Impact of an integrated approach to diabetes care at the Rumbalara Aboriginal Health Service

Aims:  To describe the effectiveness of an integrated ­primary−secondary care diabetes clinic on metabolic control among indigenous patients in a rural community Methods:  A retrospective audit of attendance to the clinic over 2 years (2 August 1999 to 31 August 2001). The service included a weekly specialist diabetes clinic integrated with the primary care team at the Rumbalara Aboriginal Health Service, Mooroopna, Victoria, Australia. Between clinics, follow up was provided by the Aboriginal health worker and other members of the integrated care team. Of the 47 patients seen, 20 had an HbA1c persistently ≥9.0% (of 21 patients identified in the community) and seven had gestational diabetes. Results:  Among 40 patients without gestational diabetes, microalbuminuria or proteinuria were present in 62%, retinopathy was present in 50%, neuropathy was present in 50% and at least one past cardiac or vascular event/surgical procedure had occurred in 25%. Of these, the 30 patients seen more than once increased their self glucose monitoring (baseline (53.3%) vs. last visit (90%); P  = 0.003) and reduced their HbA1c (10.4 ± 2.2% vs. 7.9 ± 1.9%; P  < 0.001), systolic blood pressure (138 ± 20 vs. 127 ± 18 mmHg; P  = 0.003) and diastolic blood pressure (78 ± 11 vs. 73 ± 12 mmHg; P  = 0.037) and total cholesterol (6.1 ± 1.7 vs. 5.1 ± 1.6 mmol/L; P  = 0.002), but not their weight, smoking or triglycerides. Conclusion: The introduction of an integrated diabetes care service in an Aboriginal health service can overcome many of the pre‐existing barriers to achieving metabolic targets. Poor metabolic control in Aboriginal patients is often due to lack of resources and inappropriateness of approach, rather than ‘compliance’. (Intern Med J 2003; 33: 581−585)