0% (64 mmol/mol), 127/78 mm Hg, 4.2; 1.9; 1.1 mmol/L, 2.3 mmol/L, 89 ml/min/1.73 m2 , 7.0 mg/L and 32.4 kg/m2 . Of nine clinical risk factors, the median (IQR) number of risk factors at target was 4 (3-5) for women and 3 (2-5) for men, pχ2 = 0.563. Clinical targets for BMI, HbA1c, blood pressure, triglycerides, total cholesterol, LDL cholesterol, urine albumin: creatinine ratio, HDL cholesterol and smoking were met by 14%, 34%, 38%, 39%, 44%, 52%, 54%, 62% and 64%, respectively. CONCLUSION A nurse-led model of integrated clinical risk factor assessment and diabetes education identified suboptimal levels of clinical risk factor control for avoiding diabetes chronic complications amongst Australian adults with diabetes in an Indigenous primary care setting. IMPACT A nurse-led model of diabetes care integrating clinical risk factor assessment into a diabetes education service is achievable. Understanding by stakeholders, including people with diabetes, their clinicians and health services, of the importance of regular monitoring of risk factors impacting diabetes complications is important. The novel nurse-managed iDEES primary-care model of care can assist. TRIAL REGISTRATION This study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12618001204235).
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Affiliation(s)
| | - Christopher Ryan
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Laima Brazionis
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Atkinson-Briggs S, Jenkins A, Ryan C, Brazionis L. Mixed diabetic retinopathy screening coverage results in Indigenous Australian primary care settings: A nurse-led model of integrated diabetes care. J Adv Nurs 2022; 78:3187-3196. [PMID: 35128712 DOI: 10.1111/jan.15163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 11/08/2021] [Accepted: 11/27/2021] [Indexed: 11/30/2022]
Abstract
AIMS To determine eye screening coverage and adherence to national eye screening recommendations of a nurse-led retinal image-based model of diabetes education and eye screening in Indigenous primary care clinics. DESIGN A pre-post study. METHODS During January 2018-March 2020 Indigenous Australians with diabetes at three regional Australian clinics were offered eye screening by a nurse-diabetes educator/retinal imager. At the main site the nurse recruited/scheduled participants, and at satellite sites local clinic staff did so. Visual acuity was tested and digital retinal images acquired and graded. Participants were offered rescreening at or before 12-months based on baseline results. RESULTS In total 203 adults with diabetes attending Indigenous primary care clinics were screened, with divergent results based on the recruitment methods. At the main clinic 135 of 172 eligible adults (79%) were screened. At the satellite sites, 15 of 85 (18%) and 21 of 77 (27%) diabetes patients were screened. Combined coverage 51%. CONCLUSION A credentialed nurse-educator implemented a model of retinal image-based diabetes education, measured eye screening coverage and adherence to national eye screening guidelines, met the 'acceptable 75% eye screening coverage' benchmark and improved patient eye screening guideline adherence at the one site where the nurse-educator had access to patient recruitment and scheduling. IMPACT This novel nurse-led primary care iDEES model of retinal image-based diabetes education can improve the currently low Indigenous diabetes eye screening coverage in Australia. Importantly, the nurse-managed iDEES model of integrated diabetes care is readily adaptable to other settings and populations where access to and/or uptake of eye care is suboptimal. CLINICAL TRIAL REGISTRATION ANZCTRN1261800120435.
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Affiliation(s)
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Christopher Ryan
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Laima Brazionis
- Department of Medicine, University of Melbourne, Melbourne, Australia
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Atkinson-Briggs S, Jenkins A, Ryan C, Brazionis L. Health-risk behaviours among Indigenous Australians with diabetes: A study in the integrated Diabetes Education and Eye Screening (iDEES) project. J Adv Nurs 2022; 78:1305-1316. [PMID: 35037286 DOI: 10.1111/jan.15141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 11/09/2021] [Accepted: 12/09/2021] [Indexed: 11/27/2022]
Abstract
AIM To assess the prevalence of modifiable health-risk behaviours among Indigenous Australian adults with diabetes attending a regional Victorian Indigenous primary-care clinic. DESIGN A cross-sectional observational single-site study. METHODS As part of a multi-study project we administered the Smoking, Nutrition, Alcohol consumption, Physical activity and Emotional wellbeing (SNAPE) survey tool during the study baseline visit to methodically capture health-related behavioural data in the nurse-led integrated Diabetes Education and Eye Screening (iDEES) project in a regional Indigenous primary healthcare setting between January 2018 and March 2020. This descriptive SNAPE study helps address the lack of health behaviour data for Indigenous people with diabetes. RESULTS Of 172 eligible adults, 135 (79%) were recruited to the iDEES study, 50 (37%) male. All participated in at least one survey. Median (range) age was 56 (46-67) years; 130 (96%) had Type 2 diabetes of median [IQR] duration 6 (2-12) years. All 135 provided smoking data; 88 (65%) completed all surveys. Forty-nine (36%) and 29 (22%) were current or former smokers, respectively; 5 (6%) met vegetable intake guidelines, 22 (25%) met fruit intake guidelines; 38 [43%] drank alcohol in the past year. On average, participants walked for ≥10 min at a time 4 days/week and sat for an average of 8 h on weekdays; 35 (40%) had minimal-mild, and 30 (34%) had moderate-severe depressive symptoms. CONCLUSION Suboptimal modifiable health-risk behaviours and depressive symptoms are common in Indigenous Australian adults with diabetes. IMPACT Orderly assessment and reporting of health-risk behaviours using a single multi-component survey instrument (SNAPE tool) during a nurse-led diabetes education clinical visit is feasible and efficient. Such data may facilitate personalised interventions and improve diabetes management at both individual and health service levels.
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Affiliation(s)
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Ryan
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Laima Brazionis
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Atkinson-Briggs S, Jenkins A, Keech A, Ryan C, Brazionis L. A model of culturally-informed integrated diabetes education and eye screening in indigenous primary care services and specialist diabetes clinics: Study protocol. J Adv Nurs 2021; 77:1578-1590. [PMID: 33426727 DOI: 10.1111/jan.14734] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/10/2020] [Indexed: 01/20/2023]
Abstract
AIMS To improve diabetes management in Indigenous Australians using an integrated nurse-led model of diabetes education and eye screening in indigenous primary care and specialist diabetes clinics. DESIGN A pre-post study. METHODS This study will be implemented in indigenous primary care and specialist diabetes clinics in Victoria, Australia. Participants recruited to the study will be existing adult patient with diagnosed diabetes attending study sites. A nurse-credentialled diabetes educator and certified retinal imager will deliver three study components: (a) retinal photography as a diabetic retinopathy screening and patient engagement tool; (b) lifestyle and behaviour surveys, administered at baseline and at the final visit, in 12 months. Findings from the surveys and participants' retinal images will be used to guide; and (c) personalized diabetes education. The primary outcomes are participant adherence to diabetic eye screening recommendations and health service diabetic retinopathy screening coverage. Secondary outcomes are baseline DR prevalence and changes in clinical and lifestyle risk factor levels, diabetes knowledge and satisfaction with diabetes care. DISCUSSION Compared with non-indigenous Australians, Indigenous Australians have a high prevalence of diabetic retinopathy and blindness, low adherence to eye screening recommendations and suboptimal health literacy. Nurse-credentialled diabetes educators can be trained to incorporate retinal imaging and eye screening into their clinical practice to give image-based diabetes education to facilitate diabetic retinopathy management. IMPACT Credentialled nurse diabetes educators who integrate eye screening and diabetes education can facilitate timelier diabetic retinopathy screening, referral pathways and treatment of sight-threatening retinopathy. We believe that this model of integrated diabetes education and eye screening will also improve adherence to eye screening recommendations, population screening coverage, health literacy, risk factor levels and diabetes self-care. CLINICAL TRIAL REGISTRATION ANZCTRN1261800120435.
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Affiliation(s)
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Christopher Ryan
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Laima Brazionis
- Department of Medicine, University of Melbourne, Melbourne, Vic., Australia
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Quinn N, Yang F, Ryan C, Bursell SE, Keech A, Atkinson-Briggs S, Jenkins A, Brazionis L. Screening for diabetic retinopathy and reduced vision among Indigenous Australians in Top End primary care health services: a TEAMSnet sub-study. Intern Med J 2020; 51:1897-1905. [PMID: 33196133 DOI: 10.1111/imj.14971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/25/2020] [Accepted: 06/21/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diabetic retinopathy (DR) prevalence is higher in Indigenous Australians than in other Australians and is a major cause of vision loss. Consequently, timely screening and treatment is paramount, and annual eye screening is recommended for Indigenous Australians. AIMS To assess the prevalence of DR, reduced vision and DR treatment coverage among Indigenous Australian adults with diabetes attending Top End indigenous primary care health services. METHODS A cross-sectional DR screening study conducted from November 2013 to December 2015 in two very remote Northern Territory Aboriginal primary healthcare services. RESULTS In 287 subjects, the prevalence of non-proliferative DR, proliferative DR and clinically significant diabetic macular oedema was 37.3%, 5.4% and 9.0% respectively. Treatment coverage for PDR was 60% (of 10 patients) and for CSMO was 17% (of 23 patients). Vision data were available from 122 participants at one site. The proportion with normal vision, reduced vision, impaired vision and blindness was 31.1%, 52.5%, 15.6% and 0.8% respectively. Overall, ungradable monocular image sets (46%) were associated with poorer quality images and missing protocol images (both P < 0.001). Ungradable images for DR were associated with presence of small pupils/media opacities (P < 0.001). Ungradable images for diabetic macular oedema were associated with poorer image quality (P < 0.001), cataracts (P < 0.001) and small pupils (P = 0.04). CONCLUSIONS A high prevalence of DR, CSMO and impaired vision was noted in Indigenous Australians with diabetes. Screening in primary care is feasible, but more effective screening methods are needed.
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Affiliation(s)
- Nicola Quinn
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Feibi Yang
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Ryan
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sven-Erik Bursell
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Laima Brazionis
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
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Atkinson-Briggs S, Jenkins A, Keech A, Ryan C, Brazionis L. Integrating diabetic retinopathy screening within diabetes education services in Australia's diabetes and indigenous primary care clinics. Intern Med J 2020; 49:797-800. [PMID: 31185524 DOI: 10.1111/imj.14309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022]
Abstract
As diabetes occurs in all ethnicities and regions it is essential that retinopathy screening be widely available. Screening rates are lower in Indigenous than in non-Indigenous Australians. Technological advances and Medicare rebates should facilitate improved outcomes. Use of non-ophthalmic clinicians, (general practitioners, diabetes educators, health-workers and endocrinologists) to supplement coverage by ophthalmologists and optometrists would extend retinopathy screening capacity. Diabetes educators are an integral part of diabetes management. Integrating ocular screening and diabetes education in primary care settings has potential to improve synergistically retinopathy screening coverage, patient self-management, risk factor control, care satisfaction, health economics and sustainability of under-resourced services.
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Affiliation(s)
| | - Alicia Jenkins
- Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony Keech
- Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Ryan
- Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Laima Brazionis
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Doyle J, Atkinson-Briggs S, Atkinson P, Firebrace B, Calleja J, Reilly R, Cargo M, Riley T, Crumpen T, Rowley K. A prospective evaluation of first people's health promotion program design in the goulburn-murray rivers region. BMC Health Serv Res 2016; 16:645. [PMID: 27832789 PMCID: PMC5105254 DOI: 10.1186/s12913-016-1878-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aboriginal Community Controlled Organisations (ACCOs) provide community-focussed and culturally safe services for First Peoples in Australia, including crisis intervention and health promotion activities, in a holistic manner. The ecological model of health promotion goes some way towards describing the complexity of such health programs. The aims of this project were to: 1) identify the aims and purpose of existing health promotion programs conducted by an alliance of ACCOs in northern Victoria, Australia; and 2) evaluate the extent to which these programs are consistent with an ecological model of health promotion, addressing both individual and environmental determinants of health. METHODS The project arose from a long history of collaborative research. Three ACCOs and a university formed the Health Promotion Alliance to evaluate their health promotion programs. Local community members were trained in, and contributed to developing culturally sensitive methods for, data collection. Information on the aims and design of 88 health promotion activities making up 12 different programs across the ACCOs was systematically and prospectively collected. RESULTS There was a wide range of activities addressing environmental and social determinants of health, as well as physical activity, nutrition and weight loss. The design of the great majority of activities had a minimal Western influence and were designed within a local Aboriginal cultural framework. The most common focus of the activities was social connectedness (76 %). Physical activity was represented in two thirds of the activities, and nutrition, weight loss and culture were each a focus of about half of the activities. A modified coding procedure designed to assess the ecological nature of these programs showed that they recruited from multiple settings; targeted a range of individual, social and environmental determinants; and used numerous and innovative strategies to achieve change. CONCLUSION First Peoples' health promotion in the Goulburn-Murray Rivers region encompasses a broad range of social, cultural, lifestyle and community development activities, including reclaiming and strengthening cultural identity and social connectedness as a response to colonisation.
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Affiliation(s)
- Joyce Doyle
- The Onemda Group, Centre for Health Equity, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Sharon Atkinson-Briggs
- The Onemda Group, Centre for Health Equity, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Petah Atkinson
- The Onemda Group, Centre for Health Equity, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Bradley Firebrace
- The Onemda Group, Centre for Health Equity, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Julie Calleja
- Viney Morgan Aboriginal Medical Service, Barmah, VIC, Australia
| | - Rachel Reilly
- The Onemda Group, Centre for Health Equity, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, VIC, Australia. .,Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia.
| | - Margaret Cargo
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Therese Riley
- Centre of Excellence in Intervention and Prevention Science, Carlton, VIC, 3053, Australia
| | - Tui Crumpen
- Goulburn Valley Partnerships Office, The University of Melbourne, Shepparton, VIC, 3630, Australia
| | - Kevin Rowley
- The Onemda Group, Centre for Health Equity, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, VIC, Australia
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11
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Johnston L, Doyle J, Morgan B, Atkinson-Briggs S, Firebrace B, Marika M, Reilly R, Cargo M, Riley T, Rowley K. A review of programs that targeted environmental determinants of Aboriginal and Torres Strait Islander health. Int J Environ Res Public Health 2013; 10:3518-42. [PMID: 23939388 PMCID: PMC3774452 DOI: 10.3390/ijerph10083518] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 08/02/2013] [Accepted: 08/05/2013] [Indexed: 11/15/2022]
Abstract
Objective: Effective interventions to improve population and individual health require environmental change as well as strategies that target individual behaviours and clinical factors. This is the basis of implementing an ecological approach to health programs and health promotion. For Aboriginal People and Torres Strait Islanders, colonisation has made the physical and social environment particularly detrimental for health. Methods and Results: We conducted a literature review to identify Aboriginal health interventions that targeted environmental determinants of health, identifying 21 different health programs. Program activities that targeted environmental determinants of health included: Caring for Country; changes to food supply and/or policy; infrastructure for physical activity; housing construction and maintenance; anti-smoking policies; increased workforce capacity; continuous quality improvement of clinical systems; petrol substitution; and income management. Targets were categorised according to Miller’s Living Systems Theory. Researchers using an Indigenous community based perspective more often identified interpersonal and community-level targets than were identified using a Western academic perspective. Conclusions: Although there are relatively few papers describing interventions that target environmental determinants of health, many of these addressed such determinants at multiple levels, consistent to some degree with an ecological approach. Interpretation of program targets sometimes differed between academic and community-based perspectives, and was limited by the type of data reported in the journal articles, highlighting the need for local Indigenous knowledge for accurate program evaluation. Implications: While an ecological approach to Indigenous health is increasingly evident in the health research literature, the design and evaluation of such programs requires a wide breadth of expertise, including local Indigenous knowledge.
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Affiliation(s)
- Leah Johnston
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC 3010, Australia; E-Mails: (L.J.); (J.D.); (B.F.); (M.M.); (R.R.); (K.R.)
| | - Joyce Doyle
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC 3010, Australia; E-Mails: (L.J.); (J.D.); (B.F.); (M.M.); (R.R.); (K.R.)
| | - Bec Morgan
- Centre of Excellence in Intervention and Prevention Science, Carlton, VIC 3053, Australia; E-Mail:
| | | | - Bradley Firebrace
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC 3010, Australia; E-Mails: (L.J.); (J.D.); (B.F.); (M.M.); (R.R.); (K.R.)
| | - Mayatili Marika
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC 3010, Australia; E-Mails: (L.J.); (J.D.); (B.F.); (M.M.); (R.R.); (K.R.)
| | - Rachel Reilly
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC 3010, Australia; E-Mails: (L.J.); (J.D.); (B.F.); (M.M.); (R.R.); (K.R.)
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Margaret Cargo
- School of Population Health, University of South Australia, Adelaide, SA 5000, Australia; E-Mail:
| | - Therese Riley
- Centre of Excellence in Intervention and Prevention Science, Carlton, VIC 3053, Australia; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +61-03-8344-0814
| | - Kevin Rowley
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, Melbourne School of Population & Global Health, The University of Melbourne, Carlton, VIC 3010, Australia; E-Mails: (L.J.); (J.D.); (B.F.); (M.M.); (R.R.); (K.R.)
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