Centre of Excellence for Indigenous primary care intervention research in chronic disease. Alex Brown, Alan Cass, Samantha Togni July 2011

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1 Centre of Excellence for Indigenous primary care intervention research in chronic disease Alex Brown, Alan Cass, Samantha Togni July 2011

2 16.7yr s 19 yrs Contributors to the Gap Group II - NCD 77% gap in LE ( ) Male Female CVD 33% 24% GUT 9% 10% DM 9% 9% Resp 9% 9% Zhao and Dempsey, MJA 2006

3 Kanyini Vascular Collaboration KVC I NHMRC HSR Grant Indigenous and non-indigenous researchers, Aboriginal community controlled health services, policy advisers, health economists, clinicians and communities. Kanyini to have, to hold and to care It represents one of the four foundations of Aboriginal life in Central Australia: Tjukurpa (Law, Dreaming); Walytja (Family); Ngurra (Land, Country); and Kanyini.

4 KVC I - Programme of Research Objective: To improve health outcomes for Indigenous people at risk/or with chronic vascular disease 1. An audit of chronic disease prevention and management practices within Aboriginal Community Controlled Health Services 2. A qualitative study examining barriers and enablers to chronic disease care for Indigenous Australians 3. A randomised controlled trial of a combination polypill vs usual care to maximise evidence-based, long-term therapies among high risk individuals

5 Centre of Excellence for Indigenous primary care intervention research in chronic disease KVC II CIs Alex Brown Alan Cass Sandra Eades Josee Lavoie Maree Hackett Samantha Togni AIs Anushka Patel Tricia Nagel David Peiris James Stephen Noel Hayman Kane Ellis Tom Sequist Partners Danila Dilba, Darwin NT Inala IHS, Brisbane QLD AIDA, Canberra ACT Urapuntja HS, Utopia NT WAHAC, Ntaria NT Nganampa HS, APY Lands SA Wuchopperen Health Service, Cairns Qld Maari Ma Health Aboriginal Corporation, Broken Hill NSW AMS Western Sydney, Mt. Druitt NSW Tharawal AMS, Campbeltown NSW AHMRC, Sydney NSW

6 CRE objectives 1. To improve the quality of care, quality of life and outcomes of chronic disease. 2. Examine the impact, utility and effectiveness of the federal governments Closing the Gap chronic disease package elements within partner primary care services, with a view to maximizing benefit for patients and informing policy development. 3. Develop a cadre of Indigenous primary care researchers with the skills and support to contribute to their communities needs in chronic disease into the future.

7 THE KVC AGENDA OVERCOMING BARRIERS TO CD CARE AUDIT QUAL STUDY POLYPILL RCT ALTERNATE MODELS ENGAGING FAMILY DELIVER THE EVIDENCE MAKE THE JOB EASIER ESSENTIAL ELEMENTS CD CARE CONDUITS TO/THROUGH CARE CONTEXT AND CD STRESS AND CD BURDEN STRESS AND MANAGING CD CENTRE OF EXCELLENCE IN CD INTERVENTION RESEARCH FAMILY CD PILOT TRIAL EDS TRIAL KVC CHRONIC CARE MODEL STRESS AND CD Other Interventions? MULTI-SITE INDIGENOUS PHC CD INTERVENTION TRIAL(S)

8 CRE Programme of Research Family- Based Prevention Pilot Trial KVC Chronic Care Model Evaluating and Informing Closing the Gap Co-Morbid Depression and Chronic Disease Multi-site Intervention Trials in Chronic Disease Management and Prevention

9 A. The Kanyini Chronic Care Model Culture, and the role of family in maintaining the well being of Indigenous Australians is notably absent from existing models Re defining chronic care models from the lens of Indigenous Australians is essential Source: MacColl Institute; Wagner et al

10 Developing an Indigenous CCM Stage 1: Factors associated with delivery of EB care Existing audit, SAT and qualitative data (10 sites) New sites audit, SAT and qualitative data Combine data - identify factors associated with increased delivery of EB Care Feedback cycle #1 Focus groups a each site Stage 2: Factors which have supported improvements in identification and management of CD over time Re-audit existing sites and new sites Feedback cycle #2 - Collate data Focus groups with HP and community at each site Stage 3: Develop a conceptual framework to define an Indigenous chronic care model Feedback cycle #3 Key elements of CD Care within PHC Rapid assessment tool Define elements for an Intervention trial

11 B. Family based chronic disease prevention and care Background: 1. Disengaging families in care CASPA QUAL 2. Nurse-led/DMP works (CHF, ACS, T2DM) 3. Community family, outreach, continuity 4. Poor access to prevention programs 5. Contextual and genetic risks (FHx) 6. Family = well-being (relational self) 7. Social support/capital (post AMI & depression) 8. Child/adolescent mental health, Obesity, Type II DM, CVD. COAG $$ - ICDP; Fragmented; MD team??

12 FAMILY BASED INTERVENTION CD Client CD Client CASE MANAGER ANNUAL MEDICAL ASSESSMENT CARE PLAN NEEDS SEWB BARRIERS FAMILY GOALS ANNUAL MEDICAL ASSESSMENT Routine Care MD team referrals MD TEAM CARE PLAN HOME VISIT ANNUAL MEDICAL ASSESSMENT 3 MONTH RV ANNUAL MEDICAL ASSESSMENT

13 INDEPENDANT CORRELATES WITH PREVALENT CVD (ODDS RATIOS) MHM COHORT, ALICE SPRINGS HDL-C INCOME (H v L) SMOKER hscrp EMPLOYED (Y/N) BMI TC DIABETES EDUCATION SEP INDEX HT ( 140/90) MDD

14 C. Stress and chronic disease VALIDATING THE TOOLS 250 PHC & 100 clinical pts Criterion Validity, sensitivity, specificity, psychometrics Burden, features, screening, management Qualitative assessment of co-morbid depression and CD BURDEN, ID AND MANAGEMENT OF STRESS IN PHC STRESS AND CD INTERVENTION

15 KVC Capacity Building Model Five levels of capacity building Indigenous Research Fellows, PhD candidates, emerging researchers Primary health care service partners Policy advisers Community stakeholders KVC

16 KVC integrated knowledge transfer KVC CRE-wide Knowledge Translation Plan Integrated capacity building Leadership & engagement across network Building on what exists Focus on relationships Spaces for dialogue Privileging participatory action research Community priorities Local champions & knowledge brokers De-mystifying research Relevance to key policies

17 KVC CRE governance structure Centre of Excellence in Primary Health Care Research CIs AIs Partners KVC Executive Committee Research Excellence Network Coordination Scientific Committee Indigenous Caucus Knowledge Transfer Committee Capacity Development Committee Operations Management Group Publications Sub- Committee Kanyini Qualitative Study KVC I Kanyini GAP Polypill Study Kanyini Chronic Care Model Study Family-based Chronic Disease Prevention Study KVC II Co-morbid Depression and Chronic Disease Study (TBC) Electronic Decision-making Support Study

18 Expected outcomes The KVC CRE has the direct potential to improve health service delivery and outcomes by: integrating quantitative research with rich, qualitative research - develop an understanding of the significant patient-, health care provider- and systems-level barriers to accessing necessary services developing, implementing & evaluating innovative bestpractice models, developed in partnership with, and specifically for, Indigenous people. building an evidence based platform from which to both inform & advocate for policy changes that are geared towards health service reform for Indigenous communities. Improving chronic disease outcomes, from the patient level to the broader system